Confusion Regarding J1/SoN for Canadians pursuing US Residency

[chronic32]

Bonjour,
I am a Canadian citizen who was born in Canada, grew up in Canada, went to undergrad in Canada, and is currently a third year medical student at a LCME-accredited allopathic US medical school. I am currently trying to figure out which specialty to pursue in the 2016 match (and I'm running out of time), however since I intend to return to my country I would like to put their needs in front of my personal interests and choose something that we're in dire need of. So I'm looking at the 2015 List of Needed Specialties and Subspecialties and see that these specialties currently have unlimited endorsement:
Emergency Medicine, Family Medicine, Internal Medicine, Neurology, OB/GYN, Pediatrics, and Psychiatry.

Here's where I start to get confused. The J1 means you have to come back after residency, but how many of these can you actually practice in Canada after you come back? I know FM is for sure because the training is equivalent but how about the others? I'm saying this because most of these do not have the same length of training as Canadian residencies:
EM 3 year residency (a few 4 year programs), 5 in Canada
FM 3 years, 2 in Canada
IM 3 years, 5 in Canada
Neurology 4 years, 5 in Canada
OB/GYN 4 years, 5 in Canada
Pediatrics 3 years, 4 in Canada
Psychiatry 4 years, 5 in Canada

So I'm confused because I see this scenario happening: I match into let's say EM March 2016, I apply for my J1 (assuming EM is still unlimited endorsement but who knows), I get my J1, I complete my residency, I come home to Canada an ABEM-certified emergency doc ready to work since they needed me, can't get a job because I can't get licensed because my training isn't equal length, find job in oil fields.

Basically I'm confused as to why Health Canada offers SoNs for J1s for these specialties when they know the training isn't equal length or equivalent and Canadians who trained in the US wouldn't be eligible for licensure when they finish.

Now I've heard that for the specialties with a 1-yr difference, that gap can be made up with a fellowship. But wouldn't that person pursuing a fellowship require another SoN for endorsement for that fellowship? Let's say it's the same scenario except I match into OB/GYN March 2016. To make up for the 1 year gap, I apply for a fellowship in one of the OB/GYN fellowships that are in need, Maternal Fetal Medicine (3 are needed this year). What if those are used up already by other applicants? Now what would I do? In fact, in total all the OB/GYN fellowships add up to 7 for 2015 (which will likely change in 5 years to even lower), so what would all the Canadians who matched into OB/GYN do at the end of the residency? Work at McDonald's?

And what about the specialties with a 2 yr difference in training that currently have unlimited endorsement such as EM and IM? If I match IM in March 2016 and get my J1, how will I provide my skills to Canada in July 2019? I've heard of Pathway 3, but that's only Ontario right? What about the 9 other provinces? Where's their information on this?

This makes no sense. The J1 is a "return to your country after training here" contract. So why would Health Canada endorse specialties for the J1 when they know we wouldn't be able to practice back home after we train? If anyone has any insight into this or could post some links that would be helpful. And trust me, I've already scoured SDN, the Royal College website, the Health Canada website, and Google. I've been a member of SDN since 2012 and have been reading all along but as you can see I've never posted. I wouldn't have posted unless I really couldn't find legitimate answers to these questions.

Thank you.

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[UBC2014]

These are all good questions, you can also pursue a J1-waiver.

You can also get J1 extensions for further training to round out.

 

[iceroll]

I'm still deciding between med school in Canada vs. the US right now, but why don't you go for a H1b instead? If you're intent on staying in the US then why go through the trouble of J1 visas ans SoNs?

 

[NewCanadian]

the program for issuing statements of need (for j1 visa) is well aware, and there are ways to top up the training to meet RCPSC requirements. and yes, you would apply to health canada for another letter which are issued when the additional training is to be used to meet RCPSC requirements. (the health canada website does explain this, even if it is not in great detail.0

These examples will meet RCPSC requirements:

4 years adult psychiatry and 1 year fellowship
4 years adult psych and 2 years child psych
4 years neurology and 1 year fellowship
3 years internal medicine and Chief Resident at PGY4, must be at least 60 percent clinical
3 years internal medicine plus 1 year geriatric medicine
3 years pediatrics plus Chief Resident at PGY4, must be at least 60 percent clinical
1 year medicine plus 3 years emergency medicine plus 1 year fellowship
4 years diagnostic radiology plus 1 year fellowship
4 years A and C pathology plus 1 or 2 more years of fellowship depending on whether the doctor wants to qualify in General Pathology or Anatomical Pathology.

The 'fellowships' must be ACGME for the RCPSC to accept them.

