indefatigable

I can't think of any other profession where experienced practitioners are quitting and the solution is somehow to try to coax more graduates into comprehensive FM in part by building more med schools. Yet another "I am quitting FM in Ontario" article.. in this case a 20 year seasoned primary care practitioner. https://torontolife.com/city/family-doctor-clinic-closing-burnout-inflation/ Granted she was working in a HCOL location (Mississauga), although it's close to where these new med schools are being built, but some of the highlights are "When I was first building my practice, I made about $90,000 per year, after all our office expenses were accounted for. In 2022, that figure was about $142,000". When the average medical student debt is somewhere around 150-200K, Ontario FM in HCOL locations is becoming unsustainable. Like MedicineLCS noted, this is all about show and not about substance - it sounds good for other universities to have med schools but does almost nothing to fix the underlying issues. What's the point in building more med schools if you're facing accelerating losses? Any rational strategy would involved both retention as well as recruitment. This makes me think of health care in Ontario .

At the moment, the most important thing is to focus on the road ahead of you - especially the soos. Your thoughts and worries won't change your results on the samps but further practice and studying may help with the soos. It may help your anxiety to acknowledge the uncertainty and also spend a little time thinking of the rudiments of a contingency plan. If it's helpful, even graduates who were unsuccessful on any part of the exam were able to find work settings and successfully retake any part of the CFPC exam whether it be the soo or samp. The CFPC exams are run twice a year so any setback should only be temporary. The CFPC also provides detailed feedback in the case of an unsuccessful attempt. However, I wouldn't spend too much time worrying or planning for the worse as the results are uncertain and you still have important soos in front of you.

I don't think there's any absolutes. Extra training should on average help improve areas like clinical knowledge, critical care skills and managing patient flow, but training centres may only partially reflect real-life work settings which often have fewer resources (especially consultants and diagnostics). Also patient population and standards of care may not accurately reflect community practice which may overlap more with primary care as mentioned above. While simulation exposure helps to manage HALOs (high acuity low occurence) situations, it isn't a substitute for direct experience. As such, a CCFP who may have worked in lower resource settings, and been fastidious about developing their clinical acumen, may be more comfortable with certain areas of clinical practice which aren't seen in larger academic centers by FRCPs. Of course this more the exception than the rule. Still, a CCFP who has put in the time to learn the intricacies of nuanced clinical management may in fact 5 or 10 years into practice may be a stronger clinician, especially in a community setting, than a certified ED physician who has put less time into CME and development after their residency. Nonetheless, all things being equal, FRCP is a higher standard of training than the CCFP certifications and should on average be able to better perform the job, at least initially, in most cases especially in a larger academic centre.

It looks like they use the "Medical School Application Fee Waiver Program". It's based on three components: applicant's pre-tax income (also +/- parents & partner income) annual deficit (i.e. how much going into debt each year - highest level is 18K+) personal statement It's explained in detail on page 4-5 of the following link https://www.afmc.ca/wp-content/uploads/2023/05/2023_Application_Fee_Waiver_Program_Guide.pdf

