A warning to all my North American friends considering UK & Ireland..

[AStark]

You won't end up in a malignant community program in Nebraska or wherever. in the US, the most IMG friendly places tend to be on the east coast. Look the 1,833 who were prior year graduates tend to be new immigrants to Canada who studied medicine in their home country and are driving the proverbial taxi cab. Those people don't have a strong grasp of Canadian culture, don't have Canadian electives, don't have shadowing experience, don't have a strong grasp of the Canadian language and have graduated years ago (meaning their medical skills have declined). Canadian IMGs do still have a shot at Canada, but the chances are better in the US.

Okay, fine, they'll end up at a borderline community program in Utica or Albany. I'm not sure where you're getting your information about prior year graduates - it strikes me as nothing more than supposition. Unlike you, I have already been through CaRMS and have met numerous IMG applicants who were not going through it for the first time. IMGs have a better chance in the US for now, but I invite go read the SOAP thread in the ERAS/NRMP forum to see what the prospects will be like in a couple years.

I still don't understand what would possess you to avoid an undergrad and even apply to a Canadian med school.

Stark is right about the RoS. If there is an RoS, you will be forced to work in a rural community for 5 years. Don't go overseas if you will only work in Canada. The US is just as good of a place as Canada to work and live.

Nothing wrong with a rural community - there are many I'd sooner live in than certain cities. Some parts of the US are as nice as Canada... others, not so much. Ever spent time in downtown Cleveland or Orlando?

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[AStark]

I have one correction to the post above. ROS agreements (at least the one in Ontario that I've seen) start after the conclusion of training including fellowships and subspecialty training. IMGs are certainly not barred from subspecialty training.

I would be cautious about making this assumption. It certainly does not hold true for IMGs matched to IM through Dalhousie:

Nova Scotia Department of Health and Wellness: Family Medicine sites in Halifax, Sydney, Annapolis Valley, Saint John and Moncton, Internal Medicine (without subspecialty)-Halifax site, and Anesthesia.

New Brunswick Department of Health: Family Medicine site in Fredericton, Internal Medicine (without subspecialty) - Saint John site.

http://www.carms.ca/eng/r1_eligibility_prov_e.shtml#ns_and_nb

Long story short, do not make assumptions about IMG spaces or flexibility in career choices. These are moving targets and vary by province and year-to-year.

 

[jnuts]

Again, I only know the Ontario ROS first hand. Additionally, IM can be a bit confusing. IM has pseudo-fellowships in things like endocrinology that are actually a part of residency. There's a separate round of CaRMS to match into those and you're paid as a resident. IM then has real post-graduate fellowships in the traditional sense for a true subspecialty (things like interventional cardiology).

I don't know if the NS ROS forces you into general internal or somehow stops you from doing fellowships after residency. The Ontario one does not do anything like that and Only geographically limits you to outside downtown Toronto and Ottawa for five years after the completion of your training including post-residency fellowships.

It is worth pointing out that ROS agreements in Ontario only started in 2006. That means that the first five year residency graduations were in 2011. I haven't heard I any ROS enforcement issues yet. If it ever comes up, there are a LOT if issues with the ROS contract but most of us think that there's a lot less to loose fighting it at the end of residency once we're qualified.

 

[IMG0157]

I would be cautious about making this assumption. It certainly does not hold true for IMGs matched to IM through Dalhousie:



http://www.carms.ca/eng/r1_eligibility_prov_e.shtml#ns_and_nb

Long story short, do not make assumptions about IMG spaces or flexibility in career choices. These are moving targets and vary by province and year-to-year.

jnuts is right in this case, at least for ontario. IMGs in ontario matched to IM are not barred at all from subspecialty training, but each province has their own ROS agreements, so maybe NS is more strict in that regard than ontario is. i personally know an IMG who matched to an endocrinology fellowship after completing IM at western. but i find it hard to believe that they restrict what your opportunities after a residency in IM are... it seems very unconstitutional to force someone to do GIM after an IM residency but allow their canadian counterparts to choose whichever discipline they like.

and as the current ROS stands in ontario you do not have to work in a 'rural' area necessarily- just areas outside ottawa and toronto. so areas one could work include hamilton, burlington, kingston, london, oshawa, etc. which i don't think everyone would consider rural. only a few years ago (not sure how many but definitely less than 5) the ROS contract was 5 years working anywhere north of north bay or something like that, so there's definitely been a huge change recently as current IMGs in canada are arguing that it's unconstitutional for the government to place restrictions on where they can live. so hopefully in the future there will be progressively less restrictions on where we can work.

see the link below for requirements for entering the MSM R4 match which states in the ontario criteria that:

"CMGs, USMGs, or IMGs, who are PGY3 trainees in 2012-13 and registered in a Core Internal Medicine (Notes 1 & 4) residency program in Canada or U.S. are eligible to apply."

http://carms.ca/eng/r4_eligibility_prov_e.shtml#ontario

 

[AStark]

jnuts is right in this case, at least for ontario. IMGs in ontario matched to IM are not barred at all from subspecialty training, but each province has their own ROS agreements, so maybe NS is more strict in that regard than ontario is. i personally know an IMG who matched to an endocrinology fellowship after completing IM at western. but i find it hard to believe that they restrict what your opportunities after a residency in IM are... it seems very unconstitutional to force someone to do GIM after an IM residency but allow their canadian counterparts to choose whichever discipline they like.

That appears to be the case. Not at Dal though. It's hardly "unconstitutional", it's a contract. If you don't like the terms you can attempt to match elsewhere. This may have been a more recent change at Dal, as I know a cardio fellow who was an IMG from Ireland (IIRC).

 

[jnuts]

That appears to be the case. Not at Dal though. It's hardly "unconstitutional", it's a contract. If you don't like the terms you can attempt to match elsewhere. This may have been a more recent change at Dal, as I know a cardio fellow who was an IMG from Ireland (IIRC).

Wow. If that's the case it's unbelievably restrictive. I agree there's nothing constitutionally wrong with the clause but the cost of breech might be unjust under contract law; not to mention the manner in which the contract is formed.

 

[Medstart108]

Yeah, I agree.

 

[IMG0157]

well, that's really a huge turn off for anyone applying to dal for IM if that's the case then. i would hate to be forced into doing GIM. i applied there and had no idea that that was the case. i wish things like that were really more obvious on the CaRMS program description for IMGs.

and yeah i agree, i think there are plenty of reasons for people to go abroad to study medicine. it's certainly a very risky decision to make though and you have to be open to the possibility of living/working outside canada.

