Residency South of the Border

1. Residency South of the Border Dr. Namta Gupta, CCFP FCFP May 19, 2010

2. Overview • The QC Decrèt • Visa options • McGill in the U.S. • Residency position types • U.S. Matches • ERAS/NRMP • SF Match/AUA

3. The QC Decrèt • Document released annually setting number of positions available in each discipline within QC • Decided by the Ministère de la Santé et des Affaires Sociale • Input from Post Grad Deans • Various Colleges and Federations The Qc Decrèt

4. The QC Decrèt • Aims to meet the Health needs of the population • Decrèt is released, the four Postgraduate Deans decide how the positions will be divided amongst faculties • Certain criteria have to be followed • Formulas have been established The Qc Decrèt

5. The QC Decrèt • Want to go elsewhere in Canada? • Has NO bearing on you whatsoever! • Want to go to the US (as an American)? • Has NO bearing on you whatsoever! • Want to go to the US (as a Foreigner)? • Has NO bearing on you whatsoever! • Want to go to the US (as a Canadian)? • Here’s where it gets complicated… The Qc Decrèt

6. Visa Options H-1B VS. J-1 • U.S. Residencies for Non-Americans • H-1B • Pros • Easy to convert to a permanent status in US • Does not require home country support • Cons • Requires residency program sponsorship • Many programs unwilling to take this responsibility • Requires USMLE Step 3 • Can’t write this until after grad, therefore residency start date is delayed to around Sept • Many programs unwilling to wait The Qc Decrèt

7. Visa OptionsH-1B vs. J-1 • J-1 • Pros • The “standard" visa accepted by all U.S. institutions • Easily obtained prior to residency start date • Cons • Has a 2-year home country requirement before you can receive permanent status in US • Requires a Statement of Need from Health Canada (or your home country) • Subject to provincial manpower regulations The Qc Decrèt

8. For QuebecersThe Decrèt determines whether or not you will be able to get a Statement of Need • States which disciplines are “priority recruitment” for that match year • Only issued mid 4th year after application and interview season are well underway • Statement of Need only available for “priority recruitment” disciplines • Trending toward greater restriction The Qc Decrèt

9. Match 2010 • Priority Recruitment Disciplines: • Médecine familiale • 􀂃 Médecine interne • 􀂃 Chirurgie générale • 􀂃 Chirurgie orthopédique • 􀂃 Hématologie • 􀂃 Oncologie médicale • 􀂃 Pédiatrie générale • 􀂃 Anatomo-pathologie • 􀂃 Anesthésiologie • 􀂃 Psychiatrie (incluant pédopsychiatrie) • 􀂃 Radiologie diagnostique • 􀂃 Radio-oncologie • 􀂃 Obstétrique-gynécologie The Qc Decrèt

10. Other Canadians • For a Statement of Need, • you are subject to the provincial manpower regulations of your home province • In general, less restrictive than QC • For information on your discipline of interest and • a Statement of Need, • contact Health Canada • Judith_Lewis@hc-sc.gc.ca The QC Decrèt

11. Internationals… • For a Statement of Need: • You need to apply to the • Health Ministry • in your • home country • (last place of legal residence) The Qc Decrèt

12. Things to consider… • Reciprocity of Training • Verify ACGME accreditation for programs of interest http://www.acgme.org/adspublic/ • Verify length of training for equivalency purposes • i.e., Internal Medicine is 3 years in the US and 4 years in Canada • More information is available from • Royal College of Physicians and Surgeons of Canada http://rcpsc.medical.org/ • Collège des Médecins du Québec (for QC Residents) www.cmq.org • Other provincial boards The Qc Decrèt

13. McGill in the U.S. • McGill students consistently match to a variety of competitive programs in the U.S. • McGill students are equivalent to “U.S. Seniors” • McGill is an accredited member of the L.C.M.E.

14. Massachusetts General Hospital Internal Medicine Vanderbilt University Medical Center Internal Medicine University of Illinois (Chicago) Medicine and Pediatrics Weill Cornell Medical Center Pediatrics McGill in the US Class 2010

15. McGill in the US Previous years • Sinai Hospital (Maryland) • Obs/Gyn • Yale University • Anesthesia • Diagnostic Radiology • New England Med Centre • Diagnostic Radiology • Rush University • Internal Medicine • University of Wisconsin • Family Medicine • Einstein/Jacobi Medical Centre • Peds • UC San Diego • Peds • University of Vermont • Peds • Emory University • Psych • Georgetown University • Internal Medicine • NY Eye & Ear Infirmary • ENT AMONG OTHERS…

16. Residency Position Types • Categorical Position • Includes all necessary years of training to be certified in the U.S. in that specialty • Advanced Position • Begins only after the first year of residency training (also called “PGY-2”) • Requires completion of a preliminary (“PGY-1”) or transitional year • Program will train you for that specialty once you are admitted

17. PGY-1 Residency Positions • Preliminary Position • Must be completed before you start training in an advanced specialty • Usually surgery or internal medicine Always find out what your advanced position requires! • Transitional Year Position • A preliminary position in which you rotate through different departments, much like core clerkship

18. Be Careful… • Do not take your prelim/transitional year for granted • If you match to a PGY-2, you are not automatically given a preliminary year • You must apply and interview for your PGY-1 separately • You will have to interview at several programs, as you would for any other residency position

19. US Matches • FREIDA • Database of all US residency programs • Searchable by discipline and/or location www.ama-assn.org/ama/pub/category/2997.html • ERAS/NRMP • Most US residencies • SAN FRANCISCO MATCH • Child Neurology, Neurosurgery, Ophthalmology, & Plastic Surgery • AUA Urology Match

20. ERAS/NRMP • ERAS = match application agency • www.aamc.org/students/eras/start.htm • Request ERAS access token from CaRMS in late June (help@carms.ca) • Complete electronic application • Send all supporting documentation to CaRMS for processing to ERAS • CaRMS is your “designated Dean’s Office” • They will charge you $235(+tx) for this service

21. ERAS/NRMP • Unlike CaRMS, programs have access to your data as soon as you assign it to them • The earlier the better!

