Transfer from Canadian to U.S. residency program

[597622]

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There is some info on SDN about transferring from the US to Canada, but I wanted to know if anyone has any knowledge or experience with transferring from Canada to the US, specifically from Ontario. My now fiance is a resident in Toronto. When we started dating she had just matched so now we're in a difficult spot. I as an American 4th year med student am applying for the US match this year. I cannot apply to Carms because you have to be a permanent resident- a process that takes 24 months to complete AFTER marriage. She cannot apply for the US match because she is on a contract in Ontario and even has a 5 year return of service contract after her 5year residency. On a side not: I am not sure who the f(*& in Canada makes these policies. It seems beyond f-ing unfair that anyone in the world can apply to the US but Canada requires you to essentially be a citizen TO APPLY, and not only that but they make you sign return of service contracts making you guaranteed rural labor for 5-10 years= NUTS. Anyways I am not sure what to do at this point. It seems the best way to go is for me to match in the US and help her transfer to a US program? There is literally no information online about this whatsoever that I have been able to find. We would even be willing for her to start her residency over but she cannot go through NRMP while under a Canadian program, can she? Is that a match violation? Can we apply for a waiver? We even spoke to the post-grad office at her school and they said transfers are not possible because funding would not be provided, but how can they even say that because if she goes to the US it's not them providing the funding. Honestly, this entire situation seems to have no solution and am wondering if anyone knows about this process or can provide their advice on what the best course of action would be or maybe who to talk to (i.e. NRMP, some Canadian organization, Barack Obama)?

 

[Shikima]

Why not do residency in the greater Detroit area and cross the border when you both have time. There are a lot of hospitals to apply to in Detroit, Southfield, Ann Arbor, and Flint which are close to the border. If your GF is a PGY-2 in FP in Canada, she'll be done this year anyways.

 

[UBC2014]

Transfer wont happen.

Plan on going for US residencies close to the border like shikima mentioned, and visiting each other when you can! The faster you finish your residency the better, since she will likely have to work in an underserviced area(not necessarily rural) whcih may be further north.

Hope you aren't doing the longer 5 year residencies...


EDIT:

Looking at your post history, you failed to state you are an IMG. That is a very different story than being an American graduate as your post implied. Even more so, you are applying for GS... honestly you are going to have a tough time trying to be picky about things.

I hope your marriage and everything works out, long distance will be tough. But don't try and get your fiance to jump ship or something from her residency. That is not going to happen, you are the bottleneck here not her lol.

 

[UBC2014]

And if shes a PGY2, she will be done soon and will start working, which means she will have more flexibility to see you etc.

You need to just find a resdiency as close to the border as possible, and preferablly not too long of a discipline.

Tough times though.

 

[AStark]

A couple of things:

I'm not sure there exists any process for transferring. Generally speaking Canadian residents can transfer programs within schools relatively easily and sometimes can make interprovincial transfers. Otherwise they can apply to the "second iteration" of CaRMS which is comprised of what's left after the first round.

In terms of the permanent resident aspect, you could probably expedite this if you were to get married (at least on paper) soon, but that would still only help for next year as the CaRMS deadline passed a month ago. You would be eligible to apply in the first iteration for any spot if you ended up sitting out the US match this year. I can imagine that is not appealing though.

In any case, a transfer might be possible, and your fiancée could apply to ERAS even as a PGY2. There may be a requirement to "buy out" some element of the return-of-service contract, and that would need to be investigated.

The "simplest" solution would be to match to a US program close to the border. Most of southern Ontario is within a few hours of the border.

By the way, return-of-service contracts are not at all the norm for Canadian residents, but do often come with IMG-specific spots.

EDIT: I didn't realize the OP was an IMG applying for gen surg. There are only a handful of IMG surgery spots in Canada and every one of them would require a return-of-service. You would need on site electives and letters from local staff to even be considered for an interview and it would be extremely competitive. So I would say - immigration status aside - CaRMS will not be an avenue for you.

I do hope everything works out, but a transfer would be very difficult. I don't know what specialty your fiancée is training in, but that might make a transfer easier or harder. The only upshot is that she could apply to the US match directly without having to resign from her current program. One of my former co-residents actually did this last year and matched to a psych program in Hawaii (changing specialty). I'm not sure how successful this would be for a specific location and/or more competitive specialty. He didn't have an ROS contract either.

 

[ferning]

Rural labor payback contracts of 5-10 years?

Sounds like the terms of public student loan forgiveness. Not a canadian original. Americans make serfs out of people more deceptively

 

[AStark]

It's also the price IMGs have to accept to get a residency most of the time.

