Going back to Canada

[jax00]

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I'm a Canadian looking at med schools overseas. I graduated last spring with a BKin (GPA 3.4) and my MCAT was 28R. I have lots of long-term volunteer activities and am extremely involved in sports. I applied to Canadian schools but my GPA was too low, so now I'm looking at schools in Australia, NZ and Ireland. The problem is I'm not sure how hard it will be for me to come back to Canada. I've heard stories from friends of friends of friends, but I'd like to talk to someone first-hand. I'm wondering if there's anyone who has done the transfer back to Canada, or is in the process of doing it now, and can give me some advice.

Thanks!

 

[Daemos]

next to impossible is what has been said. There are long ordeals even with completed residencies. If you want to practice in Canada, best to get into a Canadian medical school.

 

[Giemsa]

Residency in Canada for International Medical Graduates (IMGs)

Required prior to application/residency:

#1 You must be a citizen or permanent resident of Canada
#2 MCCEE exam
#3 TOFEL & TSE (variable)
#4 LMCC Part I
#5 You must sign a return-in-service contract

In Ontario, there is also a mandatory, unpaid, 5 week pre-residency assessment and an assessment verification period of 12 weeks.

In BC, there also is an BC-IMG program; a similar program also exists for IMGs who wish to apply to Alberta (IMGs eligible for second round match only).

During residency:

#6 LMCC Part II
#7 Other exams as required (e.g. Principles of Surgery)

End of residency:

#8 Royal College exams

Note that the number of residency positions for IMGs is limited (both in number and in scope). There were 1299 IMGs in the first round in 2008; there were 219 dedicated IMG residency positions available.

Infomation:
CaRMS - (R-1) - Eligibility - Basic Criteria
CaRMS - (R-1) - Eligibility - Provincial Restrictions

 

[JanikeyDoc]

Actually from what I heard from several Canadians is that Australian residency training is actually recognized in Canada. There is a Canadian member on this board that has mentioned this. I think going overseas for medical school for Canadians tends to be a very high risk proposition. Generally for US students this is not much of an issue...as long as you are willing to avoid a highly competitive residency like Derms or Rads.

 

[redshifteffect]

Actually from what I heard from several Canadians is that Australian residency training is actually recognized in Canada. There is a Canadian member on this board that has mentioned this. I think going overseas for medical school for Canadians tends to be a very high risk proposition. Generally for US students this is not much of an issue...as long as you are willing to avoid a highly competitive residency like Derms or Rads.

Yes Australian residency is recognised, but this isn't a 100% solution to going back either as there are a number of issues:

#1 You still need to get assessed by the College of Physicians/Surgeons and I've heard that this can take about 1 year

#2 You will still have to be a LMCC (MCCEE/Q1/Q2) though in fairness I believe they give you 3 years to get this out of the way, and you can still practice while taking these exams.

#3 You will still have to write your fellowship exam both in Canada + in Oz

#4 Getting into an Australian residency will undoubtedly get more competitive as there will be more graduates in the upcoming years, and therefore they will be able to be more selective. If they find out you won't be staying after getting your fellowship I doubt they will want to give you a training spot.

The "good news" is that you can go back to Canada right after you get your fellowship from Australia and get a job as a post-graduate fellow (by doing a fellowship program in some speciality area). This will require a huge pay cut on your part (a Consultant salary in Oz vs a post graduate salary in Canada (which is even less then what you were getting as a registrar in Oz)) but you can do this while you're waiting for your credentials to be assessed. Make sure you have your Oz PR/Citizenship though as if Canada decides you need something "extra" from your training it will be easy for you to go back to Oz and complete that. It's actually a relatively easy process to go back and do extra registrar years in Oz even after you've received fellowship (vs. the US where this is nearly impossible).

 

[redshifteffect]

Actually from what I heard from several Canadians is that Australian residency training is actually recognized in Canada. There is a Canadian member on this board that has mentioned this. I think going overseas for medical school for Canadians tends to be a very high risk proposition. Generally for US students this is not much of an issue...as long as you are willing to avoid a highly competitive residency like Derms or Rads.

Exactly.

Part of the problem for Canadians is the lack of a Greencard. With the economy the way it is, residency numbers in the US as well as H1B visas are being cut.

That doesn't mean it's impossible to work in the States though, just a little bit more tricky.

 

[Daemos]

I just don't think it's economical to go to Aus for school, then go back to Canada to try to practice.

From what I've been told practicing in Aus >>> Practicing in Canada.

i've really only read stuff for primary care type specialties, as that's really what I'm interested in, diagnostic/imaging and surgical specialties might be different.