 

[Unch]

Haven't been on SDN in years but this thread is indeed sobering. I see that things are changing, even since I went through in 2005-2010. Just the briefest of responses...

Matching back to North America worked for almost all my NAmerican classmates at UCC. There were 18 of us and we all matched to Canada or the US on our first try except for one woman who matched on her second try after an intern year in Cork.

Yes, a lot of us matched to FM and IM but we also had one match to FRCP Emerg in Toronto, one to ObGyn in Toronto etc. In the end, organization and preparation (and hard work) ruled. We were all on the ball with our summer electives, strategic etc. I did a residency in Saskatchewan strategically because there were spots for IMGs but I got excellent training and now I'm a hospitalist in Victoria (best job ever) straight out of residency. So I went straight through from year one in Cork, made all my matches and job acquisitions first try, had a tremendous experience and have zero regrets. All this to say it's not all bad!

 

[Medstart108]

Great job unch, but do you know anything about the return of service agreements? Nearly all the provinces now have them and most are quite unclear about the details. However, I know Ontario has a 5 year RoS no matter what (FM gets to stay closer to Southern Ontario whereas specialists have to be in Northern Ontario) whereas BC has a system for every year you do residency you need to do 1 year RoS.

I've heard IMGs want to challenge this legally, do you know if this is true?

Also i've heard you can buy your agreement out. So work 1 or 2 years and then pay the fee to get out of your agreement? Do you know if this is true?

Thanks

 

[Unch]

I went to Sask because there was no ROS. Recently, IMGs can apply there (now) in the first round so not sure if there is now a ROS. There are a few spots in the second round in BC most years with no ROS but not a great choice. Usually northern rural. Alberta is impossible. Manitoba might have a few options with no ROS but they're now pretty competitive. Ontario is the most unreasonable with the ridiculous 5 year ROS. I think the maritime a have year for year ROS. Yes, the ROS thing is unfair, inconsistent and annoying.

As for spots, Sask has the most for IMGs since it's not a sexy place to train. But again, the training is good...maybe even better since there's less attitude. Still, the numbers aren't great, even there. I think my year and since, Regina FM had about 800-900 applicants for ten or so spots. But then 90% of those they didn't even consider...

Anyway, choose your electives wisely. I did all of mine in the prairies for a reason.
Good luck.

 

[autotroph95]

Can somebody please explain to me what a 'return of service' is and what it entails? I thought IMGs just match through CaRMS for specific IMG spots, complete their residency and that's that.

 

[mgermans]

If you are willing to work in a Canadian province that is largely under-serviced, you can even match into fairly competitive specialties. That being said, I know a handful of Irish medical graduates, all of whom have matched back to Canada on their 1st attempt and they are all happy they chose Ireland for their medical education.

As well, Ireland carries with it a much better international reputation as compared to medical schools in England and Scotland, etc.

Bottom line is if you are willing to work hard, then you will get into a residency that is realistic; either in the US or Canada.

 

[Phlebotomer]

I have a question. How likely is it for a US grad to match in Canada after attending med school in ireland. Can I come back and work in the US after I complete residency in canada? I heard only good things about canada as I have.some friends and family members up there, so I wouldn't mind a few years but ultimately I would like to practce in the US.

Sent from my Nexus S using Tapatalk

 

[Medstart108]

You can't match back to Canada if you are a US citizen, you need to be a Canadian perm resident or citizen to even apply so I don't think you have that option as a US grad.

I think you can practice in the US if doing residency in Canada. You would need to write the USMLEs and pass, then you can practice in the US. However, i don't think you can ever be board certified (u need us residency to be board certified).

I would also have to respectfully disagree with mgermans on his statement that Irish medical schools are better respected than UK schools internationally.

On an internationally level I would consider them equal. You can't really reasonably suggest that medical schools at Oxford, Cambridge, Edinburgh, Imperial College and UCL are inferior to the irish schools.
International rankings do play this out, the schools listed above are all in the top 50 internationally in the medicine category as well as standard category.
Also bigger countries are more likely to have "better" universities than smaller ones based purely on population size. This often applies to US/Canada, Australia/NewZealand, Germany/Austria as well.

There is a difference between internationally reputation and international student match rates to NA.

If you look at Irish match stats they don't necessarily fall in line with the international reputation of each school. It shows you how little the role of which school you went to plays in your match success. If I was a PI, I wouldn't ever take a student over another student based on perceived reputation, even if it came down to the wire I would look at another factor to break the tie.

 

[jnuts]

A few corrections and answers. Again this only applies to the RoS agreement I've seen which is the Ontario one from 2011.

....However, I know Ontario has a 5 year RoS no matter what (FM gets to stay closer to Southern Ontario whereas specialists have to be in Northern Ontario) whereas BC has a system for every year you do residency you need to do 1 year RoS...

The agreement for Royal College Specialists is the same as the one for FM. You can work anywhere you can find a job that isn't in downtown Toronto or Ottawa. The Ministry of Health is supposed to help you find a job in a setting you like (and agree to) which may be a hidden perk as they don't offer employment help to CMGs.

I've heard IMGs want to challenge this legally, do you know if this is true?

I don't know of any legal challenges in the works. There are many possible explanations as to why it hasn't been challenged. The most likely is that people who have signed these contracts don't feel restricted enough to proceed legally either because they found a job somewhere they don't mind working or because the Ministry of Health isn't enforcing the RoS agreements. It's important to point out that there are very few job openings in downtown Toronto or Ottawa anyway. It's also possible that any challenges are being settled privately out of court. I have heard nothing about RoS since I started residency either officially or through the grapevine which given the speed of hospital gossip likely means that however it's working people aren't feeling abused.

Also i've heard you can buy your agreement out. So work 1 or 2 years and then pay the fee to get out of your agreement? Do you know if this is true?

There is no 'buy-out' clause in the contract. There is a clause that says: if breeched you may be liable for costs including your full salary and cost of training (paraphrased). There is no amount given. It's implied that the salary you get as a resident is a training stipend and that the work you do in hospital has no value. If resident work has value for even a portion of the resident salary and training costs then the damages constitute unjust enrichment (i.e. the Ministry is getting something for nothing) which is an illegal clause in contract law I've been told.

The opinion I have is that the whole contract--and the way that medical students enter the contract during the CaRMS process--is legally dubious. I'm sure the Ministry of Health knows that and that may affect their enthusiasm for enforcing the RoS agreement.

