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Can’t speak for all provinces because I’m not familiar with policies but I know of several people in my province who have gone from FM to 5-year specialities (either by transferring or applying to match in 2nd round). True that having to secure funding is an extra step but my impression was once that it’s not a huge hurdle once you get an endorsement from the program you’re transferring into.

I went unmatched after applying to a competitive speciality last year. Like you, was really debating extended clerkship & reapplying vs. 2nd iteration application. Ultimately I chose to do FM in the 2nd round. Here's some of the thing's I'd say you should think about in your decision-making: 1. How dead set are you on radiology? I would encourage you to really think hard about whether radiology is the only thing you could see yourself doing. Going unmatched really gave me a lot of perspective - I was so deadset on my speciality as a clerk and really thought I could do that and only that. When you went into medical school, I imagine you just wanted to "be a doctor". Now I realize, that's a mentality most medical students put themselves into, but is not actually the truth. This year, by luck there is actually an unmatched spot at my school for the speciality that I applied to last year and I have no interest in applying because I've figured out a pathway through FM that's going to make me just as happy, pay the same, give me more flexibility, and be achievable through several less years of training. When I spoke to a unmatched applicants from previous years, I heard the same thing (e.g., one guy went unmatched to Ortho, matched FM 2nd round - in his R1 year, the Ortho PD reached out twice to ask if he wanted to transfer into the program and the guy was like nope I'm happy in FM). 2. Is it possible for you to do something that is interesting/similar through FM? FM has a very broad scope, much more than most medical students realize. If you're dead set on radiology, you won't have many opportunities in FM for exactly that - but maybe you have other things that interested you in medical school that could be pursued through FM. I have FM preceptors who read Echo's, ECGs, etc. on the side, so certainly there is room for doing study interpretation if that's your thing. There is also a growing role of POCUS in FM. One of my FM preceptors does a procedure clinic once/week, in which he will do image-guided joint injections etc. There's also a lot of POCUS involved on ER, Anaesthesia, and sports med - all of which can be done as FM+1 programs. 3. If you were to do extended clerkship, what are the chances you are successful in matching the second time around? This was a big sticking point in my decision to go into FM. I emailed my UME office and asked for a list of the programs applicants applied to the first time around and what they matched into after extended clerkship (anonymized). I also spoke to the UME office about what the success rates were from extended clerkship (just cause some people do genuinely change their mind to do another speciality after extended clerkship so just comparing what they matched into may not be accurate). What I found was that for certain programs, extended clerkship is wonderful - Anaesthesia in particular loves extended clerkship applicants for some reason, and in the past 5 years, most of the extended clerkship applicants for anaesthesia matched the second time around. Similarly, people had decent success with Rad Onc, IM, and some of the mid-competitive surgical specialities (Ortho, Uro, OBGYN, CVSx). On the other hand, some specialities have an abysmal or almost 0 match rate after extended clerkship. Nobody who did extended clerkship for plastics, EM or Optho matched (I know in Optho people do match after doing an extra research year - just happens that noone at my school has been successful doing this in the past several years). For the speciality that I applied to, I spoke to one applicant who got 7 interviews, went unmatched, did extended clerkship, got 7 interviews again and didn't match - this was a strong applicant too as he had a PhD in this field already and tons of research/CV items. I didn't want to take this level of risk, not to mention the feeling of going unmatched twice just to end up in the same spot again. Unfortunately a number of my classmates who did the extra year, and applied to things like Optho/plastics this year ended up going unmatched again... 4. How much will the extended year improve your application? This was another big decision point for me. I sat down with the UME office and my mentors and really picked apart my personal letters, CV, and interview performance. The broad impression from the UME office was that my MSPR was quite strong compared to most students. I had published ~10 papers during medical school in decent journals, presented at multiple national/international conferences & won abstract awards. My personal letters were good. My interview performance, probably could have been improved but certainly wasn't abysmal. And I had gotten more interviews that the majority of applicants to the speciality. Sure, I could publish a few more papers, do a few more electives, work more with my referees to improve the strength of references further - but all of that was just marginal benefit. My conclusion from this was - an extended year could make a difference for a certain type of candidate: someone who decided on the speciality very late, did only 2 electives instead of 4, only had 1 letter from a specialist in the field, didn't do any research during med school, completely bombed their interviews etc. - but it wasn't necessarily going to make a huge difference for me. Likely, any improvements in my application I would make with an additional year would be cancelled out by the stigma that some file reviewers/interviewers will have against a previously unmatched candidate - I might get a similar amount of interviews as the first time, and after that, it would just be a roll of the dice again. 5. If you were to extended clerkship, will the opportunity cost be worth it? An extra year of debt from med school tuition/living costs, plus all the cost of doing a broad range of visiting electives, not getting a resident's salary & 1 year of attending salary lost. That added with compound interest totals a whole lot of money. How long will it take you to make all that back? That was a huge wall of text and certainly not comprehensive, but hopefully its a little helpful! Best of luck.