 

[redshifteffect]

I just don't think it's economical to go to Aus for school, then go back to Canada to try to practice.

From what I've been told practicing in Aus >>> Practicing in Canada.

i've really only read stuff for primary care type specialties, as that's really what I'm interested in, diagnostic/imaging and surgical specialties might be different.

One thing I forgot to add was that for GPs/Family Physicians it's slightly different (then what was mentioned above, which is for specialists).

However this varies from province to province, and basically the easiest provinces (Sask/Newfoundland) will let you start working even before you finish an FRACGP - on the condition that you become an LMCC within a specified number of years (thus no exams before you even start).

Manitoba only requires you pass the MCCEE before you start working, then gives you (from memory) 7 years to pass the QE1/QE2.

However Ontario is very strict and requires you to be a member of CFPC before you even start working - so depending on which province you are aiming to return to, you may have an easy/hard time returning.

Keep in mind you can use these provinces as a "back door" to get back to the province of your choice. However this will require you to spend a number of years in those provinces, to fulfill all the requirements to get back to the more difficult provinces.

Finally take a look at the BMJ international section both Sask/BC are advertising to recruit British GPs...if it was that hard to return I doubt they'd be advertising there.

 

[JanikeyDoc]

Exactly.

Part of the problem for Canadians is the lack of a Greencard. With the economy the way it is, residency numbers in the US as well as H1B visas are being cut.

That doesn't mean it's impossible to work in the States though, just a little bit more tricky.

Well the issue I have heard for the USA is that assuming you are an American citizen or Green Card holder that if you are applying to a non competitive field like Family Practice or Pediatrics, there is not much of an issue with getting a residency. Am I correct? I always hear of graduates from fairly mediocre Caribbean schools getting into lower prestige programs with only passing USMLE scores, the vast majority of these people are US citizens.

Point taken on the economy, but most Primary Care doctors I have spoken to in the US are predicting a severe under supply of GPs in the US while there might be an oversupply of specialist doctors in the US, it seems similar to the UK, where GPs are in short supply.

 

[redshifteffect]

Well the issue I have heard for the USA is that assuming you are an American citizen or Green Card holder that if you are applying to a non competitive field like Family Practice or Pediatrics, there is not much of an issue with getting a residency. Am I correct? I always hear of graduates from fairly mediocre Caribbean schools getting into lower prestige programs with only passing USMLE scores, the vast majority of these people are US citizens.

Point taken on the economy, but most Primary Care doctors I have spoken to in the US are predicting a severe under supply of GPs in the US while there might be an oversupply of specialist doctors in the US, it seems similar to the UK, where GPs are in short supply.

I think that if you are not picky where you what to work and your USMLE scores are decent and you are a Green car holder/citizen at this stage there is probably a job in the US. However with the increased number of US gradates, and the cut in residency positions that might not be the case in the next 4 years.

Primary care in the US vs that in other (English speaking) western countries is different. In those countries you need a primary care referral to see a specialist; so these doctors will always be in demand. Although perhaps thought of in the same manner as what American primary care physicians are thought of by their specialist colleagues (negatively) superficially they are treated very well, because without them their specialist colleagues can have zero business (because of a lack of referrals).

In the US patients can simply refer themselves to whomever they want, making the demand for GPs/Family physicians a lot less. So they are less well protected then their overseas counterparts. Typically US GPs deal with the lower SES then their specialists do (though of course this is a gross generalisation, but it was what I noted when I was there) vs. their counter parts in (English speaking) western countries. This particular SES group is also the group less likely to have health insurance and in a poor economy they are also at a higher risk of unemployment - again threatening GPs income.

 

[JanikeyDoc]

That has not been my experience with the American healthcare system and I have lived there for over a decade. My insurance company always had me see a primary care doctor, either an Internist or Family Practice physician before I could see a specialist. In fact, I had to do precisely this before getting to see a specialist for a problem I had last year. As far as low socioeconomic status, I shadowed an Internist in the US, and he seemed to have a very wide spectrum of patients. There is definitely greater disparity in the US compared to places like Australia but even from what I have seen currently in Australia it seems to be becoming a lot more like the US. The Western areas of Sydney for example are quite economically disadvantaged and not much different than poor areas of US cities. I have seen the same in Melbourne. Also there is still the potential for America to change, the new government has a very different agenda from the previous one. I think that America will eventually have a system of universal coverage for health care in the near future.

In your opinion, what do you consider "decent" USMLE scores? I was under the impression that most FM programs were taking USIMGs with merely passing scores.