 

[Medstart108]

A few corrections and answers. Again this only applies to the RoS agreement I've seen which is the Ontario one from 2011.



The agreement for Royal College Specialists is the same as the one for FM. You can work anywhere you can find a job that isn't in downtown Toronto or Ottawa. The Ministry of Health is supposed to help you find a job in a setting you like (and agree to) which may be a hidden perk as they don't offer employment help to CMGs.



I don't know of any legal challenges in the works. There are many possible explanations as to why it hasn't been challenged. The most likely is that people who have signed these contracts don't feel restricted enough to proceed legally either because they found a job somewhere they don't mind working or because the Ministry of Health isn't enforcing the RoS agreements. It's important to point out that there are very few job openings in downtown Toronto or Ottawa anyway. It's also possible that any challenges are being settled privately out of court. I have heard nothing about RoS since I started residency either officially or through the grapevine which given the speed of hospital gossip likely means that however it's working people aren't feeling abused.



There is no 'buy-out' clause in the contract. There is a clause that says: if breeched you may be liable for costs including your full salary and cost of training (paraphrased). There is no amount given. It's implied that the salary you get as a resident is a training stipend and that the work you do in hospital has no value. If resident work has value for even a portion of the resident salary and training costs then the damages constitute unjust enrichment (i.e. the Ministry is getting something for nothing) which is an illegal clause in contract law I've been told.

The opinion I have is that the whole contract--and the way that medical students enter the contract during the CaRMS process--is legally dubious. I'm sure the Ministry of Health knows that and that may affect their enthusiasm for enforcing the RoS agreement.

Thanks so much for the answers. I never knew that specialists can work in southern ontario. Even places like Richmond Hill or North York?

I do have one more question. If you do accept a training place in Ontario and are given the RoS. If you decide to do a fellowship (if its in Canada) are you allowed to do so before you start your RoS? What if the fellowship is in the US?

 

[jnuts]

To repeat the disclaimer this information is about Ontario ONLY.

My bottom line continues to be no one really knows what's going on with RoS.

I did a quick search for references for this post and it's quite telling that the ministry has taken down a lot of the previously available information. If anything the details of the program have gotten even less specific than when I signed my agreement. The CaRMS website still uses a background document from 2007! That 2007 document is the only thing available to you when you sign your binding contract with CaRMS to enter into the Residency should you match. You don't get to see the actual RoS contract until well after the match (which is one of the big legal problems I alluded to earlier as it goes to the voluntary nature of the contact).

I think the RCPSCs North and CFPCs anywhere information refers to the Physician grant program:

https://ospace.scholarsportal.info/bitstream/1873/10449/1/280295.pdf

Here's the map of excluded communities as per HealthForce Ontario. If you talk to Healthforce Ontario they deny any specific knowledge of the RoS agreement and tell you they're just a recruitment agency with no input on MoHLTC policies. But here it is for what it's worth:

http://www.healthforceontario.ca/Us...service-exclusions-in-ontario-aug-2012-en.pdf

BTW, I love this map. It really couldn't get much more vague. The two communities aren't even depicted the same way.

Some of the University pages have other information about RoS. Eg:

http://meds.queensu.ca/education/postgraduate/policies/return_of_service/finding_ros_communities

Most of it seems pretty out of date and different Universities have conflicting information. The LADAU referred to on the Queens website above doesn't exist anymore on the MoHLTC website. It did when I started residency two years ago but never had more than three jobs on it at a time most of which were for allied health positions. I think they were trying to list all underserviced health care jobs and it just fell apart. I think the Ministry is really off on that one as most medical jobs are created behind the scenes and are not publically advertised (at least the hospital-based ones).

In terms of fellowships, the language of the contract talks about discharging your obligations on completion of your 'training.' 'Training' is not defined. Again I've never heard of anyone being prevented from doing fellowships wherever they want in any field they want.

My subjective impression is that the MoHLTC knows the RoS program for IMGs is a dud and is largely ignoring it. It's politically popular for them to say immigrant doctors have ways to enter the system and they're supposed to go work in underserviced communities. I think most of us are aware that it's really not working out that way due to residency admission preferences and the existence of other entry streams for fully and partially qualified physicians:

http://www.health.gov.on.ca/english/providers/ministry/recruit/repat/repat_app.html

Even the concept falls apart under scrutiny. The best use of IMGs is to have them practice in communities with high numbers of other immigrants such that they can get excellent culturally sensitive care in a language they're comfortable speaking.

In terms of physician redistribution, I think that the MoHLTC is getting much more value out of it's other programs like tuition support and interest relief and is consequently much more focused on those programs. Most of the language around RoS available online seems to reflect this shift and avoids mentioning IMGs. Here's the description of one of the programs I'm talking about:

http://www.health.gov.on.ca/en/pro/programs/rlirp/service.aspx‎

These are programs in which CMGs can participate. There's no question that they're voluntary. It results in physicians that likely had interest in working in underserviced communities getting an incentive to do so after residency. If they want to get out of the contract the costs are well defined and quite reasonable.

http://www.health.gov.on.ca/en/pro/programs/northernhealth/docs/free_tuition_rsa.pdf

If you read the contract for the Northern tuition support agreement above it's actually very specific and outlines penalties in detail. The IMG RoS contract looks NOTHING like the tuition relief one.

Again my overall impression here is that no one knows what's going on with IMG RoS but no one is complaining about it. I think that's because it's not really being enforced.

Sorry about the ranting quality of this post but this is a pet peeve of mine.

 

[bambi]

As well, Ireland carries with it a much better international reputation as compared to medical schools in England and Scotland, etc.

Are you out of your mind??

 

[EmmalineA]

Hi everyone,

I've read this thread with a great deal of interest, and absolutely appreciate the sobering and realistic points of view that have been shared. I was hoping to get a little advice and insight about maybe attending UCD.

I recently accepted a place in the graduate entry class at UCD School of Medicine. I have also accepted a place at an MD medical school here in the US, and must decide very soon where I want to attend this fall. It has always been my dream to get my medical education in Europe and eventually practice there. I also have the benefit of being a dual US/EU citizen through my father, who was born and raised in England and emigrated to the US before I was born.

However, if I do decide to attend UCD (and that truly is my preference), I would do so with the intention of pursuing an internship in either Ireland or the UK after graduation, and permanently emigrating there with no desire of returning to the US. I understand that if I wanted to pursue a residency in the US, it would make much more sense to attend school in this country as the difficulties IMGs face coming back to NA has already been pointed out.

