Finally done Residency - What next?

I haven't written a post in a while as is my usual style to only keep posts focused on reviewing processes for getting into and how to study during medical school - mainly for Canadians studying abroad and for those looking to match to a residency program in Canada or the US.

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).

Finally DONE - An update on my journey

Hi!

I just wanted to update my fellow Canadians on my long journey. I visited Canadian IMG in July, right after I was done with residency, and he asked me : " eh man, you have posted in a while on my blog, you should post something", so here I am.

This have been great for me so far. Just to let everyone out there know, YES, there is a light at the end of the tunnel. Believe in yourself and you will achieve your goal. I just finished residency in June 2014 (Family Medicine) in the USA, passed my American Board of Family Medicine, and of course passed my MCCQE 1 and 2 along the way (May 2012 and October 2012).

After a few months of debating with my wife, having good offers on the table from the local hospitals near my residency program, and discussions with my father (who is an FP from Montreal), I have decided to stay where I am.  St Elizabeth Healthcare (Edgewood, KY) allowed to be trained as a strong well-rounded physician. I have done countless procedures in the outpatient and inpatient setting, I have moonlighted countless nights as a house doc in residency and still continue to this point (although in much less amounts). The local company has given me lots of leeway in what I envision my practice to be, so I could not be happier at this point, professionally speaking. I have joined one of my co-residents in a outpatient local group practice with 3 other providers and we have a great schedule (8am-5pm, 4 weekdays a week). No weekends, no evenings (except my random moonlightning). This allows to have a well rounded schedule and I get plenty of time for my wife and kids.

My residency program now has 2 residents in 1st year from SGU. I heard they are doing quite well. I am proud of my medical school, it trained me very well and I'm sure Canadian IMG would concur with this. Guys, any questions, any doubts, feel free to comment here and I will respond.

Take care,
Simon

Happy Holidays! A few additional tips for residency applicants...

Happy Holidays!

I have not posted anything in a while, but I have been limiting the fillers in my blog; maintaining it purely as a guide for Canadian IMG's during medical school and for those applying for post-graduate medical residency positions in Canada (and in the US).

I have been involved in the CaRMS residency candidate review process for a few years now, and have noted a few consistent issues that work against the applicant during the screening process.  These are avoidable "blunders" that can make or break your chances of obtaining an interview.

1. Every year, I've noted reference letters that, although they may be "strong" recommendations by the referee, refer to a different field of medicine than that to which the candidate is applying.

What I Recommend: Please ensure that the person writing you the letter ensures that it pertains to the field to which you are applying.  I understand that candidates may apply to different specialties and may use the same referee to write your letters for various programs.  Try to ensure that they are aware of this, so that they do not indicate their strong support for your position in Internal Medicine when you are applying to Otolaryngology, for example.

2. Some candidates use referees from research only, i.e. Referees who are scientists (PhD), but not clinicians (MD).

What I Recommend: It is important that programs see how you perform in a clinical setting, hopefully in the field to which you are applying.

3. Reference letters are from attending in fields other than that to which candidates are applying.

What I Recommend:  Once again, it is important that programs see that you are committed to training in that specialty, therefore, I strongly recommend at least 1 out of 3 letters of recommendation be from a clinician who specializes in the field to which you are applying.  I.e. You should have at least one neurologist write you a letter if you are applying to neurology.  And, as mentioned above, if the other letters are from Internists or other, please ensure that they are aware you are applying to Neurology, so that they do not state "you would make a great internist".

4. Candidates apply to a specialty in which they have not done any electives.

What I Recommend: If you have not done any electives in that particular fields and cannot clearly emphasize its significance in your personal statement, do not bother applying to that field.  Programs will see that you are more committed to simply matching to any specialty.  They will "weed out" these applications from the screening process quickly, as they do not want to risk having a candidate be unhappy in that field or potentially switching out once they match.  Trust me, it works in favor of the candidate to apply to a field where they would thrive, not just for the sake of matching.

5. Long-winded personal statements about why you wanted to be "doctor" or trying to relate personal ailments to your decision to become a physician, with only a short paragraph of why you are applying to a particular specialty.

What I Recommend:  The reason why you wanted to be a physician was included in your medical school application.  Please keep your personal statement for residency focused on why you wish to be a [Insert specialty here] and what you have done along the way in medical school or graduate work that makes you a great candidate for that particular specialty.  Research the program, and highlight why you wish to be part of that particular program.  If you are applying to more than one different specialty, do not write a standard template paragraph and simply replace one specialty for another within the text.  This is something programs do clearly notice during the screening process.

