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                                    Dr. Carlo Puzzo, PGY-1
                                    Family Medicine



1. Please introduce yourself (name, age, Canadian undergrad/masters, medical school, graduate year, residency program and year, AOA or ACGME, and state).


My name is Carlo Puzzo and I’m 26, born and raised in Hamilton, Ontario. I graduated from McMaster University in 2011 as an honours biology major and environmental science minor. From there, I attended Nova Southeastern University College of Osteopathic Medicine, graduating in 2015. I’m currently an intern at an AOA family medicine residency in North Carolina.


2. Can you tell us more about the entire visa process that you had to experience for an AOA residency?


Since it was an AOA residency, J1 was obviously out of the question. The H1b process is no different for AOA, with the caveat that it's incredibly difficult to find a program willing to sponsor. First, get your OPT. It takes about the full 3 months to receive so apply accordingly. Make sure you indicate a start date before residency starts. You can only apply for the social after the OPT start date has passed, and it takes 1-2 weeks to receive the number. Now you have your golden ticket to live and work in the US for one year. To apply for the H1b, my lawyer requested copies of my CV, residency contract, bio page, and stamped pages of my passport, OPT card, I-20, including any previous ones that ran out of signature space, and score reports for the boards (USMLE or COMLEX). 


3. What about the transition from OPT to H1b, how will this be handled?


My residency allegedly started the paperwork to transition to the H1b before I even arrived. Their lawyers and administration staff are handling most of the paperwork. I had to provide the basic stuff I mentioned above. They claim it will cost the hospital 5-6 thousand US dollars. I've heard but can't confirm that as long as they apply for the H1b 6 months before the OPT ends, you can continue to stay and work in the country while waiting for the H1b to come. The application process takes about 3 months and there is a fast track that only takes two weeks but requires more hospital money. I would wait at least the first 6 months before applying to maximize your time on the OPT, which will in turn give you more time on the H1b. Thankfully, non-profits do not apply towards the H1b cap. 


4. During my interview process I have had MANY AOA programs willing to sponsor a visa, yet I felt like many really had no idea what that process entailed. Is there anything Canadian DOs should watch out for?


This is absolutely true. Programs will tell you anything during interviews but will probably balk when they truly find out what it takes. When deciding on a program you want to make sure the salary they pay equals the average salary nationwide. This is an H1b requirement. Most DO programs pay less than MD residencies and so you might run into trouble with that. Look for hospitals that have doctors on visas currently (either residency or attendings). Also, be willing to train at a less than desirable location because the harder up they are for residents the more likely they will sponsor. 


5. From your experience, have you noticed any advantages for going USDO vs IMG (aside from the obvious, an AOA residency)?


I debate this in my mind from time to time. I feel like it's got to be a better choice getting educated stateside compared to the islands. In truth, the DO bias does exist in some specialties and in some states (probably worse in Canada). The big advantage I see with the DO is that billing can be really lucrative in an office setting. In a nutshell, you can use OMM as a billable 'procedure' on top of the office visit.


6. Any advice you can provide students who are getting ready for the match?


Don't trust a word a program director tells you. Horror stories are real. That being said, don't over stress about it all. There's not much we can change about our circumstances so don't waste your time. The important thing to remember is somehow, somewhere you will match and you will be a physician. 


7. What is a typical day like for a FM resident?


My program in North Carolina is incredibly chill, almost too chill at times. FM rotates through every specialty like a student would. I've had some attendings let me do everything and others that had me just shadow. The key is we get 1 half day of continuity clinic per week with an additional half day added in each future year. After 6 months, you no longer need to report to the attending in your clinic. 


8. Any specific 3rd or 4th year rotations you recommend for Family medicine?


Family medicine has almost all the same rotations as 3rd and 4th year. Do what you want in fourth year because you’ll probably pick up nuggets of information that can help you in family med in any rotation, but make sure you audition where you want to apply. I would also recommend a radiology rotation, just because I think it’s important to know what exactly we are looking at, rather than just trusting a radiologists read. You’ll learn some nice clinical pearls from radiologists too. Not to mention it’ll be a pretty chill rotation on top. Rotating in as many specialties as possible will also put you ahead of the game. 


