For Canadians who've completed their residency in the US, please read the prior blog post written by my colleague (Simon, aka QuebecIMG) for his thoughts on finishing residency and practicing in the US.
As for myself...
I am happy to write that I have completed my Canadian residency program in Neurology. It has been an amazing 5-year exceptional and exponential learning experience. It is bittersweet - I am happy to be done, but will miss the residency experience. I have my colleagues, allied staff, attendings, family, friends and, most importantly, patients to thank for this accomplishment.
To those who've also completed their residency training this academic year - congratulations and best of luck whether you begin your independent practice or continue your training in a fellowship program.
I thought I'd now take the time to provide information about the process of Certification at the completion of residency and fellowship, from experience, in a question/answer format.
1. Residency training in Canada vs the US
Many residency programs are longer in duration that the equivalent in the US, eg. Neurology, Psychiatry, OB/Gyn are 5 years in duration in Canada (including off-service/intern-year equivalent) vs 4 years in the US (1 year internship and 3 years of specialty training). There are exceptions to this, eg. Family medicine is 3 years in the US, but 2 years in Canada. Internal medicine and Pediatrics are 3 years in both Canada and the US.
Residents in Canadian programs are well supported by the University post-graduate office and resident associations. Residents are well prepared and the specialty board exam pass rates show this (Pass Rates).
For Canadians doing their residency in the US who are in a 4-year program, but wanting to return to Canada, they would need an additional year of accredited fellowship training in the US to make up for the difference in duration of the residency.
2. Final Residency Board exams in Canada
In Canada, the Royal College of Physicians and Surgeons of Canada (RCPC) are the certifying body for all specialty programs, and the College of Family Physicians of Canada do the same for Family Physicians.
The RCPC will notify program directors and their residents in their 2nd to last year (eg. 4th year in a 5-year program) to submit their application for assessing their preparedness to take the exam (this requires a letter from your program director, previous USMLE and/or MCC exam results (previously discussed in prior posts) and a list of all your clinical rotations during your residency. This process does have a cost of around $700 CAD. In the fall of your final year, there will then be an application to sit for the Final RCPC exam, this costs just over $4000 dollars for those taking the exam for the first time.
Exams occur in May-June, and typically consist of a written component first (usually 2 days). Most programs utilize short answer style q's, other programs, such as internal medicine and pediatrics have a multiple choice format. A few weeks later, there is an oral (OSCE) component (one day) that takes place in Ottawa, Ontario. Each specialty will have a specific date for their exam and all residents in a particular specialty will take the exam on the same day.
The results are released 2 weeks after completing the oral exam.
For some specialties, such as pediatrics and internal medicine, there are 2 separate exam dates, because of the large number of residents. These residents will be notified of the results of their written exam prior to the oral exam to determine their eligibility to sit for the oral exam. Most other specialties will not find out their results until both the written and oral components are completed.
N.B. The process and costs may change every few years, so verify with the respective certifying body.
3. I'm done the Canadian residency board exam - should I take the US exam?
Some specialty licensing bodies, for example the American Board of Psychiatry and Neurology (ABPN), require that you take and pass the Canadian specialty board exam before you can register to take the US exam. So, essentially, you would apply for it in the fall of your 1st year of fellowship or 1st year of practice (depending on what you choose to do after completing residency) and take the exam the following year. Although some of you may feel this may affect your focus during your year of fellowship or if setting up your practice, there is no better time to take the US exam than closest to your Canadian exam, since you will never know more than you did at the time of your exam (in the general broad clinical sense and for knowing minutia).
If you are Board certified in Canada, consider the following before certifying in the US. The US exam, although they tend to be shorter - sometimes only a written component in MCQ-style over 1 day, you are required to recertify every 10 years - with an application, exam and repay dues. If you do not intend to ever practice medicine in the US, this may not be worth while in the long run. However, if you intend to practice in the US or doing your fellowship in the US after completing a Canadian residency, then it would be recommended to certify as soon as possible.
4. I'm done my Canadian boards and want to obtain my independent practice license...
For any form of independent practice (not for post-graduate training), you need to obtain your independent practice license, which, in Canada, requires that you also have completed/passed your residency board exams.
Each province have their own licensing bodies, eg. in Ontario, we have the College of Physicians and Surgeons of Ontario.
The application for this can be done prior to the completion of residency or during a fellowship program, but must be done prior to starting independent practice. The process is fairly straightforward if it is done just prior to completing residency, but slightly more involved if it is done afterwards.
For those who began residency prior to 2010 and have completed their USMLEs (see previous post here), you may apply for your license, but the application is slightly more involved and takes 4 months from the time of submitting the application to final review and licensing, as opposed to 2 months for those applying at the end of residency with their MCC scores.