From https://www.theglobeandmail.com/canada/article-queens-university-medical-school-lottery/ (also https://healthsci.queensu.ca/stories/news-announcements/new-admissions-process-improves-equitable-access-queens-md-program) A wacky social experiment or an improvement on current system? Besides formalizing the idea of luck, ultimately it seems as if the final selection criteria are more or less the same (except for the low income pool) although the candidates that are being considered are based on the lottery (if meeting GPA/MCAT/Casper cutoffs ). Not sure how it compares to the McMaster lottery year .. FYI - It appears to the lottery will narrow the field from around 3 000 (making cut-offs) to 650-750 - i.e. roughly 1/4 will make it to MMI. https://www.cbc.ca/listen/live-radio/1-92-all-in-a-day Queen’s University plans to introduce a lottery to its medical student selection process in the hope it will make admissions more open to candidates from diverse and low-income backgrounds. The university in Kingston said the lottery component, set to be announced Tuesday, is unique among Canadian medical schools and will be in place starting this fall. The lottery will occur early in the application process, not for the final selection. To reach the lottery stage, students must first exceed threshold cutoffs for grade point average, scores on the Medical College Admissions Test and the Casper test of ethical judgment. A random lottery selection will winnow the pool of qualified applicants that exceed the cutoff scores to approximately 600 to 750 students. They will proceed to a series of online mini-interviews known as the MMI. From there, the top candidates are invited to an in-person panel interview, typically granted to about 300 to 400 students a year. Queen’s School of Medicine admits only about 115 candidates every year from roughly 5,000 applications, so the process is highly competitive. Health sciences dean Jane Philpott said the admissions process has historically put up barriers to students who, for various reasons including socio-economic disadvantage, haven’t been able to develop a portfolio of accomplishments that gets them to the interview stage. “This actually levels the playing field,” Dr. Philpott said of the lottery. “You still have to be exceedingly intelligent and be able to do well at school. But amongst those who can meet that bar, you have an equal chance of being offered an interview.” Peggy DeJong, Queen’s assistant dean responsible for admissions to the MD program, said the school is trying to make data-driven and equitable decisions. Under the new system, roughly 8 per cent of spaces at the MMI stage will be reserved for students of lower socio-economic status, although the number could fluctuate from year to year. Students who qualify would be entered into the first lottery to reach the MMI stage. If they aren’t successful, they would be entered into a second, smaller lottery with students who fit certain socio-economic background criteria. The criteria were devised independently for a fee-waiver program used in the Ontario medical school admission system. They include student income, parental income, spousal income if applicable, student debt and a personal statement. A 2020 study of Canadian medical student demographics, conducted through an online survey, found they had parents with significantly higher levels of education and who were more likely to be professionals or high-level managers compared with the Canadian population. They were more than twice as likely as the general population to have a family income greater than $100,000 a year. Dr. DeJong said she was impressed by a lottery model that was used in medical school selection in the Netherlands. In that case, however, the lottery was used for final admission decisions, whereas in this case it’s only to get to an interview stage. McMaster University used a lottery system in part of its med school admission process during the pandemic in 2020. “We did not want to move to a lottery to admission, because I think that would be quite distressing and it would really reduce autonomy over the process to get into medical school,” Dr. DeJong said. “We do know that when we look at the diversity of our class and looking at the data points, we’re often losing people in the admissions pathway and screening people at that initial step between application and file review.”qq

I think the pretext for both medical schools in TO is the primary care shortage, but more medical schools will not address the root causes of the shortage. In fact, there are actually more FM doctors than ever - but they're not doing comprehensive primary care. TMU is adding residency spots in excess of UGME spots, however I agree that the same matching trends will likely continue in terms of specialty preference (>)> FM. The Ontario Government announced on March 15, 2022 that TMU will receive the following ministry-funded spaces as of 2025: 94 Undergraduate Medical Education (UGME) seats for medical students 105 Postgraduate Medical Education (PGME) seats for residents If York builds a medical school like Queen's FM stream, at best it will create more FM docs, not necessarily comprehensive physicians for which there are many articles highlighting a poor practice environment: https://www.ctvnews.ca/canada/sinking-ship-doctors-say-unfair-salaries-driving-them-away-from-family-medicine-in-canada-1.6821795 https://www.thestar.com/opinion/contributors/as-family-doctors-our-prescription-for-residents-is-to-not-set-up-a-practice-in/article_92430004-d015-11ee-9408-d711cf0d1b55.html