Alternatively, doctors can obtain the 'missing time/skills' in an Ontario medical school using the Ontario Repatriation Program.
Quebec has a similar program for doctors from Quebec who will practice there afterwards.

Obgyn is difficult, however. There are no one year programs in the US to make the total of five years. In the US, there are only 3 year subspecialty programs. The RCPSC does accept ABOG accredited programs, so you would qualify with 7 years total and the RCPSC would allow you to write their exams. The problem as you have already noticed will be whether or not any of the Obgyn subspecialties are on the list for Statements of Need in the future.

Health Force Ontario has physician advisors available to help you come up with a plan.

 

[UBC2014]

I'm still deciding between med school in Canada vs. the US right now, but why don't you go for a H1b instead? If you're intent on staying in the US then why go through the trouble of J1 visas ans SoNs?

Because not all places offer H1B, because it is significantly more expensive than the J1.

It really limits options.

 

[chronic32]

the program for issuing statements of need (for j1 visa) is well aware, and there are ways to top up the training to meet RCPSC requirements. and yes, you would apply to health canada for another letter which are issued when the additional training is to be used to meet RCPSC requirements. (the health canada website does explain this, even if it is not in great detail.0

These examples will meet RCPSC requirements:

4 years adult psychiatry and 1 year fellowship
4 years adult psych and 2 years child psych
4 years neurology and 1 year fellowship
3 years internal medicine and Chief Resident at PGY4, must be at least 60 percent clinical
3 years internal medicine plus 1 year geriatric medicine
3 years pediatrics plus Chief Resident at PGY4, must be at least 60 percent clinical
1 year medicine plus 3 years emergency medicine plus 1 year fellowship
4 years diagnostic radiology plus 1 year fellowship
4 years A and C pathology plus 1 or 2 more years of fellowship depending on whether the doctor wants to qualify in General Pathology or Anatomical Pathology.

The 'fellowships' must be ACGME for the RCPSC to accept them.

Alternatively, doctors can obtain the 'missing time/skills' in an Ontario medical school using the Ontario Repatriation Program.
Quebec has a similar program for doctors from Quebec who will practice there afterwards.

Obgyn is difficult, however. There are no one year programs in the US to make the total of five years. In the US, there are only 3 year subspecialty programs. The RCPSC does accept ABOG accredited programs, so you would qualify with 7 years total and the RCPSC would allow you to write their exams. The problem as you have already noticed will be whether or not any of the Obgyn subspecialties are on the list for Statements of Need in the future.

Health Force Ontario has physician advisors available to help you come up with a plan.

Thank you NewCanadian for your response. However this leaves me a little more confused. Let's look at one of the examples, say 4 years Neurology and 1 year fellowship. The available ACGME fellowships for Neurology are:
Child Neurology 3 years
Clinical Neurophysiology 1 year
Critical Care Medicine 1-2 years
Neurodevelopmental Disabilities 4 years
Pain Management 1 year
Vascular Neurology 1 year

I see that Critical Care is endorsed, however any specialty can pursue this and Health Canada only sponsors 11 for 2015. None of the other fellowships are listed on the List of Needed Specialties and Subspecialties. So why would Health Canada have unlimited endorsement for Neurology but then not sponsor anything on the other side? Like what if I matched Neurology in March 2016, got unlimited endorsement from my government, finished my residency in 2020, and now Critical Care is no longer needed? Or what if all the Critical Care spots are taken? Then what would I do? I would be denied a SoN for all the other fellowships to make up that length gap in order to get certification from the Royal College!

The same thing goes for Adult Psychiatry...Our government gives unlimited endorsement for Adult Psych, but then limits the fellowships to Child and Adolescent Psych (16, 2 yr), Forensic Psych (3, 1 yr), and Geriatric Psych (13, 1 yr). And what's worse is that these numbers change every year. What if I enter Psychiatry then in 4 years NONE of these fellowships are endorsed, then what would I do? It's like Health Canada is saying "WE NEED YOU! UNLIMITED ENDORSEMENT!!!" But then there's a stone wall! WHY?! I'm so confused.

I can go down the list of these examples you provided, the only fellowship with unlimited endorsement in 2015 is Cardiology, although I'm almost positive that will change in 3 years. It doesn't make sense why Health Canada would offer unlimited endorsement for the base specialty but not for the fellowships when the fellowships are required by the Royal College to make up for the length difference.

I really have no idea what my plan of action is now. I will go through each specialty:

EM: I have to match to a PGY 2-4 program (there are a few, >70% are PGY 1-3), then match a fellowship after. The only endorsed EM fellowship in 2015 is Pediatric EM (only 2 endorsed, 2 yrs). This seems risky. Even if I do match a PGY 2-4, now I'm looking at getting denied a SoN in 2019 for my fellowship.