5. I am doing a fellowship, but want to do part-time moonlighting work independently....
This can be done, but requires a full independent practice license (as opposed to some residency programs which allow moonlighting during residency). The costs for the application and license, as well as malpractice insurance costs (through CMPA) are the same whether you are moonlighting part-time as a fellow or practicing full-time. Therefore, keep this in mind if pursuing fellowship training. If the costs of moonlighting can offset the costs of the independent license and insurance, then it can be worthwhile and good supplemental income to your fellowship salary.
6. I am considering a fellowship...
I definitely did, and am currently pursuing subspecialty training in a fellowship program in Canada.
Let's discuss fellowships in Canada and the US and how fellows are paid...
Canadian fellowships are fantastic training programs with some top notch opportunity for research and clinical exposure, all at major university centres. They are often not accredited, unlike some US counterparts, but are recognized when applying for academic careers within Canada. In general, fellowship training is required in order to obtain competitive academic career positions (that is in Canadian University Hospital programs), and thus why many specialists pursue fellowships.
Fellowship pay, however, is often less than what you would have received in your final years of residency. This is often because fellowship funding comes directly from the supervisor's research grants, department or from grants from funding agencies (often for research fellowship only). The latter is very competitive and often between post-PhD fellows and post-residency MD fellows. During residency, however, residents are funded by the provincial ministry of health (all residents within the same province in the same residency year are paid the same, with an increase in their salary each year).
The exception to this is some programs, such as Internal Medicine and Pediatrics, require fellowship positions, either general internal medicine or pediatrics, respectively, or in a subspecialty such as gastroenterology, rheumatology, hematology, endocrinology, nephrology, cardiology, etc. Therefore, residents finishing Internal Medicine or pediatrics will apply for their fellowships through a Match process (as they did for residency) through CaRMS. Therefore, they continue to be paid as if they were continuing their residency, i.e. 1st year of gastroenterology fellowship would pay a salary of 4th-year resident (since Internal medicine residency is 3 years, followed by a Gastroenterology fellowship).
Many US fellowships in multiple subspecialties are obtained through a match process - they however, like their residency programs, are paid depending on the particular hospital's funding allocation (just like their residency).
7. "I am an IMG who completed residency in Canada and looking to practice, but have signed a return of service (ROS) agreement limiting the areas where I can practice." - Now what?
This would be the case for those of you who matched to a residency program in Ontario, and perhaps other provinces in Canada.
Should you choose to pursue a fellowship after residency, the ROS, can be deferred until completing the fellowship.
Here is what the Ministry of Health and Long-Term Care (in Ontario) has written regarding ROS:
As per the ROS Agreement that you signed with the Ministry, you are required to do five years ROS in an eligible community approved by the Ministry.
Eligible ROS communities are anywhere in Ontario except the Toronto area and the City of Ottawa. The Toronto area is defined as the City of Toronto and its neighbouring municipalities of Mississauga, Brampton, Vaughan, Markham and Pickering.
As a reminder you must seek the Ministry’s approval for your proposed practice arrangement by submitting a fully-signed Practice Location Agreement. The Practice Location Agreement specifies the practice location and describes how “full-time” will be defined for your return of service. The Practice Location Agreement must be signed by yourself and an acceptable representative of the community where you propose to practice. Usually, the acceptable representative is the head of the facility (e.g., CEO), the established physician recruiter in a community (or another recognized organization or individual who has been directly involved in the recruitment - e.g., chamber of commerce, town official), or in the case of a group or independent practice, the lead physician in the group or the office manager in a private clinic (where this person is not a relative of the physician).
This Practice Location Agreement must be submitted to the Ministry for approval before the completion of your residency training. You are required to begin your return of service within three months from the date the College of Physicians and Surgeons (CPSO) issues you with the certificate of registration to practice.We understand that physicians may wish to use a locum opportunity to assess their fit with a community or practice facility before making a decision to settle there on a more permanent basis. Accordingly, the Ministry will accept up to one year full-time practice through locum(s) at the start of your five-year return of service period. Please note that this service must also occur in an eligible community, and that you must seek the Ministry’s approval in advance and in writing through a completed Practice Location Agreement for each locum.
Physicians looking for suitable practice opportunities are strongly encouraged to contact the Practice Ontario program at HealthForceOntario Marketing and Recruitment Agency (HFO MRA). Website: www.healthforceontario.ca Please note that the ROS Agreement is legally binding and requires that you notify the Ministry of any changes that may impact your ability to fulfill your ROS obligations including providing a signed Practice Location Agreement.
I hope this information helps those finishing their residency and moving onto the next step of their careers, whether it be fellowship or starting a practice. Congrats again!
Cheers,
Phil
(For those earlier in their medical training looking for information on medical school and getting into residency in Canada or the US, please see my earlier posts).
