Below is a survey prepared by some University of Toronto students:

Please send any additional information, or put it down yourself!

This survey is an effort to compile information on whether 2nd year Canadian medical students should write the USMLE step 1.

We realize it is hard to speak in absolute terms on this subject because policies are state/school/program specific and change over time. Nonetheless, we are trying to gather as much information as possible for Canadian medical students considering writing it. This information will be made available either in a publication or website for all Canadian medical students.

1. As you look(ed) into post-residency opportunities, have you come across any programs (or more generally schools or states) that require the USMLE? Please list and explain.

  • Yes, California, Utah, Florida, Cleveland programs all required USMLE
  • California requires USMLE - all steps
  • Yes, approximately half. Usually in the states that are more competitive places to attend (eg. East coast and West coast — better climate.)
  • I did apply to a couple of US training programs that preferred USMLE.
  • Some fellowships require the USMLE so that they can bill for patients that you see while you are not supervised.
  • Many require it, but will accept full Canadian licensure (ie FRCPC, FRCSC) as an equivalent.

2. Were your grades important (or was it just important that you passed)?

  • That you passed
  • Class rank may have been moderately important at top programs like UCSF, UCLA, UCSD.
  • Did not seem to be a factor… but may be more so in the competitive areas of ophthalmology (eg. retina, oculoplastics plastics. American standardized testing in ophthalmology that we must write annually probably had more influence than our medical school marks.

3. How about programs (or states or schools) which DO NOT require the USMLE? Please list and explain.

  • PA, Iowa, OR, did not require
  • I am not aware of any. I only applied to California
  • The only that I know for certain are: Department of Ophthalmology: Peds department: University of Wisconsin University of South Western Texas Probably does not require: University of Indiana University of Iowa Children's Hospital National Medical Center Washington D.C. Pediatric Ophthalmology Each department can structure their own requirements as they need. So the Retina dept could demand USMLE but in Peds, may not demand it.
  • Did not apply to any such programs.
  • Luckily, the fellowshiop I wanted just needed a J1 visa which does not need the USMLE. The H1B VISA needs the USMLE.

4. In your experience are Canadians doing US fellowships generally on a J1 or H1b visa?

  • 50/50
  • I am not aware of this as I am a US citizen
  • Split 50/50 but people would prefer to have an H1b visa since there is more flexibility for both the fellowship candidate and the university. Some programs demand it because they can bill the fellow's work and provide a source of income for the department under an H1B and the candidate him/herself. hier
  • Vast majority are on a J1 visa.
  • Half and half.
  • More often on a J1.

5. Would choosing to pursue fellowship opportunities in the US ever close opportunities to practice in Canada?

  • No it opens opportunities to US and Canada
  • No, not at all.
  • No
  • Don't think so, except that your lack of presence in Canada would mean less exposure/contacts here.
  • No
  • Possibly. You should check that your US program meets Canadian requirements - many do not.

6. What about for job opportunities in the US?

  • No
  • Excellent
  • Not at all.
  • Certain states require the USMLE for permanent US employment, even if it is not required for a residency or post-residency training program there.

7. Any other advice for 2nd year med students considering writing the USMLE?

  • Write it if you are considering going to the US for work or training
  • Don't wait… take them on par with your LMCCs! It's easy to get behind!
  • If you are considering working in the US, have family in the US, marrying an american citizen who may want to work there one day, have the extra time and money to do the tests, you should consider it. Or if you are unsure, you can just do USMLE 1 to keep options open, and do USMLE 2, 3 during residency since the USMLE 1 is easier to do at this stage of training rather than during residency. Note: If you do plan on working in the US, you would also likely need to write the American Boards in your subspeciality which is must be updated every 10 years (Cost: $3000).
  • I would advise against it. I wrote the USMLE Step 1 and then stopped there as I don't think it is necessary unless you really plan on doing residency in the US and want the better Visa. Doing it to "keep doors open" is in my opinion a big waste of time/money. Overall, few states require it, there are ways around it, and even if you absolutely had to do it, they are SO easy to just pass that you could do it at any point in your future without much stress.
  • The main things are: 1. Some fellowships need you to be able to bill for them. You can get a H1b visa to do this and write the USMLE, or you can try (pay money and lawyer and have outstanding CV) to get an O visa. 2. If you want to work on the weekends outside of fellowship to make money, consider getting H1b visa and writing USMLE 3. When you write your american board exams, you no longer need to write your USMLE (according to immigration lawyer), so you can hedge your bets and plan to write one exam that is useful to you rather than a bunch that are meaningless. However, being able to bill/work on weekends and earn extra money and open up some extra fellowship opportunities may be what you are looking for.

Thank you for completing our survey! We wish you best as you prepare for life after residency.

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