Everyone processes grief differently - some people like to talk about loss and others prefer to do anything but talk about the issue itself. Most people appreciate support though through presence and listening. Refocusing attention to non-medical aspects of life can help people get over their loss as mentioned above. Like everything, time has a habit of numbing one to the emotions associated with loss and eventually memories became more and more faded until disappointment is just part of the past. However, your friend is also making a value judgement on their own self worth based on a process over which they have very limited control. At the same time as encouraging acceptance and getting over their grief, I would also encourage your friend to perform strongly in PGY 1 to help position themselves for a possible transfer. If they are still really passionate about their first choice in IM, then I think FM to IM is probably the most common FM to RC switch and there seem to be open positions if your friend is willing to potentially learn in a less desirable location. But, I also agree that medicine normalizes sacrifices of all other aspects of life including living away from family and friends with no acknowledgement that work should only be one part of life and that living wherever can lead to dissatisfaction in other areas of life. Of course the flip side is that some people do get both their number one choice and end up living where they want to live. So experiences can obviously greatly differ. There was a recent business article in the G&M suggesting that luck plays the biggest role in financial success versus merit or talent. This included noting that the most talented individuals do not necessarily experience the most financial success. Extrapolating to medicine suggests that probably luck probably plays a greater role in CaRMS than is commonly acknowledged (and that would include the luck of having parents in the business, etc..). Like in life, CaRMS winners may disproportionately reap rewards. https://www.theglobeandmail.com/business/commentary/article-rich-and-successful-its-likely-youre-just-lucky/?utm_source=dlvr.it&utm_medium=twitter

Agree. Cardiac is a very small specialty. I've also never seen unfilled RC EM spots before. Still holding my breath for a full ROAD + Plastics in round two. Geographic distribution is mostly as expected although Western seems to have an unusual number of competitive positions left over. Possible transfers? UofT filled up except for an open neurology spot.

This is no longer an issue in Ontario where US Certified physicians no longer have to satisfy RC requirements - i.e. US completion and certification is sufficient. https://www.cpso.on.ca/en/Physicians/Registration/Registration-Policies/Alternative-Pathways-to-Registration (Pathway A) https://www.cpso.on.ca/News/News-Articles/CPSO-Removes-Barriers-for-Internationally-Educated

Basically the slides are comparing how well matching vs non-matching applicants do going through the CaRMS process - in uncompetitive (supply>demand) & competitive (demand>supply) disciplines. Applicants who that end up being unmatched have less chances of getting interviewed or of being mutually ranked and ultimately matching. In other words, being unmatched doesn't happen in isolation - it's the end point of a series of steps where such applicants are on average less successful than their matched colleagues. The matched percentage being higher in competitive disciplines may be a reflection of the fact that competitive disciplines (demand>supply) may be more selective with interviews, but also likely will be higher on an applicant's rank list and so an interview may be more likely to end up in a match. This could be part of the reason. However, I think it's simply a reflection of the fact that CMGs as a whole are moving away from FM (both in terms of matching & ranking) including CMGs that are unmatched.

it was definitely intentional - on a systems level, I suppose it doesn't matter too much. The raw data needed to make those comparisons will be released later in the month, but means that someone will have to process that.

The CaRMS forum was published today, but didn't include most competitive programs,.. as it usually does My takeaways: The overall CMG quota is the best it's been in 10 years at 1.08 positions to applicants (Slide 10). Increases in specialty positions are proportionally greater than increases in FM (Slide 11). Languages differences aren't accounted for however. FM is filling a record number of positions (Slide 36), but with a decreasing number of CMGs (Slide 40) & fewer matched CMGs rank FM (Slide 39) IMGs are doing better and better in CaRMS with current year grads having an 80% match rate (Slides 25 and 26) and have had a slight increase in quota (Slide 9) Unmatched CMGs as a whole are less competitive in both uncompetitive and competitive disciplines (Slides 48 and 51) - but have increasingly less interest in uncompetitive disciplines and increasingly more interest in competitive disciplines while programs are slightly trending in the opposite direction (Slides 49-50 & 52-53). Unmatched CMGs that skip the second iteration (presumably have stronger applications) have about 40-45% chance of matching to their original first choice discipline the next year (Slide 61). Unmatched CMGs unmatched in the second iteration struggle to get ranked at all or highly by programs (Slide 55) -i.e. are not close to matching. https://www.carms.ca/pdfs/carms-forum-2023.pdf