FM: All good. 3 years in US, certified by CFPC, provide skills to Canada.

IM: Match PGY 1-3 program. Do a Chief Resident (PGY-4) year (not guaranteed at any program), somehow make sure it's at least 60% clinical. Or do a fellowship in IM. Adding together all the endorsements for IM fellowships it's 51. I'm pretty sure there are more than 51 Canadians in IM programs in the US. What would I do if all the spots are taken? Again, this seems risky. The only unlimited endorsement is Cardio, subject to change in annually. I can't bank on this. It's too risky, not to mention Cardiology is an extremely tough fellowship match in the US.

Neurology: stated above, the only fellowship endorsed is Critical Care. Can't trust this path.

OB/GYN: as NewCanadian stated, OB/GYN is a difficult case with limited fellowship endorsement. Can't risk this.

Peds: Same situation as IM.

Psychiatry: stated above, limited endorsement for the psych fellowships.

So it looks like my safest bet is FM. There are too many risks with the other routes. First is the chance of matching at an appropriate program that is either PGY 2-4 for EM or for IM/Peds offers Chief Resident years. Chief resident years are not guaranteed by any program, in fact usually only the top residents are offered a Chief resident position. Second is the fact that the fellowships simply aren't endorsed. So it's too risky when I don't know how the subspecialty endorsement will change in 3-5 years, I could end up a board certified doc in the US but denied a SoN from Health Canada for a fellowship in order to practice in Canada. So I will return home and not be able to provide my skills.

I'm sitting here scratching my head. I am a Canadian, born and raised. I went to medical school in the US. Why is this situation so convoluted for me? Am I missing something? Doesn't Health Canada want me? NewCanadian do you have a link or email to the Health Force Ontario physician advisors? Thank you again for your time and response.

 

[chronic32]

Because not all places offer H1B, because it is significantly more expensive than the J1.

It really limits options.

Precisely. Many programs do not offer the H1b. 99% of programs offer the J1. For a residency program, all they have to do for a J1 is sign a piece of paper, much like my F1 student visa. There is minimal processing and it's easy for them. For an H1b, a lot more is involved and they take on more risk, and as a graduating medical student soon to be intern you have absolutely no leverage to request an H1b, they'll just take someone else. It can be done of course, there are Canadians at my school who have gone on to great programs with an H1b, but their intent is to practice in the US. I'm pretty sure I stated my intent is to return to my country, where we're in need of physicians, not stay in the US, so for me actually a J1 makes more sense than an H1b. H1b is for those who are on a green card path.

Plus an H1b doesn't solve the problem of returning home/licensure/etc...the same fundamental flaw as the J1 remains - length of training.

 

[UBC2014]

Precisely. Many programs do not offer the H1b. 99% of programs offer the J1. For a residency program, all they have to do for a J1 is sign a piece of paper, much like my F1 student visa. There is minimal processing and it's easy for them. For an H1b, a lot more is involved and they take on more risk, and as a graduating medical student soon to be intern you have absolutely no leverage to request an H1b, they'll just take someone else. It can be done of course, there are Canadians at my school who have gone on to great programs with an H1b, but their intent is to practice in the US. I'm pretty sure I stated my intent is to return to my country, where we're in need of physicians, not stay in the US, so for me actually a J1 makes more sense than an H1b. H1b is for those who are on a green card path.

Plus an H1b doesn't solve the problem of returning home/licensure/etc...the same fundamental flaw as the J1 remains - length of training.

My only point of correction, is that the H1B bypasses ALL issues relating to Canada(returning home mainly and length of training etc), if you are intent on staying in the US. Even then, once you are fully licensed you can take the appropriate steps later to make yourself eligible for licensure in Canada, otherwise simply stay put in the US.

 

[NewCanadian]

You did miss a very important point : Another letter is issued when the additional training is to be used to meet RCPSC requirements.

One year programs which are being used to meet RCPSC requirements are not subject to the list.

Any one year ACGME fellowship related to psychiatry will do.
Any one year ACGME fellowship related to radiology will do.
And so on.

If you need one year to meet RCPSC requirements, and it's ACGME, you get a Statement of Need.

www.healthforceontario.ca


I have a question for you: what would you LIKE to train in?

 

[chronic32]

You did miss a very important point : Another letter is issued when the additional training is to be used to meet RCPSC requirements.

One year programs which are being used to meet RCPSC requirements are not subject to the list.