Of course the biggest obstacle in all this, as much as I hate that this is the case, is money. Regardless of whichever school I attend, I will fund my education with US federal loans and be in an enormous amount of debt upon completing my medical degree. Staying in the US means this is less of a problem, as physicians in the States are very highly paid, especially in certain specialties. However in Europe the average physician salary is substantially less than in the States, but doctors are also in substantially less debt after school.

I guess what I want to know is how much of a risk I would be taking - I don't want to end up in a situation where I am crippled with US-med school-sized debt and unable to find employment in Ireland/UK after medical school that would allow me to pay it off (of course I know a big part of this depends on my performance in medical school and exam results, but assuming that I am able to do well enough to be competitive for an internship, I want to know what other obstacles I will face).

I wanted to know if anyone was aware of someone in a similar situation - and most importantly how they dealt with the financial side of things. If money were no obstacle I would choose UCD over the US school, but because I need to be thinking about what is going to happen to me after I graduate and how this huge amount of debt will affect the rest of my life, I really want to get as much information as possible about whether or not going to UCD would be the smart choice. It's a difficult decision with pros and cons for either choice. Bottom line, if I decide to go to the MD school, I will do my residency in the US and get my debt paid off before I consider emigrating. But since I know that I want to eventually live and work in Europe, I would rather get my education and training there as I think it would make it much easier to gain employment. But at the end of the day, is it worth that huge debt sitting on my back for the next couple decades?

 

[Medstart108]

While European doctors do make less than US doctors, European residents often make similar if not slightly more than US residents and work fewer hours.

If you have EU citizenship i think you won't have trouble getting a position.

If you would love studying in Dublin for 4 years over in the US and just like Europe in general then that does make it ok to choose UCD.

If you become a EU doctor it won't be terribly hard to pay off your debt.

 

[IrishDR]

2nd Year RCSI Student here...
Saw this thread before I started should have taken it more seriously... Anyway I am most likely going to transfer to a big three Caribbean school...no point in spending about 100K a year ( 60K on tuition alone) + accommodation etc to still be a "IMG" The teaching here is nothing to be happy about, too much favoring of arabs which is sad but true.(something shady is def going on in terms of exams passing/etc), horrible facilities, EXTREMELY disorganized classes. I can go on and on.

To anyone considering rcsi, do yourself a favor and look elsewhere. Keep your parents money. At the end of the day it comes down to your USMLE score and nothing else. GO to a Caribbean school, where you do your rotations IN THE US!!

 

[ClenKeane]

I disagree. I graduated from RCSI in 2012 and found the teaching to be world class. Studying medicine in Ireland was a life changing experience and I would choose RCSI again after having completed the degree.

I matched into my first choice for residency (Yale Anesthesiology class of 2016).

I would be happy to answer any questions regarding my experience.


QUOTE=IrishDR;14348916]2nd Year RCSI Student here...
Saw this thread before I started should have taken it more seriously... Anyway I am most likely going to transfer to a big three Caribbean school...no point in spending about 100K a year ( 60K on tuition alone) + accommodation etc to still be a "IMG" The teaching here is nothing to be happy about, too much favoring of arabs which is sad but true.(something shady is def going on in terms of exams passing/etc), horrible facilities, EXTREMELY disorganized classes. I can go on and on.

To anyone considering rcsi, do yourself a favor and look elsewhere. Keep your parents money. At the end of the day it comes down to your USMLE score and nothing else. GO to a Caribbean school, where you do your rotations IN THE US!![/QUOTE]

 

[jenjoie]

Just out of curiosity...can you give me your thoughts/information on a US student studying and practicing in the UK? I have been applying to US schools but the truth is I have always wanted to move and live abroad. Would it be a good idea for me to just get my education overseas as well?

 

[Xenops]

Just out of curiosity...can you give me your thoughts/information on a US student studying and practicing in the UK? I have been applying to US schools but the truth is I have always wanted to move and live abroad. Would it be a good idea for me to just get my education overseas as well?

My understanding is that it's difficult for a non-EU person to get training and a position after school, but perhaps someone could elaborate on that.

 

[Medstart108]

My understanding is that it's difficult for a non-EU person to get training and a position after school, but perhaps someone could elaborate on that.

If you do medical school in the UK you can get a foundation position and your specialty training (residency) without problems even if you are a non-EU citizen.

If you do medical school anywhere else in the EU and you are not a EU citizen you can't go to the UK for residency.

If you do medical school anywhere in the EU and you are a EU citizen you can go to the UK for residency.

So basically if you are Canadian/American if you want a solid back up the UK is the best option. If you are a EU citizen then going to Ireland is also ok.

 

[Jelloh]

People keep saying that it "helps" to be an EU citizen. Can anyone elaborate on what that really means, in practice? If you are flexible in location, are you likely to find yourself unemployed after intern year (as a US citizen hoping to stay and practice in the UK) or is it more that you will have a hard time only if you are dead set on a certain specialty or a certain city?

Like if I want to be a GP and don't need to be in, like, London, am I going to be out of work or is it likely to be ok?

Also, how long does it take to start moving towards getting citizenship?

 

[jenjoie]

People keep saying that it "helps" to be an EU citizen. Can anyone elaborate on what that really means, in practice? If you are flexible in location, are you likely to find yourself unemployed after intern year (as a US citizen hoping to stay and practice in the UK) or is it more that you will have a hard time only if you are dead set on a certain specialty or a certain city?

Like if I want to be a GP and don't need to be in, like, London, am I going to be out of work or is it likely to be ok?

Also, how long does it take to start moving towards getting citizenship?

I unfortunately can't answer the first part of your question, but I believe in order to be considered for citizenship you must reside in the country for a total of 5 years. The years you are in country on a student visa do not count.

I am also interested in the logistics of moving a spouse to Ireland...work permits, etc. Also, if he obtains citizenship what effect (if any) would that have on my school/internship/employment?

 

[bambi]

If you graduate from an EU country or are a citizen of an EU country you are considered equal to a UK citizen who graduated from a UK medical school. I think this is the case at all levels but is certainly the case for foundation years. This is also much better than it was a few years ago.

If you are not an EU citizen and did not graduate from an EU school in order to get a job there needs to be no one that is either an EU citizen or graduated from an EU school that is capable of doing the job for you to get it.

