FM resident considering switch into GS

[TheWorldisFlat]

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Long time lurker on these forums here, writing a message today to seek out help. I posted this in the GS thread, but I got no replies... Also, I read a couple of threads similar to my story, but i'd still like to have some additional opinions! 🙂

I just started a residency in Family Medicine here in Montreal, Quebec because that was the only program I could match into. A few months into the program, I became aware of how my experiences in life brought me in the wrong discipline, and that I'm determined to correct my mistake.

See, here in Quebec, we can get into medicine basically straight from High School. I was 18 when I started medical school. I got in because I was a workaholic, especially for disciplines like maths and physics, and had excellent grades. Also, my family had made a lot of sacrifice to get to Canada and pay for my tuition. I felt responsible for them, and felt like medicine was the best way of showing how I appreciated their efforts.

I'm a pretty hands-on guy ; I like to solve precise problems with precise solutions. I need to see tangible results for my effort. So when I got in medical school at such a young age , I wasn't very stimulated to cram for my exams and learn everything by heart for the sake of doing it. I did't really want to be a doctor in the first place! As a result, I became a bum, I lost my motivation, and my grades became piss-poor. I thought I'd be miserable in medicine anyway, so why bother?

That turned around a bit when I got to my clerkship. I worked a lot harder because I could see how my studying affected my clinical performances. I got pretty good evaluations by my supervisors, and I enjoyed it much more.

But that didn't matter when I applied to residency. My poor grades from my preclinical years shot me down, and I had to accept a spot in FM (I got lucky to match in my hometown, though).

Flash forward to today. I am now 23, and I became a lot more mature. I think my medical knowledge is on par with my colleagues. But I also have a better understanding of what I want out of life and my career. I realize I am a responsible, practical type of guy that thrives on intense, short interactions with people. I am not afraid anymore of committing and working long hours to achieve my goals.

And that's what brought me to General Surgery. I particularly loved my Vascular Surgery rotation back when I was a med student ; it is a discipline that fixes precise problems with precise interventions. It also requires one to have upmost control over their technical dexterity, and that process of mastering a skill excites me.

Thing is, I hope that time is not too late for me. I was thinking of meeting with my PD and the GS PD at my faculty to discuss what can be done to re-apply. I can still take some electives in GS or Plastics and I could maybe try to do a Masters in Experimental Surgery at the same time. If I have to finish my residency, work one or two years after while I complete my Masters, then I will do it. I'm quite young ; I'd start my GS residency at 26-27.

If GS is not an option, I guess my back up plan could be to work in the ER as a FM (pretty easy to do in Quebec) or apply to IM and do GI or Cardiology.

I started this thread because not a lot of people around me can understand my situation. I am looking for advise as to the feasibility of my project, if I am crazy to think that way, etc. I realize the system in Quebec is different, but any advice, encouraging or not, would be greatly appreciated!


Cheers!

TWIF

 

[Law2Doc]

I am skeptical that such a masters will do much for you. You need to sit down with local GS PDs and see if there is mutual interest.

 

[SouthernSurgeon]

I think the lack of responses is likely due to most peoples' lack of familiarity with the Canadian system.

I for one know little to nothing about Canada.

Using the general principles that apply to the US: If you were a marginal candidate before, your chances now are unlikely to be any better. A random postgrad masters probably won't change that. Your best bet, assuming your performance in FM residency has been strong, would be to convince the local GS PD to consider you.

 

[BlondeDocteur]

The US doesn't have clinical Master's degrees so most posters here will be unfamiliar with them and with their utility. Are you hoping to stay in Canada? I have no idea re: CARMS and the success of re-applicants, but I think a solid research program with good exposure to surgeons will help your cause.

On the flip side, it seems like the problem-based focus you'd see in an emergency department might be a good solution too, and it's a lot more attainable.

 

[Winged Scapula]

As others have said, this is an American website so most of us know little about training requirements and issues in Canada. For example, are you even allowed funding to do a second residency? That's why you didn't get any responses (plus you posted less than 2 days ago and at the time when most SDN surgical posters are either just starting internship, fellowship or just took the qualifying exam late last week - so a slow time in a forum which tends to be slower to respond anyway).

You need to talk with a Canadian GS PD and see what their take is.

 

[TheWorldisFlat]

@BlondeDocteur : I do hope to stay in Canada. However, I didn't take my step1 or 2, and I did flirt with the idea of taking them and apply in the US. Not sure if that is realistic. Do you really feel ER could fit the bill for me? I mean, there is a lot of primary care stuff in EM that irritated me when I did my rotation...

@Winged Scapula : In Canada, we would be allowed funding for a second residency. Thanks for the explanation as to why I didn't get any answers in the surgical board.

