Canadian Family Physician Interested in US IM Programs

[John Daniel]

Hello,

I am a family physician working in Canada and have an interest in coming to the US to complete an internal medicine residency. I had a few questions that I would greatly appreciate some insight into:

(1) Could my previous residency training count towards a transitional or preliminary year to shorten the total duration of training? For example, would I be able to complete an internal medicine residency in 2 years by using previous training to count as a transitional year.
-I completed a variety of rotations throughout residency (including. Emerg, ICU, IM, palliative care, general surgery, cardiology, endocrinology, obs/gyn, Peds, etc.)

(2) How much of a limitation would my score of 233 on USMLE Step 2? I am historically a strong test taker and believe that I could score quite a bit higher on Step 3 to compensate.
-I wrote 2 years ago to leave practice opportunities in the US open, so I was mainly aiming to pass at the time of writing it.
-I haven’t wrote step 1 at this time, so that score will be on the pass/fail system

-Thanks

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[gutonc]

Hello,

I am a family physician working in Canada and have an interest in coming to the US to complete an internal medicine residency.

Why? What is your end goal?

I had a few questions that I would greatly appreciate some insight into:

(1) Could my previous residency training count towards a transitional or preliminary year to shorten the total duration of training? For example, would I be able to complete an internal medicine residency in 2 years by using previous training to count as a transitional year.
-I completed a variety of rotations throughout residency (including. Emerg, ICU, IM, palliative care, general surgery, cardiology, endocrinology, obs/gyn, Peds, etc.)

The most credit you are likely to get is 6 months and for all practical purposes, the answer to this question is "no".

(2) How much of a limitation would my score of 233 on USMLE Step 2? I am historically a strong test taker and believe that I could score quite a bit higher on Step 3 to compensate.
-I wrote 2 years ago to leave practice opportunities in the US open, so I was mainly aiming to pass at the time of writing it.
-I haven’t wrote step 1 at this time, so that score will be on the pass/fail system

There are other issues in your application that would present a bigger potential problem than an average Step 2 score.

 

[John Daniel]

Why? What is your end goal?

Multiple reasons. One major reason would be career opportunities that are better suited for me.
-I am largely doing hospitalist work in small cities/towns currently. I enjoy this but won't be able to continue to work in these areas to the same extent long-term due to some personal and family factors.
-IM would give me access to better opportunities in terms of large city hospitalist work. I also expect IM training would improve my skillset for delivering patient care in the acute care hospital setting.
-The end-goal would be to open up additional opportunities to engage in work that I find meaningful/impactful in larger cities.

Again, there's other reasons but that would be one of the big reasons.

The most credit you are likely to get is 6 months and for all practical purposes, the answer to this question is "no".

Fair, good to know

There are other issues in your application that would present a bigger potential problem than an average Step 2 score.

Interesting, would you be able to explain more what you mean by that?

-Thanks

 

[gutonc]

Multiple reasons. One major reason would be career opportunities that are better suited for me.
-I am largely doing hospitalist work in small cities/towns currently. I enjoy this but won't be able to continue to work in these areas to the same extent long-term due to some personal and family factors.
-IM would give me access to better opportunities in terms of large city hospitalist work. I also expect IM training would improve my skillset for delivering patient care in the acute care hospital setting.
-The end-goal would be to open up additional opportunities to engage in work that I find meaningful/impactful in larger cities.

Again, there's other reasons but that would be one of the big reasons.

Can you practice in the US with Canadian FM training (honest question that I don't know the answer to and don't care enough to look up myself)? Is there some reason you can't practice in a larger city now?

Interesting, would you be able to explain more what you mean by that?

- Time since graduation
- Previous training completed
- Immigration status/visa needed
- If you're not an LCME graduate (US or Canadian med school)

 

[John Daniel]

Appreciate the responses @gutonc

Is there some reason you can't practice in a larger city now?

I can practice in a larger city but the opportunities are more limited for the type of work that I find meaningful and interesting. I still have a long-career ahead of me, so I believe a few extra years of residency would be a reasonable sacrifice to make for better long-term opportunities.

- Time since graduation
- Previous training completed
- Immigration status/visa needed
- If you're not an LCME graduate (US or Canadian med school)

I would definitely appreciate your opinion on how previous training/time since graduation would affect my application. I am < 2 years out from finishing a family medicine residency (p.s. family medicine 2 year residency in Canada).

I graduated from a large/reputable Canadian medical school and am a Canadian citizen. I am not sure how much being a Canadian rather than a US citizen hurts me, but I understand that I can apply to the first round of the US match then obtain a J-1 visa.

 

[rokshana]

Appreciate the responses @gutonc

I can practice in a larger city but the opportunities are more limited for the type of work that I find meaningful and interesting. I still have a long-career ahead of me, so I believe a few extra years of residency would be a reasonable sacrifice to make for better long-term opportunities.

I would definitely appreciate your opinion on how previous training/time since graduation would affect my application. I am < 2 years out from finishing a family medicine residency (p.s. family medicine 2 year residency in Canada).

I graduated from a large/reputable Canadian medical school and am a Canadian citizen. I am not sure how much being a Canadian rather than a US citizen hurts me, but I understand that I can apply to the first round of the US match then obtain a J-1 visa.

Because you are visa requiring…doesn’t really matter that you are Canadian.
Being a graduate of a LCME Canadian school will help though.

 

[NotAProgDirector]

Since you're only 2 years out from training, and are an LCME grad, I think you'll likely be able to find a spot in the US.

