Canadian Medical Student - US residency position

[onelastpuff23]

HI everyone,

I am a Canadian medical student in my final year but am dual citizen with the US. I am interested in doing an ophthalmology residency in the US. Firstly, the programs in Canada are small in number and therefore incredibly challenging to match to. Since we don't have any standardized exams, it largely becomes a large inbreeding networking issue.

I am very much interested in seeing the medical system in the US. It seems there are more opportunities and the research is second-to-none.

My revelation to pursue residency in the states came very late into my application game. Given I come from a three year program, I found it challenging to do the US boards (no summers). Secondly, given I am in the middle of an application cycle, I thought about accepting an internal medicine/family medicine residency spot to fulfill the transition year/prelim requirement. Given that both countries have similar accreditation I thought this would be a good transition.

What are your thoughts?

Is my plan naive?

---

Members don't see this ad.

 

[GoSpursGo]

Unfortunately, ophthalmology is also pretty competitive in the US--mean USMLE step 1 score is 243, compared to a national average of 228. I'm not sure how you would manage to secure the high board scores that you would need to be competitive for an ophthalmology residency while you're simultaneously completing intern year of a residency. I'm also not sure how you would get useful ophtho letters of recommendation for your application since you'll, again, be doing IM/FM residency--while it's not JUST a networking inbreeding game, for highly competitive residencies it's really helpful if the person reviewing your application knows the people who wrote your letters.

Not saying that you're hopeless... looking at available information from the San Francisco match, 20/56 international graduates (which I think you would fall under) matched. If you were instead able to stay at your school and do a year (or two?) of ophtho research while you also take USMLE steps 1 and 2, I think you would stand a much better chance.

 

[NotAProgDirector]

The OP would not be considered an IMG, since canadian schools are considered equivalent to US.

But I agree that they would need to take the USMLE's and do well. So, you could plan to take the USMLE's between now and June, then start a 1 year prelim program in the US, and apply to ophthal programs next year. But this timeline has two problems -- taking all of the steps in 6 months won't be easy, and interviewing for ophthal while in a prelim program (getting days off isn't easy, this is a job).

Really, the best plan is to take a research gap year. Do Ophthal research for a year. You'll still need to take the steps between now and application season next year.

Really, the really best plan is to take 2 research years. Then you take the steps spread out over next year, and then apply the year afterwards.

Many US ophthal applicants have taken 1 or 2 research years. If you don't have any research, you're not likely to get a US spot.

 

[GoSpursGo]

But I agree that they would need to take the USMLE's and do well. So, you could plan to take the USMLE's between now and June, then start a 1 year prelim program in the US, and apply to ophthal programs next year. But this timeline has two problems -- taking all of the steps in 6 months won't be easy, and interviewing for ophthal while in a prelim program (getting days off isn't easy, this is a job).

Is OP eligible for a prelim spot without having taken USMLEs? I don't see how OP takes step 1 and 2 in time to SOAP into a US prelim spot.

 

[NotAProgDirector]

Mostly no. As a CMG, the OP doesn't need ECFMG certification. But they will most likely need the USMLE's for licensing and/or hospital credentialing.

It's possible that if they have taken the Canadian exams and the state and hospital they are applying to allows them for licensing/credentialing. But that's mostly unrealistic.

 

[onelastpuff23]

Thank you all very much for the support and information. I would like to point out a few points that were unclear. I apologize for any confusion.

1) Canadians are not considered IMGs. The schools are LCME accredited and the residency programs are all ACGME accredited.
2) I do have research. I have about 7-8 pubs with one first author. I am working on two other first author publications. However, these aren't ophtho-related -- more Internal Medicine. I am working on two ophthalmology projects right now -- hopefully leading to papers
3) I was NOT hoping to do a prelim hear in the US but rather in Canada. Family Medicine is two years in length and has tons of elective blocks (1 month each) during which I can do ophthalmology. I am currently partaking in the CDN match. I could do a year of IM here as well but its a far demanding program
4) I do have ophthalmology letters but they are all from Canadian doctors and many will be unknown to the US program directors. I have about five from the rotations I have done. I would love to do some US rotations perhaps if I choose to withdraw from the Canadian match this year

Some questions.

