Mccee/mccqe

[stressed101]

For a Canadian citizen studying in a 5-year program in Ireland, which year of med school should these tests be completed? I understand the USMLE's more than the Canadian exams so if someone could help me out?

What exactly is the process of coming back to practice/obtaining a residency position in Canada?

Also - what is the difference between internship and residency? I always mix these two :s

Thank you.

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[jnuts]

For a Canadian citizen studying in a 5-year program in Ireland, which year of med school should these tests be completed? I understand the USMLE's more than the Canadian exams so if someone could help me out?

What exactly is the process of coming back to practice/obtaining a residency position in Canada?

Also - what is the difference between internship and residency? I always mix these two :s

Thank you.

1) The MCCEE must be written in your final year of medical school in September or November. The Medical Council of Canada defines your final year as one calander year prior to your expected graduation date. The MCCQE1 should be written before you start your residency, usually in the spring of your final year (but completion of the MCCQE1 isn't an absolute requirement to start your residency program, people who fail are still allowed to start).

To put in some context if you know the US system, the MCCQE1 is roughly the same as the USMLE Step 2. There is no Canadian exam like the Step 1. The MCCEE covers the same material as the QE1 minus the Canadian specific content and is only written by IMGs.

2) The details of the proccess to return to Canada can be found on the website of the Canadian Residency Matching Service (www.carms.ca). You're interested in the R-1 match and I'd check out the timeline they put up for a general overview. You can also browse the program requirements and provincial restrictions on IMGs. These will be the spots open this year; every year things change slightly and there isn't a lot you can do to predict exactly how.

Here's a really brief overview for getting back to Canada without using the US as a safety (if do plan on keeping the US option open you'll need to write their exams as well and split your time in Clinical electives). I'll countdown from final year to avoid the 5-year v. 4-year confusion; the plan is exactly the same in the final two years anyway:

Final Year: Write the MCCEE, apply to CaRMS, interview, pray
Summer before final year: clinical electives, study for MCCEE

Second-to-last year:Try to get clinical electives in the specialties and hospitals you'd like to apply to for residency.

Summer before second-to-last year: Possibly do a clinical elective (if available and you feel comfortable doing one), possibly do an observership, possibly do research.

Before second to last year: Decide what specialty you are focusing on. Possibly do an observership or two to help you decide on a specialty, possibly do research relevant to your choice of specialty to strengthen your application. If you're in a 5-year program you've got one extra year to do this part.

3) Internship v. Residency: The intern year is your first post-graduate year after medical school. In Ireland, the intern year is a discrete training program in both Medicine (6 months) and Surgery (6 months) that all trainee doctors are required to complete to gain general registration with the Irish Medical Council. In Ireland, you don't decide if you will specialize in Medicine or Surgery until after the Internship year and there is a subsequent application process for the next step: Senior House Officer (SHO) in Medicine or Surgery. Further specialization in Medicine or Surgery is done after the SHO program (two years) and requires additional applications to the training post of Specialty Registrar.

Whoof...mouthful

OK in CANADA, first post graduate year(PGY) students are still sometimes called interns, but the term is pretty antiquated. Most people simply say PGY-1. As a PGY-1 you are in a Specialty training program after 4 or 5 years of which you will be a General Surgeon, Internist, Neurosurgeon, or what have you, depending on the program. You do not have to re-apply to continue your training as your residency will take you right up to the level of Attending Physician/Surgeon. There are a few exceptions in Emergency med (a second match from family medicine), Pediatrics, and Internal Medicine which have other Match programs run through CaRMS during your Residency (see R-3, R-4, and the as yet to be named Pediatrics match, on the CaRMS website). As an IMG you can enter the sub-speciality matches in the same stream as Canadian graduates provided you are already in the relevant Residency program. You can apply to the subspecialty match regardless of return of service(RoS) requirements; you are allowed to defer your RoS while you're in sub-speciality training and these years do not count towards additional RoS (at least not in the FM subspecialties; the others I'm actually not sure).

Hope that answers some of your questions.

 

[Doc22B]

I must say that every post by you Jnuts is so informative and helpful that I just had to reply to say thanks 😀.
Us prospective canadian irish med students need all the help we can get and I appreciate all the time you take to help us. Cheers buddy!

 

[jnuts]

I must say that every post by you Jnuts is so informative and helpful that I just had to reply to say thanks 😀.
Us prospective canadian irish med students need all the help we can get and I appreciate all the time you take to help us. Cheers buddy!

No worries, at least I'm doing something useful while procrastinating. Thank you very much for the shout out. I remember how tough it was to find information when I started so I really feel for you guys.

 

[drsquared]

@ jnuts,

you seem quite knowledgeable about this, so i'm hoping you can answer a couple questions...please...

i'm a canadian citizen (did undergrad and phd here), but am also an EU citizen (german). will be starting a 4 year program in ireland this fall.

i don't necessarily care to come back to north america after graduation. what are my prospects for staying in ireland (i.e. getting internship, sho, and senior registrar positions etc followed, of course, by getting a "real" job after all the training is over? i'm only interested in the surgical specialties, if that matters.

much appreciated!

