eLetters: Open Letter to Canadians at Foreign Medical Schools [CMAJ

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eLetters: Open Letter to Canadians at Foreign Medical Schools
In response to: Attitudinal problems facing international medical graduates

Asad Raza
Email: asad_raza@go.com
Affiliation: Saba University School of Medicine
Posted on: March 19, 2000

The Future of Our Medical Careers An Open Letter to Canadian Students at Saba University School of Medicine by Asad Raza Revised January 2001 Thank you for taking the time to read this. First off, let me start by addressing some of the most common comments I have heard among Canadian students here at Saba University School of Medicine: A) 'I am going to do all my clinical rotations in Canada' I have contacted the Canadian Medical Association: www.cma.ca 1-800-663-7336, extension 2307 I spoke with them on the phone, and they told me that an IMG (International Medical Student/Graduate) (which is what we are) CANNOT do core rotations in Canada. Regardless of wether you are a Canadian citizen or not. You can only do electives, visit this site for info on this: Electives in Canada for FMG's: . Now, some Canadian's here at Saba have this bright idea that they will do their electives, and have Saba University count them as cores. For example, you go to Ontario (or somewhere else in Canada) and do, let's say, an elective in surgery, then Saba University accepts it for the Core surgery requirement. See what I mean? Well, this is a big mistake. Let me tell you why: When you finish medical school, and residency and apply for a license in Canada, the Canadian medical governing bodies will evaluate (in great detail) every clinical you have done. And if all your clinicals were essentially just 'electives' do you think one of the strictest countries in the world is going to grant you a license to practice medicine?? . . .I'll let you ponder this. B) 'I going to transfer to a Canadian Medical School' None of the sixteen Canadian medical schools accepts transfer students from outside Canada. In fact most, wont even look at an application from WITHIN Canada. C) 'I am going to get a residency in Canada' It is my belief that for an IMG, getting a residency in Canada with the CaRMS match is about as hard as making it to the NBA, and believe me I am very, very far from being the Michael Jordan of medical school. Just visit www.carms.ca and see how few IMG's get a residency in Canada every year. Then you have all this hoopla here at Saba about being able to get a residency in Canada 'outside the match'. Where?!? How?!? Don't just hear that and think that your set, you must have facts!! I have the highest respect for my fellow Canadian students and their opinions, and I am very willing to sit down with them and discuss these issues. But I WON'T buy into anything, unless there is proof. Rumors, and hearsay are horsesh*t, and we all know it. I definitely won't plan out my medical career based on the 'doors will open up' theory. D) 'I am not going to write the USMLE, because I am going to Canada, so I won't need it' If you don't write the USMLE, your life and career will turn into such a big joke, that even the best comedians in Hollywood will have difficulty portraying it . . . that's all I'm going to say about this. E) 'I am going to write a letter, to have Canada eliminate the Evaluating Exam, because there is no need for it' Canadian medical licencing authorities have the right and obligation to ensure Canadians get the best medical care in the world and it is my view this can be accomplished through generally accepted standardized tests such as the MCCEE that the RCPSC requires. Visit: RCPSC - . Contact the CPSO for more info: 80 College Street Toronto, ON M5G 2E2 (416) 961-1711 Even the most massive letter campaign is NOT going to get them to change this requirement. I mean c'mon, that's like me saying 'oh, I am going to write a letter to ECFMG, and ask them to eliminate the TOEFL requirement, because hey, I know my English, why do I need to write the ?' Be realistic. O.K. now let's look at some of the points, we as Canadians need to be aware of, and consider when we are planning out our medical career and future: 1) Take a look at the list of things you need to do to get back into Ontario for a residency: 1. successful completion of the MCCEE (evaluating exam) 2. successful completion of the Qualifying Examination Part I (MCCQE part 1) 3. proof of satisfactory completion of 12 months of postgraduate medical training 4. successful completion of the Qualifying Examination Part II (MCCQE part 2) Information about the Evaluating and Qualifying Examinations of the may be obtained from Medical Council of Canada, Box 8234, Ottawa, Ontario, Canada, KlG 3H7, telephone: (613) 521-6012, fax: (613) 521-9417. 