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premed_thr0waway

How many residency positions are given due to nepotism?

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Seems our friends across the border go about matching in a much more standardized manner. No one likes tests but if you have major examinations that are standardized across the country, it would be the most fair and effective way of determining residency eligibility. As far as I know (just an incoming MS1 so please correct me if I'm wrong), there isn't a STEP 1/2 equivalent in Canada (or at least Ontario). Speaking anecdotally, I know quite a few people whose parents or relatives have lead to them matching into derm or optho; people which by no means are exceptional or top of their class (actually, one of them was literally bottom 10% of her graduating class). 

So this begs the question, do we need to reconsider how residency positions are attained in Canada? I'd love to hear your thoughts, especially those who've already started or finished residency. 

 

P.S. I know having these tests doesn't completely eliminate nepotism, but it's definitely a start. 

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You're right to point out we've got a problem with standardization for residency applicants in Canada. But you have to be careful when you suggest a test as the solution. Unless a test has proven validity in terms of success/outcomes of the test takers, it can simply become a waste of time/money/energy AND a red herring. We need to address out current situation, but I don't think STEPs are the solution.

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1 hour ago, premed_thr0waway said:

Seems our friends across the border go about matching in a much more standardized manner. No one likes tests but if you have major examinations that are standardized across the country, it would be the most fair and effective way of determining residency eligibility. As far as I know (just an incoming MS1 so please correct me if I'm wrong), there isn't a STEP 1/2 equivalent in Canada (or at least Ontario). Speaking anecdotally, I know quite a few people whose parents or relatives have lead to them matching into derm or ortho; people which by no means are exceptional or top of their class (actually, one of them was literally bottom 10% of her graduating class). 

So this begs the question, do we need to reconsider how residency positions are attained in Canada? I'd love to hear your thoughts, especially those who've already started or finished residency. 

 

P.S. I know having these tests doesn't completely eliminate nepotism, but it's definitely a start. 

Some, probably. But having a test doesn’t make sure the student/resident is good. In the US there is grades, USMLEs, AOA, research, elective performance but at the end of the day who you know is still huge. Canada doesn’t have grades or USMLEs, but you can still do research and know your stuff cold on electives to make a good impression. 

The other thing that id say is that in the US, these exams and grades are necessary to standardize medical education. There are obviously some world class schools in the US, but there are also some really really bad ones. So having standardized national exams allows those students in the low tier schools the chance to show they still know what they’re doing even if they’re school isn’t known to produce good doctors if they want to match to something competitive. This is irrelevant in Canada since the medical education quality is so equivalent across schools. 

While Canadas system seems less standardized, it is still standardized. Everyone has the same opportunity to do research, everyone can do electives, everyone can get through med school without red flags and everyone can get to know and impress the department they want to match to. Whether you actually do or not makes the difference, and that’s on you - I can guarantee that if you coast in electives, don’t do any research, don’t get to know the department, have red flags from med school/clerkship, or are just not enjoyable/useful to have on service, 99/100 will not be matching to derm/plastics/ENT etc. Yes there are occasional outliers, but I think you will find that the majority matching to super competitive specialties in Canada are deserving and very competitive applicants. 

PS, ortho isn’t competitive in Canada. Like not at all. 

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1 hour ago, ZBL said:

Some, probably. But having a test doesn’t make sure the student/resident is good. In the US there is grades, USMLEs, AOA, research, elective performance but at the end of the day who you know is still huge. Canada doesn’t have grades or USMLEs, but you can still do research and know your stuff cold on electives to make a good impression. 

The other thing that id say is that in the US, these exams and grades are necessary to standardize medical education. There are obviously some world class schools in the US, but there are also some really really bad ones. So having standardized national exams allows those students in the low tier schools the chance to show they still know what they’re doing even if they’re school isn’t known to produce good doctors if they want to match to something competitive. This is irrelevant in Canada since the medical education quality is so equivalent across schools. 