 

[Zelda840]

Wow - lots of information here! I've been considering applying to a few schools in Ireland, but this info is pretty sobering. I'm a US citizen and will have my BS in Neuroscience here in a couple months, so was only looking at the 4 year programs. Seems like that might not be the best option, though. I don't have my sights on surgery or anything, but I also don't want to limit my options to only FM. I suppose I'll just go the safe route and stay in the states, though it does kill a little piece of me to not get to experience Dublin.

 

[huanhoho]

Very nice comments in the topic.

So if the residency program has now almost equal number of graduation and US still has shortage of psychiatrists, what's about recognizing psychiatrists from overseas with reasonable criteria?

I'm a doctor and psychiatrist (residency ended in 2012) in Brazil and I'm searching for migration options in US, UK or Australia/NZ. Our residency program is very similar to other programs.

The reason about I want to leave Brazil is the political way the country is following. It's very complicated and I can write a book about that...

I'll be in Australia in May and maybe I'll search for some help with the pathways in Area of Need and specialty validation in some mental health services.

I read about UK incentives in psychiatry some years ago but I don't know how it's working now. In 2006 UK had a scheme to attract overseas psychiatrists and after 2 years maybe get a fellow.

Someone can tell something about that?

Do you think it's too hard to achieve my goals in US, UK or Australia? Is someone in a similar way?

Regards.

 

[Medstart108]

Very nice comments in the topic.

So if the residency program has now almost equal number of graduation and US still has shortage of psychiatrists, what's about recognizing psychiatrists from overseas with reasonable criteria?

I'm a doctor and psychiatrist (residency ended in 2012) in Brazil and I'm searching for migration options in US, UK or Australia/NZ. Our residency program is very similar to other programs.

The reason about I want to leave Brazil is the political way the country is following. It's very complicated and I can write a book about that...

I'll be in Australia in May and maybe I'll search for some help with the pathways in Area of Need and specialty validation in some mental health services.

I read about UK incentives in psychiatry some years ago but I don't know how it's working now. In 2006 UK had a scheme to attract overseas psychiatrists and after 2 years maybe get a fellow.

Someone can tell something about that?

Do you think it's too hard to achieve my goals in US, UK or Australia? Is someone in a similar way?

Regards.

I'm not sure but yeah i don't see why not, i mean you would be providing services as a physician without any of the cost to train you. In the US, you would need to re-do residency, they don't recognize foreign qualifications at all, but in the UK they might recognize you in some way you need to ask the GMC about this. check out the GMC website. http://www.gmc-uk.org/doctors/plab.asp

 

[deleted158872]

First of all, a bit of background about myself. I'm a US-IMG who came over to England for medical school in 2007. I managed to jump through all the hoops and was able to match into a pediatric residency in America. As an IMG, I've always had my eye on the foreign graduate situation and I've been seeing a disturbing trend over the last few years. And I just wanted to take this opportunity to share my thoughts and findings.

Ever since the onset of residencies in America, there have always been more residency spots than American medical graduates. That's why it has been relatively easy for foreign graduates to match into the 'IMG friendly' specialties (FM, IM, Neuro, Psych, Peds etc) and even occasionally sneak into the competitive fields. Foreign graduates were the ones who filled the gap.

But over the last few years, there has been a boom of osteopathic schools + increased enrollment in MD schools + opening of new MD schools. On the other hand the number of residency spots have remained the same due to budget constraints, and financial troubles. So if you put two and two together, there is a really dark cloud looming in the horizon for foreign medical graduates. It's projected that by 2015, the number of American graduates (MD+DO) will nearly equal the number of residency spots.

This would mean that even those five specialties will be quite challenging for IMGs (Even if you are from the UK or Ireland), unless you are an exceptional candidate with really high grades, excellent USMLE scores, research and electives at top hospitals. Have a look at this thread if you want to read more about the American situation http://forums.studentdoctor.net/showthread.php?t=858100

I am fairly certain that highly qualified IMGs will still be able to get "a" residency spot in America even if it's 2017 or 2020 in the traditionally IMG friendly specialties. But I'm pretty sure competitive specialties will almost certainly be off-limits unless you are an absolute superstar candidate (I'm talking PhD, years off for research, multiple publications in international journals etc.)

There are a handful of Canadians in my class, so I am quite aware of the CARMS situation as well. It's a similar type of picture, with more and more Canadians studying abroad with each passing year and a stable number of residency spots. Most of the times you are competing for a very very limited number of IMG 'quotas' or fighting for unfilled spots in the second round. I know a few people who decided to settle for Family Medicine or Psychiatry although they really wanted to do Pediatrics or Internal Medicine. The competition is getting incredibly tough and this article breaks it down quite nicely. http://www.cbc.ca/news/health/story/2011/02/22/canadian-students-medicine-overseas.html

The UK is really strict when it comes to foreign students (not sure about Ireland). Even if you go to school here, if you are not an EU/UK citizen, it is almost impossible to find good training posts beyond 2 years after graduation.

If you do come here, keep in mind that from the day you set foot in England/Ireland, you are walking on eggshells. You cannot afford to have even one red flag on your application. The competition for residency is going to be extremely tough in the coming years. So, no retakes during medical school and no poor scores or failures in any of your USMLEs or MCCEEs. Trust me...that is a lot of pressure, because one slip up and you have almost invariably burned off all your bridges to head back home. Even if you come out on the other end unscathed, getting into a well reputed residency program in a good metropolitan city will be tough, much much harder than getting into a north american medical school. There's a good chance that you'll find yourself in an unfortunate position where you'll have to compromise on your career choice and not be able to do what you love.

Therefore if you are a high school student, I would strongly advice you to do your undergraduate in North America, and apply to North American medical schools in a few years time; even if it means a bit of short term pain and uncertainty. Trust me, the long term consequences of going abroad significantly dampen the short term gains.

If you are an undergraduate student or finished your degree, try to get into North American medical schools for at least two years. In my opinion, only then should you even consider the possibility of going abroad for medical school. Do a post-baccalaureate or post graduate degree, retake the MCATs, do whatever it takes to improve your application. Europe should be your last resort after you exhaust all your North American options.

If you are already in UK/Ireland, at least you now know what you are up against and will be better prepared when the time comes to wage that uphill battle to get back home. Do audition electives at places where you want to work, these are invaluable!! Second only to your USMLE/MCCEE scores. On top of that, do research, get published, go to conferences, present audits, volunteer, and take on leadership roles. Turn yourself into a solid, well rounded applicant!