2) You will lose a year due to the MCCEE. See, you can't write the MCCQE part 1 until you have got your results back for the MCCEE, and these results always come back after the deadline has passed for the MCCQE. So you have to wait until the following year to write the MCCQE. Even the Canadian student at Saba, who disagrees with me about everything, agreed with me(!) about this. Just contact Medical Council of Canada www.mcc.ca and have them send you applications for these tests and take a look for yourself. 3) One year of post graduate training requirement for IMG's. As stated above, one the requirements for obtaining a residency, is one year of post graduate training. MYTH: There are 24 spots for residency in Ontario for IMG's. FACT: Those 24 spots are not for residency. They are for this one year of post-graduate training that is a prerequisite for applying for a residency position in Ontario through the Ontario International Medical Graduate Program. There are 12 positions at U of Toronto, and three at each of the following schools: Western, McMaster, Queens and Ottawa. The OIMGP provides this pre-residency training to evaluate and to upgrade the qualifications of IMG's. There are approx. 275 applicants each year for those 24 spots. Contact the OIMGP for details: Tel: (416) 978-2459, Fax (416) 978-8712 Ontario IMG Program: . Let's talk a little about this (here is where the real fun of this letter begins): O.K. first off, the OIMGP gets about 275 applications each year. Everyone who applies has to write a test. The top 72 scoring applicants are then invited back to write a second test. Then the best 24 are selected. Those 24 get the splendid opportunity to do one year of unpaid medical training in Ontario. After they complete this training (and have passed MCCEE, MCCQE) they are now ELIGIBLE to APPLY for a residency. In Ontario, you cannot enter the first OR second round of the CaRMS match, and after the second round there is a grand total of zero spots remaining. . . .there has been a recent increase in the number of spots from 24 to 36 . . . but what's the use if there are no residencies? 4) Not much left in the second iteration, and nothing left after the second iteration. Let's talk briefly about the CaRMS match. 151 Slater Street, Suite 802 Ottawa, ON Canada K1P 5H3. The match is done in two rounds (iterations). The first round is open ONLY to graduates of Canadian medical schools. If a Saba student tells you otherwise, he is on crack. (Hey maybe he got some from Kenny . . . bad taste I know, but it had to be said). The second round is open to IMG's in some provinces. But if you go and visit the CaRMS web site, you will see that there is didly squat left in the second round . . . nickel and dime. 5) B1 Visa for clinicals. Yes, Canadians need a B1 Visa to do clinicals in the United States. Apply as early as possible for this otherwise you won't be allowed into a hospital to do your rotations. Saba administration has the forms, also visit US Embassy: Citizenship and Immigration Canada: for related info. 6) The H1-B and J-1 Visa's for residency in the U.S. Other IMG's (from India, China, Europe, Africa etc.) come to the U.S. with J-1 Visa's in hand. Canada won't issue you a J-1 unless you have secured a job in Canada. Good luck trying to find a job in Canada five years in advance. So as a Canadian your only realistic hope is the H1-B Visa. To get this you will have to write USMLE Step 3 before starting your residency. Around twelve states allow candidates to sit for this exam before residency (it is normally written DURING residency). To find out which states, visit: FSMB (Federation of State Medical Boards): . To find out about the USMLE Step 3 visit: or For info about the J-1 and H1-B Visa's visit: 7) The J-1 exchange Visa is a very bad idea for Canadians. First of all it is very difficult to get, just look at the list of requirements you have to fulfill to get this Visa from Canada: Basically, if a miracle happens and you get this Visa from Canada, then you are entitled to go to the U.S. to do a residency. But after the residency you have to return to Canada for a minimum of two years. Think you will get a Canadian license after returning? Read: to see how mistaken you are. The J-1 can drive a man insane. Go for the H1-B Visa. 8) So as you can see, Canadians are in a different stream than all other IMG's, and that stream is appropriately called 'Sh*ts Creek'. 