US vs Canada for Residency

[Gucio]

Greetings,

My wife (American) and I (Canadian) need to figure out where to do our residency: US or Canada?

We study in the US.
We have a large debt $400 000 (US) upon graduation
We both hold graduate degrees
We want to start chipping away at our debt in residency

We compared the Canadian and US salaries on line and Ontario seems better at current exchange rates ...however we need some honest input about residency.

1) What are the ‘hidden’ fees and dues that we will encounter in residency (both in the US and Canada)....Canada covers dental and health (a big factor for us)
2) Should malpractice be a factor in our selection
3) Where are better opportunities to moonlight and make extra $? How is the situation in the US/Canada? I heard the US is better...
4) What questions/factors should we even consider?
5) Who should we ask for advice?

Below is what we found online for those of you who are interested. Any constructive and evidence/experience based input would be greatly appreciated.

Regards,

Gucio and Maja

p.s. does anyone know what a call stipend is?



http://www.carms.ca/eng/r1_program_salaries_e.shtml

Ontario
Gross annual PGY-1 salary
$46,017*
Gross annual PGY-2 salary
$53,715
Gross annual PGY-3 salary
$56,978
Gross annual PGY-4 salary
$60,838
Gross annual PGY-5 salary
$64,877
Gross annual PGY-6 salary
$68,675
Gross annual PGY-7 salary
$71,388
Gross annual PGY-8 salary
$75,428
Educational leave
7 days/year
Annual vacation
4 weeks
Meal allowance
NO
Frequency of call
1 in 4 In-hospital, 1 in 3 home
Pregnancy leave
17 weeks
Provincial health insurance
Yes
Parental leave
18 weeks
Extended health insurance
Yes
Provincial dues (% of salary)
1.7%
Dental plan
100% paid
CMPA dues paid
No
Long-term disability insurance
Yes - 70% of salary
Statutory and floating holidays
5 days plus 2 personal floater
Life insurance
Yes. 2 x salary
Sick leave
6 months


Call Stipend
$100 in-hospital; $50 home call




* As of July 1, 2006 . Visit the PAIRO website. http://www.pairo.org/


Cook County Chicago

Benefits

Salary
As of December 2003, the salaries for a PG levels are as follows:

PGY1: $38,903.02
PGY2: $41,078.44
PGY3: $43,081.48

Paid Moonlighting:
For permanently licensed eligible PGY-3 residents on consult rotations, moonlighting is available. This work is reimbursed at $57.22 per hour.

Vacation Leave
Four weeks of vacation is given to all housestaff.

Holidays
Housestaff physicians shall be entitled to be off with pay for the following Hospital Holidays or equivalent:
New Year's Day Labor Day
Dr. M.L. King Jr.'s Birthday Columbus Day
Washington's Birthday Veterans' Day
Lincoln's Birthday Thanksgiving Day
Memorial Day Christmas Day
Fourth of July Christmas Day


In addition, each housestaff physician will be eligible for a floating holiday, which he/she can schedule in advance subject to operational needs. Housestaff physicians may be required to work on the Hospital Holidays. If housestaff physicians do work on a Holiday, a compensatory day off shall be scheduled elsewhere, in the same rotation, if possible.


Maternity and Paternity Leave
Housestaff physicians shall be granted maternity and paternity leave to cover periods of pregnancy, newborn childcare, and/or newly adopted childcare.

Family and Medical Leave
An eligible employee may take approved unpaid family and medical leave of up to twelve (12) weeks per rolling twelve (12) month period. For specifics you should contact your departmental administrator, the Department of Human Resources or Medical Education.

Parking
Parking is available to Hospital housestaff physicians with a valid Hospital I.D. through the Department of Professional Affairs. The cost is $35/four weeks.

Meals
Housestaff physicians will be provide with three hot meals in the cafeteria each day of the week and will be permitted up to five guest meals per month free of charge in the cafeteria. Snacks are also provided free of charge for all overnight calls.

Counseling Services
Counseling services are available through the Employee Assistance Program (EAP) of Cook County. They can be reached at 864-2926

Lab Coats
At the time of initial hire, housestaff physicians will be furnished up to four (4) lab coats free of charge. During their employment, replacements will be furnished free of charge when the condition of the lab coat so warrants.

Malpractice Insurance:
Covered at 100%.

Health and Disability Insurance:
The County provides health benefits to housestaff physicians and dependents. The County offers to the housestaff physician and his/her family the option of choosing a Health Maintenance Organization (HMO) or Preferred Provider Organization PPO from those available and federally qualified in the Chicago area for this health coverage.
Ordinary disability benefits will be provided in accordance with the rules and regulations of the Cook County Employees' Annuity Benefit Fund.


Dental Insurance
All residents are eligible to participate in the County’s Dental HMO plan. There is no cost for this benefit

Life Insurance:
All housestaff physicians shall be provided with life insurance in an amount equal to their annual salary at no cost to the housestaff physician.