While Canadas system seems less standardized, it is still standardized. Everyone has the same opportunity to do research, everyone can do electives, everyone can get through med school without red flags and everyone can get to know and impress the department they want to match to. Whether you actually do or not makes the difference, and that’s on you - I can guarantee that if you coast in electives, don’t do any research, don’t get to know the department, have red flags from med school/clerkship, or are just not enjoyable/useful to have on service, 99/100 will not be matching to derm/plastics/ENT etc. Yes there are occasional outliers, but I think you will find that the majority matching to super competitive specialties in Canada are deserving and very competitive applicants. 

PS, ortho isn’t competitive in Canada. Like not at all. 

woops, I meant optho*

Fair point about differences in quality of medical education (although I'd definitely argue there are tiers in the Canadian system, just not as extreme). However, I still feel it's so much more who you know rather than what you know here in Canada compared to America, as far as residency goes anyway. 

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9 minutes ago, premed_thr0waway said:

woops, I meant optho*

Fair point about differences in quality of medical education (although I'd definitely argue there are tiers in the Canadian system, just not as extreme). However, I still feel it's so much more who you know rather than what you know here in Canada compared to America, as far as residency goes anyway. 

The tiers you are thinking about are nothing like what you'd see in the US though. As far as nepotism is concerned, it is present especially in the ultra-competitive fields, however who's to say it doesn't happen in the US. The US is large enough that it is also easier to hide nepotism. Additionally, nepotism can only go so far, stories of nepotism spread far further than stories of nepotism not working. 

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5 minutes ago, premed_thr0waway said:

woops, I meant optho*

Fair point about differences in quality of medical education (although I'd definitely argue there are tiers in the Canadian system, just not as extreme). However, I still feel it's so much more who you know rather than what you know here in Canada compared to America, as far as residency goes anyway. 

Then you'd be incorrect, and you will see this once you actually start med school and eventually interact with MDs and med students from across Canada. You are no more likely to be a superstar doctor going to UofT vs Sask. Match rates don't reflect school prestige in Canada, unlike the US - in Canada there's far more regional bias. For example, most people going to NOSM have no intention of being a plastic surgeon - they want to be a rural family doctor, so consequently few will match to plastics by design. 

I think you are unnecessarily differentiating what you know and who you know. Sometimes, you get to know the right people by knowing the right things. Do well on a surgical rotation, and I'll bet your staff will happily introduce you to the program director and just like that, suddenly you're "known" by the program. The situations you are describing where person X is relatively unaccomplished and matched to Y specialty just because their parents or neighbor is in specialty Y are extremely few. Yes, we do not put as much emphasis on your absolute score in med school like the US does, but at a certain point maybe it doesn't matter if you were 90th percentile or 80th percentile - you still know what you need to know to start residency, and probably other factors like how you fit with the program, what other skills you bring to the table besides reading and memorizing are important. Again, those just squeezing by at the bottom of the class likely will have deficiencies elsewhere and not be matching to things like plastics/derm/ENT anyways. 

Bottom line: don't put so much faith in a single number from a single test. That's just bad statistics. 

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10 minutes ago, ZBL said:

Then you'd be incorrect, and you will see this once you actually start med school and eventually interact with MDs and med students from across Canada. You are no more likely to be a superstar doctor going to UofT vs Sask. Match rates don't reflect school prestige in Canada, unlike the US - in Canada there's far more regional bias. For example, most people going to NOSM have no intention of being a plastic surgeon - they want to be a rural family doctor, so consequently few will match to plastics by design. 

I think you are unnecessarily differentiating what you know and who you know. Sometimes, you get to know the right people by knowing the right things. Do well on a surgical rotation, and I'll bet your staff will happily introduce you to the program director and just like that, suddenly you're "known" by the program. The situations you are describing where person X is relatively unaccomplished and matched to Y specialty just because their parents or neighbor is in specialty Y are extremely few. Yes, we do not put as much emphasis on your absolute score in med school like the US does, but at a certain point maybe it doesn't matter if you were 90th percentile or 80th percentile - you still know what you need to know to start residency, and probably other factors like how you fit with the program, what other skills you bring to the table besides reading and memorizing are important. Again, those just squeezing by at the bottom of the class likely will have deficiencies elsewhere and not be matching to things like plastics/derm/ENT anyways. 

