All medical students have a variety of questions regarding match day. But for international medical students, the details surrounding the process of getting matched into a US residency program can seem even more complicated.

When it comes to US medical residency positions, Canadians studying medicine abroad (CSAs) are considered international medical graduates (IMGs). This means they must undergo the same process for selection into US residency training as other IMGs who completed their schooling outside of the US.

Join us as we outline the steps required to qualify for US medical residency programs as a CSA.

4 Things CSAs should know about obtaining residency positions in the US

Recent data from the Association of American Medical Colleges (AAMC) indicates that approximately 23 percent of US medical residents and fellows are graduates from international institutions.

For CSAs specifically, there are a few common questions worth addressing:

1. Is it harder to obtain a US medical residency as an CSA/IMG?
   While the National Resident Matching Program (NRMP) in the United States does not have dedicated spots specifically intended for IMGs, international grads like CSAs can participate in the NRMP Match alongside US medical graduates and other applicants.

   Most US residency programs are more concerned about a candidate’s educational qualifications than they are about a candidate’s citizenship. But it’s still worth considering that some international medical institutions are more effective than others in preparing their graduates for US residency positions.

   The Educational Commission for Foreign Medical Graduates (ECFMG) notes that the current match rate for IMGs in the US is roughly 59 percent. Canadian students who earned their medical degree from St. George’s University (SGU), however, have experienced a 92 percent success rate in the US Match over the last three years.*

2. What is required for CSAs/IMGs to qualify for the US Match?
   Both US med students and IMGs are required to take the same standardized exams in order to participate in the NRMP Match. These exams play an important role in the residency application and evaluation process.

   Expect to sit for the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 CK. The USMLE Step 1 assesses a student’s understanding of the basic science concepts that are taught during the first two years in US MD programs. The USMLE Step 2 CK covers the clinical knowledge students gain during their final two years of med school.

   After successfully completing these exams, you can submit an application to receive ECFMG Certification, which is a requirement for participation in the NRMP Match.

   In addition to acceptable USMLE scores and ECFMG certification, CSAs/IMGs hoping to qualify for the US Match must possess a medical diploma from a school identified in the World Directory of Medical Schools, along with med school transcripts available to submit.

3. How do CSAs apply for the US Match?
   In Canada, the application process is administered through the Canadian Resident Matching Service (CaRMS). But med students looking to participate in the NRMP Match in the US will need to submit applications through the Electronic Residency Application Service (ERAS).

   While it is an entirely separate system, CSAs/IMGs must register for ERAS through CaRMS, which acts as a sort of administrative body for Canadian med students and graduates applying to US positions.

   From there, the journey toward landing a residency position is very similar to what Canadian students experience through CaRMS. Applications are submitted, a computerized mathematical algorithm is used to place applicants with the programs they qualify for, residency interviews commence, rank order lists are established, and matches are eventually secured.

   It’s also worth noting that CSAs are permitted to participate in both the US Match and the Canadian Match if they desire. Be sure to keep in mind, however, that whichever match runs first will take precedence, and you will be contractually obligated to honor that placement.

4. Do Canadian students need a visa to complete a US medical residency?
   If you get accepted into a US medical residency program, you will need to ensure you take the proper measures to be granted temporary citizenship while you complete your training. There are a couple of different visa options to consider.

   Most CSAs/IMGs who obtain a US residency position apply for a J-1 visa. This is a temporary training visa that allows foreign medical grads to reside in the US for the duration of their residency (and fellowship, if applicable), with a maximum allowance of seven years. After completing their training, J-1 visa-holders are expected to return to their home country for at least two years.

   It’s worth noting, however, that there are waiver options available that allow IMGs to bypass this two-year home country requirement. J-1 visa holders who have completed their medical residency training in the US can request a waiver of the home-country requirement if they commit to working in a medically underserved area.

   An alternative option would be to apply for an H1-B visa, which is available for temporary workers in specialty occupations who hold professional-level degrees. It allows a qualifying foreign national to enter the US for employment for up to six years, and it has no two-year home residence requirement.

   Different medical institutions have varying criteria regarding the types of visas they accept, so be sure to examine the details of each program closely.

Prepare for the US Match

The prospect of matching into a residency position in the US as an international grad is exciting, as it could open a number of different doors for your career as a physician.

As you navigate the complicated logistics that come with being a CSA/IMG applying to be a US medical resident, don’t overlook the other important elements required of a successful applicant. By understanding which factors US residency programs are focused on, you can better prepare for application season.

Learn more about what to expect in our article “How to Land the Medical Residency You Want: 7 Criteria You’ll Be Evaluated On.”

*Average of 2021, 2022, and 2023 residency rates. Residency placement rate is defined as the total number of Canadian students/graduates who obtained a US residency divided by the total number of Canadian students/graduates who applied to a US residency program in a given year as of April 2023.