1) Does doing a family medicine year in Canada meet the prelim year requirements? I am not quite sure how these work in terms of mandatory rotations etc. The benefits of doing family medicine in Canada is the salary, and the ability to do "elective" blocks which would allow me to pursue an ophthalmology residency thereafter with more recent letters.
2) Must I pass ALL THREE STEPS? or just the step 1 exam before applying to ophthalmology programs if I have an MD at the time of my application
3) Does going unmatched in CANADA affect or have any stigma for the SF match? Will the gap between MD and residency be seen as a negative?
4) Are Canadian ophthalmology reference letters worth anything? I currently have about five letters, three of which are from academic staff at Canadian institutions.

Thank you for your time.

 

[rokshana]

Thank you all very much for the support and information. I would like to point out a few points that were unclear. I apologize for any confusion.

1) Canadians are not considered IMGs. The schools are LCME accredited and the residency programs are all ACGME accredited.
2) I do have research. I have about 7-8 pubs with one first author. I am working on two other first author publications. However, these aren't ophtho-related -- more Internal Medicine. I am working on two ophthalmology projects right now -- hopefully leading to papers
3) I was NOT hoping to do a prelim hear in the US but rather in Canada. Family Medicine is two years in length and has tons of elective blocks (1 month each) during which I can do ophthalmology. I am currently partaking in the CDN match. I could do a year of IM here as well but its a far demanding program
4) I do have ophthalmology letters but they are all from Canadian doctors and many will be unknown to the US program directors. I have about five from the rotations I have done. I would love to do some US rotations perhaps if I choose to withdraw from the Canadian match this year

Some questions.

1) Does doing a family medicine year in Canada meet the prelim year requirements? I am not quite sure how these work in terms of mandatory rotations etc. The benefits of doing family medicine in Canada is the salary, and the ability to do "elective" blocks which would allow me to pursue an ophthalmology residency thereafter with more recent letters.
2) Must I pass ALL THREE STEPS? or just the step 1 exam before applying to ophthalmology programs if I have an MD at the time of my application
3) Does going unmatched in CANADA affect or have any stigma for the SF match? Will the gap between MD and residency be seen as a negative?
4) Are Canadian ophthalmology reference letters worth anything? I currently have about five letters, three of which are from academic staff at Canadian institutions.

Thank you for your time.

realize that optho is one of the MOST competitive residencies in the US...and its in the SF match, which is earlier than the NRMP match, so that shortens your time to become competitive.

Do you HAVE to have Step I, CK, and CS done and passed? No...as a Canadian Med student, you are not an IMG...but will you get serious consideration from optho residencies without it? probably not...realize those that are applying to optho have high Step scores, are usually AOA, and have optho research (not just IM)with publications.

I can't speak for the reciprocity of Canadian residency, but i would image not...but the optho program websites should have that info available.
and sure going unmatched is going to raise a red flag.

your best bet is to do a research year or 2 in the US...your optho LoRs and involvement in research up there should help with getting you a spot done here and then apply with better credentials. This will give you time to get the Steps done as well.

 

[NotAProgDirector]

An FM year in Canada definitely meets the requirements of the American Board of Ophthalmology. From their website:

One (1) year* of internship with direct patient care: All applicants, both graduates of allopathic and osteopathic medical schools, entering ophthalmology training programs must complete a post-graduate clinical year (PGY-1) in a program in the United States accredited by the Accreditation Council for Graduate Medical Education (ACGME) or a program in Canada approved by the appropriate accrediting body in Canada. The PGY-1 year must include direct patient care experience in fields such as emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, surgery, or a transitional year. As a minimum, six months of this year must consist of a broad experience in direct patient care. It is a requirement of the ABO that the Program Chair ascertain that an individual has completed an accredited PGY-1 in the United States or in Canada prior to the start of the ophthalmology residency.

As mentioned above, you probably have to pass and do well on Steps 1, 2CK, and 2CS to be considered. It is very unlikely that any US program will consider you without them, as getting a training license or being credentialed by hospitals probably requires it. It is possible that if you've passed the equivalent Canadian exams that they MIGHT be considered, but without exam scores your application will likely just be tossed.

