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Statement of need- EM *please help!*

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VlCODlN

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Hi everyone,
I'm a Canadian in 3rd year of med school in US. I'm interested in applying for EM and wanted to clarify some things. I kind of suck at legal things/ visas and want to triple check my understanding. When I was in 1st/2nd year Canadians at my school told me we could apply for only 4 year EM programs for J1 (we could only do 3 year programs on H1B). As H1B is more difficult to obtain than J1 and there are also far less 3 year programs vs 4 year, this was very discouraging. So recently I heard something about Canada changing their visa rules so I emailed them and this is their response:

On an ongoing basis Health Canada (HC) examines evidence related to physician workforce need prior to issuing statements of need (SONs) to applicants for a J1 Visa. A SON is one of many requirements of the United States (US) government in order for applicants to obtain a J1 Visa to undertake postgraduate medical training in the US.

Effective Sept 10, 2018, the following changes have been implemented for all three SON Categories (A, B, C):
· applicants will not be screened against a list of pre-identified specialties, sub-specialties or fellowship training needs (including limits);
· applicants will no longer require a letter of support from their home province or territory; and
· applicants will no longer need a letter of support from a Canadian medical school or proof of Canadian medical licensure, since validation of previous medical training is the responsibility of the host institution in the US.

Prior to receiving a SON from HC, applicants continue to:
· declare their firm intention to return to Canada following completion of their residency/fellowship to practice in their chosen specialty;
· adhere to Canadian licensing requirements set by medical regulatory bodies, such as the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada, Medical Council of Canada and provincial-territorial medical certifying bodies; and
· assume all risks associated with undertaking training outside a Canadian medical school/training institution as it pertains to licensure and employment.

In regard to your question, you will be eligible to apply for a SON for Emergency Medicine programs (3 year or 4 year programs) however, you must follow up with the medical regulatory bodies to ensure your training will be recognized upon return. This is the applicant’s responsibility to adhere to Canadian licensing requirements set by the medical regulatory bodies. Receiving a SON is not a guarantee of employment or licensure in your desired specialty or practice location upon return to Canada.



So to make sure I have this right... the previous 4 year program for J1 & only 3 year programs on H1B is out the window and now we can apply for a 3 year program and get a J1?? Im thinking of staying in US for now so could I do a 3 year EM residency on a J1, do whatever for the 2 year back home requirement (can't do a waiver since EM isn't part of the Conrad 30 specialities), then apply to the US for an H1B job in EM after the 2 years is up?
The bolded part only applies if I intend to go back to Canada (meaning if I want to go back, I obviously have to meet Canada's requirement of 5 years for EM, the medical exams, etc) but since I dont plan on that I'm good to do a 3 year EM program on J1??

I want to make sure I'm understanding the changes correctly since it's a huge change from a couple years ago.
Thank you for your help
 

s5260205

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You can do any residency of your choice on any visa if your ultimate goal is to stay in US (i.e., 3 year vs 4 year and J1 vs H1 all out the window, since you can get boarded either way). Just be mindful of the equivalency in length of training, as you already alluded to, 5 year of EM in Canada vs 3/4 years in US, if you intend to ever return to Canada to practise medicine. I am not in EM personally, but for neurology, we would do 1 additional year of ACGME-approved fellowship to be eligible for Canadian board. How you can accomplish that for EM is beyond me unfortunately (maybe a chief year? not sure if they would recognise U/S fellowship or anything not explicitly EM).
 

VlCODlN

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You can do any residency of your choice on any visa if your ultimate goal is to stay in US (i.e., 3 year vs 4 year and J1 vs H1 all out the window, since you can get boarded either way). Just be mindful of the equivalency in length of training, as you already alluded to, 5 year of EM in Canada vs 3/4 years in US, if you intend to ever return to Canada to practise medicine. I am not in EM personally, but for neurology, we would do 1 additional year of ACGME-approved fellowship to be eligible for Canadian board. How you can accomplish that for EM is beyond me unfortunately (maybe a chief year? not sure if they would recognise U/S fellowship or anything not explicitly EM).

Thanks mate. That was my understanding but I didn't trust myself. Also all the whining I hear from other Canadians made the process seem more daunting. I do plan on staying in US to practise. I believe it still matters whether I do J1 or H1B though right? If I do H1B I can just apply for a green card straight from my H1B. If I do J1, I have to go back to Canada for 2 years after residency then apply to US to work under an H1B, then apply for a green card. So the difference would be 2 years back in Canada or not. Do I have that right?
 

s5260205

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Thanks mate. That was my understanding but I didn't trust myself. Also all the whining I hear from other Canadians made the process seem more daunting. I do plan on staying in US to practise. I believe it still matters whether I do J1 or H1B though right? If I do H1B I can just apply for a green card straight from my H1B. If I do J1, I have to go back to Canada for 2 years after residency then apply to US to work under an H1B, then apply for a green card. So the difference would be 2 years back in Canada or not. Do I have that right?
2 year home requirement can be waived if you were to work at a federally recognised underserved area. You will be limited by where you can work for 2 years after residency and also need to find a place to sponsor you green card (same for H1b for this). Most physicians are able to get waiver however, so I would not worry about it if your goal is to match EM and applying to H1b-only programs can jeopardise your chances of matching.
 