If I were applying right now, I wouldn't even entertain the possibility of studying in the UK, not even for a nanosecond!! Things have changed so much in the last five years and they're heading downhill with each passing year. Of course you'll hear the anecdotal success stories, but please take them with a grain of salt. Because behind every success you hear about on SDN there are stories without happy endings; struggles, hardships and regrets we never hear about. I'm the only American in my class and we had seven Canadians when we first started. Three of them failed out at different junctures of our course. Out of the four who are still here, two of them applied to Canada this year (the other two are planning to apply next year because they haven't written their MCCEE yet). Unfortunately both of them did not match despite coming from a well reputed medical school in England and possessing bachelors degrees from Canada. They're trying for round 2, but most likely they'll have to stay here and try again next year. So if this is the situation today, just imagine what's looming in the horizon? There is a category 5 hurricane brewin' in the ocean my friends.....be very very careful before you decide to swim directly towards it.

Sorry about this epic gloom and doom message. But I really think that anyone who comes to England or Ireland should be aware of the long term consequences and be able to make an informed decision. I know how difficult and unfair the medical admission process in North America is. I've seen many qualified candidates fall through the crack time and again. And I understand the appeal of well reputed medical schools in Ireland and England, places that are willing to give you a shot at your dreams. But just make sure that you have exhausted all your options back home before you get on that transatlantic flight. That way you will have absolutely no regrets a few years down the road, and you can be at peace with your decision for the rest of your life.

If you knew all this already, I'm sorry for taking up your time. But either way, I hope it was at least a little bit helpful. All of this is just my personal opinion based on my own experiences and observations; please don't take it as anything more. Having studied in the UK and having just gone through the match, I feel like I have gained quite a lot of insight into this process. Others might disagree with me. So please do your own research and come to your own conclusions. I wish you all the best and don't hesitate to message me if you have any more questions or need any help.

Thank you very much for your post.

I have a question: Some US residencies require IMGs to have "at least 1 year of clinical rotation in the US". If I go to Ireland to study and do 1 or 2 elective rotations in the US (winter and summer are the only chances to do electives in the US, afaik), will that fulfill the "at least 1 year" requirement demanded by some US residencies?

 

[Medstart108]

Thank you very much for your post.

I have a question: Some US residencies require IMGs to have "at least 1 year of clinical rotation in the US". If I go to Ireland to study and do 1 or 2 elective rotations in the US (winter and summer are the only chances to do electives in the US, afaik), will that fulfill the "at least 1 year" requirement demanded by some US residencies?

No it won't. If they say 1 year it basically means unless you went to UQ-O or SGUL INTO or the Caribbean you won't be able to apply. However, most programs don't say that.

 

[torontopharm]

No it won't. If they say 1 year it basically means unless you went to UQ-O or SGUL INTO or the Caribbean you won't be able to apply. However, most programs don't say that.

HMI affiliated schools in Poland allow your clinical rotations to be done in USA (the entire 2 years).
But it's an agency and there are rumors that they're not the best people to deal with Plus their step 1 pass rate might be crap compared to the schools you mentioned.

 

[deleted158872]

feels the need to bump this thread.

anyone has similar / different opinions?

 

[RCSI student]

feels the need to bump this thread.

anyone has similar / different opinions?

I'll post a bit about my story and opinion. I'm not trying to persuade or deter anyone from their choice because, IMG route is a good choice for some and a bad choice for others and nobody but you can make that decision.

I started at RCSI four years ago because like most people in my class it was either go the IMG route or choose a different career. At the time I received plenty of warnings from my American and Canadian colleagues telling me not to go. The main warnings in 2012 were along the lines of: IMG numbers will drastically increase in 2016 and the USMD/USDO will surpass the number of available residency positions making IMGs obsolete etc. Despite their predictions the IMG match rate has increased from 49.1 --> 53.9 (U.S. IMGS) and from 40.6 --> 50.5 (Non U.S. IMGs) from 2012 to 2016 ( http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf ). I worked hard in medical school and ticked all the boxes for a good application and managed to match to my first choice. I also had the pleasure of watching nearly all of my friends and the majority of my classmates not only match but, match to one of their top 3 choices. Even the few people I knew who didn't match in 2015, managed to match this year as well. I also got to spend 4 years living in a pretty sweet city and sneak in a handful of cheap trips around the rest of Europe. Obviously not everyone matches and I met a few people on the interview trail who were on their second or third cycle but, these were the minority.

With regards to my opinion towards potential IMGs. This is a very difficult process. You will have to work harder than you ever have before. There will be a lot of stress and probably a few grey hairs. You have to be willing to be flexible with regards specialty and location (many if not most people do get the specialty of their choice and location of choice but, had less desirable choices as back-ups). There will be obstacles in your way like the upcoming statement of need restrictions for Canadians but, with a little research and intuition they can be worked around. There will always be a risk of not matching or having to settle for a specialty thats not your first choice. If you are not okay with any of the above statements then perhaps you should reconsider your choice to go the IMG route. Whether you succeed or not will depend entirely on you. That being said; more than half of all IMGs match to the U.S. and this year there were over 6,000 IMGs who achieved their dream of matching as a U.S. resident. Studying abroad is the experience of a lifetime and I would do it again in a heart beat. Its not the right choice for everyone and some people are better off going a different route.

 

[deleted158872]

I'll post a bit about my story and opinion. I'm not trying to persuade or deter anyone from their choice because, IMG route is a good choice for some and a bad choice for others and nobody but you can make that decision.

I started at RCSI four years ago because like most people in my class it was either go the IMG route or choose a different career. At the time I received plenty of warnings from my American and Canadian colleagues telling me not to go. The main warnings in 2012 were along the lines of: IMG numbers will drastically increase in 2016 and the USMD/USDO will surpass the number of available residency positions making IMGs obsolete etc. Despite their predictions the IMG match rate has increased from 49.1 --> 53.9 (U.S. IMGS) and from 40.6 --> 50.5 (Non U.S. IMGs) from 2012 to 2016 ( http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf ). I worked hard in medical school and ticked all the boxes for a good application and managed to match to my first choice. I also had the pleasure of watching nearly all of my friends and the majority of my classmates not only match but, match to one of their top 3 choices. Even the few people I knew who didn't match in 2015, managed to match this year as well. I also got to spend 4 years living in a pretty sweet city and sneak in a handful of cheap trips around the rest of Europe. Obviously not everyone matches and I met a few people on the interview trail who were on their second or third cycle but, these were the minority.