I will try and meet the GS PD. He will be able to tell me the best course of option. Thanks for the replies guys! Always fun to see you guys care about other people's worries.

 

[NotAProgDirector]

What I have heard about training in Canada is that for the more competitive positions, connections are very important. Thus if you can impress the local GS PD, anything can happen.

Your other choice is to apply to the US. As a canadian grad who was "lazy", I guessed you haven't taken the USMLE's. So, you get another chance. Study like crazy and prove your prior poor performance was not your best effort, and then apply in the US. With good USMLE's you could apply to GS or EM.

 

[link2swim06]

@BlondeDocteur : I do hope to stay in Canada. However, I didn't take my step1 or 2, and I did flirt with the idea of taking them and apply in the US. Not sure if that is realistic. Do you really feel ER could fit the bill for me? I mean, there is a lot of primary care stuff in EM that irritated me when I did my rotation...

@Winged Scapula : In Canada, we would be allowed funding for a second residency. Thanks for the explanation as to why I didn't get any answers in the surgical board.

I will try and meet the GS PD. He will be able to tell me the best course of option. Thanks for the replies guys! Always fun to see you guys care about other people's worries.

You obviously aren't doing vascular surgery but you are still working with your hands at least a few times a shift.

Also ER is harder to match into than GS in the US. So I'd just assume you'd do surgery if you decided to come to the US.

 

[TheWorldisFlat]

@aProgDirector : Indeed, I haven't taken my USMLE. I didn't think ERAS was open for Canadian Graduates. I don't mean to abuse your kindness, but you mean to say that connections aren't that important to apply in the US? What's the timetable like? And could I apply as a FM doctor? Thanks 🙂

 

[mvenus929]

@aProgDirector : Indeed, I haven't taken my USMLE. I didn't think ERAS was open for Canadian Graduates. I don't mean to abuse your kindness, but you mean to say that connections aren't that important to apply in the US? What's the timetable like? And could I apply as a FM doctor? Thanks 🙂

I'm sure there are special stipulations that make Canadian graduates slightly different from other international graduates, but I'm not familiar with them, so I won't speak to them.

Connections can get you in some places, but generally, there are a lot of people involved in making the decision to rank, and since it is a ranking system, they don't just offer spots to people. So, no, connections aren't that important in the NRMP system.

As far as the timetable... Applications open up on Sept 15th, interviews occur anytime between October and February, and rank lists are due at the end of Feb. Match Day is the third Friday in March. The academic year starts around July 1 (usually a week or two before that for orientation purposes).

If you aren't content with a FM spot in Canada, why would you want to apply to one in the US?

 

[gutonc]

I'm sure there are special stipulations that make Canadian graduates slightly different from other international graduates, but I'm not familiar with them, so I won't speak to them.

Graduates of Canadian med schools are considered graduates of LCME schools as it relates to the Match and licensing rules. Visa issues remain of course.

 

[NotAProgDirector]

Agreed with gutonc. Canadian and US schools are considered equivalent, so the OP is not considered an IMG at all.

Canadian students are absolutely free to participate in ERAS -- as is any physician from any country.

Connections are much less important in the US, especially for "big" fields such as IM and GS. There are many spots. EM is a bit more close knit -- newer field with less spots. In general you need a specific LOR from an EM program (called a SLOR) to apply to many programs.

So, you can apply via ERAS if you want. Application season opens Sept 15th, so you need to get moving if you plan to do this. You can apply as a graduated Canadian MD. Interviews tend to happen Nov-Jan, with rank lists due end-Feb and matching in mid March. You'll need to make sure your current program is willing to give you enough time/flexibility to interview.

But, you basically can't apply this year as you have no USMLE scores. In general, the Canadian exams are considered equivalent to the US exams for licensing, so you could finish your Canadian training and then come to the US and work (visa needed, other challenges, but possible). But you won't be able to get a residency slot without them, and you can't possibly take them fast enough to have scores for this year. Plus, you'll want time to study so you do well -- doing poorly will only hamper your application further.

So, here's the plan:

1. Continue in your FM program
2. If you can transfer to a Canadian GS program, that's your best option.
3. Assuming #2 fails, consider studying for and taking USMLE Step 1.
4. If you do poorly, stop. You are an FM doc in Canada.
5. If you do well, take Step 2, consider applying to residency programs in the US.

By the time you reach Step 5, you'll probably be done with your FM training.

 

[BoardingDoc]

On the flip side, it seems like the problem-based focus you'd see in an emergency department might be a good solution too, and it's a lot more attainable.

Emergency Med is currently as if not more competitive than GS, so I don't know why applying to a more selective specialty would help.

 

[TheWorldisFlat]

Agreed with gutonc. Canadian and US schools are considered equivalent, so the OP is not considered an IMG at all.

Canadian students are absolutely free to participate in ERAS -- as is any physician from any country.

