Ethics Of Gaining Ip Status

[CXR]

More specifically, is it ethical to go to school/move somewhere for the sole purpose of getting IP status and making the road to med school easier? 

[FeelingTheBern]

Link: http://www.macleans.ca/news/canada/rx-get-out-of-town/

The section of quotes from admissions directors across Canada:
 

Medical school officials have mixed opinions about the practice. “We see people moving to Alberta specifically so they can apply as an in-province applicant,” says Dr. Ian Walker, the director of medical admissions at the University of Calgary. “Are they gaming the system? Yeah, they are. Is that morally reprehensible? I don’t think so, because we set the system up. I think it’s a natural instinct to look at the system and say, ‘OK, how can I achieve the most advantage for myself?’ ” Walker believes such students are likely to stay and work in Alberta after graduation, so it’s a gain for Alberta.

 

Dr. Evelyn Sutton, the assistant dean of medical admissions at Dalhousie University in Halifax, sees it much the same way. The application is completed a year before classes start and medical school is four years, so anyone who graduates from Dal’s program will have spent at least six years there. “There’s nothing like the faith of a convert,” she says, suggesting students who come “from away” are likely to stay permanently.

Dr. David Snadden, executive associate dean of medical admissions at UBC, takes a different view, which perhaps explains the reluctance of applicants to talk about relocating. “When you see things like somebody moving around a lot it makes [admissions officers] ask other questions like, ‘I wonder what’s going on here?’ ” he says. “Maybe this is legitimate and maybe it’s not.” Even with much of the personal information blanked out on applications, the facts could suggest that a person has moved for the wrong reasons, says Snadden, offering an example. “If you have someone who says, ‘I’ve always been interested in rural medicine, it’s what I’ve wanted to do all my life,’ and they’ve never been in the country apart from the year before they apply,” says Snadden, “you’d be questioning that.”
 

I have to agree with Dr. Ian Walker and Dr Evelyn Sutton on this one. Dr. Walker especially hit it right on the head. They set up the system, because they see that's how long an applicant should be "in-province" to show their commitment in getting into their school. If they wanted to make it more impossible, they can increase the number of years, or even say that they must have completed a X number of years of secondary or post-secondary education in their province.

[marta12345]

Lets see the various competing factors:

 

1) Autonomy- people have the right to move to another province if they believe it would improve their overall med school chances.

2) Beneficence of the applicant- it may be in the best interest of the applicant to move to another province to improve their chances, especially because med schools often have more lenient admission criteria for IP applicants

3) Justice - It is unfair for the in province applicants that some people are moving elsewhere to gain the IP status. It is making competition unfair for them. In addition, med schools have the IP status b/c they believe there is a higher likelihood that the IP med students that they train are going to stay and practice med in the province. However, the people who move to gain IP status may not stay to practice medicine, and may leave immediately after they finish their med school.

Also, as a tax payer in that specific province, it is unfair that you are paying for the tuition of people for out of province applicants

 

It is an issue that needs to be evaluated properly:

- do people who gain IP status stay in the province once they finish med school

- is it in the best interest of that specific school to have some applicants move to gain IP status?

 

 

I honestly believe that people have the right to move to another province if it will help them gain an advantage, however, I believe it is unfair for IP applicants.

[InstantRamen]

 

3) Justice - It is unfair for the in province applicants that some people are moving elsewhere to gain the IP status. It is making competition unfair for them. In addition, med schools have the IP status b/c they believe there is a higher likelihood that the IP med students that they train are going to stay and practice med in the province. However, the people who move to gain IP status may not stay to practice medicine, and may leave immediately after they finish their med school.

Also, as a tax payer in that specific province, it is unfair that you are paying for the tuition of people for out of province applicants

 

I honestly believe that people have the right to move to another province if it will help them gain an advantage, however, I believe it is unjust.

 

What if there is someone who is rural/SWOMEN who got into medicine and matched to urban family/non-rural specialty?

What if a CMG moved to the US for better compensation?

What is someone who was born and raised in a specific province, went to medicine there and matched to somewhere else? (Many of my classmates want to do this)

 

Do you believe that these are unjust scenarios as well?

 

I personally don't see a problem with it. Outside of medicine, people move to benefit themselves all the time. Whether it be lower cost of living, better job, better lifestyle, being an in province applicant for med school. 

 

Also, you build your network at the school you attend. I'm sure that many of of these applicants (even OOP applicants) will consider staying in the province to train.

[Bambi]

It is both fair and ethical to apply and use the rules in one's best interests.

 

Adcoms are free to change the rules of the game in any way they wish and as often as they wish. The fact that resiliant applicants openly use the rules to their advantage is nothing more than the exercise of common sense and good judgment. If anything, they are to be congratulated and certainly not admonished. 

 

It is unethical, however, for medical schools to apply nepotism for acceptance of students into residency positions and rather than complain about this, certain medical schools should perhaps clean their own house before throwing stones at applicants. 

[rmorelan]

Lets see the various competing factors:

1) Autonomy- people have the right to move to another province if they believe it would improve their overall med school chances.