With regards to my opinion towards potential IMGs. This is a very difficult process. You will have to work harder than you ever have before. There will be a lot of stress and probably a few grey hairs. You have to be willing to be flexible with regards specialty and location (many if not most people do get the specialty of their choice and location of choice but, had less desirable choices as back-ups). There will be obstacles in your way like the upcoming statement of need restrictions for Canadians but, with a little research and intuition they can be worked around. There will always be a risk of not matching or having to settle for a specialty thats not your first choice. If you are not okay with any of the above statements then perhaps you should reconsider your choice to go the IMG route. Whether you succeed or not will depend entirely on you. That being said; more than half of all IMGs match to the U.S. and this year there were over 6,000 IMGs who achieved their dream of matching as a U.S. resident. Studying abroad is the experience of a lifetime and I would do it again in a heart beat. Its not the right choice for everyone and some people are better off going a different route.

thanks for sharing!

what do you think about the OP's perception about shorter vs. longer rotation time in the US? is he right about spending 2 clinical years in the US (eg, Caribbean, Ochsner) being better than 2-3 months for match purposes?

 

[PhysioMD]

^ personally I think it depends on where / what you want to match into.

Where would you ideally like to match??

 

[deleted158872]

^ personally I think it depends on where / what you want to match into.

Where would you ideally like to match??

primary care in the Northeast US.

 

[PhysioMD]

I personally would think if 2 students (1 from Ireland and 1 from SGU) had identical strong Step Scores, and the SGU student had multiple strong US letters of reference compared to maybe 1 rotation and 1 letter for the Irish student, they would take the SGU student and say it is better "american experience". At the end of the day they want to ensure the resident will be able to function in the American healthcare system. And the SGU student who spent 2 years will have an advantage. That's not to say that schools don't value Irish healthcare, of course they have great doctors there, but it is a different system and the primary goal is to train a resident in the US who will succeed in the US, and the SGU student will have shown an ability to handle the US system (which is quite different in ways).

 

[PhysioMD]

primary care in the Northeast US.

I honestly think primary care will not be tough to match into. Just make sure you have a few US electives done (also observership on time off).

 

[RCSI student]

thanks for sharing!

what do you think about the OP's perception about shorter vs. longer rotation time in the US? is he right about spending 2 clinical years in the US (eg, Caribbean, Ochsner) being better than 2-3 months for match purposes?

That's a very difficult question to answer. In theory longer rotation time in the US should equal a better match chance but, that doesn't translate into match stats. NRMP IMG data is unfortunately from 2013 and a bit outdated but, it shows a country comparison match rate which puts Ireland on par with the top Caribbean countries (better than a good few of them). There's a few reasons I can think of as to why this may be. The first is that because we only do 3 electives we tend to use them to audition at ideal programs. In your case, you would work very hard to get a primary care elective in the Northeast which could not only turn into a job the next year but, rec letters from those programs would carry a lot of weight in nearby programs (medicine is a very small world). The second reason is that many Irish students do rotations and got letters from some of the best hospitals in the country (Harvard, Mayo Clinic, Yale, Sloan Kettering, Duke, Colombia etc.). Those letters carry a ton of weight. Another reason is that Ireland and UK have a strong reputation in certain areas of the U.S. (the northeast is one of those areas). There are tons of Irish grads and current residents who are constantly showing off the quality of European medical training. I know several residencies that haven taken at least one Irish grad every year for the last few years and have continued that trend this year. The main thing is that Ireland has maintained a strong match rate that is comparable to the top Caribbean schools.

 

[Medstart108]

I'll post a bit about my story and opinion. I'm not trying to persuade or deter anyone from their choice because, IMG route is a good choice for some and a bad choice for others and nobody but you can make that decision.

I started at RCSI four years ago because like most people in my class it was either go the IMG route or choose a different career. At the time I received plenty of warnings from my American and Canadian colleagues telling me not to go. The main warnings in 2012 were along the lines of: IMG numbers will drastically increase in 2016 and the USMD/USDO will surpass the number of available residency positions making IMGs obsolete etc. Despite their predictions the IMG match rate has increased from 49.1 --> 53.9 (U.S. IMGS) and from 40.6 --> 50.5 (Non U.S. IMGs) from 2012 to 2016 ( http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf ). I worked hard in medical school and ticked all the boxes for a good application and managed to match to my first choice. I also had the pleasure of watching nearly all of my friends and the majority of my classmates not only match but, match to one of their top 3 choices. Even the few people I knew who didn't match in 2015, managed to match this year as well. I also got to spend 4 years living in a pretty sweet city and sneak in a handful of cheap trips around the rest of Europe. Obviously not everyone matches and I met a few people on the interview trail who were on their second or third cycle but, these were the minority.

With regards to my opinion towards potential IMGs. This is a very difficult process. You will have to work harder than you ever have before. There will be a lot of stress and probably a few grey hairs. You have to be willing to be flexible with regards specialty and location (many if not most people do get the specialty of their choice and location of choice but, had less desirable choices as back-ups). There will be obstacles in your way like the upcoming statement of need restrictions for Canadians but, with a little research and intuition they can be worked around. There will always be a risk of not matching or having to settle for a specialty thats not your first choice. If you are not okay with any of the above statements then perhaps you should reconsider your choice to go the IMG route. Whether you succeed or not will depend entirely on you. That being said; more than half of all IMGs match to the U.S. and this year there were over 6,000 IMGs who achieved their dream of matching as a U.S. resident. Studying abroad is the experience of a lifetime and I would do it again in a heart beat. Its not the right choice for everyone and some people are better off going a different route.

I cannot emphasize the fear mongering enough. When I was deciding to go abroad the forums were filled with these sorts of posts, all citing the same JAMA article that if anyone had read properly (instead of reading the eye catching first paragraph) only predicted that US medical school first years would equal US residency spots by 2016-17. At the time people were saying that this would mean that by 2015 all IMGs would have no chance at matching anymore.

Not only did this fail to account for the growth in residency spots in general, it also overestimated the speed at which US medical schools opened and it also misinterpreted the article, if US first years truly did = US residency spots in 2016-17, then the problem would not even become apparent until 2020 when they graduate.


http://jama.jamanetwork.com.libaccess.lib.mcmaster.ca/article.aspx?articleid=1475200#ref-jvp120100-1

If you look at the article, in the first paragraph it makes a grandiose accusation that in 2015 US grads = US residency spots. The article it cites to prove that US residency spots will equal US graduates by 2015 never mentions that at all in its own article. Amazing how JAMA let this piece of shoddy work get published.