22. ERAS/NRMP • NRMP = actual matching agency • www.nrmp.org • Must register with both ERAS andNRMP • NRMP registration opens August 15, 2010 • Rank order lists submitted to NRMP by February 23, 2011

23. SF Match-Early! • www.sfmatch.org • Registration/Application begins in June • Each specialty has its own timetable • Often only match to advanced (PGY-2) positions • You will likely also have to apply to the NRMP for a preliminary/transitional (PGY-1) position

24. AUA Match • Urology runs its own • separate match in the U.S. • www.auanet.org/residents/resmatch.cfm • Since applicants to this are limited each year, we won’t discuss this exhaustively, but don’t hesitate to contact us if you have questions or need assistance

25. Timeline • Depends on: • Matching system(s) of choice • Individual Programs • Deadlines may differ from that of the matching systems • Be sure to verify the deadlines for EACH program • Some interviews offered “first-come, first-served” • Once quota is full, additional invites are unlikely • Your best interest to apply early • Accept all early invitations as programs can overbook • If you have not heard from a program of interest, call and ask about the status of your file

26. Applying to the US • How many programs should I apply to? • Largely dependent on you, your finances, and your level of comfort with risk • 2004 ERAS application stats: • 1-5 programs for combined programs (Med/Peds, etc.) • 40-45 programs for very competitive specialties • 10-20 programs for most other disciplines • Average of 1.54 specialties

27. Applying to the US • How many programs should I rank? • Dependent upon: • Interview experiences • Level of comfort with risk • 2007 NRMP stats: • Average of 13 competitors for eachcompetitive specialty position • Average of 7-9 competitors for each position in other disciplines • Longer rank order list maximizes your chances • No data available on average rank order list length between matched & unmatched candidates • Single discipline applicants most often unmatched in Dermatology, Plastics, Ortho, E.N.T., Rad. Onc., Obs/Gyn

28. You and the USMLE • Average Step 1 scores for NRMP disciplines • www.nrmp.org • Under “Data and Reports”, click “Charting Outcomes in the Match” • Step 1 scores commonly used as a “Filter” • Due to late issue date of Dean’s Letter • “Cutoff” scores not often published • Many programs require Step 2 before Rank Order list deadlines • Be sure to verify this for your programs!

29. Dean’s Letter (MSPR) • McGill follows AAMC guidelines • Nota letter of recommendation • More like an elaborate transcript • Every clinical rotation is included • ICM, clerkship, and electives • Global category – NO numeric grades • Meets, Exceeds, etc. • ALL narrative comments • Unedited except for grammar

30. Dean’s Letter (MSPR) • MSPR Review • In September • Specific dates TBA via class e-mail • Sample MSPRs can be viewed in the Career Advising Office. No electronic version of a sample can be e-mailed to a student.

31. McGill’sMSPR Includes only faculty-related awards/activities Faculty scholarships and research carried out through the bursary program All other relevant activities should be reflected in your CV Does not include overall individual class rankings since BOM is pass/fail U.S. MSPR Includes elaborate section on unique attributes, abilities, and extra-curricular activities Provides overall class ranking for each student Dean’s Letter (MSPR) VS. **Despite the fact that some US programs are not sure how to use our Dean’s Letter, as noted before, many McGill students consistently match to top competitive programs in the US

32. What happens if you don’t match… • Don’t Panic… We will be here to support and assist you if you go unmatched

33. What happens if you don’t match… • CaRMS • NRMP can be used as a back-up, but only if you applied and submitted rank order lists to both systems • 2nd Iteration • List of unfilled positions released on Match Day • Same as 1st round but more condensed timeline • Interviews usually by phone

34. What happens if you don’t match… • SF Match/ AUA • Hopefully, you have applied to a second choice discipline that you can have as a runner-up through the NRMP • If not, there are always some available positions left-over after the match, and we can assist you in exploring these options

35. What happens if you don’t match… • NRMP • List of unfilled positions released for • The Dean’s Office provides you with facilities to “scramble” in and personal support as needed • You select interesting/suitable programs and apply manually (fax, telephone, and e-mail) • It is a crazy and stressful process, but the outcome is usually good for those applicants who approach it with patience and pragmatism SCRAMBLE

36. What happens if you don’t match… • Take a year off to do research, • humanitarian work, etc. • Pros: • Potential publications, additional references, reflection • Cons: • Clinical activity prohibited after graduation • Competing against fresh batch of applicants • Stigma of unmatched applicants • Application process for following year match starts too early to complete meaningful research

37. And so… • We’ve given you a lot of information, and the process • may seem overwhelming, but the bottom line is this: McGill students do well, and you’re a McGill student! • As always, contact us if you ever have questions, concerns, • or would like us to review your CVs, personal statements, etc. (514) 398-5557 namta.gupta@mcgill.ca or careeradvisor.med@mcgill.ca