The hidden strings of having “abroad” as your plan b for medical school

So, yeah, apologies all around. This one is going to be another long one. In my three cycles of applying to Canadian medical schools (and getting rejected) I did what a lot of Canadian students do.

I applied to a medical school “abroad.”

Specifically, for me, I applied to the University of Queensland in Australia, one of the most popular spots for Canadian’s to go abroad (Ireland, Poland and the Caribbean being the other most popular). And why not? I’d been rejected in Canada for that cycle, and the application was super easy. OzTREKK, a service that helps Canadian’s go study abroad in Australia waived the application fee, and they even held the “applicant meetings” (not called interviews, and very much more relaxed than an interview) in all the major cities in Canada (Toronto for me).

And I got offered acceptance.

Now, this was a nice ego boost, especially after two cycles of rejections, and I was pretty excited. I was starting to fear that getting into a Canadian school just wasn’t going to be possible, and Australia could be a great adventure. Sure, there’d be some problems if I wanted to come back to Canada, but in the glow of an actual acceptance, that seemed pretty trivial to me.

That I couldn’t pay for it was less trivial.

See, Macleans has written a lot of articles about the fees of doing medical school abroad. $250,000 is the conservative estimate, compared to about $80,000 max for Canadian schools, with most of that funding coming from bank loans and family loans. The thing about funding an international medical education that none of these articles or slick study abroad programs mention is this: in Canada, banks will give you professional student loans for medical school up to $250,000 dollars without a cosigner (someone who is responsible for the full amount of the debt if you drop-out or default).

But only if you are attending a CANADIAN medical school.

Yep. If you’re going international, or even to the USA you need a cosigner with at least half a million dollars in assets before the bank is going to give you that money. And, because that person will be on the hook if you default, it basically means your parents must have that much money, because very few other people are going to trust you that much.

Needless to say, my parents just didn’t have that kind of money around.

And federal loans are useless, as if you’re going abroad, the Canada Student Loan program will only give you a max of about $9000 per year. Not even close to being enough. So, I had to refuse the offer of acceptance, and commit myself to the struggle of getting into a Canadian school. Needless to say, I was pretty down about it. But, as I did some more research after the fact, I realized that there are other reasons why abroad isn’t quite as shiny as it seems. Beyond the gaping debt and the ability to finance that education, IMG (International Medical Graduates) have 2 other problems trying to return to Canada to do a residency.

1) CaRMS: The Canadian Residency Matching System is an agency that all medical graduates need to apply to if they want to do a residency in Canada. The graduate applies to several residency programs, interviews there and then ranks their choices. The interviewers at those programs provide a ranked list of students they want, and then the system matches them. In 2010 CaRMS recorded that 96% of Canadian Medical Graduates (CMG – who have gone to Canadian schools) matched to residencies, and Macleans reports that the first choice match rate at Canadian schools ranges from 97%-85% (Ottawa highest-Queen’s lowest, with most schools above 90%).

To contrast, only 23.5% of IMG’s matched AT ALL. And within those, 50% matched to family medicine (the most common and least preferred residency).

These aren’t exactly inspiring numbers, and remember, it doesn’t matter if you are a Canadian citizen, if you went abroad for medical school you are an IMG. A return to service agreement can up your chances of returning and getting a residency, but it also commits you to 10 years in a rural area, something most of us probably wouldn’t be willing to do.

2) Tests: So all students have to do the Medical Council Qualifying Exam 1 and Qualifying Exam 2 whether they are Canadian or International to practice and have a residency in Canada. However, only international students have to take the MCC Evaluating Exam and the NAC (National Assessment Collaboration – except in Ontario, as of 2015 everyone has to take it there, because Ontario sucks) exam before being able to return. Well, you say, but that’s not so bad. That’s only two extra tests, I can do that.

The MCCEE usually requires students to take a full year off to study for it.

So yeah, they’re not just little tests. Now you’ve added another year to the 8 that you’ve already put in to get to that point, and I don’t know about you, but that doesn’t sound great to me. Add that to the fact that if you’re unsure if you’re going to get a Canadian residency and you write the USMLE (to have an opportunity to be placed in the American matching system) you’re probably going to need more than a year, because that’s a badass test as well.

So yeah. Getting into medical school in Canada is hard. It’s a numbers game, and the odds aren’t in your favor. And yes, abroad is going to be the right choice for some people, regardless of extra cost, IMG choices or the MCCEE, and I totally respect that.  If that’s you, go for it, and good on you.  But before you throw in the towel in applying to Canada for the (at least slightly) easier process of getting accepted abroad, give what I’ve said some thought, and know that it does come with some hidden strings.

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