No one is going to care if you don't match in Canada. Many US applicants for Ophthalmology take 1-2 gap years for research.

I have no idea whether canadian ophthal letters are of any value in the US.

If you want to go down this path, the next step is taking the USMLE. You need to do really well, not just pass. A poor score on the USMLE and this dream is over.

 

[MedicalSport]

I know a guy, Canadian, who graduated from Queen's School of Medicine a couple years ago. He did his intern year at UCLA and is now doing his ophthalmology residency at Stanford. From what I hear he killed the USMLEs. So yes, it's possible.

 

[onelastpuff23]

Thank you all for your replies!

I have a few questions for you if you don't mind.

In Canada, we do not have grades, class ranking, or any objective metric to evaluate students assign from P/F. How are these schools interpreted in the eyes of Program directors?

Must I pass all three of the USMLE step exams? or is a solid score on the step 1 only necessary?

I have done a lot of elective/"away" rotations in internal medicine. I also did about 10 weeks of ophthalmology rotations. I am not sure how PDs will interpret this at all. Will PDs think I am undecided? Will they value my application?

thanks

 

[GoSpursGo]

You will need to take and pass step 1 and both parts of step 2. If you have no grades from med school, then the board scores become even more important, as they are seen as the "great equalizer" where you can be judged fairly against all the US students who took the same test.

 

[WingedOx]

Unfortunately, ophthalmology is also pretty competitive in the US--mean USMLE step 1 score is 243

You guys are making me feel old. It was 235 when I took step 1.

 

[NotAProgDirector]

In Canada, we do not have grades, class ranking, or any objective metric to evaluate students assign from P/F. How are these schools interpreted in the eyes of Program directors?

Must I pass all three of the USMLE step exams? or is a solid score on the step 1 only necessary?

I have done a lot of elective/"away" rotations in internal medicine. I also did about 10 weeks of ophthalmology rotations. I am not sure how PDs will interpret this at all. Will PDs think I am undecided? Will they value my application?

thanks

Some schools in Canada are P/F, but others give grades. If your school is P/F, then everything will depend upon your steps and any US rotations that you do. Unless there's some secret grading system behind the scenes that's in your MSPE (unlikely).

As mentioned, Step 1, 2CK, and 2CS.

IM PD's will see it as "I'm really interested in Ophthal but I'm applying to IM as a backup" unless you convince us otherwise. Ophthal PD's will see it as "I'm interested in Ophthal".

 

[onelastpuff23]

Thank you very much!

I am still a little concerned about Canadian applicants vs USA medical students. Even though both are considered equivalent in accreditation, and I am a dual citizen.

In the eyes of the programs, would program directors still see Canadians as "IMGs" or "internationals" for all intents and purposes? would they still favor students from US medical schools?

 

[ThoracicGuy]

Thank you very much!

I am still a little concerned about Canadian applicants vs USA medical students. Even though both are considered equivalent in accreditation, and I am a dual citizen.

In the eyes of the programs, would program directors still see Canadians as "IMGs" or "internationals" for all intents and purposes? would they still favor students from US medical schools?

Canadian residents would still require visas, so that could be a bit of a sticking point. They are certainly seen as generally better candidates than IMG and FMG candidates overall. Canadian schools are LCME accredited.

 

[gutonc]

Canadian residents would still require visas, so that could be a bit of a sticking point. They are certainly seen as generally better candidates than IMG and FMG candidates overall. Canadian schools are LCME accredited.

But OP is a dual citizen. So more or less on par with any other AMG.

 

[ThoracicGuy]

But OP is a dual citizen. So more or less on par with any other AMG.

Yes, I meant Canadian students in general.

 

[NotAProgDirector]

It's hard to say. US PD's might be less comfortable with canadian medical school training. Not that many Canadian grads come to the US. Some Canadian schools use complicated, or P/F, grading systems that make those students difficult to assess. The same thing can be said about some US schools. So it's hard to say.

