by Mieke Heyns, MD, Anna Steve, MD, Jiayi Hu, MD, Justin Yeung, MD
This is an exciting time of year as many medical students begin clerkship here in Canada, and start to experience the ins and outs of hospital and clinical practice. Nevertheless, as a medical student you always have to be thinking of the next step, and for plastic surgery keeners that means a residency position. Residency training may or may not be completed in the same country where you completed your medical school training. Let’s review several key aspects of both Canadian and US Plastic Surgery Residency programs.
The Canadian System
Residency programs in Canada consist of 5 years of training. Generally, time is divided into 2 core surgery years and 3 years of specialty specific training. Canada has 11 plastic surgery residency programs, and took a total of 23 students in the 2016 R-1 match, filling all positions. Applications are made through the Canadian Resident Matching Service or CaRMS. All schools require applicants to be Canadian citizens or have permanent residency; most schools need a minimum 2-3 letters of reference, medical school transcripts, a personal letter, medical student performance report, CV, and prefer students to have done an elective at their institution. Three schools accounting for 4 spots also require French competency. Interviewees are then selected based on these criteria. Of note is that Canadian medical school transcripts for most English schools are pass/fail, so less emphasis is placed on academic standing.
Additionally, US graduates from an osteopathic medical school are broadly considered International Medical Graduates (IMG) applicants and need to have completed the MCCEE and NAC examination. IMG’s must have Canadian citizenship or permanent residency. For English schools, the Universities of McGill and Toronto each have 1 dedicated IMG spot; Toronto requires applicants to sign a 5-year return of service agreement to practice anywhere in Ontario excluding Toronto or Ottawa upon completion of training. The last IMG to match to these 2 schools was in 2013; of note, McMaster and Ottawa also occasionally have IMG spots depending on the year. However, this may be due to low application numbers; 2016 saw only 4 IMG candidates ranking Plastic Surgery as their top choice compared to 50 CMG candidates.
A graduate from an allopathic school of medicine in the United States having Canadian citizenship or permanent residency status is considered equivalent to a CMG. These students can apply to all positions available to CMG students through the CaRMS portal. For osteopathic school of medicine graduates the eligibility criteria varies and is more restrictive depending on the province.
The U.S. System
There are two pathways to complete plastic surgery training in the United States if you are trained in the allopathic medicine system: a three-year independent plastic surgery program or a six-year integrated program. Independent programs only accept residents who have completed either a residency in general surgery, otolaryngology, urology, orthopedics or neurosurgery (with some exceptions if this training is completed at the same institution as the plastic surgery training). In 2015, there were 41 independent programs offering 70 positions. However, this number is decreasing.
In contrast, the number of integrated programs are growing, as many schools have recently transitioned away from the three-year independent program. There are 69 integrated programs in the United States with 152 positions (only 101 positions in 2012), one of which went unfilled in the 2016 match. Interestingly, 20 of these positions are in the state of California alone. Applications are administered through the Electronic Residency Application Service (ERAS), with applicants also needing to register with the National Residency Matching Program (NRMP). In general, students need to submit their ERAS application form, CV, USMLE Part 1 +/- Part 2 scores, 3 letters of reference, dean’s letter and medical school transcripts to apply.
Canadian medical school attendees will contact CaRMS to obtain their ERAS tokens in order to start their applications, and IMG must contact the Education Commission for Foreign Medical Graduates (ECFMG) for their tokens in June when applications open. Please note that IMGs applying for the US programs are not required to have US citizenship or permanent residency. US medical school graduates obtain their token from their graduating school’s dean’s office; the next steps in the process are largely similar between U.S. and non-U.S. graduate applicants. In 2016 for 152 integrated spots, there were 178 U.S. senior applicants and 38 others including U.S. (no longer seniors), Canadian, and IMGs. Of these applicants 133 U.S. seniors matched along with 18 others, including zero Canadian graduates. The last Canadian graduate to match to a U.S. residency in Plastic Surgery through NRMP was in 2006.
Take note that the above information may not apply to all schools, some U.S. residency programs choose not to participate in using ERAS or NRMP for the matching process. There is also no succinct location to find school requirements and program descriptions. Rather, applicants are encouraged to contact each residency program individually to find out about requirements. This can lead to inefficiencies in the application process, especially since most integrated program websites lack information needed by applicants1.
Applicants can apply to both U.S. and Canadian schools, with the knowledge that depending on the year, one matching system may precede the other. Thus, if you match through the system with an earlier date you will automatically be withdrawn from the other. If you fail to match in the first iteration, and that the NRMP Supplemental Officer and Acceptance Program (SOAP) runs before the CaRMS second iteration, the same rules would apply. A J-1 visa must be obtained by the Canadian medical graduate, but only after a residency offer has been accepted.
As an osteopathic trained physician, you may apply for Doctor of Osteopathic (DO) programs, which are offered as independent programs. They are similar to allopathic programs but far fewer in the number of spots. In 2017, there are eight programs approved by the American Osteopathic Association, and most of them are in the northeastern states.
Whether you are looking to stay in the same country or venture across the border for your Plastic Surgery Residency there are many options. For candidates this means plenty of decisions. For programs this means having up to date information that is easily accessible in order the attract the strongest candidates.
Good luck everyone!
- Hashmi, A., Policherla, R., Campbell, H., Khan, F. A., Schumaier, A., & Al-Mufarrej, F. (2017). How Informative are the Plastic Surgery Residency Websites to Prospective Applicants?. Journal of Surgical Education, 74(1), 74-78.