Any one year ACGME fellowship related to psychiatry will do.
Any one year ACGME fellowship related to radiology will do.
And so on.

If you need one year to meet RCPSC requirements, and it's ACGME, you get a Statement of Need.

www.healthforceontario.ca

OOOOOOOOOOHHHHHHHHHHHHH! That is a key point. 1 year ACGME fellowships, not subject to the list. >1 year, subject to the list. Now I understand what you were saying about OB/GYN as well. I love you. This makes sense now and gives me options. Thank you very much NewCanadian for clearing this up.

 

[chronic32]

My only point of correction, is that the H1B bypasses ALL issues relating to Canada(returning home mainly and length of training etc), if you are intent on staying in the US. Even then, once you are fully licensed you can take the appropriate steps later to make yourself eligible for licensure in Canada, otherwise simply stay put in the US.

Ah you're right! No wonder everyone wants that H1b!

 

[chronic32]

You did miss a very important point : Another letter is issued when the additional training is to be used to meet RCPSC requirements.

One year programs which are being used to meet RCPSC requirements are not subject to the list.

Any one year ACGME fellowship related to psychiatry will do.
Any one year ACGME fellowship related to radiology will do.
And so on.

If you need one year to meet RCPSC requirements, and it's ACGME, you get a Statement of Need.

www.healthforceontario.ca


I have a question for you: what would you LIKE to train in?

As I previously stated, I would like to train in whatever Canada needs most. This is why I've only brought up the specialties with unlimited endorsement. Out of these specialties that I've rotated in, my absolute favourite was EM. In fact, if Health Canada had unlimited endorsement for all specialties I would still go for EM! I love EM. Unfortunately it looks like EM isn't viable because I'll need to match to a PGY 2-4 program and there are only a few. I do have great stats (250s Step 1, clinical research, honoured every clerkship except Peds), but I still may not be able to match to one of these programs. When I started med school and through my preclinical years I always thought I wanted to do Radiology, but I was there when the people who were married got denied a SoN (later granted) and I thought what a nightmare that must have been to go through! I looked at that and said, "Okay, we don't need Radiologists clearly, so I'm going to open my eyes to other specialties." Turned out I loved EM. But to say Health Canada didn't have an influence on that decision would be a lie. I ruled out Radiology and most of the surgery subspecialties before I could even give them a chance because Canada doesn't need them. I'm okay with that though! As medical students we should be concerned with what Canada actually needs. Doesn't matter if we go to school in Canada or abroad. But I'm worried because now even EM is sort of iffy. So I'm going to have to look into the exact number of PGY 2-4 programs and see if I have a shot at those then look into other options. I wasn't a huge fan of Neurology, IM, Peds, or Psych though.

 

[UBC2014]

You sound like a strong student, with 250 steps just find programs that offer h1b and pick whatever speciality you actually want. If its EM, still apply to h1b providing ones too.

 

[chronic32]

You sound like a strong student, with 250 steps just find programs that offer h1b and pick whatever speciality you actually want. If its EM, still apply to h1b providing ones too.

I'm sure I could match an EM program and get an H1b however if they're a PGY 1-3 program or a PGY 1-4 program I won't be able to practice in Canada. As NewCanadian said the only way would be if I matched to a program that's PGY 2-4, did a prelim medicine year, then a fellowship after. These programs are limited and who knows if they offer the H1b, I doubt it. But again, it's weird that if I matched a PGY 1-3 or 1-4 they'd still offer me a SoN for a J1 when they know even with a fellowship I couldn't work back home.

 

[UBC2014]

http://www.cpso.on.ca/policies-publications/policy/pathway-3-–-u-s-or-canadian-medical-degree-or-doct

Isn't the whole point of Pathway 3(Canadian MDs and USMD/DO who do US ACMGE training), that if youre board certified in the US, that you just have to work "under supervision" for a year (pretty loose term) and you're good to go without having to do the extra training?

"Unlike the College’s policy for ACGME-trained specialists, 1 this pathway does not require that the ACGME residency be comparable in content and duration to a Canadian training program in the same discipline."

Once you got your license in Ontario, I would be very surprised if you couldn't just port that over to any other Canadian province. Or is this too big of a leap? Once you go through the red tape in one province, seems unlikely a different one would turn you down.

 

[chronic32]

http://www.cpso.on.ca/policies-publications/policy/pathway-3-–-u-s-or-canadian-medical-degree-or-doct

Isn't the whole point of Pathway 3(Canadian MDs and USMD/DO who do US ACMGE training), that if youre board certified in the US, that you just have to work "under supervision" for a year (pretty loose term) and you're good to go without having to do the extra training?

