United States vs Canada | Medical School & Becoming a Doctor

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Medical training is strenuous anywhere in the world, but it certainly does not work the same way in every country. Between becoming a fully trained doctor in Canada or the U.S., which path is harder, longer, or more expensive? Let’s break it down one category at a time.

If you want to become a fully trained physician in either Canada or the United States, there are at least three stages you must go through in both cases. The first one is premed, completed in university or college. That’s when students learn basic sciences like biology, genetics, and chemistry. The second stage is medical school itself, which is generally divided into preclinical and clinical years. Finally, there is residency, which is when newly-minted doctors specialize and work towards their board certification.

 

1 | Premed

You’ll start as a premed in college or university in both Canada and the U.S.

American medical schools require a bachelor’s degree prior to matriculating, which generally takes at least 4 years. The good news is you can major in whatever you want, as long as you fulfill the prerequisite requirements, such as biology, chemistry, physics, and the like.

Technically, Canadian medical schools allow you to enter medical school without a bachelor’s degree. However, most students do complete all 4 years and get a bachelor’s degree prior to matriculating to medical school. Unlike their American counterparts, Canadian premeds are not required to complete the same 2-year-set of prerequisite courses. The University of Ottawa requires organic chemistry, for example, but Queen’s University has no prerequisites. And just like in the U.S., you can major in any subject you’d like.

Tuition cost also varies between these two countries, and that’s mostly because Canada heavily subsidizes higher education. In the U.S., public medical school tuition averages nearly $37,000 per year, whereas private medical school tuition averages $58,000 per year. That’s before living expenses, which are highly variable based on the city you’re living in.

In Canada, the costs are quite different. The average tuition is around $13,000 for Canadian students and $23,000 if you’re an international student.

 

2 | Medical School Application

Completing your premed requirements doesn’t guarantee admission to medical school. You still have to face the MCAT and a competitive admission process. Getting into medical school in Canada is considered more competitive compared to getting into medical school in the U.S. based on average MCAT scores and admissions rates.

MCAT

The Medical College Admission Test, or MCAT, is the standardized exam for both Canadian and American students applying to medical school. Although students from both countries take the same test, there are some key differences you should be aware of.

First, Canadian schools weigh MCAT section scores differently than their U.S. counterparts. In the U.S. schools give each section approximately equal weighting, although there is some variation between programs. However, in Canada, MCAT assessment varies significantly by program. the Critical Analysis and Reasoning section of the MCAT, also known as CARS, is generally more heavily weighted. The University of Toronto has an MCAT cutoff such that if you’re above a 125 in each section, with 1 section allowed a 124, your MCAT isn’t evaluated competitively. At McMaster, the MCAT accounts for 32% of your final admissions decision, and the only section they look at is CARS. Queens looks at all sections, while Ottawa doesn’t use the MCAT as an evaluation criterion. At Western, they evaluate all sections, with different cutoffs each year – the CARS section generally faces the hardest cutoff.

Second, Canadian medical school matriculants have a slightly higher average MCAT score. In 2019, the mean MCAT score for matriculants in the U.S. was 511.2 compared to 512.5 for Canadian students.

Competitiveness

The competitive process for medical school admissions doesn’t end with the MCAT. Comparing admission rates highlights the fact that competition is fierce in Canada. Recently, approximately 53,000 students applied to 22,000 medical school seats in the U.S. In comparison, about 14,500 students applied to 2,500 Canadian medical school positions. That results in 5.65 applicants per seat in Canada, versus 2.38 in the US.

This may seem strange – after all, isn’t Canada short on doctors? Shouldn’t more applicants be able to gain admission and ultimately help fill the gap? While Canada presents the 19th highest GDP per capita globally, it only ranks 76th on physicians’ density. Canada has relatively fewer doctors than countries like Uzbekistan and Jordan.

When speaking with my Canadian colleagues about these issues, two hypotheses arose to explain this phenomenon:

The first and more politically correct one is that there are simply not enough financial resources. Canadian higher education is highly subsidized by the government, which obviously represents significant expenses.

The second possibility, which is just a theory, revolves around medical lobbyists in Canada. The idea is that there is an incentive to keep the supply of physicians low to maintain practicing doctors’ high pay.

Provincial Privilege

Canadian medical schools give preferential treatment to students who are from the same province. After all, these students are most likely to stay after graduating, thus serving the location population. There are some exceptions in Ontario, where they treat all Canadians equally, meaning if you live in Ontario you may not get as much of a home-province advantage.

The University of British Columbia, for example, officially requires a greater minimum GPA for out-of-province applicants. In their own words, “BC applicants with an overall academic average of less than 75% and out-of-province applicants with an overall academic average of less than 85% will not receive full file reviews and thus will not proceed further through the application process.