2) Beneficence of the applicant- it may be in the best interest of the applicant to move to another province to improve their chances, especially because med schools often have more lenient admission criteria for IP applicants

3) Justice - It is unfair for the in province applicants that some people are moving elsewhere to gain the IP status. It is making competition unfair for them. In addition, med schools have the IP status b/c they believe there is a higher likelihood that the IP med students that they train are going to stay and practice med in the province. However, the people who move to gain IP status may not stay to practice medicine, and may leave immediately after they finish their med school.

Also, as a tax payer in that specific province, it is unfair that you are paying for the tuition of people for out of province applicants

 

I honestly believe that people have the right to move to another province if it will help them gain an advantage, however, I believe it is unjust.

 

3) it is unjust that someone has an inherent advantage just because they live in a particular part of the country?

If is unethical for people to leave after graduation, is then in turn is it ethical for that province to accept doctors trained outside of that province? Is it ethically wrong then for an IP student to move away post graduation as well? 

 

not to answer anything but rather just exploring the topic  

[marta12345]

What if there is someone who is rural/SWOMEN who got into medicine and matched to urban family/non-rural specialty?

What if a CMG moved to the US for better compensation?

What is someone who was born and raised in a specific province, went to medicine there and matched to somewhere else? (Many of my classmates want to do this)

 

Do you believe that these are unjust scenarios as well?

 

I personally don't see a problem with it. Outside of medicine, people move to benefit themselves all the time. Whether it be lower cost of living, better job, better lifestyle, being an in province applicant for med school. 

 

Also, you build your network at the school you attend. I'm sure that many of of these applicants (even OOP applicants) will consider staying in the province to train.

 

 

I think it is unfair for the IP applicants.

 

I honestly feel if someone is willing to move to another province to gain IP status to possibly improve their chances for med -- then they are showing a lot of dedication 

[InstantRamen]

. 

[1994]

I think it is unfair for the IP applicants.

Would you care to elaborate?

 

In-province status is defined differently at every school; however, what is common is that the criteria to be considered a resident is what the school believes allows the applicant to adequately contribute to the province during their residence and increases their likelihood of staying beyond medical school (the ultimate goal for such policies). For some schools, the amount of time to obtain IP status is quite lengthy and anyone who uproots their life to live, work and settle down in that province for multiple years should rightfully be considered just as much of a resident as someone you deem to be a true IP applicant.

 

IMO where the real unfairness lies is more specific -- i.e. McGill, where iirc you are a resident if you are simply born in QC even if you have lived elsewhere since then (possibly other schools too, I'm not sure). No quota for OOP spots in ON schools. Non-ON being equal to non-SWO/Ottawa Ontarians and choosing to attend those schools over their home school when they benefit so greatly from policies designed to encourage them to stay. If some of these were addressed there would be less of a reason for people to try and "cheat the system" by relocating.

 

I think the perception is that it is unfair/unethical to gain IP status and leave after graduating, but you can't ignore that there are many residents of these provinces who themselves choose to leave anyway either prior to matriculating to medical school or for residency (why are all Vancouver/Toronto residency spots so desirable?). I don't have any hard stats, but I would think this cohort is more numerous or at least comparable to those relocating to gain IP status.

[ralk]

I think it depends largely on what kind of IP system is set up and what people do to gain IP status. If it's a simple residency requirement of X number of years, I don't see much problem with people moving to obtain that, especially for schools who have rather long IP requirements. In this case, schools are looking for people to have a certain degree of connection to the area, so if you go out of your way to demonstrate that connection, that's entirely fair.

 

The situation changes, however, when a school looks at where someone has roots stemming from before university education. Western's SWOMEN requirements are set up like this, looking for individuals who effectively grew up in the SWOMEN area by looking at where applicants attended high school as a proxy measure. There is a loophole where individuals attended high school in a place like London, but their whole family was outside the SWOMEN. Their connections were therefore not in the SWOMEN area. That adheres to the letter of the rule, but not the spirit, and so I do consider that unethical. Western clearly agreed, strengthening their SWOMEN requirement to insist on a longer time in high school in the SWOMEN area to qualify. Yet, it wouldn't surprise me if people continue to game this system, to their benefit and the detriment of others, including the region's patients.

 

Regarding the possibility - indeed in many cases the probability - that those who receive IP status by whatever means may move away from the area, that's not a problem all. The argument for regional preferences in medical school admissions is statistical, not deterministic. We don't accept people from underserved areas because they will stay there, but because they're more likely to. That's what available research indicates and so long as the data continues to support that statistical likelihood, the justification for regional preferences continues to hold. There are benefits to physician mobility that are absolutely worth preserving, so long as that mobility isn't "everyone moves to Toronto/Vancouver", which regional requirements help prevent. I'm from the SWOMEN region, I'm staying in the area (likely indefinitely), but it does not bother me in the slightest that many of my SWOMEN classmates are moving onto other locations that better fit their career goals and personal preferences at this time.

[1D7]

From the top-down perspective, it should be assumed applicants are doing everything they can (within the rules) to maximize their chances for admission/hiring in any competitive process. There are always moral/ethical gray zones where applicants can game the system; however it's not difficult to predict how individuals will try to circumvent the current set of IP preference rules & criteria. The individuals designing the system top-down are the one responsible for accounting for these foreseeable circumventions.

 

This doesn't absolve applicants of all moral/ethical responsibility, but it does mean that the more poorly designed the rules are, the more fault it is of the rule makers rather than the applicants for circumventing the rules.