"Unlike the College’s policy for ACGME-trained specialists, 1 this pathway does not require that the ACGME residency be comparable in content and duration to a Canadian training program in the same discipline."

Yeah like I said I'm aware of Pathway 3 but that's 1 province out of 10. Correct me if I'm wrong but that's not a pathway to an unrestricted license in all of Canada. So I'd be an ABEM-certified EM physician licensed to practice in all 50 States and Ontario...so broken. I'm pretty sure the rest of the country is screaming for board certified ER doctors, or else they wouldn't offer unlimited endorsement.

 

[UBC2014]

Yeah like I said I'm aware of Pathway 3 but that's 1 province out of 10. Correct me if I'm wrong but that's not a pathway to an unrestricted license in all of Canada. So I'd be an ABEM-certified EM physician licensed to practice in all 50 States and Ontario...so broken. I'm pretty sure the rest of the country is screaming for board certified ER doctors, or else they wouldn't offer unlimited endorsement.

But wouldn't you then have an unrestricted license in Ontario? Maybe contact whatever other province you're interested in, and ask if licenses are portable. I can't see why someone licensed in one province (unrestricted) can't move to the other. I'm fairly sure thats what some of the IMGs you end up in Sask or PEI do...but i could be very wrong.

BC has https://www.healthmatchbc.org/Register.aspx

And report back here

 

[UBC2014]

Also here is an older thread, maybe someone on there is still active: http://forums.studentdoctor.net/threads/working-in-canada-after-training-in-us.756362/

 

[NewCanadian]

http://www.cpso.on.ca/policies-publications/policy/pathway-3-–-u-s-or-canadian-medical-degree-or-doct

Isn't the whole point of Pathway 3(Canadian MDs and USMD/DO who do US ACMGE training), that if youre board certified in the US, that you just have to work "under supervision" for a year (pretty loose term) and you're good to go without having to do the extra training?

"Unlike the College’s policy for ACGME-trained specialists, 1 this pathway does not require that the ACGME residency be comparable in content and duration to a Canadian training program in the same discipline."

Once you got your license in Ontario, I would be very surprised if you couldn't just port that over to any other Canadian province. Or is this too big of a leap? Once you go through the red tape in one province, seems unlikely a different one would turn you down.

You would not necessarily be PAID as a RCPSC specialist. don' t forget, you have to find the mentor/supervisor willing to work with you for that 12 to 18 months, and you have to pay for it. Yes, at the end of the 'supervision', you could work independently, but you would be a CPSO specialist, not an RCPSC certified specialist. There may be a way to take the RCPSC exams, but this you'll have to check yourself with the RCPSC credentials unit.

the only truly portable licence is one where the doctor has both RCPSC and LMCC. that is, he/she has RCPSC certification and he/she has passed all the MCC exams. Doctors trained in the US often do not bother taking the MCC exams.

if you need to find all the regulatory authorities in one place/link, go to www.fmrac.ca

 

[NewCanadian]

I'm sure I could match an EM program and get an H1b however if they're a PGY 1-3 program or a PGY 1-4 program I won't be able to practice in Canada. As NewCanadian said the only way would be if I matched to a program that's PGY 2-4, did a prelim medicine year, then a fellowship after. These programs are limited and who knows if they offer the H1b, I doubt it. But again, it's weird that if I matched a PGY 1-3 or 1-4 they'd still offer me a SoN for a J1 when they know even with a fellowship I couldn't work back home.

in the future, four year EM programs will be supported for j-1 visa, not three year EM programs.
4 year program plus one year ACGME fellowship, Or
1 year internship (prelim medicine, surgery, or transitional year) plust 3 years EM plus one year ACGME fellowsship/
Why? Because if you take the 3 year program, and attempt to pursue two ACGME fellowships, the RCPSC would accept (assess) only one of them. So, keep this in mind and be warned.
Those students who have started, or about to start, 3 year EM prorgrams, may or may not get additional support - remain to be seen. They might get one more year of support, but then they will be expected to find the fifth year in Canada (e.g. Ontario Repatriation Program).

 

[NewCanadian]

p

I'm sure I could match an EM program and get an H1b however if they're a PGY 1-3 program or a PGY 1-4 program I won't be able to practice in Canada. As NewCanadian said the only way would be if I matched to a program that's PGY 2-4, did a prelim medicine year, then a fellowship after. These programs are limited and who knows if they offer the H1b, I doubt it. But again, it's weird that if I matched a PGY 1-3 or 1-4 they'd still offer me a SoN for a J1 when they know even with a fellowship I couldn't work back home.

um, if you pursue an EM 1-4 plus one ACGME fellowship, for a total of five years that are recognized by RCPSC, that IS supportable for Statement of Need and J1. that's five year, and you would meet the RCPSC requirements with that plan.

