Hi, I'm an Canadian who graduated from an Irish medical school and is very familiar with the process due to my friends who matched to the USA. I can't speak to the experience after residency as they are still completing residency.
As a Canadian, I think its important for you to know about the current climate for CSA in the US. Anyone who started residency after 2016, can no longer complete sub-specialty training in IM or Peds that are longer than one year. J1 Visas and statement of need is only offered for 1 year fellowships. This leaves only palliative, geriatrics, or a chief resident year. In addition, Canada is decreasing the statement of need issued for most specialities except FM. This means unless, your doing FM, you might have trouble getting a statement of need if you match. As a result, Canadians are getting less and less interviews in the USA.
Particular states that are easier include Michigan, Chicago, New York, New Jersey. Even if a State is non-IMG friendly, there may be pockets of program that are IMG friendly within that State so its still worth applying. You can use "match-a-resident" to filter IMG friendly programs and FRIEDA to see which programs offer J1 Visa.
As an IMG from Ireland, some of your obstacles include:
1. Securing enough experience in the USA. Some programs require a minimum of 3 months, 6 months, or 1 year of experience in the USA.
2. Less interviews because of the J1 Visa issue. Program directors are less reluctant to interview Canadians because of the statement of need issue.
3. Doing well on board exams. Your pretty screwed if you fail a board exam.
4. Irish guidelines different from American guidelines.
5. Taking time off rotation to fly to interviews in the USA.
6. Differences between US and Irish Clerkship. Irish clerkship is very variable. More often than not your just observing. Less autonomy. In the US, there is more autonomy as a medical student. Canadian electives are the best. You start seeing multiple patients on your own right away for the most part. You can also participate in over night calls.
7. Getting support for USMLE in your program. Might have to rely more on your peers. In the USA, medical schools prepare their students well for USMLE. In Ireland, its up to you to figure out what you need to know.
After residency, if you on a J1 Visa, you can't stay in the USA after residency unless you apply to get a J1 Visa waiver. You can get one by agreeing to work in an underserved area for 2 years. Alternatively, when you start residency, you can see if a program will sponsor an H1B, but this is super costly to the program and rare.