I'm actually less convinced by those schedules. A lot of the IM "Primary Care" track seems to be more what some FPs do in Canada - e.g. addiction, homeless, indigenous, LGBTQ care.. I don't see IM doing that in Canada commonly. I do agree that the the IM Primary Care more hospital/in-patient based but obviously doesn't include any obs/gyn, surgery or psych which is a component of FM training. FM training in Canada is variable across different programs. e.g. Prince George at UBC (more acute/inpatient including multiple ER, CTU blocks, ICU, but also addictions,Native Health etc..) under Site information & Sunnybrook FM (maybe a bit closer to the UCSF FM curriculum but more geriatrics/palliative vs newborn/L&D ) https://carms.familymed.ubc.ca/training-sites/prince-george/ https://www.dfcm.utoronto.ca/sunnybrook-health-sciences-centre-0

There are definitely confounders as Internists do primary care in the US and have the same length of training as FM. There are also literally twice as many IM vs FM residency position in NRMP (9380 vs 4916) vs CaRMS which has the opposite ratio (538 vs 1629). So a priori one should expect more IM vs FM matches in the US including at top schools (NRMP, CaRMS). For example, the 3-year NYU accelerated MD has a "Primary Care" track but it's through Internal Medicine and there's no Family Medicine there (NYU). FM in Canada is a successor of GP, but still retains a lot of those generalist characteristics, with hospitalists, GPA, etc,.whereas IM in Canada has much less outpatient. Patients can't self-refer to specialists in Canada, whereas they can in the US. That being said, although FM is near the bottom of the pay scale at the US, it's not very different from IM - perhaps because IM in the US has more of a primary care component, I'm not really sure. In Canada, IM in some provinces is much better paid than FM i.e. the pay gap is even larger. Anything surgical in the US is well-paid, as well as gastro/cardiology/derm/radiology.. In Canada, ophthalmology, radiology and cardiology are generally tops - cardiology is one of the highest paid in the US as well. https://www.medscape.com/slideshow/2022-compensation-overview-6015043?icd=login_success_email_match_norm#3

Exams can be curved to have same pass/failure rate - but it's a little complex. However, if say Day 1 has 90% pass rate vs Day 2 has a 99% pass rate there may be other issues.

People do talk. The cases each weekend are apparently different, but are the same within the weekend. The stats on passing first weekend vs second weekend; first day vs second day etc would be interesting to know - any significant difference to me would suggest a problematic exam.

Sounds like a few different narratives with respect to FM in AB It’s fine, as good as anywhere else It’s on a downward spiral - avoid at all costs With respect to unmatched CMGs and AB Uninterested in FM and AB Unable to match even in the second round Broadly speaking two trends seem to hardening/appearing CMG generally preferred but no longer CMG first (ie some unmatched CMGs may just be seen as too unsuitable as compared to alternatives and borne out by the data). Unmatched first round IMGs for FM may be considered a better alternative for instance in AB anything but FM for many med students I think these trends are going to continue in the future and will have some downstream consequences. I would expect number of unmatched CMGs to climb to 150-200 per year in the next couple of years I don’t think there’s an easy answer because it’s a complex issue. i know of a FM colleague who was unmatched from a small surgical specialty and matched to FM. This resident compromised with respect to FM and the program compromised with respect to the obvious lack of demonstrates interest in FM. This resident has since actively tried to transfer out with the knowledge and even help of their own preceptor. They have not been successful, but in the meantime has been a stellar resident and could likely choose any +1 that they are interested in despite having a clear interest in a different type of work some might argue that this resident is an inappropriate choice for FM. Indeed, I think in the future this type of resident will find it much more difficult to match to FM regardless of their obvious ability. However, where is the fault? The resident for gunning for something they are/were interested in? The med school for admitting someone who maybe was more likely to gravitate towards surgery? The program for admitting the resident that has performed well? The resident for accepting a program to continue a medical career? I think that’s part of the reasons why the whole issue is complex - obviously adding the IMG issues makes things even harder

Yeah it seems that the government is try to steamroll the existing FPs within the province - it seems as if part of the goal with IMGs may simply be a "CMG busting" strategy as they are less likely to push-back. https://edmonton.ctvnews.ca/unfilled-residency-spots-suggest-there-is-no-alberta-advantage-says-ama-president-1.6376456?fbclid=IwAR3Yv3ts0xcGRXDNDmee3fD-5Mn9eNP819dWurk-J_o9bVRQeeGlZvUkDVQ AB seems to have the greatest US alignment out of all Canadian provinces and so I'm not surprised on some level that some of the problems that are happening in the US are getting imported there.