 

[Fiddler09]

@ jnuts,

you seem quite knowledgeable about this, so i'm hoping you can answer a couple questions...please...

i'm a canadian citizen (did undergrad and phd here), but am also an EU citizen (german). will be starting a 4 year program in ireland this fall.

i don't necessarily care to come back to north america after graduation. what are my prospects for staying in ireland (i.e. getting internship, sho, and senior registrar positions etc followed, of course, by getting a "real" job after all the training is over? i'm only interested in the surgical specialties, if that matters.

much appreciated!

Good question - I'm in the same boat (dual citizenship - USA and Ireland). I can't get a straight answer from the college - might have to inquire from a higher authority.

I did my graduate training in the USA and as a result of living outside Ireland for more than 3 years, I am classified as an international student.

I think the way it used to be (and it may still be that way) is that EU students get first preference in the 'matching' system and then IMGs are further down the pecking order.

 

[med2UCC]

For the purposes of doing intern year and other training, if you're an EU citizen you get treated like other EU citizens regardless of what other citizenship you hold or where you have been living. The intern spots are awarded based on class rank, but if there is an EU citizen who is unplaced someone who is not an EU citizen would be bumped from their intern spot and the spot would be given to the EU citizen.
So, just to clarify, if you are an EU citizen and attend an Irish school you should have no problem getting an intern job, and shold be able to get an SHO job after as well. Cheers,
M

 

[jnuts]

I'm actually in the same boat of dual EU/Canadian citizens (Hungarian in my case). Its a legal requirement in Ireland and the UK that you cannot differentiate between EU citizens when hiring in any field. In order to hire outside of the EU applicant pool you need to prove that there are no EU citizens capable of filling the post.

I think that having both passports and coming to Ireland is the best possible situation. The first question I ask anyone thinking about Ireland is are you, or can you get, a European citizen(ship). If you are or can, you are able to try for a post back home but have a very strong back-up plan here in Europe. While most Canadians use the States as a back-up (and Americans don't seem to need one) my plan is to try for Canada, but I wouldn't be that upset if the best opportunity ended being here in Ireland or in the UK.

There are a couple of caveats that may explain why the answer you got wasn't that straight forward. This is the first year that Ireland has moved to a central application system for Intern jobs and there are uncertainties about how things will play out. Ireland, like the US and Canada, has a number of students studying other places in Europe and repatriating them has become a priority. Prior to this year the medcial schools organized their own internship programs and Irish students studying other places were offered Intern jobs only after the Medical school's own graduates whether these graduates were EU citizens or not. While they were creating the new system there was some buzz about giving preference to Irish citizens over other EU grads, and whether or not full-fees students counted as EU students even though they weren't subsidized. As far as I understand it, living outside the EU before starting medical school has enough legal bite to remove your entitlement to educational subsidies as those are contingent on residency in a member state (as are all benefits to protect against double claiming and benefit shopping). Non-residency doesn't remove your equal employment protection as that's not residency dependant. Regardless, by the time you finish medical shcool you've been in Ireland long enough to establish Irish residency if you're already an EU citizen (if you're not an EU citizen the years you spend in university in Ireland do not count towards immigration requirements as a condition of the visa).

In the end, the Irish preference hasn't happened and would very likely be illegal; however non-EU citizens can no longer be considered before EU citizens who went to med school elswhere in the EU. Intern year jobs are now an open competition between people with EU citizenships based on class rank, provided you went to medical school in the EU.

The application details can be found here:
http://medicalcouncil.ie/Registration/First-Time-Applicants/Internship-Registration/

In terms of higher level jobs, I've never noticed or heard of any intra-EU discrimination so its not an issue as far as I'm aware. But as a medical student, my exposure to higher level hiring intrigue is limited.

One of the other issues that concerned dual citizens had to do with registration with the Irish Medical Council. This is the general medical license that lets you look for training jobs/ be able to practice and it requires an "intern year". That used to be a big issue for people who were thinking about returning to Europe after a Residency in North America as you had to: (1)stay in Ireland for an extra year, or (2)find a program in North America that fit the IMC's definition of an intern year: 6 months of medical training AND 6 months of surgical training within 18 months of graduating, or (3)go through the steps to gain IMC registration when you wanted to return like any other foreign trained doctor.

That was a problem as most North American residencies are either medical or surgical and not both (with some exceptions like Obs/Gyn). Now the definition of the intern year has changed to 3 months of medicine and 3 months of surgery within a year of graduating so hopefully more programs abroad will fit these criteria. Certainly more of the surgical programs will (which are the only ones I care about anyway 😛).

The bottom line is that dual citizens seem to have the best of both worlds; but this is the first year of a new system so nothing is concrete (for instance I'm not sure what will happen if the Internship application pool is flooded with non-Irish applicants from another member state). However, things look good for now and any changes that wouldn't favour dual citizens going to school in Ireland would face some pretty hefty legal hurdles as far as I understand the situation.