But honestly, you need to discuss this with the credentials unit at the RCPSC. They are the experts and they have the final word.

 

[NewCanadian]

As I previously stated, I would like to train in whatever Canada needs most. This is why I've only brought up the specialties with unlimited endorsement. Out of these specialties that I've rotated in, my absolute favourite was EM. In fact, if Health Canada had unlimited endorsement for all specialties I would still go for EM! I love EM. Unfortunately it looks like EM isn't viable because I'll need to match to a PGY 2-4 program and there are only a few. I do have great stats (250s Step 1, clinical research, honoured every clerkship except Peds), but I still may not be able to match to one of these programs. When I started med school and through my preclinical years I always thought I wanted to do Radiology, but I was there when the people who were married got denied a SoN (later granted) and I thought what a nightmare that must have been to go through! I looked at that and said, "Okay, we don't need Radiologists clearly, so I'm going to open my eyes to other specialties." Turned out I loved EM. But to say Health Canada didn't have an influence on that decision would be a lie. I ruled out Radiology and most of the surgery subspecialties before I could even give them a chance because Canada doesn't need them. I'm okay with that though! As medical students we should be concerned with what Canada actually needs. Doesn't matter if we go to school in Canada or abroad. But I'm worried because now even EM is sort of iffy. So I'm going to have to look into the exact number of PGY 2-4 programs and see if I have a shot at those then look into other options. I wasn't a huge fan of Neurology, IM, Peds, or Psych though.

Actually, the decisions are made at the provincial level, not by Health Canada. HC is a huge department, and does not bother with the j1 visa doctors. The case you mentioned was a nightmare for the two students because they made it so complicated for themselves. All I have to do is put two and two together and see that the 2015 List of Specialties has a lot more allowance for radiology therefore the simplest answer is that the province that put forward the radiology allowance for 2015 made the decision to approve the two students last year. Whatever fuss the two made was ultimately a fuss: a mountain out of a molehill. I'm pretty sure the two students (now residents) may find this remark callous and unsympathetic (as they did in the past), but still, the whole fuss was entirely unnecessary. Yes, I have my own opinions; like them, or not.

Back to you: if you love EM, go for it. Do a Transitional Year (in my opinion, an excellent preparatory year), then attend EM for three years, and make sure you get a one year ACGME fellowship to make it a total of five years. Go and read the RCPSC Specialty Training Requirements for Emergency Medicine; there may even be something in there you can pursue if you get the OK well in advance from the College and plan your fellowship curriculum accordingly.

 

[NewCanadian]

I'm sure I could match an EM program and get an H1b however if they're a PGY 1-3 program or a PGY 1-4 program I won't be able to practice in Canada. As NewCanadian said the only way would be if I matched to a program that's PGY 2-4, did a prelim medicine year, then a fellowship after. These programs are limited and who knows if they offer the H1b, I doubt it. But again, it's weird that if I matched a PGY 1-3 or 1-4 they'd still offer me a SoN for a J1 when they know even with a fellowship I couldn't work back home.

maybe i'm repeating myself, but:
attend a transitional year or prelim in medicine
attend EM PY1,2,3
attend one year ACGME fellowship
total is five years in an ACGME environment. it is doable.

 

[UBC2014]

Actually, the decisions are made at the provincial level, not by Health Canada. HC is a huge department, and does not bother with the j1 visa doctors. The case you mentioned was a nightmare for the two students because they made it so complicated for themselves. All I have to do is put two and two together and see that the 2015 List of Specialties has a lot more allowance for radiology therefore the simplest answer is that the province that put forward the radiology allowance for 2015 made the decision to approve the two students last year. Whatever fuss the two made was ultimately a fuss: a mountain out of a molehill. I'm pretty sure the two students (now residents) may find this remark callous and unsympathetic (as they did in the past), but still, the whole fuss was entirely unnecessary. Yes, I have my own opinions; like them, or not.

Back to you: if you love EM, go for it. Do a Transitional Year (in my opinion, an excellent preparatory year), then attend EM for three years, and make sure you get a one year ACGME fellowship to make it a total of five years. Go and read the RCPSC Specialty Training Requirements for Emergency Medicine; there may even be something in there you can pursue if you get the OK well in advance from the College and plan your fellowship curriculum accordingly.