Superficially, unfilled CMG FM spots are a bad look for unmatched CMGs with the implication being there is a lack of interest for these spots from them. Unfortunately these are some "known unknowns" with respect to this - we actually don't really know the preference of the unmatched CMGs, whether they applied to those spots, were granted interviews, ranked etc., nor the internal workings of the FM programs in AB which account for the bulk of these left over English-speaking spots (in terms of their own decision making with respect to CMGs and IMGs). However, I think it would be fair to say that even if AB changed its policy (the only province apparently not to allow cross-overs in second round) it would neither significantly impact the number of unmatched IMGs nor the supply of FPs. The passage I quoted above certainly makes little mention of unmatched CMGs and much of the narrative above around IMGs seems to be a bit of a false flag - I don't think a divisive approach will change much on the ground. The reality is there is only a limited number of residency positions - maybe, at best, +20 more positions gets filled, partially at the expense of more unmatched CMGs (like with what happened in other provinces in the second round), but that doesn't really solve the underlying issues. 1. I certainly think there has been known "soft pressure" on home school programs in the past, in terms of taking unmatched CMGs which is something that IMG advocates have strongly spoken out against. Whether this has changed anything on the ground is hard to tell. 2-3. Of course - most of the unfilled spots are effectively unavailable or considered unappealing in terms of being French or military or consisting of a handful of path/public health spots. The exception is the high number of unfilled FM positions in AB in Edmonton especially (CMG) and Calgary - certainly it does create public pressure to uniformly change these to competitive stream positions in the future in terms of perception as mentioned above. However, it's true that there may indeed be IMGs more willing to accept what is available rather than being picky given the high competition and thus providing a needed supply of labour. Exactly - this is the bottom line. Unfortunately, I think the unfilled FM positions in urban AB do create a negative perception towards CMG which makes advocacy more difficult. By positively linking IMGs with FM in contrast to CMGs in the public consciousness, within a context of multiple strains within FM, CMGs may be losing public sympathy many who simply want a family doctor. I do wonder how much worse things will get before they break or turn into something else - there is certainly the implication in the passage quoted that at a certain point filling seats is more of a priority than matching CMGs. However, the underlying ratio problem isn't simply going to disappear and will likely continue to get worse without any systemic changes. Future backlog clearing may be harder - for example, from what I understand, the military has made policy changes towards its training of medical officers to favour internal rather external recruitment. While all provinces seem to be concerned about the lack of FPs, it's unclear to what extent this is translating to more residency positions.

Program preference of unmatched grads is also partly what I'm wondering especially when it comes to seeing unfilled FM positions in AB with a number of unmatched CMGs. In the past, as you point out, having FM as an obvious backup or "parallel plan" didn't seem to matter for matching results for CMGs who were given considerable leeway. However, I'm not sure if we're also entering a new stage in terms of priorities - for example, maybe the AB FM program had less interest in such CMGs? Maybe given the public primary care demand that we've entered a "tough luck" era for CMGs that might have prioritized more competitive unsuccessful parallel plans i.e. filling the most seats is the biggest priority? Yet, could it also be that that the AB FM program is acting more selectively towards unmatched CMGs even at the risk even of not filling (perhaps it's an outlier program?)? Clearly, given the large pool of IMGs there are going to be many more such applicants that have focused on FM and these applicants appear to be sometimes prioritized over unmatched CMGs from a cursory exam of the data at least in the second round as compared to last year. Unfortunately, the snapshot doesn't give a full picture of positions:applicant ratio which has also always failed to account for language differences despite being an important component of the effective ratio - likewise, I'm not sure how well previous year graduates are accounted for just like what happened in the past. However, assuming that most of the unmatched are not comfortable in French, like in previous iterations, simple math does show that the number of those unmatched CMGs (even restricting to those that participated only in the second round) is considerably greater than the effective number of available positions. But, yes I do agree that what happened 5-10 years ago has faded from memory and also that the outlook/perception for FM has changed considerably. Still, I think that we probably have much tighter matching ratios than many applicants may realize and that public priorities/support for residents may be fading given the family medicine shortage situation. Sure 110 total unmatched CMGs seems small relative to total number of grads, IMGs, .. but that's the size of a small med school class that obviously is hard to create, get into, etc.. and likely will keep growing given that if anything, re-allocation of dedicated CMG residency positions, rather than creating new ones seems to be more of a priority. There are obvious significant personal and system-wide costs in dealing with unmatched CMGs.