 

[597622]

These replies have been very helpful. There is almost no real info on this on the internet and this is turning into a quite real dilemma for us, so I appreciate each and every opinion.

So to give more info I am an IMG and have several interviews in the US in "close" proximity to my finances program in Toronto (Southern Ontario). i applied to every program in Detroit area as well as NW NY, and got a majority of the invites and have already interviewed or still will. I am only interested in doing Gen Surg. Yes, I know it's picky and I have absolutely no right to be picky because as an IMG you simply are 2nd in line. The thing is, I got a lot of interviews and have a real shot at matching, but as many wrote above you don't get to pick your program or geographic location as an IMG in GS, you just rank everything and hope you get SOMETHING. Some of the programs also told me outright they'd match me for a prelim year or two if I didn't match categorical with them, so that might be a decent option while we figure this out at least to have some sort of guarantee we will be near each other (if even temporarily).

 

[597622]

I guess the real question is can a Canadian resident on a ROS contract apply to ERAS? And if so can they do that and apply for PGY-2 or 3 openings or would they have to start over?

 

[597622]

And lastly, does the ROS contract prevent someone from working in the US after residency? I know the whole point is to get more doctors into under serviced areas (i.e. not downtown Toronto) but what if someone were to want to leave Canada altogether? Would Canada refuse to sign the J1 as I've heard happens with people matching to "unneeded" specialties?

 

[ThoracicGuy]

These replies have been very helpful. There is almost no real info on this on the internet and this is turning into a quite real dilemma for us, so I appreciate each and every opinion.

So to give more info I am an IMG and have several interviews in the US in "close" proximity to my finances program in southern Ontario. i applied to every program in Detroit area as well as NW NY, and got a majority of the invites and have already interviewed or still will. My fiancé is a psych resident in R2, so she has a long way to go before finishing R5. I am only interested in doing Gen Surg. Yes, I know it's picky and I have absolutely no right to be picky because as an IMG you simply are 2nd in line. The thing is, I got a lot of interviews and have a real shot at matching, but as many wrote above you don't get to pick your program or geographic location as an IMG in GS, you just rank everything and hope you get SOMETHING. Some of the programs also told me outright they'd match me for a prelim year or two if I didn't match categorical with them, so that might be a decent option while we figure this out at least to have some sort of guarantee we will be near each other (if even temporarily). Who knows maybe that program will keep me on for 5 years as is the case with prelims in certain instances.
But anyways, I have done a few electives in GS and Ortho in Ontario, and have a few Canadian LOR's so it's not like I would be applying with nothing. I met with a PD at my finance's program while I rotated there and he said there are 175 people applying annually for their one img-designated spot. So to sit out the match this year (after all the effort, and money put into interview season) to have a 1/175 chance at matching there I think is fiscally and logically unsound. However that is what my fiancé wants me to do.
It would mean I'd have to take the MCCEE by March, something which I can't even imagine having just taken CK and literally now had 60 days of back to back to back interviews jammed into 2 months and then I have 2 months of electives. Everyone says MCCEE is easy to take right after CK but I didn't schedule it like that cause I simply didn't have the time to nor the money. So I'm kind of confused on whether to even invest the $2500+ in even taking the MCCEE+NAC OSCE (and also rushing marriage papers just to become a PR to have the right to apply) just to have that tiny chance at matching at that program next year or should I just match in the US and perhaps my fiancé with her being in psyche can apply to ERAS (psyche is less competitive and I think with her resume she'd have some say in geographic location provided good board scores etc.)

Some of you above wrote that it is not possible to apply to ERAS while in a Canadian program, some of you did. She is willing to start over as a PGY-1 in the US, but I think as someone stated there is some sort of fee to break the contract and it's from what I heard upwards of $100K.

Really appreciate all the feedback!

Trying for a 1 in 175 chance of matching is not worth the time or money to invest in that. Matching to a close us program would be far easier and a better use of your time and resources.

 

[NotAProgDirector]

A few more facts might be helpful. Your fiancee has a 5 year ROS contract -- that's most likely because she is an IMG and matched in CaRMS. Occasionally ROS contracts are given to CMG's in exchange for tuition/living expenses, but I expect you were both in the Carib.

Thoughts:

1. Her Canadian training counts equally to US training. Hence, she could transfer to a US program with 2 PGY years completed as a PGY-3. There is no need to start again as a PGY-1. Some programs may be concerned about bringing in an advanced resident like this, might have her start as a PGY-2 for a few months to make sure her skills were OK.