I'm curious more on your thoughts about the "fuss"? I'm not sure how not getting a visa to pursue your training is a fuss tbh or what alternative they had..

 

[UBC2014]

You would not necessarily be PAID as a RCPSC specialist. don' t forget, you have to find the mentor/supervisor willing to work with you for that 12 to 18 months, and you have to pay for it. Yes, at the end of the 'supervision', you could work independently, but you would be a CPSO specialist, not an RCPSC certified specialist. There may be a way to take the RCPSC exams, but this you'll have to check yourself with the RCPSC credentials unit.

the only truly portable licence is one where the doctor has both RCPSC and LMCC. that is, he/she has RCPSC certification and he/she has passed all the MCC exams. Doctors trained in the US often do not bother taking the MCC exams.

if you need to find all the regulatory authorities in one place/link, go to www.fmrac.ca

Hmm this is interesting, but surely once cpso certified, there are not different billing codes for a rcpsc doc vs their cpso counterpart?

 

[UBC2014]

Thank you @NewCanadian for all your input it is really appreciated.

 

[MontereyMD]

Why are you so concerned about Health Canada, the convoluted Canadian health care system and playing by Canada's fragmented rules? Believe me but Health Canada and Canada doesn't give an f about you. Isn't that's why you're at a U.S. medical school? Get some confidence and take advantage of the U.S. medical opportunities in your lap. Hurry up and marry a U.S. citizen, get PR and apply to any U.S. residency that you desire without worrying about the effed up imploding Canadian system

 

[NewCanadian]

Hmm this is interesting, but surely once cpso certified, there are not different billing codes for a rcpsc doc vs their cpso counterpart?

I know nothing about billing codes.

 

[UBC2014]

Why are you so concerned about Health Canada, the convoluted Canadian health care system and playing by Canada's fragmented rules? Believe me but Health Canada and Canada doesn't give an f about you. Isn't that's why you're at a U.S. medical school? Get some confidence and take advantage of the U.S. medical opportunities in your lap. Hurry up and marry a U.S. citizen, get PR and apply to any U.S. residency that you desire without worrying about the effed up imploding Canadian system

haha, I really would love to hear your story some day via PM!

 

[NewCanadian]

haha, I really would love to hear your story some day via PM!

Let Sleeping Dogs Lie.

 

[I-said-doctor]

Because not all places offer H1B, because it is significantly more expensive than the J1.

It really limits options.

Do the programs have to pay or the residency applicants? If it's the programs that have to pay to sponsor an applicant for H1B, can the applicants not offer to pay for their own visa? Or is that unusual/illegal/bribery or whatever? I am just trying to figure out why the H1B visas are limited

 

[torontopharm]

Do the programs have to pay or the residency applicants? If it's the programs that have to pay to sponsor an applicant for H1B, can the applicants not offer to pay for their own visa? Or is that unusual/illegal/bribery or whatever? I am just trying to figure out why the H1B visas are limited

The residency program themselves pay for it.
You as an applicant are not allowed to pay for it.
The h1b visas are limited because it costs the employers a lot to go through the process, as opposed to J1 visa. Also, h1b leads toward a green card..probably why a limited amount is issued out.

 

[NewCanadian]

Do the programs have to pay or the residency applicants? If it's the programs that have to pay to sponsor an applicant for H1B, can the applicants not offer to pay for their own visa? Or is that unusual/illegal/bribery or whatever? I am just trying to figure out why the H1B visas are limited

reply: I can't find the news reference (weblink) right now. The following is based on a private conversation with a lawyer in the US who knows the details. When I find the news story again, I will come back here and include it. I know you guys need the evidence...

A resident made an agreement with the training institution that he would pay some of the fees associated with obtaining the H1B visa; the institution would withhold some $ from the paycheque each pay until the fees were paid, so to speak. this agreement came up against the law in the US that all residents are paid the same. The consequence is some institutions are wary of H1B costs and legal consequences.

 

[gggggg2]

Bumping an old thread, but it seems like you may be the people who have the info I need. I am a canadian medical student, and I am interested in US residency. Partly to just get to experience training somewhere else, and also because there is a predicted big spike in medical students going unmatched. I strongly want to do pediatrics. My issue is that training in the US is 3 years for general peds and 4 for general peds in Canada. So then I can't come back and work, without doing an extra year or something?

I actually would prefer to do sub-specialty training anyway. Does this then get rid of the issue of general peds only being 3 years? As in canada we subspecialty match from peds after 3 year too. I am assuming though there could then be issues with continuing the J1 visa etc as they only originally covered me for the 3 year program. I guess it is likely easier to do residency here if I can then a subspecialty in the states?