Bottom line: don't put so much faith in a single number from a single test. That's just bad statistics. 

Yes this. Programs have to work with their residents often for 5+ years. They will not take someone they don't like just because their parent is in the same specialty. If their parent happens to be in the department of the same specialty and same school they are applying to and this parent has some influence (i.e. is not hated), then yes, maybe in that case nepotism will play a part. However, these cases generally aren't that common. Even in these cases, the applicant will need to be at least on a similar level to their competitors to get selected.

Where nepotism has more of an impact is through research and shadowing opportunities people who have parents who are doctors/know doctors can secure for them. It is common to see academic physicians take on a student as a favour. 

With all that being said, there really is not too much to complain about. Nepotism in the residency selection process I can assure you is less than nepotism is most other fields. Some businesses are run openly like dynasties and people seem to accept it. If you work hard, distinguish yourself, you can still be noticed. Nepotism is very unlikely to be the sole factor ruining your residency chances. 

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I strongly dislike nepotism and don't condone it, but out of all white collar professions - I think medicine is Canada isn't nearly as bad as other fields. If anyone graduated in finance or commerce or law, they'd tell you how blatantly rampant nepotism is. In medicine, even if nepotism helps secure med students a residency spot, they still have to put in the work during residency. If not, they will fail the royal college exam and will not have favourable job prospects (unless nepotism pulls through again)

So I have to agree with all the sentiments other posters have expressed. Yes who you know is important, but this only gets you so far. Residency programs and faculty still need to be convinced that you won't be a pain in the ass through your training. Dealing with someone who's rude to the nurses, super lazy, and doesn't study is a recipe for disaster - and that's the last thing any program or faculty want for 2-7 years.
 

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12 hours ago, #YOLO said:

lots. ask yourself why are so many of the imgs that match back in canada children of staff physicians. you have ur answer there. #BanIMGsUntilCanadiansMatch

Not that what you are saying may not be factor but A LOT of IMGs are children of staff physicians to start with (need a high income just to pay for it after all). Plus they do generally have ECs/networking that helps, and often are quite well trained/not idiots either (by products often of their upbringing as well). 

I don't know if you have every seen IMG pools that make it for interviews - the ones that I have run into have a lot of children of doctors on them. Still only going to accept 1-2 of them overall but I found it interesting what the mix was (so many Canadians most often from physician families, so many non-Canadians with various backgrounds).  You do become a bit desensitized just be repetition to where people come from. Not to say the system is perfect of course. 

Everyone has a take in this but I think everyone Canadian applicant should have a reasonable chance to match prior to others trained elsewhere (I won't say all because some people only apply to fields that I think a reasonable interviewer would say isn't a good fit - and that includes family medicine (they aren't the dumping ground waste products of other fields, ha), and some people have red flags - professionalism issues mostly that if bad enough should seriously restrict getting a position (although that should have been dealt in medical school - which can be somewhat hampered in their efforts to remove some students).  I view it similar to our royal college examination system - the pass rate is very high because almost everyone is good enough at the end of residency and the design to be while brutal also achievable - 97% pass rate for instance for radiology, but it isn't 100% and because of that you work your ass off in your final year, and those few that aren't ready are held back.  

 

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9 hours ago, FeelingTheBern said:

I strongly dislike nepotism and don't condone it, but out of all white collar professions - I think medicine is Canada isn't nearly as bad as other fields. If anyone graduated in finance or commerce or law, they'd tell you how blatantly rampant nepotism is. In medicine, even if nepotism helps secure med students a residency spot, they still have to put in the work during residency. If not, they will fail the royal college exam and will not have favourable job prospects (unless nepotism pulls through again)

So I have to agree with all the sentiments other posters have expressed. Yes who you know is important, but this only gets you so far. Residency programs and faculty still need to be convinced that you won't be a pain in the ass through your training. Dealing with someone who's rude to the nurses, super lazy, and doesn't study is a recipe for disaster - and that's the last thing any program or faculty want for 2-7 years.
 