 

[redshifteffect]

That has not been my experience with the American healthcare system and I have lived there for over a decade. My insurance company always had me see a primary care doctor, either an Internist or Family Practice physician before I could see a specialist. In fact, I had to do precisely this before getting to see a specialist for a problem I had last year. As far as low socioeconomic status, I shadowed an Internist in the US, and he seemed to have a very wide spectrum of patients. There is definitely greater disparity in the US compared to places like Australia but even from what I have seen currently in Australia it seems to be becoming a lot more like the US. The Western areas of Sydney for example are quite economically disadvantaged and not much different than poor areas of US cities. I have seen the same in Melbourne. Also there is still the potential for America to change, the new government has a very different agenda from the previous one. I think that America will eventually have a system of universal coverage for health care in the near future.

In your opinion, what do you consider "decent" USMLE scores? I was under the impression that most FM programs were taking USIMGs with merely passing scores.

When I was talking about referring yourself directly to a specialist - I meant in general. I can't speak for every health plan in the US (as there are way too many, which is part of the problem) but in general there is definitely the ability to bypass the GP altogether, in Australia/Canada/UK/NZ etc. 100% of patients must see the GP first. It would be interesting to see what percentage of patients in the US do the same thing (my guess would be that this figure is a lot less, but I do not have access to the hard figures).

As for SES - it's true there are definitely areas of low SES in Australia/Canada etc. but this has very little bearing on healthcare since Australia's medical system is socialised. The majority of the income a GP makes is that which the government pays, worse case scenario if you see a low income patient in Oz you bulk bill so the patient has no out of pocket expense, and you take the government's money as the full payment for the consultation.

In the US however if the patient is unemployed and from a poor SES and therefore has neither the ability to pay for the consult nor health insurance there is very little you can do - and I saw this time and time again. For the GP it's basically a free consult, or they take whatever the patient can give them.

From what I've heard the residency programs have gotten a little more competitive in the last 2 years. I've known USIMGs who've had trouble securing family medical positions in average hospitals with scores of 80-85. However this is all hearsay so I have no idea if it's actually gotten harder, or if that was just something that these people had trouble with.

*Edit* BTW an "internist" in Australia is still a specialist (as in Canada/UK/NZ/Ireland/SA) and even to see them you need a referral from a GP.

 

[shan564]

To the OP: Consider that you might need to retake the MCAT if you want to go to Australia. 28 might just be good enough to get you into UQ, but that'll depend a lot on what this year's entering class is like.

 

[redshifteffect]

I suppose the other thing to consider is what specialty you are interested in as well as whether your goal is to return to Canada or to a specific province as the two aren't necessarily the same.

Based on what I've seen doing American post graduate training while being on par with training from the UK/Ireland/Australia in the eyes of most Canadian provinces can actually be a hinderance in certain cases - depending on the specialty. The main benefit I can see to US training is perhaps the 1-2 years you would save on average for certain specialty programs, and the fact that geographically you would still be living fairly close to Canada.

I think that if you're happy with post-graduate training in primary care, Australia offers you more then the US could. If you combine the RIPS scheme, with the fact that certain provinces like Saskatchewan and Newfoundland easily accept GPs from Australia you would have the potential to earn 600 000 + (assuming maximal benefits from the RIPS) over the 4 years you do primary care in Australia (1 intern year + 3 GP years). Even after taxes and expenses if you saved from that amount you could easily have a nice down payment on a house or practice in Canada.

The main downsides I can see to this course of action really is the fact that if you are not from either Newfoundland, BC (which is actively recruiting British GPs currently) or Saskatchewan (there may be other easier provinces, but these are the ones that I know of) you would have to spend 2-5 years in that province before being able to be eligible for the CFPC exam (which is required by the more strict provinces like Ontario to be fully licensed). Now either way I see it doing GP in America does not get around this problem. The only way around it would be to attempt a match in Canada - but even then you would likely be subjected to a ROS agreement, and your total net savings as the end of that time would be significantly less then if you stayed in Australia, not to mention that you would be unable to obtain a citizenship/PR of Australia making it very difficult to return to locum or send your kids to Uni in Oz on HECS rates (lets face it the demand to go to Uni in Oz is only going to increase - based on the fact that about 30%-40% of my graduating high school class has now been to Oz to do things ranging from Teachers College to Masters in Physiotherapy/Pharmacy etc).

 

[Daemos]

(lets face it the demand to go to Uni in Oz is only going to increase - based on the fact that about 30%-40% of my graduating high school class has now been to Oz to do things ranging from Teachers College to Masters in Physiotherapy/Pharmacy etc).

That's quite a high %, that's also very surprising!