As mentioned, you'll basically be starting at the PGY-1 level -- advanced credit can sometimes be obtained but that usually requires a 3 year residency, and honestly you probably don't want to start as a PGY-2 -- you'd be expected to perform as well as other PGY-2 residents, and that would likely be an issue. Plus, there's many more PGY-1 positions available.

You're correct you'll need a visa, likely a J. They are easy to get.

If you look at other threads about people changing residencies, you'll read about a problem with funding. This will not be an issue for you, since your prior training was outside the US.

You'll need to pass S1, and then apply. The most important LOR will be the one from your prior FM program. If you can do some clinical work with an IM residency in Canada and get a letter from that -- would be ideal.

 

[CCM-MD]

Hello,

I am a family physician working in Canada and have an interest in coming to the US to complete an internal medicine residency. I had a few questions that I would greatly appreciate some insight into:

(1) Could my previous residency training count towards a transitional or preliminary year to shorten the total duration of training? For example, would I be able to complete an internal medicine residency in 2 years by using previous training to count as a transitional year.
-I completed a variety of rotations throughout residency (including. Emerg, ICU, IM, palliative care, general surgery, cardiology, endocrinology, obs/gyn, Peds, etc.)

(2) How much of a limitation would my score of 233 on USMLE Step 2? I am historically a strong test taker and believe that I could score quite a bit higher on Step 3 to compensate.
-I wrote 2 years ago to leave practice opportunities in the US open, so I was mainly aiming to pass at the time of writing it.
-I haven’t wrote step 1 at this time, so that score will be on the pass/fail system

-Thanks

If your plan is to ultimately work in Canada, make sure you look into the licensing/credentialing issues. You will need at least 4 years of IM training and will have to jump through some hoops to be eligible to take the RCPSC IM exam. As someone who’s taken both US and Canadian exams… The RC exam is immensely more painful to study for and pass. If your plan is to stay in the US, you should look into the challenges of obtaining a J1 waiver and ultimately a green card etc.

As a Canadian citizen who strongly considered going back and ultimately chose to stay in the US, I’ve navigated through a lot of these issues. My personal opinion is that this is a bad idea. I wish you the best of luck.

 

[AlbinoHawk DO]

You can only get 6 months' credit for FM residency regardless of the department you rotated

 

[gutonc]

Appreciate the responses @gutonc

I can practice in a larger city but the opportunities are more limited for the type of work that I find meaningful and interesting. I still have a long-career ahead of me, so I believe a few extra years of residency would be a reasonable sacrifice to make for better long-term opportunities.

I would definitely appreciate your opinion on how previous training/time since graduation would affect my application. I am < 2 years out from finishing a family medicine residency (p.s. family medicine 2 year residency in Canada).

I graduated from a large/reputable Canadian medical school and am a Canadian citizen. I am not sure how much being a Canadian rather than a US citizen hurts me, but I understand that I can apply to the first round of the US match then obtain a J-1 visa.

I think @NotAProgDirector and @CCM-MD have answered your questions quite well. Other than being unnecessarily vague about what the type of work you find meaningful and interesting is (hospitalists are hospitalists, if you want to be a GI instead, just say so, if you want to work in the US and can't with just 2y of residency training, just say so), I think you've got your answers here.

Take Step 1.
Apply.
See how things go.

 

[John Daniel]

Since you're only 2 years out from training, and are an LCME grad, I think you'll likely be able to find a spot in the US.

Perfect. I wanted to mention that I am debating waiting 2-4 years to apply due to some external factors, but I don't necessarily have to wait. Would waiting a few years to apply hurt? I don't grasp why being 2 vs. 5 vs. 10 years out of training has an impact.

I think @NotAProgDirector and @CCM-MD have answered your questions quite well. Other than being unnecessarily vague about what the type of work you find meaningful and interesting is (hospitalists are hospitalists, if you want to be a GI instead, just say so, if you want to work in the US and can't with just 2y of residency training, just say so), I think you've got your answers here.

In terms of work, I didn’t think there’s too much more to say then big city IM work > big city FM work for myself. Main short-term plan in any case would be to match to IM program, but I would add that I would consider specializing (mainly cardio). May not be super realistic to match to a strong program sending grads to cardiology fellowships when considering factors such as 233 step 2 score and 2nd residency, though.

If your plan is to ultimately work in Canada, make sure you look into the licensing/credentialing issues. You will need at least 4 years of IM training and will have to jump through some hoops to be eligible to take the RCPSC IM exam. As someone who’s taken both US and Canadian exams… The RC exam is immensely more painful to study for and pass. If your plan is to stay in the US, you should look into the challenges of obtaining a J1 waiver and ultimately a green card etc.

As a Canadian citizen who strongly considered going back and ultimately chose to stay in the US, I’ve navigated through a lot of these issues. My personal opinion is that this is a bad idea. I wish you the best of luck.

Thanks for the perspective. I have some awareness of these challenges but as above am strongly considering nonetheless. US and Canada would both be a consideration for me afterwards. I am not entirely sure of the process of applying to work in the US long-term, but I have family in the US that are citizens. I imagine having family there would be helpful with an application to stay/work if I went that route.

 

[NotAProgDirector]

Yes, years out from graduation is very important. First, it's hard to step back into a training mindset when you've been out unsupervised for a while. Second, programs might be worried that it would be hard for other residents to supervise you due to your prior experience. And last (and perhaps most important), some programs simply filter out applicants by year of graduation -- a 3 or 5 year cutoff is not uncommon.