I would recommend waiting until right before your rotation to do the training as you’ll likely forget everything you learned if you do it too early without actually using it clinically. Not sure where exactly your elective will be - I know there is some differences in the software depending on geography despite it all being on the EPIC platform. All of Alberta is on EPIC now and there is an online manual for how to use it here: https://manual.connect-care.ca/tools/Patient-Portal Hopefully that’s helpful.

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Oh looks like you’re absolutely right - thanks for chipping in. Should’ve added that other than the UofC programs, I don’t actually have personal experience with any of the others & it’s just based on what I’ve heard (to be taken with a grain of salt)

I can wholeheartedly endorse doing any rural program. Simply put, the biggest advantage is that when you're on your family medicine blocks (anywhere from 10-12months of your 2 year residency), you aren't limited to doing clinic - you can do emerg shifts, GP-A, surgical assist, etc. There's also a certain degree of flexibility that comes from being the only learner or one of the only learners at a site. Your rotations aren't going to be service-based because preceptors usually don't have residents/med students working with them, so not only will call probably be lighter than big academic sites, but for example, you can say you want to go do psych emerge on a given day because they don't rely on you to do the rounding or see the clinic patients. Rural training also has a bigger focus on acute care, so by design the program is already going to have more block time in areas such as ER/anaesthesia. A lot of urban programs are also shifting towards making ICU a selective or completely removing it from their mandatory rotations, which is not the case for rural. On average, because a lot of training is longitudinal, there is more elective time set aside in rural programs too, which you can spend doing visiting electives. As a rural resident you're going to be funded for a number of acute care courses that your urban colleagues will not. In urban FM programs you'll get the standard BLS, ACLS, ATLS, and maybe PALS. Certain programs may also have additional courses (e.g., NRP, ACORN). But you're not gonna get CASTED or POCUS independent partitioner certification (normally $5000 out of pocket!!) like in some rural programs, which is super helpful for emerge. Anecdotally, rural residents have better match rates into CCFP-EM. There's also a lot of perks to rural programs (e.g., you get $20,000 student loan forgiveness in your first two years of residency from the Canadian government). I'm only familiar with rural programs in Western Canada, but among them, these ones have a reputation for being strong for EM (not an exhaustive list): UBC-Prince George, UBC-Nanaimo, UofC-Lethbridge, UofC-Medicine Hat, UofA-Red Deer, UofA-Grand Prairie, USask-North Battleford, UManitoba-Brandon, UManitoba-Steinbach. Happy to chat more if you have questions.

Absolutely - family docs don't make 300k for a 900 patient panel in Alberta (despite being the best paid of any province, or maybe second after BC now). There's been a large discussion at the higher levels about this (only privy to part of this) but the broad thinking is that this is just posturing by the government to attract more nurses into the province. Purely from a financial perspective, it would never pan out because there's already no more money to put into healthcare, let alone to have less patients be seen for more money. The whole NP model also works much better in private systems like the US than it would here. There, the hospitals/clinics only care about their bottom lines, so if they can get away with paying NPs less than MDs, who cares if they order more tests, or put out more referrals, or see less patients in the same time, or can't handle complex patients: all of these inefficiencies are payed for by the insurance companies (and ultimately the patient). In our healthcare system, it's all going to come out of taxpayer dollars one way or another... Not to mention switching to the NP model is gonna make them lose out on the abundance of extremely underpaid labour they currently get out of residents since NPs don't do residency training...