 

[redshifteffect]

That's quite a high %, that's also very surprising!

I was surprised too...but Ontario is getting difficult to get admission for almost everything. I was surprised when a bunch of Kinesiology students (who were from my highschool) started coming here for Physiotherapy.

 

[Daemos]

I was surprised too...but Ontario is getting difficult to get admission for almost everything. I was surprised when a bunch of Kinesiology students (who were from my highschool) started coming here for Physiotherapy.

Wow Ontario sounds like a closed door for EVERYTHING, which is really sad actually.

 

[redshifteffect]

Which is why I see very little future there unfortunately. I think it's good in a way because it makes you think about the rest of the provinces (where there is still plenty of opportunity).

It's a little sad that we Ontarioans tend to think Ontario is Canada 😉

 

[redshifteffect]

http://careers.bmj.com/careers/view-job.html?id=20003059

Have a look at the BMJ International site Saskatchewan is even hosting a career fair in Ireland. They seem to very proactive in recruiting doctors.

 

[chihuadog]

Residency in Canada for International Medical Graduates (IMGs)

Required prior to application/residency:

#1 You must be a citizen or permanent resident of Canada
#2 MCCEE exam
#3 TOFEL & TSE (variable)
#4 LMCC Part I??
#5 You must sign a return-in-service contract

In Ontario, there is also a mandatory, unpaid, 5 week pre-residency assessment and an assessment verification period of 12 weeks.

In BC, there also is an BC-IMG program; a similar program also exists for IMGs who wish to apply to Alberta (IMGs eligible for second round match only).

During residency:

#6 LMCC Part II
#7 Other exams as required (e.g. Principles of Surgery)

End of residency:

#8 Royal College exams

Note that the number of residency positions for IMGs is limited (both in number and in scope). There were 1299 IMGs in the first round in 2008; there were 219 dedicated IMG residency positions available.

Infomation:
CaRMS - (R-1) - Eligibility - Basic Criteria
CaRMS - (R-1) - Eligibility - Provincial Restrictions

According to the basic criteria site, i only see the requirement for MCCEE and not LMCC part 1. am i missing something?

So basically for an IMG with canadian citizenship(like me, an IMG from china with canadian citizenship), one can basically apply to CARMS if one has taken the MCCEE? Someone confirm this for me or correct me if i'm wrong.

And I heard from my sister that if an IMG has taken USMLE step1 and step 2, one could just use the USMLE scores instead of MCCEE. Can someone confirm this for me as well?

Also i was wondering if any of you know what hospital look for in their IMG's.. are they looking for high GPA's, or which schools they graduated from, or their test scores on MCCEE/USMLE? those numbers (219 spots for 1299IMG's) speak for themselves that it's very very competitive, so i was wondering how i could improve my chances. Thanks for the help guys.

 

[cleothecat]

D.O. is a recognized route to medical licensure in most Canadian provinces.

 

[Giemsa]

According to the basic criteria site, i only see the requirement for MCCEE and not LMCC part 1. am i missing something?

Technically it's not required for application, but as all Canadian residents write it in their final months of med school, it is frequently used by schools (it was at mine) to weed through the hundreds of IMG applications that we would receive. Having passed the LMCC part 1 before you apply is a plus for your application.

And I heard from my sister that if an IMG has taken USMLE step1 and step 2, one could just use the USMLE scores instead of MCCEE. Can someone confirm this for me as well?

No. All IMGS must have the MCCEE to apply to residency.

Also i was wondering if any of you know what hospital look for in their IMG's.. are they looking for high GPA's, or which schools they graduated from, or their test scores on MCCEE/USMLE? those numbers (219 spots for 1299IMG's) speak for themselves that it's very very competitive, so i was wondering how i could improve my chances. Thanks for the help guys.

#1 Rotations at their hospital in their specialty
#2 Rotations in other Canadian hospitals in their specialty with great LOR
#3 Currently living in their province

Basically, PDs in Canada are looking for sensible, well-balanced, congenial residents. Maladjusted people can have very high test scores. So they want somebody that they've actually seen/met/talked with/seen in action and thus someone who they can be certain would make a pleasant, hardworking, industrious resident. Exam scores tend to be used to further winnow down this group.

Just as with Canadian residents, the best way to get a residency is to do an elective in the field/at the hospital you're interested in, and impress them.

 

[JPR22]

Published research generally helps, as does a donation to the program.

 

[chihuadog]

Technically it's not required for application, but as all Canadian residents write it in their final months of med school, it is frequently used by schools (it was at mine) to weed through the hundreds of IMG applications that we would receive. Having passed the LMCC part 1 before you apply is a plus for your application.