Just to add - I really don't think it gets that far in Canada, at least compared to almost any other field I can think off. Medical school admissions is very well shielded from it and that is of course the major hurtle. Personal experience is no substitute for proper analysis but I have seen a lot of children from well known doctors get shut down in their attempts to match to various things, usually when those people have some form of expectation their lineage will help them. Also I would any advantage if it exists even would rapidly evaporate outside of your home school area in most cases anyway. 

By the time you get to the job hiring point - your own merits or lack there of will be front and centre. 

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I have a friend who is a resident currently at a Canadian school, and he applied to the same school where a close family member is an esteemed colleague on the faculty. Once the interviewers realized this, he was out of the running, notwithstanding that he was qualified strictly on his own merits. The school did not want to be accused of nepotism and out of an abundance of caution, he was not selected for this highly competitive spot.  

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7 minutes ago, Bambi said:

I have a friend who is a resident currently at a Canadian school, and he applied to the same school where a close family member is an esteemed colleague on the faculty. Once the interviewers realized this, he was out of the running, notwithstanding that he was qualified strictly on his own merits. The school did not want to be accused of nepotism and out of an abundance of caution, he was not selected for this highly competitive spot.  

Ouch - I mean that is almost as bad - the entire point is be judging people solely on their merits after all. 

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I don't think adding USMLE type scores into the Canadian Residency match help anyone to be honest. 

99.9% of people in med school are smart enough to finish residency. 99% of people have the work ethic to finish residency if motivated. 

 

 The tests are looking at general medical knowledge, not knowledge specific to a specialty. Just cause you are good at memorizing general medical knowledge doesn't mean you will be a good surgeon or psychiatrist. The skills and thought process are just so different.

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3 hours ago, NLengr said:

I don't think adding USMLE type scores into the Canadian Residency match help anyone to be honest. 

99.9% of people in med school are smart enough to finish residency. 99% of people have the work ethic to finish residency if motivated. 

 The tests are looking at general medical knowledge, not knowledge specific to a specialty. Just cause you are good at memorizing general medical knowledge doesn't mean you will be a good surgeon or psychiatrist. The skills and thought process are just so different.

Surprisingly, surgical residencies in the US have some of the highest MLE scores, but this is one of the criticisms.  

General knowledge is more emphasized in the Canadian curriculum and entering FM CMG residents do better than USMGs in US FM resident tests.  

It's possibly due to the fact that primary care is more valued in Canada than the US, and for FM at least, I'm not sure if the MLE is the best way to quantify aptitude for that specialty.  

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On 7/3/2018 at 8:34 PM, #YOLO said:

lots. ask yourself why are so many of the imgs that match back in canada children of staff physicians. you have ur answer there. #BanIMGsUntilCanadiansMatch

IMGs in Ontario for family med use a relatively objective method by using 2 board exam scores primarily in determining who moves on. It's a somewhat fair system to be honest. Now as for IMGs in specialties or outside of Ontario... whole different story. 

Though I wouldn't fox nepotism with an outright ban :P OP brings up a valid point about requiring objective metrics. However, the US (even with its objective metrics) has about a 4% rate of people who don't match. Comparing that to Carms, I think what we see in Canada is quite reasonable to be honest... in terms of the rate of those who match. 

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On 7/3/2018 at 8:50 PM, ZBL said:

Some, probably. But having a test doesn’t make sure the student/resident is good. In the US there is grades, USMLEs, AOA, research, elective performance but at the end of the day who you know is still huge. Canada doesn’t have grades or USMLEs, but you can still do research and know your stuff cold on electives to make a good impression. 