Housestaff Association
The Cook County Hospital Housestaff Association (HSA) is the union representing interns, residents and fellows employed by the Hospital. It has existed as the housestaff physicians' organization for many years and as a union since the early 1970's.

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Members don't see this ad.

 

[Winged Scapula]

What are the ‘hidden' fees and dues that we will encounter in residency (both in the US and Canada)....Canada covers dental and health (a big factor for us)

All US residencies will cover at least a portion of your health (and usually including dental and vision) policies. For singletons or just you two, the portion that you may be responsible for (assuming you have no major preexisting conditions), is generally minimal ($25 - $50 USD per month). For family coverage, including children, can be several hundred dollars a month. Every US program has different policies, so we cannot generalize and say that Canada is overall better unless it costs you absolutely nothing in which the additional cost for health benefits in the US may be a few dollars a month to a few hundred.

Some programs do not have meal allowances to use while you are in-house on call, and some do. Those that do may be generous, and some may not be. Again, wide variability, although it may make no difference if you bring food from home while on call.

Some hospitals will charge you for parking; some may charge for extra coats, etc.

I understand some programs offer moving allowances or housing allowances. This may help offset some costs inherent in relocating and living in an expensive city.

Bottom line is that the costs of residency may vary from program to program in the US, but with the exception of health care, they are generally negligible.

Should malpractice be a factor in our selection

Not during residency. This is covered for you and does not come out of your paycheck. They should also cover the "tail" - ie, responsibility for any suits brought against you after residency for acts occuring during residency. If you are employed by a hospital after residency completion in the US, generally your malpractice is also covered by a group policy, and should not be a factor in your employment decision. Private practice is a different story and the rates of malpractice insurance in the US vary wildly depending on your specialty.

Where are better opportunities to moonlight and make extra $? How is the situation in the US/Canada? I heard the US is better...

I am not familiar with the moonlighting situation in Canada. Some US residency programs may prohibit you from moonlighting - either at all, or externally (ie, not at your home program). Moonlighting options tend to be better in communities with hospitals which are not covered by residents (ie, the small hospital without a residency program), or not enough residents to cover all the shifts. Again, whether or not you are allowed to moonlight will be up to your residency program director and their policies.

Moonlighting is a double edged sword - you'll make more money, but will likely increase your tax bracket and put yourself into a position where you do not qualify for economic hardship deferment for payment of your student loans. You may find that you are too tired or don't want to moonlight. Current residents at programs you are considering can tell you about which specialties and hospitals have opportunities to moonlight.

The first problem I noticed with the salary info is that you are comparing current Canadian salaries with 4 year old US salaries (the Chicago data is from 2003). The residency salaries have increased a fair bit since then but given the current, nearly even, exchange rate, it is unlikely that in today's market you will make the same salary in the US as you are at the more senior levels in the US. Most residencies in the US start around $40, although some cities it may be $45 or more. There is a wide variation in salary around the US and it is not always so that larger, more expensive cities pay larger salaries.

Once you graduate though, in general, salaries for US physicians are greater than in Canada. Thus, I wouldn't base my decision about where to train on residency salary. You can defer your loans, although interest will increase while in training.

You need to decide where you want to live...if you want to live in Canada permanently, they try to get a residency there. Matching there is even more competitive than in the US, and as a non-citizen, your wife may have even more trouble than you. There are more job opportunities in the US and you may find it easier to match into the same or geographically close programs here. If you want to practice in Canada, it may be better to train there but you would be eligible to work in both countries as long as you train in an ACGME approved program.

 

[Gucio]

Thank you Dr. Cox for your response...We did not even think about the cost of parking! That is why we posted here...as for the posting old US resident salaries I honestly could not find any recent figures on the internet...Could you provide some details?

 

[Gucio]

Sorry hit the submit button multiple times...

 

[OncoCaP]

Seems like you could make it work either way (assuming everything works out in terms of getting into residencies that you like).

Where do you want to live eventually ... the U.S. or Canada? What kinds of things you would like to do, do you like warm or cold weather? If applicable, do you want your kids to be Americans or Canadians? Whose family would you like to be closer to (his or hers)? Canadian system covers everyone, but some procedures and specialists have long wait times.

 

[Winged Scapula]

Thank you Dr. Cox for your response...We did not even think about the cost of parking! That is why we posted here...as for the posting old US resident salaries I honestly could not find any recent figures on the internet...Could you provide some details?

Parking at the hospital is generally not a huge expense (I didn't pay anything during residency, only pay $25 for the entire fellowship).