9. Are you surprised to see the interest in osteopathic medicine by Canadian premeds grow so fast in recent years?


No, I always figured it would continue to grow. With most of the laws that allow us to practice in Canada signed somewhere in the 2000's and on, osteopathic medicine will keep growing as word spreads. Canadians are the biggest winners with this new merger too. Going forward, you're guaranteed an ACGME residency. You will be able to apply to your schools local programs, get the J1 if you have to, and apply for Canadian medical licences smoothly. Plus as founding member of Nova’s COMSA chapter I’d like to think that I had something to do with Nova going from one Canadian in the class (yours truly) to five or more a year in the class after me ;).


10.   Last question (and most important), Kessel’s trade out of Toronto. How would you rate this move?


I would have liked to see what Babcock could have got out of him. 


Family Medicine

Dr. Dennis Fiddler, PGY-3
Family Medicine

1. Please introduce yourself (name, age, Canadian undergrad/masters, medical school, graduate year, residency program and year, and province).

Dennis Fiddler, 25, University of Toledo (Biomedical engineering), Nova Southeastern University College of Osteopathic Medicine, 2014, PGY-1 Family Medicine at the University of Toronto (Barrie Site), Ontario

2. Why Family Medicine?

Family medicine for me was looking into the challenge that is medical care. Family physicians are the first line to see a variety of disease and have to manage it on a daily basis. It allows us to be detectives to try and determine the cause of the disease, direct their medical care, and if necessary contact a specialist on their behalf. There is also the aspect of managing one’s care over long term and seeing how they have improved by your hand which is rewarding.

3. What is a typical day like as a FM resident?

Every program has different areas where to the residents are on a daily basis. Typically the day is divided into halves or thirds. You can have any assortment of specialist clinic, hospital, surgical, obstetrical, or family medicine clinic depending on the rotation you are on. Depending on the rotation you can be quite busy with extra call added on to the schedule.

4. How was the CaRMs/NRMP residency match?


I found that the CaRMS match was better put together than the NRMP match. All of the interviews were along the same time frame and CaRMS essentially walked you through the application process. The NRMP match seemed really scattered a lot of the interviews and talking to programs about their information was all done by yourself, which was more time consuming for a 4th year medical student.

5. How different or similar are clinical rotations/residency in Canada vs the US?

Essentially the same. You go to the site you are supposed to be learning at and get as much educational exposure to the program you are in. As a “clerk” in Canada it appears as though residents and attendings give you more independence and one of your key roles is learning how to document properly. I know that when I went through the 3rd and 4th years I was not able to write anything on a real chart as there was the potential for litigation with whatever I wrote. In addition I have transferred from large academic center where I did my rotations in my clinical years to a smaller suburban setting. I can tell that there is a difference between the people that you interact with on a daily basis. In the smaller areas people are more willing to help you as a clerk or resident. Versus in the bigger centre it was a free-for-all and you have to be first in line to get your proper experience.

6. Do you miss the warm Florida weather and beaches?

Florida was great really in the winter. Otherwise for me it was too hot. Going to the beaches was also awesome. The problem was though that if you were outside you weren’t studying. This was the challenge. You could try to study on the beach but the sand and the wind would blow your papers everywhere. Therefore a lot of my time was spend indoors looking at the outdoors.


7. Do you have any tips for interviews in the USA/Canada residency programs?

Be genuine. I was able to participate in the interviews as part of the University of Toronto last year. Many people would hold onto their research and how it has made them who they are. Honestly I didn’t care. My purpose was to ensure that you would be a good person to work with in the future. If they couldn’t hold a conversation with a person they just met then they would not get very good marks. We all know that people who graduate from medical school are smart, otherwise they would not have made it this far. You have to showcase yourself as a person first.

8. As a Canadian, what do you recommend doing anything special to improve your application for residency?

Getting as many rotations as you can in the area you want to practice. This is very helpful in getting your application seen by people in Canada.


9. Where do you see the Canadian DO population 5 years from now?

Hopefully bigger than what it is now. I understand that there are difficulties for people to return for various reasons. However I find Canada is a great place to practice.


10. Last question (and most important), did the Toronto Maple leafs do the right thing by trading for Phil Kessel?


Interviewed by Pranay Chander

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