The other thing that id say is that in the US, these exams and grades are necessary to standardize medical education. There are obviously some world class schools in the US, but there are also some really really bad ones. So having standardized national exams allows those students in the low tier schools the chance to show they still know what they’re doing even if they’re school isn’t known to produce good doctors if they want to match to something competitive. This is irrelevant in Canada since the medical education quality is so equivalent across schools. 

While Canadas system seems less standardized, it is still standardized. Everyone has the same opportunity to do research, everyone can do electives, everyone can get through med school without red flags and everyone can get to know and impress the department they want to match to. Whether you actually do or not makes the difference, and that’s on you - I can guarantee that if you coast in electives, don’t do any research, don’t get to know the department, have red flags from med school/clerkship, or are just not enjoyable/useful to have on service, 99/100 will not be matching to derm/plastics/ENT etc. Yes there are occasional outliers, but I think you will find that the majority matching to super competitive specialties in Canada are deserving and very competitive applicants. 

PS, ortho isn’t competitive in Canada. Like not at all. 

Research has little value in terms of day to day clinical acumen. And looking smart on electives can be done via regurgitating stuff you read on your phone 2 minutes earlier. It's also prone to extreme bias.... 

1 hour ago, marrakech said:

Surprisingly, surgical residencies in the US have some of the highest MLE scores, but this is one of the criticisms.  

General knowledge is more emphasized in the Canadian curriculum and entering FM CMG residents do better than USMGs in US FM resident tests.  

It's possibly due to the fact that primary care is more valued in Canada than the US, and for FM at least, I'm not sure if the MLE is the best way to quantify aptitude for that specialty.  

I've seen that study. In Canada, you tend to work relatively hard in 4th year. In USA, you tend to do nothing in 4th year. The latter won't be as sharp in the immediate aftermath, which is when that study was done.

Also, we have to appreciate the fact that a curriculum is one thing but preparing for board intensely is another. The knowledge yield from the latter will be higher. If you have to study to get a pass on tests during the year, you simply aren't accumulating the knowledge level of someone who also has to study brutally hard (on top of school tests) for 2 months both in 2nd and 3rd year. 

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44 minutes ago, medigeek said:

I've seen that study. In Canada, you tend to work relatively hard in 4th year. In USA, you tend to do nothing in 4th year. The latter won't be as sharp in the immediate aftermath, which is when that study was done.

That's surprising to me, since US students sometimes have to go through an intermediate match (e.g. transitional year) and often seem to have graded rotations (e.g. H/P/F).  Given a relatively high unmatched rate, I would think doing "nothing" could risk putting themselves at future risk.

 I'm not sure after the CaRMS deadline that CMGs work as hard as before, since at usually at that point, things are set until interviews.

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49 minutes ago, marrakech said:

That's surprising to me, since US students sometimes have to go through an intermediate match (e.g. transitional year) and often seem to have graded rotations (e.g. H/P/F).  Given a relatively high unmatched rate, I would think doing "nothing" could risk putting themselves at future risk.

 I'm not sure after the CaRMS deadline that CMGs work as hard as before, since at usually at that point, things are set until interviews.

Yes in the US system you work hard in 3rd year but 4th year after a couple of aways you essentially dial it in. 

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5 hours ago, marrakech said:

That's surprising to me, since US students sometimes have to go through an intermediate match (e.g. transitional year) and often seem to have graded rotations (e.g. H/P/F).  Given a relatively high unmatched rate, I would think doing "nothing" could risk putting themselves at future risk.

 I'm not sure after the CaRMS deadline that CMGs work as hard as before, since at usually at that point, things are set until interviews.

my experience is we don't - not only because it doesn't "count" as much in many cases but also because you have just done say 16 months giving it a lot. Have to slow down a bit at some point. Now you have hopefully electives or core most likely not related to your preferred residency program but also everything seems disconnected from what happens next. Even the LMCC part 1 to a degree - often a general test given once you know for sure you are not going to be a generalist. 

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