Thanks for the clarification. I don't mean to sound like a ***** but is the LMCC part 1 the same thing as MCCQE1? because i've been web-searching info for LMCC1, trying to find out what it is, and so far with no results.. Some suggestions as to how to prepare for LMCC1 is also greatly appreciated.

No. All IMGS must have the MCCEE to apply to residency.

Understood. Thanks.

#1 Rotations at their hospital in their specialty
#2 Rotations in other Canadian hospitals in their specialty with great LOR
#3 Currently living in their province

My med school requires that I do almost all of my rotations in China, though, with a maximum of 3 months for clerkship elsewhere. Should i apply for clerkship in Canada or the US to help boost my chances? I was thinking of applying to harvard for clerkship which I thought would be an invalueable experience... should I pass that up and do my clerkship in Canada instead? Thanks for your input.

Just as with Canadian residents, the best way to get a residency is to do an elective in the field/at the hospital you're interested in, and impress them.

how good are my chances if i do an elective at UBC? i keep hearing it's nearly impossible to get residency in BC as an IMG, it's quite discouraging, even though getting residency in BC would be ideal for me.

 

[redshifteffect]

I know a student here who did Clerkship in Harvard. I'm guessing it's the same one where you "pay" for the privilege of doing a rotation there?

If so don't waste your time he spent hours (he was doing Orthopaedics) under his professors but was only able to afford 5 weeks in the department. He still found it hard to get LORs as they were expecting him to spend a minimum of 10 weeks.

You might be better off trying to go directly to where you hope to match rather then having a "Harvard" clerkship on your CV.

 

[redshifteffect]

More interesting reading:

http://www.cmaj.ca/cgi/content/full/178/4/379

 

[chihuadog]

I know a student here who did Clerkship in Harvard. I'm guessing it's the same one where you "pay" for the privilege of doing a rotation there?

If so don't waste your time he spent hours (he was doing Orthopaedics) under his professors but was only able to afford 5 weeks in the department. He still found it hard to get LORs as they were expecting him to spend a minimum of 10 weeks.

You might be better off trying to go directly to where you hope to match rather then having a "Harvard" clerkship on your CV.

The only payment that i know of is for the tuition fee of something around $3200 USD per month(1/12 of their yearly tuition). I was originally planning to go for a month but from what you said maybe i need to go for 3months to meet the minimum 10 weeks requirement, which would certianly make me think twice about going because I would be hard-pressed to find $10,000USD, which doesn't even include a place to stay or living expenses.

I would apply to where i want to match but I'm not sure if I would match in BC even if i applied for their program. it's probably a lot easier to match in new foundland/PEI/nova scotia than it is to match in BC. It brings up another problem of applying where i want to go, or applying where i'm most likely to be matched. Would i be putting all my eggs in one basket if i put all my hope in trying to go back to BC?

 

[Giemsa]

Thanks for the clarification. I don't mean to sound like a ***** but is the LMCC part 1 the same thing as MCCQE1?

Yes, same thing. After you pass both part I and II, you become a LMCC (licentiate of the medical council of Canada). (In the old days we used to call them LMCC part 1 and 2.) For prep, we read the Toronto Notes http://www.torontonotes.ca/

how good are my chances if i do an elective at UBC?

I don't know for sure, but the UBC website says that it does not accept elective students attending schools other than those in Canada, US, UK, Ireland, Australia, New Zealand or South Africa.

http://www.med.ubc.ca/education/md_...the_UBC_Visiting_Student_Elective_Program.htm

I'm not an IMG, but I think that your best bet for a Canadian residency would be to:

#1 Do an elective at a program that you would consider attending. It should be a well-regarded program with a respected program director, where you will have a chance to show off how great a resident you will be. It is imperative to get a great LOR from the program director, because this will be your "in" with the other program directors across the country.

#2 Apply widely.

#3 If possible, consider a US residency (they have far more open residency positions than we do).

#4 Think outside the box. Some really desperate communities are so in need of physicians that they will sponser a residency position just to train you, in exchange for your returning to their community to practice. Contact your health authorities and see if they're interested.

 

[chihuadog]

i'll probably take the usmle's and look into getting residency in the US also. in fact that was my plan until i heard freak stories of img's stuck with j1 visa.

it seems most universities in canada have a max limit of 8 weeks for electives. how many weeks of electives would you recommend to get LOR's? thanks for the advice so far.

i get the concept of "thinking outside the box" but as a foreigner i really wouldn't know which areas of US are underserved and willing to sponsor my residency. wouldn't i be able to match these hospitals on ERAS if they were so desperate?