2. It's unclear how you "buy out" her ROS contract. The language online suggests she would need to pay back all of her salary, plus training expenses, interest, etc. She can probably just "skip out" on all of it and come to the US, but she should assume she will forever be unable to work in Canada, and may not even be able to visit (not sure if Canada would arrest someone for non-payment of debts). If the contract has more specific language, that would be helpful.

3. If she comes to the US, she'll need work authorization. The easiest way to do that is get married to you, but that's also a legal minefield and you should contact an immigration attorney before you get married to sort out the rules.

4. Betting on an IMG training spot in GS in Canada is foolish.

5. Passing up a categorical GS position to be close to her is a difficult decision that should be weighed carefully. There is no guarantee that any prelim position will ever turn into a categorical position. You might not become a surgeon down that path. Relationships can end over stress/guilt/anger issues like this.

So, options:

A. Your best option has already been stated. She continues training in Canada, you train in the US, hopefully close enough so you can see each other often. It's a long road for both of you. Once you finish training, you can work in Canada with your US training. She'll end up completing her ROS.

B. You could see if she could transfer to a US program. The cost of the ROS buyout could be prohibitive. She would still need to find a psych program in the US, but that shouldn't be too difficult if her performance is good where she is. Then you both train here in the US, ultimately can live in either the US or Canada. Another possibility is to see if she could finish her training in the US and then still complete her ROS contract -- that would avoid any financial penalty and allow you to overlap for some time. I doubt this will fly, though.

C. Trying to get into a Canadian program is a huge longshot, not worth it IMHO. In the process you'll be making yourself less competitive for US positions (by wasting time).

D. It's already too late to even apply to psych programs this year, by next year she is almost finished.

 

[AStark]

In terms of the ROS, it may be possible to remain in the contract even with a transfer - the commitment is for practice post-residency, which could still be done even after completing training in the US.

 

[597622]

A few more facts might be helpful. Your fiancee has a 5 year ROS contract -- that's most likely because she is an IMG and matched in CaRMS. Occasionally ROS contracts are given to CMG's in exchange for tuition/living expenses, but I expect you were both in the Carib.

Thoughts:

1. Her Canadian training counts equally to US training. Hence, she could transfer to a US program with 2 PGY years completed as a PGY-3. There is no need to start again as a PGY-1. Some programs may be concerned about bringing in an advanced resident like this, might have her start as a PGY-2 for a few months to make sure her skills were OK.

2. It's unclear how you "buy out" her ROS contract. The language online suggests she would need to pay back all of her salary, plus training expenses, interest, etc. She can probably just "skip out" on all of it and come to the US, but she should assume she will forever be unable to work in Canada, and may not even be able to visit (not sure if Canada would arrest someone for non-payment of debts). If the contract has more specific language, that would be helpful.

3. If she comes to the US, she'll need work authorization. The easiest way to do that is get married to you, but that's also a legal minefield and you should contact an immigration attorney before you get married to sort out the rules.

4. Betting on an IMG training spot in GS in Canada is foolish.

5. Passing up a categorical GS position to be close to her is a difficult decision that should be weighed carefully. There is no guarantee that any prelim position will ever turn into a categorical position. You might not become a surgeon down that path. Relationships can end over stress/guilt/anger issues like this.

So, options:

A. Your best option has already been stated. She continues training in Canada, you train in the US, hopefully close enough so you can see each other often. It's a long road for both of you. Once you finish training, you can work in Canada with your US training. She'll end up completing her ROS.

B. You could see if she could transfer to a US program. The cost of the ROS buyout could be prohibitive. She would still need to find a psych program in the US, but that shouldn't be too difficult if her performance is good where she is. Then you both train here in the US, ultimately can live in either the US or Canada. Another possibility is to see if she could finish her training in the US and then still complete her ROS contract -- that would avoid any financial penalty and allow you to overlap for some time. I doubt this will fly, though.

C. Trying to get into a Canadian program is a huge longshot, not worth it IMHO. In the process you'll be making yourself less competitive for US positions (by wasting time).