Application Process

There are noteworthy differences and similarities between applying in the U.S. and Canada.

Except for nine medical schools, U.S. universities use a common application system called the American Medical College Application Service, or AMCAS. The equivalent of AMCAS to DO schools is the American Association of Colleges of Osteopathic Medicine Application Service (AACOMAS).

On the other hand, most Canadian medical schools use their own independent application systems, Ontario being the exception. All six Ontario medical schools use a common application system called the Ontario Medical Schools Application System, or OMSAS. There is no OMSAS equivalent for osteopathic medical schools since Canada doesn’t offer any DO programs.

Although the exact systems differ between countries, the core of your application will be very similar. In both America and Canada, programs seek a holistic understanding of an applicant, rather than basing their competitiveness purely off scores. While your MCAT and GPA are important, the soft components of your application, such as letters of recommendation, personal statement, work and activities, and other factors are important considerations prior to being offered an interview. CASPer, a video and text based application created at McMaster University, has increasingly become a larger component in assessing candidacy at several Canadian medical schools, and now, some in the U.S. are following suit.

And of course, how you perform on the interview is critical in determining whether you’ll receive an acceptance offer.

 

3 | Medical School

What about life after medical school acceptance?

Medical schools operate similarly between the two countries. At almost all schools, the first two years are preclinical, and the last two are clinical.

In the first two years, or preclinical or pre-clerkship years, you’ll learn the foundational sciences of medicine, like anatomy, physiology, and the various organ systems. These two years’ emphasis is on understanding physiology and pathophysiology through textbooks and classroom didactics.

The latter half, or clinical years, is when you spend most of your time in a hospital or a clinic instead of a classroom. These years are divided into rotations, each lasting between 2 and 8 weeks. During each rotation, you’ll be on a particular service, such as pediatrics or general surgery. Your grades are based on an exam at the end of each rotation in addition to evaluations from your supervising physicians.

Most Canadian medical schools have pass/fail for all 4 years of medical school. In the U.S., it’s more common to have pass/fail during the preclinical years, but a graded system with Honors, High Pass, Pass, and Fail during the clinical years. U.S. medical students also have to face the dreaded USMLE Step 1 and Step 2CK, while Canadian counterparts have nothing of the sort to worry about. Instead, Canadian medical students take the MCCQE, their USMLE equivalent, for licensing after they match.

This translates to a lower stress environment, for the most part, amongst Canadian medical students. They don’t have to worry about getting honors in all their clinical rotations, as their American counterparts do. Instead, they simply need to excel in the rotation for which they are going to apply into.

 

4 | Residency Application

The residency application process for U.S. and Canadian students varies starkly, primarily due to differences in medical school objective measurements.

In the U.S., USMLE Step 1 is taken after the second year of medical school and has been the single most heavily weighted objective factor in residency matching. For that reason, it causes a great deal of stress and anxiety for many medical students. In 2022, it’s transitioning to Pass/Fail, which will likely place greater emphasis on USMLE Step 2CK, which is generally taken after the third year of medical school.

In September of your final year of medical school, you’ll submit your application through the Electronic Residency Application Service, or ERAS, for most specialties. There are a few specialties that have their own separate match outside this system. Just like applying to medical school, you’ll need to submit your test scores, transcripts, personal statement, letters of recommendation, and activities list.

In the subsequent months, interviews are offered, and in February, candidates submit their rank list. Match day occurs in March, where you open up your envelope and find where you’ll be attending residency.

Because Canadian medical students don’t have grades and don’t have a standardized test like the USMLE that is factored into their residency application, their candidacy is primarily a function of their letters of recommendation, personal statement, and CV. If you’re applying into a highly competitive specialty, research becomes more important too. Residencies may also give preference to students who have completed an elective rotation at their program.

The licensing exam for Canadian medical students, the MCCQE Part I, is taken at the end of medical school after match. Therefore, it has no bearing on one’s residency application.

 

5 | Residency

If you made it this far, congratulations, you’re officially a doctor and are now in the final stage of your training to get board certified.

The exact duration of each specialty varies in each country. Internal medicine is 3 years in both, but family medicine is 2 years in Canada and 3 years in the U.S., whereas anesthesiology is 5 in Canada but 4 in the U.S.

In terms of pay, you’ll be making roughly $50,000 to $60,000 per year depending on your year in training in both countries. After residency is when you’ll take a significant raise as an attending.

As for the lifestyle, residency in both countries is grueling. In the United States, the ACGME has mandated an 80-hour work week restriction, although certain specialties, often the surgical ones, are known to violate this and exceed sometimes over 100 hours per week. In Canada, current duty-hour restrictions allow residents to work 70 hours per week on average and up to 100 hours per week during peak periods.

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