Should you follow these recommendations along with those from my initial blog posts, you will significantly increase your chances at obtaining an interview.  Once you make it to the interview, the rest is based on how your interact with the interviewers and whether your personality fits well with the program.  The odds are in your favour and so is the match process, as I have previously discussed in an earlier post.

Please follow me on Twitter for more regular updates: @medstudentopps.

Wishing all of you a Happy Holiday season and best of luck to those applying for residency in 2014.

- Phil

This just in (well, recently in)...

SGU provided some recent stats that may be of interest to those considering med school abroad:

St. George's University (SGU) medical students who took the USMLE 1 for the first in 2011 achieved a 95% pass rate.  The first-time pass rate for students at US and Canadian medical schools for this same period is 94%.  SGU's US and Canadian students who took the USMLE Step 1 for the first time in 2011 achieved a 96% pass rate.

For three years, since 2009, the first year SGU medical students took the National Board of Medical Examiner's (NBME) Comprehensive basic sciences, the mean score achieved by SGU students is 64.  This score is higher that a cohort of over 20,000 US medical student first-time test takers from LCME-accredited medical schools.

Of 2011 graduates:

93% of eligible US graduates who applied for a postgraduate position (residency), obtained a position by July, 2011.  97% obtained a position by July, 2012.

Of 2012 graduates:

91% of eligible US graduates who applied for a postgraduate position, obtained a position by July, 2012.

Way to go!  

Don't forget, CaRMS applications are due soon!

Some of you looking to apply to residency in Canada should review the individual program requirements on the CaRMS website: http://www.carms.ca/eng/r1_program_e.shtml

You should also check out the CaRMS IMG match results from 2012: http://www.carms.ca/eng/operations_R1reports_12_e.shtml

Best of luck in 2013!

The Michelangelo Code

Read Article here

FAQ’s (A pooled list of good questions I’ve been asked by medical students):

1. Question:

I have taken all my USMLE steps and have a few interviews for internal medicine in US. Do i need to apply through the CaRMS match in order to get a J1 visa or just taking the MCCEE would get me the statement of need?

Answer:

For a J1 Visa, you must:

1.Hold a valid ECFMG certificate (which you will receive once you have completed USMLE 1, 2CS, 2CK and graduated).

2. Hold a contract or official offer for a position in an accredited residency program

3. Provide a statement of need (issued by your home country - this serves to confirm your commitment to return to Canada upon completion of training in the US).  To obtain one, you can visit the Health Canada website.  

You must pass the MCCEE to get one.

2. Question:

What are the commonly asked residency interview questions for which to prepare?

Answer:

See my list here:

http://canadianimgmatch.blogspot.com/p/interview-questions.html

3. Question:

Is it really important to have the MCCQE1 as well as the MCCEE?

Do residency programs in your experience prefer students that have also completed the MCCQE1?  I had to complete the USMLE's first due to school requirements for graduation, so I was unable to schedule the exam before this upcoming May session.  My classmates previously informed me that the USMLE's are considered equivalent to the MCCQE's.  

Answer:

They don't consider the QE exams for the match.  USMLEs at this time are only equivalent in Ontario for those who entered residency in 2010 and prior. You will have to take your MCCQE's after starting residency.

4. Question:

“I am at [a great Carribbean med school] and about to take the Step 1 USMLE.  As soon as I complete the Step 1, I plan to do some shadowing & get some additional accreditations that might enhance my CV.  A big concern I have right now is how my USMLE score will affect my chances of matching in Ontario.  Did your scores weigh heavily, if at all?”

Answer:

USMLE scores typically do not matter when applying to Canada.  You will submit your scores to the CaRMS application site, but they are not typically considered.  I do, however, recommend that you study hard for it to keep options open in the US and obtain as many US interviews as possible (for the interview experience and to have more choices for a residency).  

The MCCEE is what you will need to take for applying to Canada.  This score does matter for IMG's, mainly as a screening/cut-off tool for interview invitations. Once you get the interview, the score no longer matters.  

I talk about scheduling the MCCEE in my first blog post.  You should take the MCCEE in September 2012, not too long after you take the USMLE step 2 CK. The content is essentially the same.  Be sure to study for each USMLE using USMLEWorld online q bank for practice and getting used to the format/timing.  

The MCCEE exam is a shorter exam (4 hours) with shorter question stems.  To get an idea, do a few sets of questions on "Canada QBank" a couple of weeks before you take the MCCEE.  