 

[onelastpuff23]

I emailed a program administrator at an ophthalmology program who indicated they treat ALL APPLICANTS the same regardless of medical school training. I am very curious if this is strict policy. The statistics show IMGs have very low match rates overall in ophthalmology

 

[ThoracicGuy]

I emailed a program administrator at an ophthalmology program who indicated they treat ALL APPLICANTS the same regardless of medical school training. I am very curious if this is strict policy. The statistics show IMGs have very low match rates overall in ophthalmology

What they say on the phone or in an email and what they say behind closed doors may be totally different. With you being an IMG, I wouldn't count on matching in Opthalmology even coming from Canada. I would tell most us students not to count on it either.

 

[rokshana]

What they say on the phone or in an email and what they say behind closed doors may be totally different. With you being an IMG, I wouldn't count on matching in Opthalmology even coming from Canada. I would tell most us students not to count on it either.

technically he is not an IMG as a Canadian graduate..

 

[ThoracicGuy]

technically he is not an IMG as a Canadian graduate..

True, though he still would have a tough time at ophthalmology.

 

[rokshana]

True, though he still would have a tough time at ophthalmology.

agreed, but his limitations really stem from having no step scores.

IMHO, all things being equal, programs will rank a US senior higher...but rarely are all things equal.

 

[ophthope]

This is the most honest answer I can give and if it sounds a bit bleak, sorry.

From the other side of the curtain I can tell you that no matter how many times you get the answer "we treat all applicants equal" from official communications channels, the hard truth is different and that should be obvious when looking at match rate statistics for IMGs. And regardless of ACGME accreditation and not "technically" being an IMG or whatever - if you graduate from a medical school that is not in the US you are considered an IMG to an Ophthalmology program director. Sure, Canada is better than France or India, but you're still an IMG. Beware of people who are accustomed to Internal Medicine or other residency applications because Ophthalmology is not at all the same process.

I think it helps to understand the perspective of the other side, so here's how the application process works at most institutions for Ophthalmology that I know of:
1. Program Director receives an enormous amount of applications from all over the world.
2. Gather all the IMGs as a group and then send them all rejection letters.
3. This step used to be to repeat #2 for DO applicants but this is thankfully changing at many institutions and DOs have a way better chance of matching into MD Ophtho programs than in the past.
4. Screen out all the US MDs below the whatever the lowest Step score the institution has decided to accept. One published survey said that only 30% of programs had a USMLE cut-off, but I am highly skeptical of that claim.
5. Review the remaining applications in more detail to decide the invitation list.

Honestly, most successful applicants to Ophthalmology are in the boat where they are stressing about the details that separate them from the crowd AFTER point #5 here. And I just want to say that although this process may seem unfair or biased it's really just pragmatic. When you get 600 applications for 3 positions every single year that you have to sort through after your week of a full clinic and OR schedule... you're going to find a way to streamline that process. You can cut out much more than half of that work pretty much instantly in steps 2, 3, & 4 above. So that's what happens. At the end of the day a program interviews only 10-20% of applications it receives and you have to make that 80-90% culling somehow.

The most likely situation in which this typically goes any differently for an applicant is if they have a personal connection to a program. I know at least a handful of people personally that only received interviews at 1-3 programs and still matched. They got interviews only at programs where they knew people in the program/administration, had done away rotations and made a very favorable impression, and at their home programs. And they matched, because a known entity with good work ethic who is intelligent and just bad at standardized tests is still a great Ophthalmology applicant and a better gamble than the 260 step score guy that seemed a little cocky on interview day.

So despite having dual-citizenship, in a lot of institutions your application is likely not going to be looked at long enough for a program director to even see it. There is a higher chance for you than other IMGs, for sure. But not really close to the chance that a US graduate has at a fair look.

If I was in your shoes, knowing what I know, this would be my plan:

1. Match into Ophthalmology in Canada. Good standard of living, nice people up north, and salaries typically a little higher for comprehensive Ophthalmologists. I know Tim Horton's is going through a rough patch right now but you've got that national treasure too.