CaRMS has released some snapshot data. 110 total unfilled positions with 100 in FM (with 67 in QC). [Compared to 115 and 99 in FM last year] 22 unfilled FM spots in AB including 15 CMG spots at UofA 110 total unmatched current-year CMGs including 54 that participated in the second round [vs 35 last year]- 56 only first round [vs 48 last year]. A record number of 555 IMGs matched - especially previous year graduates without prior post-graduate training. I find it a little perplexing comparing some of the unfilled positions as well as the number of unmatched CMGs. I understand that some CMGs are supposedly gaming the system by loosely participating the second round with no intention of matching, in order to get more electives, but I wouldn't be surprised if the number of unmatched continues goes up next year. However, I also find the narrative in media like the G&M has shifted into advocacy for IMGs - unmatched CMGs seem to be more of an afterthought. For instance, AB, was the only province which didn't have IMGs compete in the second round (Ontario switched this year). AB policies apparently may change next year. Despite the quote below, digging into the data from last year suggests that matching in the second round is a bit of a zero sum game - i.e. more IMG matches is partly at the expense of less CMG matches. It makes me wonder how much of Ontario residency backlog clearing was in reaction to tragic death of R Chu and whether today it would mean anything. So my take is: Something's happening with FM residency in AB especially Expect more IMGs in the futures Unmatched CMGs are considered less of a concern and will likely increase in the future. https://www.carms.ca/pdfs/2023-R-1-data-snapshot.pdf https://www.theglobeandmail.com/canada/article-organization-for-medical-residency-placements-reveals-100-family/ https://www.carms.ca/pdfs/3kue3632yvW_R1_2_OverviewByDiscipline_EN.pdf "Alberta stands out as the province where family medicine vacancies increased the most, doubling to 22 from 11 vacancies last year. Rosemary Pawliuk, the president of the Society for Canadians Studying Medicine Abroad, attributed the increase to Alberta’s decision not to follow every other province in allowing international medical graduates – a group that includes Canadians who study at overseas medical schools – to participate in the second round of matching this year. If those provinces hadn’t allowed international graduates to participate in the second round, Ms. Pawliuk said, “we would have had a horrendous increase in unfilled positions.” “If you really want to maximize you make the competition open,” she added. International graduates were allowed to apply for positions that went unfilled in the first round until a few years ago, when provinces changed their policies in an effort to ensure that as many graduates of Canadian medical schools as possible secured crucial residency posts. The policy change reduced the number of unmatched graduates of Canadian medical schools, but contributed to an increase in the number of vacancies, particularly in family medicine. This year, with international graduates allowed into the second round, 555 graduates trained abroad nabbed residency slots – the highest number in at least a decade. But 847 international medical graduates still went unmatched, according to CaRMS data. The number of students who graduated from Canadian medical schools this year and went unmatched was 54, up from 35 last year. Scott Johnston, press secretary for Alberta Minister of Health Jason Copping, said in an e-mail that the province is considering allowing international medical graduates into the second round next year. In the meantime, the universities of Calgary and Edmonton will be filling as many of the unfilled seats as possible “through a post-matching process with Alberta-based international medical graduates,” Mr. Johnston said."

