Interview With Dr. Carlo Puzzo

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.