Alternatively for the US path:

1. Blow the Step exams out of the water, score as high as you absolutely can.
2. Everything else on your resume should be stellar as well (research, volunteer activities, etc)
2. Do an intern year in the USA or you're making this even harder on yourself, this might be out of order on the list.
4. Do away rotations at a number of low-tier Ophthalmology programs in the US and be absolutely stellar and endear yourself to the people at those programs.
5. While at those programs, try to obtain some sources for good letters of recommendation.
6. Get your application in early.
7. Reach out directly via email or phone to each program where you apply saying that you wanted to let them know ahead of time that although you went to medical school in Canada, you are a US citizen as well and do not require a visa.

At least that's what I'd do. A match is possible, but not probable given the match statistics. You'll have to do everything possible to skew the odds in your favor. Good luck!

 

[DrfluffyMD]

I don’t think many posters here get it, but canadian medical schools are LCME certified and are equivalent to USMD schools. Those graduates are not IMG in the strictist sense.

 

[ophthope]

I don’t think many posters here get it, but canadian medical schools are LCME certified and are equivalent to USMD schools. Those graduates are not IMG in the strictist sense.

I "get it" as in their education is basically the exact same as someone in Alabama or New York or Idaho. I just don't think it matters.

Most program directors are going to look at the application, see the applicant is not from a school in the US, and throw it into the same pile of applicants as the ones from every other non-US country regardless of the fact that it is LCME accredited. They still need a J-1 visa, right?

Again I want to point out that when I was an internal medicine intern a number of my fellow interns/IMED residents were from Canada. It did seem to be an easier process for them. Not so in Ophthalmology. Do any of you have some sort of knowledge of greater numbers of Canadians matching into US Ophthalmology programs compared to applicants from other countries to refute my claim that it will be just as hard?

 

[onelastpuff23]

I appreciate your views and insight. I certainly don't dispute them. I am just a bit flustered to be honest as to why a definition of IMG definition would be different than the SF criteria.

I also like DO candidates and think they should be treated better. However, I am not sure why their odds should be better than Canadian applicants. After all, aren't Canadian and US MDs considered equivalents whereas DOs are accredited differently?

Is the filtering done by ECFMG status? or geography alone (sorry I pm'ed you this as well).

Most program directors are going to look at the application, see the applicant is not from a school in the US, and throw it into the same pile of applicants as the ones from every other non-US country regardless of the fact that it is LCME accredited. They still need a J-1 visa, right?

If I don't need a J-1 and have US PR/Citizneship does the ball game change? or would I be seen the same as a caribbean/Irish grad

 

[rokshana]

I appreciate your views and insight. I certainly don't dispute them. I am just a bit flustered to be honest as to why a definition of IMG definition would be different than the SF criteria.

I also like DO candidates and think they should be treated better. However, I am not sure why their odds should be better than Canadian applicants. After all, aren't Canadian and US MDs considered equivalents whereas DOs are accredited differently?

Is the filtering done by ECFMG status? or geography alone (sorry I pm'ed you this as well).



If I don't need a J-1 and have US PR/Citizneship does the ball game change? or would I be seen the same as a caribbean/Irish grad

SF and NRMP are different matching systems so the definitions can be as they see fit.

The long and short of it is that Optho is uber uber competitive and they can be as selective as they want...there are way more US seniors, who are AOA, with a ton of research to pick from...and many of them don't match...anyone outside that profile is going to have an uphill climb. You have no USMLE scores, you have no USCE experience, and while you go to an LCME school and have US citizenship, you still will not be on par with a US senior...end of story. Fair, probably not, but...life is not fair.

Can you improve your application? Yes, and that had been spelled out time and time again in this thread...you really, REALLY want Optho in the US, you are going to have to do extra to get the CHANCE to get there, but even then its not a guarantee. And if you aren't a good candidate in Canada, its unlikely that you will be able to get a spot in the US.

 

[Iris42]

Also note that in order to be eligible to write your boards in Canada you'll need 5 years of ACGME accredited in Optho. All the Ophtho programs in the US are only ACGME accredited for 3 years. This means you'll have to do a 2 year ACGME accredited fellowship before being able to go back to Canada. And the only ACGME accredited fellowship in Ophtho is oculoplastics which only takes 4 fellows per year !!!!