I did see that post and like most other people did take it as a bit of a joke. It's an interesting idea, but unfortunately I don't believe it would work any better. To summarize, from what I understand, your proposal basically removes any program rank lists and substitutes a random list in place. Firstly, unfortunately, CaRMS does charge to use its platform. Even if programs aren't submitting rank lists, applying to a program does cost money. So, once again, applicants with more money can buy more tickets to the lottery and have a better chance of matching to programs that they prefer. Secondly, while there are certainly problems with nepotism etc under the current system, your proposal removes any pretence of applicants and programs being best matched to each other. Lotteries can create winners but they create a lot of losers too. I don't see that as in issue - if IMGs train and then choose to stay the US then that's their choice. At least under the rule change, Canadians citizens or PRs that choose to work and stay in the US will not be able to protest that they are unable to come back to Canada because of licensing restrictions.

Perhaps you could explain your sortition approach? Is there any role of student interest in discipline? After all, at the moment there's around 80% of students matching to first choice discipline so I think any change would have to improve on that. I do think there are potential motivation issues with a pure sortition approach. If there's no incentive or consequence for putting in good/bad performance in terms of matching, I can see students getting more cynical especially if they may end up in a discipline they don't want to do whether it be surgery, psychiatry or pathology. Likewise, matching unhappy students to disciplines they don't want to do might also make programs unhappy and create more problems in the future with students trying to transfer,..

It looks like Québec did create an organization CÉDIS after the human rights commission in 2010. 12 years after this it seems there's been some improvement, with more IMGs able to work in QC, but still room to grow. QC still has the lowest proportion of IMGs (9%) well bellow Nunavut (16%) or PEI (18%) and obviously still has many unfilled residency positions despite IMGs who have successfully done clinical rotations with credentials recognized - here's an update from last year. https://ici.radio-canada.ca/nouvelle/1928068/medecins-etrangers-discrimination-quebec-saskatchewan Edit: Of course you are free to choose your own user name, but the poem that your name is referring is from a Palaeolithic era compared to the news articles. As you know, QC has passed an aggressive French-language Bill which suspends constitutional rights of other language speakers to achieves its ends. Sortition potentially has advantages including less gunning, less nepotism/connections, less stress,.. and much less system overhead. Still applicant performance and motivation could take a drop since these are irrelevant under a pure sortition scheme. So I'm not sure how much program buy-in there would be - at the minimum programs probably want applicants who have shown some interest e.g. rotation and some ability. So then should sortition be restricted to applicants who have done a rotation in a discipline? But does it matter if someone has done two weeks vs eight or more weeks? Potentially an applicant could increase their chances of matching by spreading out their electives as much as possible. So it gets complicated pretty quickly, but maybe it's possible to come up with something which improves on the current system with some limited sortition. Perhaps programs posting up criteria which allow anyone to enter the draw run through CaRMS haha? The other caveat is there would clearly be an advantage to apply to as many programs as possible under pure sortition, which would still favour those with more resources.

Although on paper it may appear that QC is open to IMGs, QC has had a history of acting unfavourably towards IMGs in the past. There was even a report issued by the QC Human Rights Conditions (although it was non-binding). Things might have changed - but QC has by far the lowest number of IMGs proportionally out of other provinces. Here's a quote from 10-15 years ago: "However, in this case, the Quebec Human Rights Commission conducted a three-year investigation and concluded this week that international medical graduates are subject to "ethnic-based" discrimination. The inquiry found that while every doctor who graduated from a Quebec medical facility was offered a residency in 2007, two-thirds of foreign-trained doctors who had passed their medical equivalency exams in the province were rejected. The faculties at Quebec's medical schools do not place foreign-trained doctors in residencies because of "apprehension" about their qualifications, the commission said, which is all the more regrettable because 85 residency positions remained vacant." https://www.theglobeandmail.com/opinion/editorials/stop-doctor-discrimination-in-quebec/article1314853/ "The Quebec government has promised to spend $2.5 million this year to make sure 65 residency spaces are reserved for foreign-trained doctors, the health ministry said." https://www.cbc.ca/news/canada/montreal/que-schools-deny-foreign-trained-mds-residencies-1.927485