On top of that, if you keep reading the article:
"A forecasted physician shortage has led to expansion of enrollment in existing US medical schools and establishment of new ones (both allopathic and osteopathic), with 19 230 first-year students enrolled in 2011; the number of students graduating from US medical schools is therefore increasing quickly (projected to reach 26 709 enrolled per year by 2016-2017, a 37% increase relative to 2002-2003).4 However, the number of training positions in US residency programs has not similarly expanded and, indeed, may contract as a consequence of decreases in graduate medical education funding. In 2011 there were 26 386 postgraduate year 1 positions in Accreditation Council for Graduate Medical Education–accredited programs (growth rate from 2001-2010, 0.883% per year).1"

You will see that they even predicted 26.7k enrolled per year aka first years in 2016-17. Assuming that the number of PGY-1 spots did not budge at all from 2011, would not even equal until around 2020.

I will be 100% honest I knew that those people who were fear mongering were wrong but I couldn't fight against the sheer amount of people saying it, but I just knew one day that they would be proven wrong and you can even go back to those posts back in 2012 and 2013, I said that one day when all the rumor mill proved false, all the fear mongerers would not say a peep. Low and behold, it turns out to be true. At the end of the day, the USMGs and CMGs who post this stuff do not have any skin in the game, they are actually more likely to encourage you to keep trying at home because that is the way they got in.

Thank you for sharing your experience and congrats on matching.

 

[popeyespinach]

This is a question targeted to anyone who knows about studying abroad or has studied abroad. Suppose I wanted to pursue a residency in neurology, general surgery or ortho, how difficult would it be for someone to pursue that having studied in Ireland (TCD and NUIG is where I applied), to say, going to Israel (any one of Technion, Sackler or Ben Gurion) where they are affiliated with some schools in NY? I understand if I wanted to pursue neurology, GenSurg or Ortho, I'd have to do elective rotations in north america and definitely in those areas. So how difficult is it to set up those elective rotations? Mind you, I have no connections in the medical field whatsoever.

 

[RCSI student]

This is a question targeted to anyone who knows about studying abroad or has studied abroad. Suppose I wanted to pursue a residency in neurology, general surgery or ortho, how difficult would it be for someone to pursue that having studied in Ireland (TCD and NUIG is where I applied), to say, going to Israel (any one of Technion, Sackler or Ben Gurion) where they are affiliated with some schools in NY? I understand if I wanted to pursue neurology, GenSurg or Ortho, I'd have to do elective rotations in north america and definitely in those areas. So how difficult is it to set up those elective rotations? Mind you, I have no connections in the medical field whatsoever.

I'll break it down for each option:
Gen Surg: generally pretty straightforward to get an elective. I know a few classmates took a general surgery elective in collaboratives because most of the medical ones were taken. There's a lot of gen surg electives available.
Ortho: probably top 5 most competitive specialties and nothing will be easy about getting an elective or matching to Ortho. You will need 250+ on both Step 1 and Step 2 along with 3 ortho electives resulting in 3 letters of rec essentially comparing you to the second coming.
Neurology: a bit of niche specialty. They will want to see genuine interest in matching to neurology and if you can show that it shouldn't be too hard.

 

[UBC2014]

This is a question targeted to anyone who knows about studying abroad or has studied abroad. Suppose I wanted to pursue a residency in neurology, general surgery or ortho, how difficult would it be for someone to pursue that having studied in Ireland (TCD and NUIG is where I applied), to say, going to Israel (any one of Technion, Sackler or Ben Gurion) where they are affiliated with some schools in NY? I understand if I wanted to pursue neurology, GenSurg or Ortho, I'd have to do elective rotations in north america and definitely in those areas. So how difficult is it to set up those elective rotations? Mind you, I have no connections in the medical field whatsoever.

popeye, aren't you a Canadian? Just a heads up that Health Canada sponsors zero statement of needs for Ortho training in the U.S. It does however sponsor 15 general surgery and 20 neurology SONs. So if you do everything right and do match to a US program in either of those 2 specialities, you should be fine for a SON based on current data.

 

[popeyespinach]

popeye, aren't you a Canadian? Just a heads up that Health Canada sponsors zero statement of needs for Ortho training in the U.S. It does however sponsor 15 general surgery and 20 neurology SONs. So if you do everything right and do match to a US program in either of those 2 specialities, you should be fine for a SON based on current data.

Hi @UBC2014, yes I am Canadian. Would you mind clarifying what you mean by sponsoring statement of needs? I don't understand why Health Canada would have to sponsor someone to do a residency in a US program? So confusing all this

Edit: Just googled and read this.
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/postgrad-postdoc/index-eng.php
This is super informative

 

[UBC2014]

Hi @UBC2014, yes I am Canadian. Would you mind clarifying what you mean by sponsoring statement of needs? I don't understand why Health Canada would have to sponsor someone to do a residency in a US program? So confusing all this

Edit: Just googled and read this.
http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/postgrad-postdoc/index-eng.php
This is super informative

Yikes, Yes, every EVERY premed looking to do medicine as a Canadian citizen abroad should read that first and foremost.

As a Canadian citizen, Canada holds your fate for the J1 visa to do residency training in the U.S. via a Statement of Need. The US Dept of Immigration requires a Statement of Need from your country of permanent residence etc, stating that they need doctors of your residency program, before you can successfully be on your way of getting a J1 visa to do residency. All non-US citizens need a visa to do residency in the US. The most common by far is the J1.

You can refer to my other posts about H1B, and it will make even more sense why I was "arguing on the internet" about due diligence of USMD/USDO schools first and foremost for the majority of cases.

So yeah, unless you do STEP 3 and are an absolute rockstar, and potentially sit out an year(you can only do Step 3 after you graduate..state dependent, and it is required for the H1B, could cause issues for timing unless you are a December grad, or sit out a year..or get really lucky with timing to make it for July 1st), you won't be getting an H1B for Ortho as an IMG. And J1 is out of the question for Ortho and a few other fields as a Canadian IMG.

EM is pretty much(not 100%!) out too, since Canada only accepts the 4 year EM programs now and there are so few of them, as most are 3 year programs...but its not completely impossible.

 

[Medstart108]

On the flip side Ortho is not as competitive in Canada since the job situation isn't so great still, they take around 5-6 IMGs each year, probably the easiest surgical subspecialty to match to as an IMG.