 

[Psoralin]

You need to refer to this link: 2018-2019 List of Needed Specialties for Issuing Statements of Need under Category B - Canada.ca

Of particular concern to you are the following points:

• For training programs that are shorter in duration than the Canadian equivalent, additional training, in a one-year, Accreditation Council for Graduate Medical Education (ACGME)-accredited training program (i.e. one-year ACGME-accredited fellowship) will be endorsed for the purposes of meeting the RCPSC STRs in the specialty. (E.g. one year of Geriatric Medicine or Palliative/Hospice care after three years of Internal Medicine, or one year of Pediatric Anesthesia after four years of Anesthesiology).
• 
  
• For training programs where one-year ACGME-accredited fellowships do not exist, namely Pediatrics and Obstetrics/Gynecology, sub-specialty training, in fields noted on the List of Needed Specialties, will be endorsed to ensure physicians meet the RCPSC requirements. Please note that the list of sub-specialties is subject to change and endorsements will be based on the list of approved sub-specialties in the year the Statement of Need is requested.

So yes, you can do Peds, and subspecialty training in the US to meet the Specialty Training Requirements (STRs) of the Royal College of Physicians and Surgeons of Canada for Pediatrics. Also be aware that there is a specific list of acceptable subspecialty training listed on that website, and any deviations from it will not be endorsed for J1 renewal.

 

[gggggg2]

You need to refer to this link:

Of particular concern to you are the following points:

• For training programs that are shorter in duration than the Canadian equivalent, additional training, in a one-year, Accreditation Council for Graduate Medical Education (ACGME)-accredited training program (i.e. one-year ACGME-accredited fellowship) will be endorsed for the purposes of meeting the RCPSC STRs in the specialty. (E.g. one year of Geriatric Medicine or Palliative/Hospice care after three years of Internal Medicine, or one year of Pediatric Anesthesia after four years of Anesthesiology).
• 
  
• For training programs where one-year ACGME-accredited fellowships do not exist, namely Pediatrics and Obstetrics/Gynecology, sub-specialty training, in fields noted on the List of Needed Specialties, will be endorsed to ensure physicians meet the RCPSC requirements. Please note that the list of sub-specialties is subject to change and endorsements will be based on the list of approved sub-specialties in the year the Statement of Need is requested.

So yes, you can do Peds, and subspecialty training in the US to meet the Specialty Training Requirements (STRs) of the Royal College of Physicians and Surgeons of Canada for Pediatrics. Also be aware that there is a specific list of acceptable subspecialty training listed on that website, and any deviations from it will not be endorsed for J1 renewal.

perfect, it appears that all the sub-specialties of pediatrics and internal medicine are on that list.

 

[s5260205]

perfect, it appears that all the sub-specialties of pediatrics and internal medicine are on that list.

Sub-specialty Training
For physicians whose residency began in 2015 or earlier, all applications for the following fields of sub-specialty training will be endorsed. Please note that sub-specialty training that does not appear on this List will not be supported.

Those only apply to those who started residency before all this BS about subspecialty went into effect. You will not be able to do most subspecialties on a J1 visa in US without first returning to Canada for 2 years. Your best bet is still stay in Canada; imo, it's not worth the thousands of dollars and extra effort to study for USMLE when you can very well stay in Canada for paediatric residency.

 

[Psoralin]

Sub-specialty Training
For physicians whose residency began in 2015 or earlier, all applications for the following fields of sub-specialty training will be endorsed. Please note that sub-specialty training that does not appear on this List will not be supported.

Those only apply to those who started residency before all this BS about subspecialty went into effect. You will not be able to do most subspecialties on a J1 visa in US without first returning to Canada for 2 years. Your best bet is still stay in Canada; imo, it's not worth the thousands of dollars and extra effort to study for USMLE when you can very well stay in Canada for paediatric residency.

I see where there could be some confusion about all this. Under the section "Subsequent training, if your residency started in 2016 or later" it clearly states: For training programs where one-year ACGME-accredited fellowships do not exist, namely Pediatrics and Obstetrics/Gynecology, sub-specialty training, in fields noted on the List of Needed Specialties, will be endorsed to ensure physicians meet the RCPSC requirements.

I think the idea is that for example, if you are in IM and you started after 2016, you wouldn't be able to get a J1 for a Gastro Fellowship because they would force you to do a one year Fellowship or Chief Resident year to meet the STRs instead. If howevere, you started before 2015 you would be able to do the three year Fellowship. Since there are no one year Fellowships in Peds they will be sponsored for the J1 for any of the Fellowships listed. That's the way I understand it.