A+B seem like the most realistic options. The greatest dilemma, like you said, is what to do NOW? I have to choose by end of February how to rank and this is a HUGE dilemma. I am reluctant to pass up on a categorical spot, but the places I interviewed for a prelim year and would consider had a really long track record of keeping their prelims annually and/or finding them other spots. Yes, this is risky, and I am essentially forced to choose between close geographic proximity to my fiancé or my career (one that I have dreamt about since I was a kid). I wouldn't force such a dilemma on my worst enemy.
You raise a very interesting point in #5. The psychological aspect of this is immense as well. Should I choose a prelim spot near her over a guaranteed surgical career associated with a categorical spot, I could see myself resenting her in the future and her feeling guilty or remorseful for making me make such a choice. I want to do right by her, but at the same time such a choice could make our relationship more difficult or even end it.
Her being able to transfer to a PGY-3 spot would be very interesting. She is willing to do an extra year if it means going back one year, but this is the whole reason I am asking this on this forum- there is no info about this online. You are right that Canadian programs=US in terms of accreditation but the funding is different. She has gone to her GME office and they said it isn't possible to transfer. I would imagine if she applied to ERAS for a PGY2/3 spot then she would have to get permission to leave from her current program including LOR's and evals etc. I doubt the GME office secretary knows what she's talking about because it is very very rare for someone to transfer Canada to US, but she was attempting to sound like she was certain.
She is allowed to do a 6 month elective anywhere in the world as part of her PGY-3 year. So as you said, she can't apply for the US match for 2015 anyways and by the time she would potentially start for 2016 she will have already finished PGY-3 in Ontario and you can subtract a 6 month elective (I would assume setting up such a rotation in the city where I match wouldn't be terribly difficult or competitive but would she have to take the USMLE's?). I also would really like to know whether it is possible for her to go to the US and then do her ROS in Canada. I can't see how Canada wouldn't want that- they wouldn't have to pay a resident for those years! But Canada's rules are nuts particularly their immigration laws (the fact that it takes a US citizen 24 months to become a permanent resident after marrying a Canadian citizen is enough proof. My brother married a girl from New Zealand and she received a green card the next day in the US, but I digress). I don't think she would be willing to jump ship from the contract and potentially ruin her entire Canadian credit record and citizenship. She owns a house in Ontario and also her family lives here so I don't think that's reasonable for her. I think that would be a last resort option.
Seriously thank you guys so much for your input and happy new year.

 

[597622]

Another thing that I don't understand is if the ROS has to start IMMEDIATELY after completing residency? Let's say she finishes her residency in 2018, does she have to start her ROS literally right away in Ontario, or can she for example not work for 2-3 years while I finish in the States? I imagine she could do a 2 year fellowship in the US while I finish up but I am also not sure on that. I know tons of Canadians go to the US for fellowships, but for Psych there are very strict rules on which fellowships are accredited and which are not and I am not sure how ROS plays into this. Either way if she can do her ROS 2-3 years after finishing residency that would make this a lot easier. If it starts the day after she finishes residency, then she is tied down to Ontario for 8 years while I am tied down to a surgical program for the next 5-6 years. Long distance will absolutely not work out for that duration of time. I know you guys aren't my psychologists, but I can't imagine doing it for that long. However, I think we could wait until she finishes her psych program in 3 years (with potentially a 6 month period together in that). I think that is doable but it depends on whether the ROS must be completed right after residency.

 

[Winged Scapula]

You are in a tough, unenviable position.

I am going to suggest that the most obvious, easiest answer is to rank Categorical GS positions at the top of your list, regardless of location, with Prelim positions at the bottom. While that may mean you end up not living near your fiancee (note the two "e"s at the end; this notes that you are speaking of a woman; you're using the masculine version), let's explore my reasons for suggesting so:

1) you state that you have chosen Prelim programs which are close to your fiancee; however, given that a GS internship, Prelim or note, is not "easy on hours", how much time will you really have with her? If you are in the same city and live together, that is reasonable, but anything that involves a commute or is a few hours away will typically result in limited time together anyway.

2) you state that you have chosen Prelim programs that have a good track record of keeping or finding positions for their Prelims. In almost all cases that I am aware of, these are superstar residents. Being a Prelim who is trying to attract enough positive attention, but keep the negative at a minimum (and there will be some negative regardless of who you are), is exhausting. It is a nearly year long audition. Thus, you cannot be spending your days off or weekends with your fiancee doing fun stuff: you will be spending it studying for the ABSITE and for honing those connections to ensure a Categorical position. The best Prelims I ever saw were kind, generous, hard working (as in, EVERYTHING that year was geared toward getting a new position; vacations were spent studying or going to conferences to make connections). You cannot overestimate how hard this can be, even at a program with a "good track record". Thus, you may wish to consider what sort of stress this will put on your relationship. Your fiancee, in a specialty which is quite a bit different, may not understand your concerns and needs to maximize your time at the program. After all, you will only be there for 3 months before applications for next year start.