Connections are much less important in the US, especially for "big" fields such as IM and GS. There are many spots. EM is a bit more close knit -- newer field with less spots. In general you need a specific LOR from an EM program (called a SLOR) to apply to many programs.

So, you can apply via ERAS if you want. Application season opens Sept 15th, so you need to get moving if you plan to do this. You can apply as a graduated Canadian MD. Interviews tend to happen Nov-Jan, with rank lists due end-Feb and matching in mid March. You'll need to make sure your current program is willing to give you enough time/flexibility to interview.

But, you basically can't apply this year as you have no USMLE scores. In general, the Canadian exams are considered equivalent to the US exams for licensing, so you could finish your Canadian training and then come to the US and work (visa needed, other challenges, but possible). But you won't be able to get a residency slot without them, and you can't possibly take them fast enough to have scores for this year. Plus, you'll want time to study so you do well -- doing poorly will only hamper your application further.

So, here's the plan:

1. Continue in your FM program
2. If you can transfer to a Canadian GS program, that's your best option.
3. Assuming #2 fails, consider studying for and taking USMLE Step 1.
4. If you do poorly, stop. You are an FM doc in Canada.
5. If you do well, take Step 2, consider applying to residency programs in the US.

By the time you reach Step 5, you'll probably be done with your FM training.

Best advice I could hope for when writing on these forums. Thank you so much!
Is there a limit to how long I can wait after I graduated from my FM training?
Also, here in Canada we have a book called the Toronto Notes to help us with our LMCE. Do you have an equivalent for the USMLE step 1 and ?

 

[ThoracicGuy]

Best advice I could hope for when writing on these forums. Thank you so much!
Is there a limit to how long I can wait after I graduated from my FM training?
Also, here in Canada we have a book called the Toronto Notes to help us with our LMCE. Do you have an equivalent for the USMLE step 1 and ?

Sooner is better. If you can apply while you are in your last year of training, that would be ideal. First Aid series is usually good for USMLE, at least back when I took it. Feel free to ask in the Allo forum for more opinions.

 

[NotAProgDirector]

Sooner is better. If you can apply while you are in your last year of training, that would be ideal. First Aid series is usually good for USMLE, at least back when I took it. Feel free to ask in the Allo forum for more opinions.

Agreed. There is no official limit, but the farther out you get from your training the less successful you will be. Already this is an uphill battle for you, you don't want to make it any harder. You should plan on applying in your last year of FM residency.

 

[BoardingDoc]

Best advice I could hope for when writing on these forums. Thank you so much!
Is there a limit to how long I can wait after I graduated from my FM training?
Also, here in Canada we have a book called the Toronto Notes to help us with our LMCE. Do you have an equivalent for the USMLE step 1 and ?

As thoracicguy said, First Aid is the go to resource for studying for step 1. It isn't quite as useful for step 2 but still good. One of the best things you can do is to simply do as many practice questions as possible. USMLEWorld is a great questionbank for both step 1 and step 2.

 

[BlondeDocteur]

Emergency Med is currently as if not more competitive than GS, so I don't know why applying to a more selective specialty would help.

I think you misunderstand. In Canada many ERs are staffed solely by FM docs, especially in rural areas, and from what I understand FM training in Canada is more tailored to acute care than it is here. As a backup, he can become an FP who works solely in an acute care/urgent care setting.

 

[BoardingDoc]

I think you misunderstand. In Canada many ERs are staffed solely by FM docs, especially in rural areas, and from what I understand FM training in Canada is more tailored to acute care than it is here. As a backup, he can become an FP who works solely in an acute care/urgent care setting.

I see what you're saying. I will freely admit that I don't know much about how healthcare works in Canada, but from what you said I'm not sure that FM as a way to work in the ED is a good longterm plan. There are many EDs in the US that are also staffed by FM trained docs, however, they are all slowly being phased out in favor of BC/BE EM docs. I have no idea if this is also the case in Canada but it's definitely something I would look into before completing a FM residency with the plan to work in an ED afterwards as a lifelong career.

 

[chartero]

I see what you're saying. I will freely admit that I don't know much about how healthcare works in Canada, but from what you said I'm not sure that FM as a way to work in the ED is a good longterm plan. There are many EDs in the US that are also staffed by FM trained docs, however, they are all slowly being phased out in favor of BC/BE EM docs. I have no idea if this is also the case in Canada but it's definitely something I would look into before completing a FM residency with the plan to work in an ED afterwards as a lifelong career.

This is one case where American specialty politics don't map closely to Canadian. In Canada FPs have a strong and secure place in EM, especially FPs who add a one-year EM fellowship and CCFP(EM) certification from the Canadian College of Family Physicians (family medicine board). More: Emergency medicine: Canada (Wikipedia).