5. Question:

What is the scope if one apply for residency in a specialty after completing master in that field?  For example, if one is interested in doing residency training in pediatrics, what's the scope of getting a residency in peds after completing master in pediatrics? Will it be a boost on Residency application or will it have a negative impact b/c one is out of clinical practice for long time?

Answer:

From my experience, having a Master's degree definitely boosts your application in applying for residency, especially if it is in the same field.  It will provide you with reasons and points of discussion for choosing that particular specialty.

Keep in mind that in Canada when applying for your license before commencing residency (i.e. in Ontario through the CPSO, http://www.cpso.on.ca/), you will need to provide information as to any pause taken during medical practice.  This should not be an issue however, since your reason would be to complete a Master's degree immediately after completing medical school. 

That being said, in certain fields of general practice, i.e. Internal Medicine, Family medicine, pediatrics, a Master's degree is not expected or required, since many in these fields end up working in the community setting after completing residency, not necessarily as academics (but there are certainly many academic careers that can come from completing one of these residencies). 

If you have applied in your final year of medical school and have not matched to a residency program, then doing either a master's or a research year is better than taking the year off, but committing yourself to a Master's may require a minimum of two years. You may even be able to do some clinical observerships if you find the time in a place where you'd like to match.

6. Question:

Were there a fair number of individuals in the mid 30's age range at SGU or will I be “geriatric”?

Answer:

We definitely had a mixed crowd.  Most in their 20's, but we had several in their 30's and even a few in their 40's and 50's, believe it or not.  It really is "never too late".   We had some students who had careers in completely unrelated fields, some who went to grad school, and some who worked as Chiropractors, Physician Assistants and nurses before applying.  You will not be a "Geriatric".

7a. Question:

I am an SGU student, about to start my third year clinical rotations and am starting off with medicine core as my first rotation. I will be new to the wards and the added pressure of performing well on an important rotation is making me nervous.  

Answer:

Medicine is actually a good one to start with.  You'll cover the most important (high-yield) areas needed for boards, so you'll be motivated right off the bat and have an early head start on your studying.   You will also see the general approach in clinical scenarios you will apply to other rotations (i.e. you'll be able to look at the big picture when you're on Surgery and be a lot more thorough). Don't worry; they don't expect you to know everything.  They know you are just starting your clinicals!

7b. Question:

I was wondering if I could please ask for your advice on how to prepare for these rotations, what to keep in mind during medicine and if there is anything important that I should be doing during clinicals?

Answer:

You will be studying along the way. The SGU affiliated hospitals typically have great didactic lectures scheduled for the students.  These are all important topics for boards.  Pay attention during those and it helps to study the topic beforehand if you know the schedule in advance.  Don't over-study...enjoy your clinical experience and enjoy your time in the US!  You will likely review again before the end-of-rotation exams.

In terms of textbooks, please check out this page I made on my blog 

http://canadianimgmatch.blogspot.com/p/highly-recommended-textbooks.html

click the link on the left for "Wards".  Those are the books I bought.  

These will obviously depend on your rotations (i.e. you may not need the Neurosurgery text!).

Did you read my blog on "How to study for the Boards and Wards"?

http://canadianimgmatch.blogspot.com/2010/04/how-to-study-for-boards-and-wards.html

This described how I studied during my rotations.

8. Question:

I have completed all of my USMLE with scores from 86-99, and MCCEE and MCCQE1 with scores in the 95+ percentile.

What programs you think I stand a good chance in? Neurology and Internal Medicine is my preference but I am open to other good specialties like Radiology, OB GYN, etc. 
I understand some are thought o get in but what is your suggestion and what should I do to make this happen?
Any other suggestion you want to give me?

Answer:

Your qualifications look solid.  If you have a Canadian citizenship, you are ok with the current exams you have completed.  If you do not, you will likely need to complete the MCCQE2.  

Having a reference from a Canadian physician will definitely help, especially if they are in the field to which you are applying, and they are relatively well known in their field or a program director (but this is not always necessary).

You will need to put forward a very good reason in your personal statement as to why you want to switch from your current program to one in Canada and in a new particular specialty.

Also, you must convey to the program that you really want to practice in that specialty.  I know it's difficult to get what you absolutely want, and that sometimes you may feel you have to settle for almost anything in order to match, but programs will see that and may question you on why you have selected certain rotations and why their specialty.  It may be better to apply to maybe one or two specialties in which you will be 100% satisfied if you match.  Do not apply to multiple, unless you have a solid reason and personal statement tailored to each specialty with an amazingly solid and convincing argument as to why you deserve to be in THAT specialty, and have the rotations and letters to back it up (i.e. Radiology and OB/GYN - very competitive, and very niche specialties).  Applying to IM, peds and/or family would be easier given your match in the US.  

