Finding Your Way Home : Information on Rotations and Residency in Ontario

1. Finding Your Way Home:Information on Rotations and Residency in Ontario

2. Where Do I Start? – I have NO connections Talk to everyone you know – try to find a shadowing opportunity at a hospital in your area on every break – this is a great networking opportunity. Ask your family doctor who the local physician recruiter is or look this information up on-line. They may be affiliated with a particular hospital or region. Send them an e-mail and introduce yourself – ask them what clinical opportunities exist in your area.

3. Where Do I Start? – I have NO connections Try to meet people face to face – this is your best chance at creating a lasting impression – be flexible – make it clear you are willing to work in any environment If you are from an area that is underserviced sell the fact that you want to practice there. Talk about your roots in the community, your family there, anything that ties you to that area. Did you go to a university with a medical program? Did you do any research there? E-mail the clinical department, tell them you are an alumnus and ask about what your options are.

4. First Impressions Be sure to ask about core rotations if this is what your after– it is easier to get elective rotations and most universities have a system in place to apply. Remember that you only have 1 chance to leave an impression – be selective in your choice of language – don’t downplay your status as an IMG and don’t oversell yourself.

5. Cores or Electives? In Ontario it has been communicated to me and to the past clinical liaison that residency program directors will give preference to those students who have pursued core clinical work in the province however elective work also gives you a favourable advantage. Obviously the more Canadian clinical work you can secure the better. Keep in mind your electives can be done in regional health units or other settings that are not university affiliated - this can cut out a lot of the red tape.

6. Location, Location, Location Consider going North or going East. In both of these areas the so called ‘12 week rule’ is less likely to be upheld and there obviously is a greater need In Ontario, Look at the LADAU list – this a list of underserviced areas published by the MOHLTC These spots are where IMGs who secure a residency match via CaRMS must fulfill their 5 year ROS agreement

7. Location, Location, Location • If you can obtain clinicals in one of these communities and make connections you may have a better chance of securing residency later – it isn’t as bad as you think – Windsor, Burlington, Perry Sound and Barrie are considered underserviced. • In Southern Ontario you are less likely to secure rotations but it is not impossible. Consider however that you might only get 1 – try for 12 weeks and consider a rotation that be helpful to you in the future. • The CPSO does not care where you do your rotations, only that you have fulfilled Saba’s degree requirements

8. If you have a connection… Great, just don’t take it for granted. You will likely have to deal with the university affiliated hospital where the physician in question works and may encounter resistance relating to your status as a 3 year student. Some universities only offer rotations to 4th year students as a way of preserving cores for their own students. Just be persistent and ask your contact to help you if you run into a problem. Prepare your CV (a link to the guidelines is at the back of this document) Call Sandy and let her know you have a rotation set up. Make sure the affiliated university has no issue with taking you on before you call her. Ensure your immunizations are up to date.

9. Timing is Everything You want to start the process no sooner but no later than 4th semester. Your break between 3rd and 4th is a good time to meet with any potential contacts. When you are telling a doctor or university about when you are available for rotations consider the time you will need to write the step – typically students need 6-8 weeks to prepare.

10. Rejected? Be prepared to hear NO a lot before you find a break. The good news is many Saba grads have been able to get at least 1 core or elective in Canada, and Ontario is slowly becoming more IMG friendly. Also doing rotations in canada does not limit your ability to go back to the US for residency if you choose do do so. As long as the hospital you were at has a residency program then the rotations are considered “greenbook”.

11. WSIB If you are considering rotations in Northern Ontario you will be going through NOSM – and they require WSIB coverage. There is now a system in place to deal with this complication but it requires you paying for private insurance for 1 year. So even if you get only 1, 12 week rotation, you may be stuck with 9 months of extra insurance payments. Fortunately for now, NOSM is the only Canadian school requesting this type of coverage.

12. Applying for Residency as an IMG The MCCEE is required for all IMGs It is similar to the Step 1 but has a greater assumption of basic science info and is more clinical in nature – the rep I spoke to at the MCC told me it is more of a fusion between Step 1 and 2 If You must then apply and sit for the MCCQE1

13. CEHPEA As of April 19, 2007 the Center for Evaluation of Health Professionals Educated Abroad or the CEHPEA replaced IMG Ontario The CEHPEA evaluates all foreign grads, in our case this step will come after you successfully complete MCCEE and MCCE1 and are ready to apply for first year of residency - PGY1 You are now required to complete the CE1 – the general comprehensive clinical exam The CPSO website says that preference is given to candidates to are successful on the CE1 – however in speaking to the college I was told that those who fail it are not likely to be considered in the match

14. MCCE2 After 12 months of residency you are able to sit for the MCC2 and proceed with your second year of residency The MOHLC however has some confusing information that suggests that core clinical work done in Canada will fulfill this 12 month requirement. I don’t have a clear answer on this yet.. You complete your residency and then sit for the Royal College exams – then you can apply for a permanent liscence in Canada.

15. Too Complicated?? Consider Repatriation In Ontario, IMGs who have 1 or 2 years left in a residency program can apply for repatriation Your application goes through one of the 5 Ontario Universities for post-graduate residency in collaboration with the MOH If accepted you will be required to complete a ROS agreement in an under serviced area

16. And The Easiest Route?? Complete residency in the US Apply as a relocating MD As of April 06 the USMLE is considered equivalent to the MCC exams but only in Ontario The CEHPEA will likely require you to sit for the CFPC (family) or RCPS (specialty) You can apply to both the Canadian and American match in the same year – keep in mind though that the American match comes up first If you match you are removed from CaRMs If you don’t match with CaRMs you are looking a year until you can reapply

17. CaRMS If you don’t match with CaRMs you are looking a year until you can reapply Although IMGs and CMGs both apply in the first round, there are parallel streams with designated spots for both Not all of these spots are filled every year despite the large number of applicants

18. Recent Developments With the launch of the CEHPEA it was decided that people accepted to FP residencies will have to complete a pre-residency assessment which delays the start of your residency There is currently discussion on implementing this for specialty residencies possibly in 2008

19. Sorry to Exclude Most of the Country In a nutshell, the only province which students can’t match in the first round is Alberta - they also require students doing rotations to be in their 4th year The West in general is tough but if you look at the IMG Canada website – more resources are now in place In the Atlantic provinces most hospitals are officially or unofficially affiliated with Dal. Dal will stick to the 12 week rule sometimes, so best advice is to set things up yourself especially in NS and NFLD– try the rural health centers. So far the East is the most IMG and Saba friendly

20. For More Information IMG Canada: http://www.img-canada.ca/en/resources/img_programs.htm MCC: http://www.mcc.ca/pdf/IMGQEI_e.pdf CEHPEA: http://www.cehpea.ca/ CARMS:http://www.carms.ca/eng/r1_eligibility_prov_e.shtml http://www.cpso.on.ca/ Health Force Ontario: Health Force Ontario:http://www.healthforceontario.ca