 

[drsquared]

thanks for the replies, guys. truly.

i've been reading through the last few months of news postings on the Irish Medical News website. there are several (many!) articles there relating to several issues that could potentially affect my ability/desire to practice medicine in ireland in the long term. for example, recent changes that drastically reduce pay for NCHDs (a concern when you're 300,000 EUROS in debt), and the (quite frankly) pathetic probability, even for EU citizens, of obtaining consultant positions down the road (18-25% of NCHDs ever attain them, apparently).

are there realistic options besides staying in ireland? UK or elsewhere in the commonwealth, for example? if so, at what point in your training would it be best to make the move? i've heard it's going to be virtually impossible to obtain training positions in australia (and NZ too?) in the near future due to the so-called "tsunami" of australian grads. would it be any easier after intern year, for example?

i just want to know whether i'll have options other than the US and Canada if i decide not to remain in ireland.

ps: @ stressed101: sorry, i'm new to fora in general, and it appears your thread has been hijacked. apologies.

 

[jnuts]

thanks for the replies, guys. truly.

i've been reading through the last few months of news postings on the Irish Medical News website. there are several (many!) articles there relating to several issues that could potentially affect my ability/desire to practice medicine in ireland in the long term. for example, recent changes that drastically reduce pay for NCHDs (a concern when you're 300,000 EUROS in debt), and the (quite frankly) pathetic probability, even for EU citizens, of obtaining consultant positions down the road (18-25% of NCHDs ever attain them, apparently).

are there realistic options besides staying in ireland? UK or elsewhere in the commonwealth, for example? if so, at what point in your training would it be best to make the move? i've heard it's going to be virtually impossible to obtain training positions in australia (and NZ too?) in the near future due to the so-called "tsunami" of australian grads. would it be any easier after intern year, for example?

i just want to know whether i'll have options other than the US and Canada if i decide not to remain in ireland.

ps: @ stressed101: sorry, i'm new to fora in general, and it appears your thread has been hijacked. apologies.

I think that your question is getting into the realm of medical crystal balls. Trying to predict employment markets for top level medical jobs at least a decade down the road is difficult to say the least. Considering the situation in Ireland and the UK, I'm reasonably sure given the amount of animosity in the system now that things will be very different in a decade when you'd be thinking about going for consultant. There's already noise in the UK about transitioning away from the consultancy system. And the system in Ireland will not be able to persist for long with the huge discrepency in Consultant v. NCHD saleries that exists now. If were ever at that point you can bet I'd make some noise about it (and peole are making a lot of noise). Already the system is incredibly stressed; the emmigration rate is massive (mostly by recruitment to the States/Aus). These posts are then filled through immigration. There are actually hospitals in Ireland where the rounds are done in Arabic. That's one of the questions you need to ask yourself about the 18-25% consultancy statistic. Given the numbers, you'd think that medical Ireland would be dominated by NCHDs; its not, so who are these doctors and where do they go? All I'm saying is that the system is under stress and will have to change. A lot will have to do with how Ireland's economic situation moves in the next ten years. The eventual change might be abysmal it might be grand, its really hard to say.

However, there are a few basic indicators that finding a high paying job as a doctor won't be too much of a problem in the future. The WHO is predicting a HUGE deficit of medical professionals in my generation and no country in the developed world is training enough doctors to meet the current demand. That is in the context of a massive increase in demand for medical services assocaited with changing medical practices and an increasingly aged population. Even in Australia, the increase in medical graduates is probably short of the supply they will need; and the employment pressure is coming from a lack of training spots, something that the market will likely correct as the purchaser starts paying more and more for medical services. Physician saleries are governed primarily by supply and demand, and this balance is the reason that renumerations have increased to astronomical levels in places like the States that have an inelasticity in this regard due to the private system. In order to maintain their supply--something that health care consumers eventually become very vocal about--regions will compete for doctors and salaries go up. The US has always been the trend setter in this regard, but other countries (especially the English speaking axis) have had to follow.

 

[Fiddler09]

Thanks for all the info jnuts! 👍

 

[alexc]

Thanks j nuts for all the great information. Do you happen to know the timeline for taking the USMLE? Especially if I am planning to do both USMLE and the Canadian exam? I am in the 5 year program going into year 2.

 

[med2UCC]

Thanks j nuts for all the great information. Do you happen to know the timeline for taking the USMLE? Especially if I am planning to do both USMLE and the Canadian exam? I am in the 5 year program going into year 2.

USMLE 1 after 3rd year of a 5 year program. USMLE 2 CK and CS after 4th year (or sometimes during 4th year - had a friend do this who aced them), MCCEE after 4th year/beginning of 5th year, MCCQE1 at end of 5th year if you can fit it in or during residency 1st year otherwise (that's what I did). Cheers,
M

 

[alexc]

thanks med2ucc!

I have read on this forum that if you don't time exams right you won't be able to apply for residency on time, or must wait a year after graduation before starting, do you understand what that's all about? Is it something to do with when Irish students get their diplomas? I'm confused about this.