Also note that there are way fewer IMG spots in Canada (Family and IM are growing in number, but they also have many more applicants).  You should check the CaRMS website to see the statistics of applicants last year.

Be sure to consider location and lifestyle.  Programs in Ontario are all great and there is a major focus on teaching with really strict rules on allowing residents to have their dedicated teaching time uninterrupted by clinical practice.  

They are all major university programs, so the training should be great no matter where you end-up.

Some info on Neurology in Canada:

There are few IMG-friendly programs.  Most are in Ontario (Western, Toronto, McMaster, Ottawa).  These are major centers with a large catchment area, so you will have a good amount of exposure to all of those rare diseases you read about in textbooks, but never thought you'd see.  

If you take all of your MCC exams prior to applying, you have more chances outside of Ontario.  For Quebec, you will need to take a French equivalency exam as well, even for McGill (which is an English program).

The Neurology program is 5 years long.  (In the US, it is 4 years with your first year being entirely in Internal Medicine).

  

In Canada, much of your rotations in your first 2 years will be medicine subspecialties (this also includes ER and ICU).  

At Western (UWO), you would have 2 months of neurology in PGY-1 and 4 months of neurology in PGY-2.  

You will also have 2 months of neuro-radiology and 1 or 2 months (your choice) of neurosurgery.

Upper years: urgent neuro clinic, subspecialty rotations (epilepsy, neuromuscular, neuropathology, pediatric neurology, etc.), electives, longitudinal clinics where you manage followup of your own patients.

Some advantages of a 5-year neurology program:

1. More exposure to subspecialties of neuro (Neuromuscular/EMG, Neuropath, Epilepsy/EEG, Movement disorders, Stroke, Neurorads, NeuroICU, etc., with more elective time).  This will make you feel very comfortable/competent should you choose to go into general neurology/community practice.  Having 5 years of training is also appealing if applying to practice or do a fellowship in the US later on.

2. If you decide to switch early on to a different specialty, it will be easier, because most specialty programs in Canada are 5 years, including Surgical specialties, OB/GYN, EM, etc. and the 5-year funding can be transferred over.  (for example, I have a colleague who switched from Urology to EM early in his 3rd year and had no problem doing so).  That being said, I don't recommend switching. I hope you get what you truly want right from the start.

9a. Question:

You mentioned in your first blog post that med students need to write the MCCEE in order to get the J1 to do residency - is this a hard and fast rule?

Answer:

Yes, you need to write the MCCEE if you plan to get into a residency in Canada or the US right out of med school, without taking a year off.   This will help getting a J1.  The J1 basically requires two things...matching to a US program and filing the right papers through the Canadian government (see the link I provided on my blog).

9b. Question:

What if I want to get a US residency where the hospital sponsors me on a H1B? Would I still need to write the MCCEE if I don't want the J1?  

Answer:

The likelihood of getting an H1B is next to impossible before finishing med school in time to start your residency (this should answer your next questions as well!)  Also, they offer these less and less.

9c. Question:

You wrote that I would need time off after I graduate to apply for the H1B visa - why? Is there a long processing time?
What if I begin my residency on the J1 (so that I can start residency right after graduating and so that I'm not taking time off after I graduate to wait for the H1B visa application to go through) and then start looking for hospitals that could sponsor my H1B and issue the J1 waiver to exempt me from having to come back to Canada? Should I ask the hospital I apply to for residency to just start me on a J1 but then later switch to a H1B?

Answer:

The hospital will have their requirements for non-US citizen IMG's defined as accepting of J1 or H1B.  Most accept the J1 because this doesn't cost the hospital anything, whereas sponsoring you for an H1B costs them several thousand $$.  You may apply for a waiver down the road.  This is based on need by the hospital and if they're willing to support you.   Hope this answers your next few questions.

P.s. there are plenty of opportunities to work in Canada after residency in the US...so don't worry about the J1 and having to come back.  The J1 is good for up to 7 years, so it should be enough to do a fellowship after residency, unless you plan on going into neurosurgery (which in itself is 7 years long)! 

10. Question:

Do teaching hospitals in the US treat Canadians from Caribbean med schools or Canadians from US med schools better? 

Answer:

No difference in most places from what I've seen.  Most of the affiliated US hospitals have been used to training IMG's for years.  A lot of the attendings in many US schools/hospitals were IMG's!

