ralk

For my look, # ranked discipline as first choice is the denominator, not the numerator. It's # who ranked discipline as first choice AND matched to it, divided by the # who ranked discipline as first choice regardless of what they matched to. The CFMS publishes this same statistic in their Matchbook every year, though it looks like they've restricted access to them now and I can't personally access them. I've run the stats on this and posted them somewhere in this forum every year since 2014 (the 2014 stats are in this thread at the start) except last year I believe when another poster ran the numbers and posted them first. I'm not in a position to draw up previous years' stats right now, but will see if I can find the old year's numbers on my computer when I get the chance.

For those interested, ran my version of the stats on last year's match earlier, just not in this thread. I usually look at the rate of successfully matching to a first choice discipline as my main metric - using quotas as the denominator provides a useful look, but I find it can get difficult to interpret as they're heavily impacted by people backing up and by regional mismatches in quotas vs interest, especially for middle-competitiveness specialties. Link is below.

To provide a bit more context, we're talking being unable to finish 1 week early, after having completed and passed the standard number of blocks (including all selectives, electives, and core rotations). Family doesn't exactly lack for flexibility in how you spend your time either, at least in 2nd year. Haven't heard anything different from 5 year programs either, admittedly with less exposure. Residency is still very much a time-based committment.

Haven't heard of any examples and I'm skeptical it's going to be available on any significant scale. I know it's not a thing in FM, despite being ostensibly competency-based for some time now (found out from a bit of a unique circumstance it's a shockingly firm time requirement, down to the day and even independent of blocks/rotations passed).

Can't say I've heard of that requirement, do you have a source for that? The linked CPSO document clearly states that it does not apply to rural FM residents with significant ED training, and makes no mention of a file review for such residents.

Plenty of exceptions here, fortunately. Those who trained as residents in rural settings with a reasonable amount of ER experience, working in a similar setting with the same level of ER requirements, are exempted, for example. I think the idea is to prevent people training in urban centres with minimal ER training to simply jump into a rural ER for which they're really not qualified to work in. That makes sense to me and in many ways is already part of our guidelines (don't do things you're not qualified to do), this just removes the grey area for this specific circumstance.

When EM became a distinct discipline, both the Royal College and the CFPC developed certification pathways. They're considered equivalent, for the most part, because that's how they started. It's a weird historical quirk of our healthcare system. There are pros and cons to doing the 5 year Royal College program vs the 2+1 FM program for EM, which are well-detailed on this site and elsewhere (I won't repeat, please try searching for it, there's plenty already written on this subject), but they essentially lead to the same place. The reason more people don't do 2+1 program is that there are hard caps on the number of +1's available and it is a VERY competitive application. As difficult if not more difficult to get into than the 5-year Royal College residency program, which is itself one of the most competitive residencies to land. And, unlike with a failed application to the 5-year program, if you don't get the +1, that's your only chance (at least as things are currently set up), and you're then stuck as an FP. For those who want to be an FP that's fine, but as I said, most FM+1's in EM do only EM, and so they want to be EM physicians. The 5-year program provides an assurance right from the start that, once all is said and done, you'll be an EM physician.

If you want to go for the 2+1 option without any applications to the 5-year EM program, your electives should be typical for that of any other FM applicant. That is, 2-3 FM rotations and then a mix of whatever interests you so long as it has relevance to FM. A few EM electives would probably be recommended, if only to jump-start your abilities for residency and develop contacts as you move towards the +1 applications, but aren't strictly speaking required either. If you're really looking at a few days of clinical practice plus a few ER shifts each week, I'd probably recommend against doing the +1. Currently, the FM+1 program in ER is more intended for its graduates to work in EM full-time. As the other posters have noted, doing just a bit of one probably leaves you without enough regular experience to be sufficiently competent in both. If that's the practice mix you're looking for, the best option currently would probably be rural practice in places with a small ER department. These are usually staffed by FM docs without a +1 in ER. These ERs function more like walk-in clinics, with fewer patients who tend to be less acute overall. The higher acuity patients still may need to be dealt with, but because resources are limited in these rural ER departments, anything that requires urgent management often has to be shipped out to a larger centre. Overall means fewer skills to maintain (though there are still very valid concerns about whether such patients are receiving a high enough standard of care). FM +1's work in all sorts of emergency departments, including in saturated areas. Competition for those jobs is fairly steep, and I'm told there are a few hospitals that have practice groups that seem to prefer Royal College applicants (can't say I personally know which ones), but going the FM+1 route doesn't seem to restrict practice location too much, at least for the time being.