I think it’s super variable geographically. I can tell you how it works where I did med school and where I’m doing residency. In med school (large city/academic center) - during the day, staff was usually there at 7am and left at 5-5:30pm. On weekends they’d be there the whole day as well, but weekend rounding only took the morning, so the rest of the day, they just stuck around in case something came up. They did not do any call while in service. Generally they did 1 week on and then several weeks off. Only ever worked with one staff that was on for two weeks at once and he said he’s prob gonna stop doing that cause it’s getting too tiring. For my residency site, staff generally gets here at 8-8:15am. They leave usually by 5-5:30 although sometimes they have stayed until 6:30 at the latest (even though handover is at 5pm to the evening team). They do a week on at once. They do also do around 2-3 days of overnight call during their week of service because we aren’t at a large academic site where there’s an army of residents to cover call. My understanding is that the GIMs make more money at my residency site than my med school site because smaller site = less specialists available = more procedures/billing opportunities.

Not sure what you mean by EM is heading downwards... perhaps you mean that it is increasingly becoming burdened with primary care patients and an increased workload - which is true. Although if you mean that somehow EM is going to be taken over by AI, I think that's not a remotely accurate statement, despite it being a "pattern recognition" field like Rads/RO. Also, as someone who was interested in Rad Onc when I was in medical school, the broad sentiment among physicians was that AI would make work easier for those practicing, allowing them to be more efficient/see more patients (an example is that contouring takes a lot less time now), but not actually take away jobs from practicing physicians. Perhaps over time, there would be reductions in residency positions as less physicians would be need for the same job, but again this wouldn't take work away from those already practicing. This is also supported by hard data. Have a look at the CARO workforce reports - although RO became an oversaturated field in the 2000s, there was a significant reduction in residency positions since, and there now a huge shortfall of physicians. Residents are getting jobs directly out of residency without a fellowship at major centres, and this is not project to change for at least the next 5+ years. I can't comment on rads but I imagine it might be similar. Burnout in the ED has been so high after the pandemic that we've essentially lost a generation of physicians and allied health workers. Every hospital in my city is having trouble filling it's EM shifts. Some of the smaller towns in the province have actually had to shut down their ED at times because they cannot staff them, and send everyone with emergent issues to the city. EDs are trying to hire NPs or anyone they can find to meet manpower needs. The job market is so good that even fresh +1EM grads are getting jobs in major cities directly out of residency, which was not the case several years ago. So the idea that finding work is going to be difficult for new EM grads is also patently false. The CAEP workforce reports estimate that it will take a decade to train enough physicians to just replace what we lost during the pandemic. And that's not even accounting for all the additional physicians we will need to cover the patient needs resulting from the failure of primary care in this country and an aging population.

At UofC we had EPAs introduced at the clerkship level too. Most of my classmates didn't complain too much, because we only had to do 40-something across the entirety of clerkship & as other posters pointed out, it was super cherry-picked who/when you sent them out (I think I only had one EPA that was ever rated as "required supervision" rather than "able to do independently" because I only ever sent them to residents who were happy to fill them out without even looking at them, rather than sending them to staff). Starting off as a new R1 though, I've heard that my program in particular has some crazy EPA requirements (you need to complete several per week on average) and that's something I'm really not looking forward to. Thankfully my specialty/program allows for a lot of 1-on-1 time with staff physicians without a more senior resident present, so hopefully that'll make it easier to get them. Completely agree that EPAs are something that was devised by out of touch academics and admin with the ultimate goal of justifying their positions and publishing "the incredible gains made by medical learners" as a part of a series of esoteric scientific papers in some shitty journal. Noone really likes them or sees them as anything more than an administrative hurdle.

Unless you happen to have some serious connections, realistically the answer is no. Dermatology is such a small speciality it's a gamble if even a single spot would open up across the country. Even if one were to open up, I imagine the competition would be fierce from people across a number of PGY levels/specialties, some of whom may have connections to the program. The most sure chance you may have is if you were able to convince the program to create a supernumary position for you (or purposefully set aside a position for you in a given year's match - i.e., if they have an IMG position, not rank anyone and then have you apply to it in the 2nd round when it opens up to all applicants). But that would require connections.

Some schools (e.g., UofT) also do not allow you to re-take courses if you passed them, unless they was a certain grade requirement to qualify for entry or transfer into a particular major/minor that you did not meet.

The schools do not communicate with each other. You should be fine as long as you don’t overthink it and end up doing something stupid like actually telling them you accepted two offers. Now, stop worrying and go enjoy your acceptance and summer.

Isn’t that only for IMGs? Or do they also care for CMGs?

Damn boi you need a nephrology consult? Cause you saltyyyyy