For those who dread the MCAT (My spiel to the wannabe medical student):

What prompted me to write the following is a US News article I just read on their website, titled “Top 3 Reasons Medical School Applications Are Rejected”.

I recommend reading it before reading my blog post below.  Here’s the link: http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2012/02/06/top-3-reasons-medical-school-applications-are-rejected

Have faith people!  Yes, I agree, grades do matter, and I also agree that an obvious progressive upward trend or a small blip on the radar shouldn't hold you back.   Your grades show how much effort you put into your chosen coursework.

I do feel however that your MCAT performance only matters because it is the only “standardized” tool available.  I am sorry to those who enjoyed a music degree in undergrad; the MCAT is looking to punish you.  I don't believe the MCAT provides a strong correlate with how you will perform in medical school.  Unfortunately, it is still being used. 

To give a personal example, I took my MCAT while in grad school (far removed from the basic chemistry and physics courses I took in my first year of undergrad) and had very little time to study for it, given my demands in the lab amongst other important aspects of extra-curricular involvement.  My MCAT score was let's just say in the "20's".  The writing sample was my best section (Scored an “S”, scoring is from J-T).  I still had several research publications, presentations, leadership roles in extra-curricular activities and teaching experience in the life science fields, with a 3.7 undergrad GPA and a 4.0 grad GPA.  Unfortunately, I did not even get an interview at a Canadian/US medical school (I didn’t bother applying to most, considering I knew the MCAT score would keep me from entering the door).   I decided to apply to SGU as I was encouraged by the consistently successful residency matches to great programs in the US.  I was accepted to SGU and certainly put the work in!  I maintained one of the top GPA’s in my class; did well during my clinical rotations in the US alongside Cornell students, and scored 240+/99 on my USMLE.  I eventually obtained many residency interviews in the US and Canada, and matched to a great Canadian residency program and had pre-match offers from US programs.

My medical school experience will be missed.  I studied basic sciences in amazing weather with students from all over the US, Canada, the UK, etc., and was taught by American and Canadian professors.  I loved living in New York during my clinical years – not many med students outside of those at NY med schools can say that. 

I must say though, I am glad to be home and training in one of the top programs in my specialty.  So far, residency is going great; I’ve kept up the momentum, and my rotation evaluations/feedback from attending physicians and staff have all been extremely positive.  I am now involved in conducting interviews and enjoy providing constructive feedback for successful matching.

There are some students who score in the high “30’s” on their MCAT and have a personality that would not necessarily fit with most in the setting of clinical/academic medicine (and no, I am not referring to those that apply to pathology – my pathologist colleagues are fantastic people).

Point of the story: Clearly, the MCAT score is not reflective of your competence and professionalism as a future physician.  Schools need to “ease-up” on the weight they put on this exam as a screening tool for medical school candidacy.  Some school have, but unfortunately not enough.

-------------------------------

Additional advice for med student hopefuls:

Do your best, study hard, and enjoy the undergraduate/graduate life.  Take it all in.  Always be respectful of colleagues, keep the drama at home, be open to criticism and, in the words of Jay-Z, “Wipe the dirt off your shoulder”.  All of these will be reflected in your letters of recommendation when it comes time to apply to med school.

When you decide to take the MCAT, try taking it shortly after you’ve completed your core basic sciences.  Take a review course only if you have the time for it and willing to spend the money or if you need the strict defined scheduled lectures and practice sessions.  If you’re involved in research, many research supervisors do not accept “studying for your MCAT” as a good reason to take time off.  I understand from my own personal experience that taking this much time off is not always feasible.

Mature applicants looking to switch careers may not be able to take any time off without losing their job in the “hopes” of getting into med school.

Do not re-take the exam if you don’t feel any more prepared the second time around.   Don’t sweat the small things.  Remember, we are not applying to be rocket scientists; maybe brain surgeons, but trust me, rocket science in my opinion is way more complex than neurosurgery.

If you truly wish to be a physician, but do not wish to prolong the torture of trying to get into a US or Canadian school, apply overseas.  The training in most places will prepare you well and the programs teach all of the same evidence-based practices (or should).  The one caveat I have is this.  If you plan on applying to a Canadian residency program (as a Canadian citizen), going to the UK, Australia, etc. is just as appealing to the programs, if not more so, than going to a Caribbean school.  If you plan to apply to a US residency program, Caribbean medical schools  (SGU, Ross, AUC, SABA) may be a better option given the opportunity to do all of your clinical rotations in the US.  I do not recommend completing too many clinical rotations in the UK coming from a Caribbean school, as some residencies may not accept those rotations as transferrable.