3) if you choose a Prelim program, you will need time off for interviews. The program must be supportive of this, but they may require that you use your vacation time to do so; thus putting more strain on your relationship.

4) by choosing (and hopefully matching to) a Categorical GS position, while you cannot let your guard down, you have the luxury of at least relaxing; you have a 5 year position unless there are egregious mistakes (despite what SDN may have you believe). You can use any golden weekends and vacations to spend with her, and she with you.

5) if you should choose a Prelim position with a good track record of obtaining Categorical positions for its interns, bear in mind that most places are not in the same location or one of your choosing. Mayo has a good track record for example, but you will note that we almost never keep the Prelims in the program but rather find someplace else; someplace else that may be even farther from your fiancee and not necessarily someplace you prefer.

Outside of the obvious difficulties in having a LDR, please do not underestimate how difficult it is to translate a Prelim GS position into a Categorical one.

 

[Winged Scapula]

I agree with everything @Winged Scapula has said. By FAR the most common outcome of a prelim GS year is that you will be at another institution, in another specialty, the following year.

I should add that, even with attrition, the number of non-designated Prelim positions >> PGY2 categorical GS positions available. So not everyone who wants a position is going to get one.

 

[597622]

You are in a tough, unenviable position.

I am going to suggest that the most obvious, easiest answer is to rank Categorical GS positions at the top of your list, regardless of location, with Prelim positions at the bottom. While that may mean you end up not living near your fiancee (note the two "e"s at the end; this notes that you are speaking of a woman; you're using the masculine version), let's explore my reasons for suggesting so:

1) you state that you have chosen Prelim programs which are close to your fiancee; however, given that a GS internship, Prelim or note, is not "easy on hours", how much time will you really have with her? If you are in the same city and live together, that is reasonable, but anything that involves a commute or is a few hours away will typically result in limited time together anyway.

2) you state that you have chosen Prelim programs that have a good track record of keeping or finding positions for their Prelims. In almost all cases that I am aware of, these are superstar residents. Being a Prelim who is trying to attract enough positive attention, but keep the negative at a minimum (and there will be some negative regardless of who you are), is exhausting. It is a nearly year long audition. Thus, you cannot be spending your days off or weekends with your fiancee doing fun stuff: you will be spending it studying for the ABSITE and for honing those connections to ensure a Categorical position. The best Prelims I ever saw were kind, generous, hard working (as in, EVERYTHING that year was geared toward getting a new position; vacations were spent studying or going to conferences to make connections). You cannot overestimate how hard this can be, even at a program with a "good track record". Thus, you may wish to consider what sort of stress this will put on your relationship. Your fiancee, in a specialty which is quite a bit different, may not understand your concerns and needs to maximize your time at the program. After all, you will only be there for 3 months before applications for next year start.

3) if you choose a Prelim program, you will need time off for interviews. The program must be supportive of this, but they may require that you use your vacation time to do so; thus putting more strain on your relationship.

4) by choosing (and hopefully matching to) a Categorical GS position, while you cannot let your guard down, you have the luxury of at least relaxing; you have a 5 year position unless there are egregious mistakes (despite what SDN may have you believe). You can use any golden weekends and vacations to spend with her, and she with you.

5) if you should choose a Prelim position with a good track record of obtaining Categorical positions for its interns, bear in mind that most places are not in the same location or one of your choosing. Mayo has a good track record for example, but you will note that we almost never keep the Prelims in the program but rather find someplace else; someplace else that may be even farther from your fiancee and not necessarily someplace you prefer.

Outside of the obvious difficulties in having a LDR, please do not underestimate how difficult it is to translate a Prelim GS position into a Categorical one.

Thanks for the very detailed response!
A lot of what you described is definitely something to consider. Obviously, I would rather match categorical for all of the reasons you mentioned. Being a prelim is never advantageous or enjoyable and I have interacted with many depressed, sad, tired prelims that have shared your sentiments about prelim GS. Actually your chances of matching categorical after a prelim year are about the same as matching PGY-1 without a prelim year (the ratio of applicants to spots is about the same). The places I would consider doing a prelim year are places that A) have at least once given spots to their prelims in the past (demonstrating that hard work and dedication has a chance to be rewarded- something that isn't the case at many programs especially top-tier), B) the prelims in the program have shared positive outcomes C) almost all of the prelims are still in GS (which is the case at many of the best prelim programs), I have done my research!
You gave the example of Mayo clinic- I have met a prelim from there who is now categorical at a good university and shares that everyone in their class of 7 prelims is still in GS with the exception of one who had visa issues.