Ha! This is why I'm visibly and audibly salty around clerks. Parts of medical education - both medical school and residency - suck, a lot! Doesn't mean we should ignore the good parts or walk around sullen all the time, but half the reason the sucky parts of medical training continue to be sucky is that we treat it like it's a secret. And as you say, even beyond changing things, acknowledging the sucky parts makes them easier to get through.

As noted, some schools in Canada do require organic chemistry, and if you're looking at the US at all, most schools there do. It can be helpful for the MCAT, but is by no means required. Chemistry basics do need to be learned for the MCAT, but that can be self-taught without too much difficulty, though it does of course take a bit of time. I had zero chemistry courses at the university level, organic or otherwise, and did quite well on the MCAT.

Good find, thanks for posting this! One thing to point out with these numbers, however, is that this only represents billings to the government and does not account for part-time work. Both those factors would probably bring FP income up closer to the other specialties. Hard to find decent apples-to-apples comparisons for income between specialties, unfortunately, and this comes about as close as it gets.

I think in a lot of cases, rural gets pumped up because they're usually unpopular sites for both residency and work afterwards. However, they do have some real advantages for the right people. First, rural programs tend to have better faculty-to-resident ratios. This means some more individual attention from multiple preceptors and potentially the opportunity to see more uncommon conditions/perform procedures if your preceptors are proactive about pulling you into cases that give you such opportunities. Second, rural residencies work under whatever scope of practice exists in that community, which tends to be wider than in urban settings. This typically involves some Emergency Department coverage as well as some inpatient coverage, depending on the local set-up for FM docs, neither of which are overly common in urban programs. Depending on the set-up, OB care and nursing home coverage can be a part of rural residency programs, though those are common in urban programs as well. Whether these advantages mean an overall higher-quality program I think comes down to the individual person as well as the program. If you really want EM and/or inpatient exposure, or want to work in a rural setting with a rural population, rural programs have some clear advantages. If you're not interested in ever being in the ED, covering inpatients, or working rurally, then the advantages are less clear and really depend on the individual programs themselves. Where off-service rotations are done can matter quite a bit too, though the urban vs rural divide is not necessarily what matters here. Doing off-service rotation in non-academic centres, where Royal College residents aren't running the show, can be a major advantage in getting some better training and independence in these specialties. However, rural FM residents often have to do these rotations in the same academic centres as urban residents. In these cases, the "regional" programs, programs set up in or near larger city centres but not primarily affiliated with an academic hospital, can have the edge. Point is that there is a difference between urban vs rural, but distilling a program down to just those two categories is too simple in looking at program quality or fit. There are good urban programs and good rural programs. There are bad urban programs and bad rural programs. You can get a lot of independence in some urban programs, as well as in some rural programs (I'm in an urban program and have as much independence as I want, even at this early stage). It's the individual program and individual site, along with how well the site matches your learning goals, that matter for whether you'll get a good quality residency education in FM. Anywhere that the preceptor(s) take on regular EM shifts where their residents join them. Electives at any program allow for EM exposure, but if you can work it into your standard FM blocks, that's the ideal situation. These programs tend to be more rural.

CaRMS is a zero sum game. PDs know this. If they're giving one candidate a boost for something, they're necessarily punishing other applicants for not having that thing. There's nothing wrong with submitting USMLE scores, they aren't going to hurt an application, but I wouldn't expect them to help either.

Many CMGs will be writing the USMLE just to pass, because that's all they need to do if they're doing their residency in Canada. There's no point trying to do exceedingly well because it simply doesn't matter. So, there's not much point in program directors placing much stock in high scores, because while it might identify some candidates with strong academics, it's going to miss many others who either chose not to write the USMLE, or did only as well as they needed to. It has merits as a measure if everyone writes it with the same goal in mind, but that's not the case in Canada, so programs directors don't (and I'd argue shouldn't) care much about it.

An offer to Windsor is to that campus specifically, so I would not expect to get moved to London.