9) Applying for a residency in the United States: To apply for a residency in the U.S. to have to apply through the ERAS Electronic Residency Application Service: The U.S. residency match is done by NRMP (National resident matching program): Unless you are lucky enough to pre-match. This would be oh so sweet. The list of all available residency positions in the U.S., is nicely summarized at this excellent site: FREIDA (Fellowship and Residency Electronic Interactive Database): 10) Canadians need to be very realistic about their goals. The worst Saba student, who de-celled twice and failed USMLE on his/her first try (but is a U.S. citizen) will be able to get a residency in Internal Medicine without ANY problem. But you as a Canadian, even with a 90 on your USMLE and a #3 ranking in your class could still get screwed, blued and tattooed come match time. Hospitals look at applicants without a Visa, the way you and I would look at our feces, if we were suffering from inflammatory diarrhea. 11) It is important to do ALL your clinical rotations (cores and electives) in the U.S. We have (I hope) already established that Canada is a closed door for IMG�s. So our goal is a residency in the U.S. Doing all your clinicals in the U.S. allows you maximum opportunity to make contacts, which are invaluable come residency selection time. Also, the USMLE Step 2 exam is based entirely on U.S. clinical experience, doing clinicals outside of the U.S. does not prepare you well for the Step 2 exam. 12) Is the United States a nice place to raise a family? For those Canadians afraid to go to the U.S., let me offer you this: there are plenty of places in the U.S. that are as safe, and crime free as Goose Bay, Labrador . . . so don't sweat it. You can live a happy life, with your family, keeping your culture alive, and your children will have a prosperous future. 13) Caribbean Medical Schools were never intended or designed to educate Canadians. They were opened to cater to rejected U.S. applicants. That is the whole premise, and that is for whom this whole system is geared toward. But what happened over the years is that, it became so ridiculously difficult to gain admission into a Canadian medical school that many, many Canadian students flocked down to the Caribbean. The American Association of Medical Colleges () publishes a list annually of the most difficult places to gain admission into a medical school. Ontario tops the list every year, followed by California, New York, British Columbia and Texas. 14) Let's help each other. I love to share info I have gathered with my fellow Canadians. If you know something that I don't, please share it with me, I am willing to listen, but please back it up with proof and fact. As one of my Canadian classmates - James Brown would say --> 'During a drought, don't piss on my leg, and tell me it's raining'. In other words, don't give me false hope, (Saba's James Brown is not related to the Godfather of soul, actually he's a white guy). . . . depressed? Don't be! Here's what you need to do: 15) My advice (what I have been saying since day one): a) Write the USMLE Step 1, Step 2, TOEFL, and CSA b) Get your ECFMG certificate c) Apply for a residency in the United States (There a lot of opportunities in the U.S., as long as you choose an IMG friendly residency: e.g., internal medicine, psychiatry, family practice etc., things can work out. Saba is one of the few good Caribbean medical schools, and they are recognized with residency directors all over the U.S.) d) Write USMLE Step 3 as soon as you graduate and obtain the ECFMG certificate and apply for your H1-B Visa (USMLE Step 3, is the easiest of the three steps, if you have passed Step 2 with a score of 215 you can pass this the next day. Take a look at this site for a partial list of IMG friendly hospitals in the U.S. that sponsor the H1-B visa for residency: ) e) If you are single, marry a U.S. citizen (There is one guy here who has already done so, and he will have a nice shiny green card (permanent resident status) in his wallet pretty soon as a result) Whew! Well, that's it for now my Canadian friends. I hope this has provoked some thought. I sincerely wish you all the best of luck. Asad Raza Saba University School of Medicine January 2001 comments/questions/suggestions/rebuttals/hate mail -->

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