Getting a statement of need (for J1 visas) is currently a huge issue for Canadians that want to use the USA as a back-up, especially for IM programs. From what I remember, most of the SONs are for FM but there are much more IM residency spots up for grabs in the US. It's even worse for specialties such as radiology.
It's been very disheartening seeing Canadians score a US residency spot only to find out that they can't take it up anyway due to the aforementioned.
It's been more extensively discussed in the Irish forums.
Confusion Regarding J1/SoN for Canadians pursuing US Residency
Going to US for residency? Coming back for sub-specialty training?
In event of any premeds wondering about this.
I mean.. it's tough.
I think premeds really have to do some soul searching and research prior to going off-shore now.
So many Western countries are entering this flux of oversupply in the competitive specialties that are metro hospital based. Meanwhile there remains that chronic need for more remote and rural practitioners. A country has to protect it's own domestically trained workforce first whether it be at the residency level or the consultant/attending one. We're already feeling this in Australia, and my now-ex classmates practicing in Canada now used to discuss it being a similar issue. For instance, maybe you were trained as a nephrologist, but there's only so many attending positions to go around, junior ones have to practice as a rural IMs for a brief period of time.
The CAP was not required to match prior to last year. This means that applicants would have to fly back to do a single day assessment late in 4th year in order to be eligible to apply to CaRMS. You have to have the NAC done in order to apply to the CAP so that means two separate flights. Also the MCCQE1 was never a requirement to apply to the match. None of the CMG's sit the exam before matching. It is a harder exam than the EE and as such probably means it is harder to distinguish yourself.
I mean I did all of these things aside from the CAP in order to match, but I can see how people can struggle with all of this. Its such a huge money sink to apply for such few spots that I can see why many decide to stay in australia.
To be fair, it's one notoriously hard province that rarely takes IMGs to begin with. Apparently, a place with more stigma than say Ontario - anecdotally from what I get told. to get a rural/remote position is to have done substantially well.
Similar to how tough California is. I've lost track of whether even UQO grads can apply there for residency. I'm sure the current students are more up to speed with this. Your school must be on a list of considered schools to even apply. No tests can be taken.
It is rough that it's now two separate dates for two clinical 'exams'. The CAP & The OSCE.
But it's just one province's requirements.
To me, it reads of one country catching up to other Western ones. They always compare and look at what other countries are doing.
But it also causes me to wonder what happened for them to increasingly change things, standard assessments on those with foreign degrees.
It's long been much harder to say practice in Australia as an IMG (from a non-UK country). The AMC exams have long been a barrier and have limited places for those interested in taking them. So if you miss out, you wait another few months to a year.
Asked around (so anecdotal) re:
Didn't IMGs have to sit the MCCQE1 at some point anyways (after sitting MCCEE)? I am not sure how this change will affect match rates for CaRMS. Seems like a streamlining effort to me.
QE1 - A minority of grads were already taking both the QE1 and EE to bolster chances in the past, apparently it was recommended for some applications. It's interesting that it's now mandatory.
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Much of this thread has been focused on the hurdles from the grad or student perspective.
Which I can understand, from being a student. I remember being told this. When you're a medical student going through, your primary concerns are your own teaching, learning and the internship.
But when you go into the workforce. [This is just me reflecting, it's not directly responding to anyone in this particular thread.]
This shifts. Patient care, the team you're own and your own work ethics and getting jobs done in time become primary. Keeping the work flow going, keeping up a standard of care. Your own 'teaching and learning' fit where they may at the end of a busy day, much of my own learning is on the job anyway. But in terms of 'thoughts' it couldn't be anymore lower or maybe forms 10% of my consideration over the course of the day. Students are lower down the list too, but no less important, I try to fit their needs below patient care but just above my own.
when this is off balance it's tragically so. I'd worked with IMGs of all different 'work qualities' and levels. Some were amazing - they were my bosses, or co-residents. Others were.. needless to say they are now repeating internship (like the entire thing) or were let go. You couldn't given them unstable patients to look after and you needed to look after their jobs and yours, then look over their shoulders at the jobs they were sorta capable of doing. The hours and workload triples and the team is at threat of burn out. Which in turn compromises care and there's greater frequency of mistakes occurring. In turn, the hospital is less likely to take a chance on further IMGs of a similar background.
In Australia anyway, you could opt for limited supervision if you only passed the AMC written - and while it can be challenging, you try to pass it enough times and you probably will. But it hardly reflects your abilities on the practical level. I've worked with those who can't fluently speak English still pass that exam anyway. Then they're given a chance, they have no way of following-through. It's soul destroying for them too, there's routinely threads on this in the General residency issues forum, but in terms of IMGs that matched in the US. [now I'm probably going to get a bunch of PMs from IMGs asking me about how they can work in Australia..]
I'm now often of two minds looking at standard assessments or hurdles on "IMGs"
It's a still a group that poses a lot of 'unknowns' to any hospital that hires them.
So, I certainly don't blame countries outside of Australia if they require extra assessments of me should I move. As annoying as they are. Having left medical school now and realizing nothing is what I used to think it was.
Again, we talk about internship bottlenecks ignoring how much the rest of the training pathway has already been affected. And how much the government is looking into this now. There's far more applicants for many of the royal colleges and for advanced trainee positions. Maybe you get an internship this year, but you may not end up an attending where you want to later. It's still mainly going to be FM for everyone. Unless you're willing to persistent for years as a rotating resident or unaccredited/PHO trainee.
There's always this balance between the individual and the healthcare system or the good of the community that doctors serve.
Between self-entitlements and what a country actually needs. i don't know that we'll ever get this right. I know there's constant efforts to figure it out. I often worry that particularly off shore premeds (and even medical student) don't consider it enough and their priority is..their own self entitlements or individual 'dreams'. While completely disregarding everything else around them.
As if to say, who cares if the country doesn't need another orthopedic surgeon, or that there's not enough surgeons around to train extra trainees to be of a baseline standard to care for patients. Or that may not be enough attending positions to go around or patients. Or your personality isn't suitable for this, and you end up this very average surgeon (when you could have been an excellent FM or dermatologist - of top of my head). As if it's their god-given right to be an orthopod no matter what the circumstances, just because they want this. We talked about it being PGY5-6 to get into RACS for general surgeon, some orthopedic hopefuls are looking at PGY10 to get into a training program. (not always, but it happens).
Similarly, I think it's noble for premeds to say I'm willing to do rural medicine, but it's just not a field that everyone or just anyone can excel in. It great undervalues what these practitioners do.
But there's a lot of responsibility on public health, and in this context, patient care & community needs take precedent. There's just so much more to medicine than an individual's career aspiration, it's a public service and resource in many countries. It's simply not like many other professions where conceivably if you have ability you can do whatever you want. And completely disregard community or government needs and resources.