VlCODlN

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2 year home requirement can be waived if you were to work at a federally recognised underserved area. You will be limited by where you can work for 2 years after residency and also need to find a place to sponsor you green card (same for H1b for this). Most physicians are able to get waiver however, so I would not worry about it if your goal is to match EM and applying to H1b-only programs can jeopardise your chances of matching.

Wait I can do the 2 year waiver for EM too?! I thought it was only certain primary care specialities outlined by the Conrad 30 thing (IM, FM, paeds, OBGYN).
I heard of Canadians working at a US hospital bordering Canada so they'd live in Canada and work in US for 2 years as a way around the 2 year home requirement. Could I just do that instead of working in a medically underserved area for 3 years?
 

s5260205

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Wait I can do the 2 year waiver for EM too?! I thought it was only certain primary care specialities outlined by the Conrad 30 thing (IM, FM, paeds, OBGYN).
I heard of Canadians working at a US hospital bordering Canada so they'd live in Canada and work in US for 2 years as a way around the 2 year home requirement. Could I just do that instead of working in a medically underserved area for 3 years?
You can do waiver for just about every specialty as long as there are openings, including academic medical centres. Not sure about living in Canada and working in US though; I'd think you'd need to get sponsored H1b if you were to do that but whether DHS would approve it is another question.
 

VlCODlN

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You can do waiver for just about every specialty as long as there are openings, including academic medical centres. Not sure about living in Canada and working in US though; I'd think you'd need to get sponsored H1b if you were to do that but whether DHS would approve it is another question.

Incredible. Thank you so much for all your help and best of luck
 

Gos81238ia

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Thanks mate. That was my understanding but I didn't trust myself. Also all the whining I hear from other Canadians made the process seem more daunting. I do plan on staying in US to practise. I believe it still matters whether I do J1 or H1B though right? If I do H1B I can just apply for a green card straight from my H1B. If I do J1, I have to go back to Canada for 2 years after residency then apply to US to work under an H1B, then apply for a green card. So the difference would be 2 years back in Canada or not. Do I have that right?

To be eligible for an H1B you need to be graduated and done USMLE Step 3, so you are probably not eligible if in med school. If you start on a J1, you are correctly reading that there is a "2 year home return requirement" attached to that. This is only a requirement to live in Canada. Could theoretically live just across the border and work in the US for 2 years. The way to get around that is to sign a "J1 waiver" deal. This is usually a 3 year contract in an under serviced area. Have to complete the whole thing to be able to stay in the US afterwards. I believe then you transition to an H1B and then a green card, but don't quote me on that last part.
 

lovelyladyn

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Hi there,

I am in exactly the same situation. MS4 right now, originally from Canada and I am interested in EM. Got several interviews however more than half are from 3 year programs, which I would hate to exclude from what Ive heard other canadians say about Canada only issuing SoN for 4 yr programs. VICODIN, could you give an update on how the process went for you? I am having a hard time just finding a number to contact in the government to get any current information. I don't care to return to Canada really, I intend on staying in the US. My school said it would be easier to match on a J1 that is the only reason Im applying for it, but ultimately I dont need to find any equivalency to be licensed in Canada, I simply want to match and stay in the US. Anyone here can elaborate on their recent process with the Govt, J1 and SoN, especially in the EM field. Much appreciated guys, it's been a crazy year with so many uncertainties. I really don't want to leave this part up to chance.
 

bearded frog

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Hi there,

I am in exactly the same situation. MS4 right now, originally from Canada and I am interested in EM. Got several interviews however more than half are from 3 year programs, which I would hate to exclude from what Ive heard other canadians say about Canada only issuing SoN for 4 yr programs. VICODIN, could you give an update on how the process went for you? I am having a hard time just finding a number to contact in the government to get any current information. I don't care to return to Canada really, I intend on staying in the US. My school said it would be easier to match on a J1 that is the only reason Im applying for it, but ultimately I dont need to find any equivalency to be licensed in Canada, I simply want to match and stay in the US. Anyone here can elaborate on their recent process with the Govt, J1 and SoN, especially in the EM field. Much appreciated guys, it's been a crazy year with so many uncertainties. I really don't want to leave this part up to chance.
I assume you have reviewed Statement of Need Program for Medical Graduates Pursuing Postgraduate Medical Training in the US - Canada.ca ?
 
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