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Another reason to do your Step 1


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I think the real logistical issues with going to the US for residency are:

1. Visa... Health Canada has been somewhat stingy in giving out Statements of Need for J-1 visas. If you're a US citizen or green card holder this isn't an issue but for most Canadians it is... not every category is at its numerical limit but some of the specialties are... you are competing with IMGs for these statements of need, after all...

2. Length and style of residency. FM is 3 years in the US, and that extra year doesn't give you any sort of extra practice rights in Canada (like doing a +1 year in Canada might). It's just an extra year of service at a resident's salary. IM in the US is a different beast - the way I understand, you have way more focus on primary care, and even then to practice in Canada you still need a 2 year fellowship even for GIM. Other specialties like psychiatry are shorter in the US, so you have to do an extra year to meet Royal College standards. Doesn't make it impossible but there are logistical issues, and once you count out FM, IM, Psych, that's the vast majority of residents. Other specialties have statement of need bottlenecks, as described above

Also in order to apply to the US not only do you have to do Step 1, Step 2 CS and CK before the ranking deadline, you should ideally do electives and get letters from US-based preceptors, but then you're diluting your competitiveness for Canada. And you're also spending loads of money to apply for NRMP and have to take more time off to do interviews. The US is also starting to have problems with large numbers of unmatched students as residency spots aren't keeping pace with overall student body growth and increasing numbers of US IMG's.

I think most people are going to have to choose either CaRMS or NRMP right off the bat and concentrate their strategy - hence why I think most people still try and match to Canada despite some advantages to trying for the US.

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12 hours ago, shematoma said:

I think the real logistical issues with going to the US for residency are:

1. Visa... Health Canada has been somewhat stingy in giving out Statements of Need for J-1 visas. If you're a US citizen or green card holder this isn't an issue but for most Canadians it is... not every category is at its numerical limit but some of the specialties are... you are competing with IMGs for these statements of need, after all...

2. Length and style of residency. FM is 3 years in the US, and that extra year doesn't give you any sort of extra practice rights in Canada (like doing a +1 year in Canada might). It's just an extra year of service at a resident's salary. IM in the US is a different beast - the way I understand, you have way more focus on primary care, and even then to practice in Canada you still need a 2 year fellowship even for GIM. Other specialties like psychiatry are shorter in the US, so you have to do an extra year to meet Royal College standards. Doesn't make it impossible but there are logistical issues, and once you count out FM, IM, Psych, that's the vast majority of residents. Other specialties have statement of need bottlenecks, as described above

Also in order to apply to the US not only do you have to do Step 1, Step 2 CS and CK before the ranking deadline, you should ideally do electives and get letters from US-based preceptors, but then you're diluting your competitiveness for Canada. And you're also spending loads of money to apply for NRMP and have to take more time off to do interviews. The US is also starting to have problems with large numbers of unmatched students as residency spots aren't keeping pace with overall student body growth and increasing numbers of US IMG's.

I think most people are going to have to choose either CaRMS or NRMP right off the bat and concentrate their strategy - hence why I think most people still try and match to Canada despite some advantages to trying for the US.

That's been my thought as well, which is why I've always been skeptical of people suggesting applying for residencies in the US. If you're a dual citizen or have a spouse who's a US citizen, it's a much more viable option than if you're only a Canadian citizen/PR

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I think shikimate's point is for people to write the Step 1 in case they go unmatched so that they can write and apply to the US the 2nd year. However, I don't know if these are necessarily the same population of people. Writing the Step 1 and achieving a high enough score is not necessarily easy and the people who do achieve these scores usually do end up matching in Canada. It is much easier to just do more electives and try to match in Canada. 

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