I can give you some links to US salaries but remember that there is such variability between programs that I don't know how it will really help you unless you match at one of the programs:

Harvard (2005-2006 data)
http://www.hms.harvard.edu/ortho/apps/salaries.html

Hennepin (in Minneapolis)
http://www.hcmc.org/education/salary.htm

U of Ill, Peoria
http://www.uicomp.uic.edu/Residency/ResidentSalaries.html

Kettering, Ohio (data unknown)
http://www.kmcnetwork.org/meded/Benefits.cfm

UT Southwestern
http://www.utsouthwestern.edu/utsw/cda/dept200270/files/214265.html

U of Arizona
http://www.fcm.arizona.edu/residency/resident_salaries_and_benefits.htm

UMDNJ/Robert Wood (my program)
http://www2.umdnj.edu/pgmeweb/salaries.htm

Ok...so I'm getting tired of listing these. I simply typed "resident salary" into Google and got tons of links. You can also go to the websites for programs you are interested in, follow links to Graduate Medical Education or Residency programs and find the info (though not every program will have it listed).

BTW, I took a look at health benefit cost for a resident, spouse and children at my former program and its $147 per month; $51 per month for a single person. I note this because I didn't realize that it was so much more expensive elsewhere; another poster noted he was quoted $600 a month in health benefits for his family at another residency. So make sure you check that out, because it can vary wildly, just like salaries.

As noted above, all of this information is going to vary SO widely and you don't necessarily have a choice where you match and what you'll be paid, so you really just need to decide, REGARDLESS of all the above, where you do want to live and practice? That is where you should do your residencies.

 

[Gucio]

Thank you for the suggestions

 

[Miami_med]

It also depends where you feel like ultimately practicing. Many specialities have varying training length requirements. Take Emergency Medicine, which is 3-4 years in the US vs. 6 in Canada. If you wanted to do this in the US, you'd have to factor in two to three attending years at 200k each into your calculation to equal training length. If I remember correctly, IM is four years in Canada vs. three in the US. Family Medicine, on the other hand, is only two years in Canada and three in the US. If you want to practice in the country with longer training length, then this is moot. However, practicing in the shorter length country may reduce total years and lead to a net increase in total compensation. Also, US salaries tend to be higher (especially outside of primary care), so take that into account as well.

 

[andros]

Take Emergency Medicine, which is 3-4 years in the US vs. 6 in Canada.

you make a good point about differences in residency lengths, but I just wanted to correct one thing. Emergency Medicine in Canada isn't a 6 year residency (maybe some are if you do a masters, but certainly not all of them are). There are 5 year emergency medicine programs or you can do a 2 year family medicine residency + 1 year emergency fellowship, which is fairly competitive to get.

I know people often talk about differences in salaries, but the docs in Canada do fairly well, especially specialists, in a less litigious society and without the hassles of HMO's (which I'll admit I don't know much about).

Good luck with your decisions!

 

[Miami_med]

you make a good point about differences in residency lengths, but I just wanted to correct one thing. Emergency Medicine in Canada isn't a 6 year residency (maybe some are if you do a masters, but certainly not all of them are). There are 5 year emergency medicine programs or you can do a 2 year family medicine residency + 1 year emergency fellowship, which is fairly competitive to get.

I stand corrected.

 

[Gucio]

Hey,

Thanks all. The situation with residency length is a factor because of the $... the other threads about how much the take home pay for residents/interns is very interesting.

I have a another question...does anyone know of any good scholarships for female latina medical students...outside of the AMA minority one...and yes I have Googled this but a number of the ones posted seem to be discontinued...

All the best,

Gucio and Maja

 

[SMRT]

If you wanted to go to Canada, your wife would need to become a permanent resident to be eligible for CaRMS (still a lot a red tape despite being married). Are you both graduates of a Canadian or American med school? If not then you'll be considered IMGs which is a whole other can of worms.

A call stipend is extra pay you get for doing call shifts ($100 per shift in house, $50 per shift home call).

But I think the most important factor is that you should do residency in the country that you want to eventually live and work in permanently.

 

[Gucio]

Hey,

SMRT (is that a Simpsons reference...

LCME school for both of us...but yes...she would have to become a landed immigrant...as will have to get a green card if we stay in the US...But we are not sure were we want to live yet...although the work atmosphere will play a big role. I used work for several years in Canada in health care and loved the environment and I am a supporter of the Canadian health care model...but I am willing to give the benefit of the doubt to the American system...not sure yet...and we still have to do some rotations in Canada...I hope Maja likes it there as much as I do.

All the best and thank you,

Gucio and Maja

 

[smartspartan]

Hi...

I'm a Canadian citizen and plan to attend med school in Canada itself. However, as all of my family is settled in the states, I would like to move to the states in the future.

I was considering to attend med school in the USA, but
1. too expensive
2. too few seats for non-US citizens/green-card holders.

that got me worried... is it the same case for residency opportunities? If I attend a well-known med school like the University of Toronto, how easy is it for non-US citizens/green-card holders to avail residency positions in desired fields (don't know which one yet) in the USA?

I have gone through the licensure procedures, and I understand I will have to give the USMLE, and come there on a H1-B visa. but to get the visa, i'll need a residency offer...

if it is too cumbersome to get a residency position, I might have to consider going to med school in the states... The help is really appreciated.