Complex question from a Canadian-American citizen

[HarmoniousEgg]

---

Members don't see this ad.

Hi everyone,

This is a bit of a niche question but I would appreciate if anyone has any advice on this. I am a Canadian studying at a Canadian medical school right now, and it's possible that I'll want to do an IM subspecialty fellowship in the USA and/or work in the USA after I'm finished. I plan to do residency in Canada.

I'm considering writing my USMLE Step exams to make it easier to get fellowships & moonlight legally as a fellow. I also hear that Canadians write their Step exams to get visas easier. However, I'm also an American citizen. Does this mean that taking the Step exams have less inherent value for me, since I don't require a visa to cross the border? I don't know anyone in my situation who could advise me on whether or not I should write my Step exams, so I would appreciate any advice people can give me.

 

[KnightDoc]

I'm not sure there is a good reason to take the Step exams if the fellowships don't look at them and you don't need a visa. At the fellowship stage, isn't it much more about where you went to school, how you did, and where you did your residency, and how you did? Do fellowships even look at Step scores?

You'll be a American who already graduated medical school and finished residency. I don't see how a Step score is going to add anything to your CV. Would you need Step scores to get a job in the US without a fellowship? If not, then that's probably your answer.

 

[NotAProgDirector]

There isn't an easy answer.

If you complete residency (+/- fellowship) in Canada and then want to come to the US, there would be no value to taking the USMLE exams. All states will license you with the LMCC exam alone, and I expect all hospitals (should you need to get privileged) will accept it also. You'd apply for a medical license, you won't need a work visa, no issues / no worries.

If you want to do a fellowship in the US, it's more complicated. Although a full license is available in all states with the LMCC exam, some states have a training license and in some only the USMLE is allowed. That's not a deal breaker since you can always get a full license instead -- although it's more expensive a a bit of a pain to do so. Many fellows end up with a full license anyway so they can moonlight, and some programs / states require them for fellows anyway.

The trickiest part is ERAS. It's possible that some programs may filter on the presence of USMLE exams. Although the LMCC should count as equivalent, some PD's may not see it that way. They may just be worried that they don't understand your situation and will decline to take you. Or, they may simply consider your application incomplete without the exams. Very few have any comfort interpreting MCCQE scores. Not having a score might make you stand out -- and perhaps not in a good way.

Much depends on the fellowship you're considering. If it's one of the highly competitive ones (Cards, GI, HO) then you'll need to hope that some programs are willing to consider you without USMLE scores. If you want a low competitive field (ID, Nephrology, Endo) then I expect it won't matter at all. Rest of the options are somewhere in the middle.