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I have been in family med residency in Canada for the past year. It was not what I wanted at all (ranked second to last in CaRMS). I have been trying to switch into psychiatry unsuccessfully due to lack of funding. I have been told by psych program directors that I have a strong application and would be an "excellent psychiatrist", but the funding for extra seats is just not there.

I am completely miserable in my current residency and have taken much time off already on stress leave because of how it is affecting my wellbeing. I am seriously considering dropping out altogether and declaring bankruptcy because I am THAT unhappy. I also have a medical problem that makes the surgical competencies of family med nearly impossible to achieve. Hence, my hopelessness.

I am looking for all alternatives before quitting altogether. I am considering writing the USMLE to apply for Psychiatry. I would appreciate opinions and advice on this.

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My general advice is if you consider writing USMLE, you just should do it.

However in your case, do you seriously consider to do a full 4-5 years residency in the US, far from your family, with all the financial burden it will incur? I think you should do some soul searching, I am not sure USMLE will change anything in your case, and will just cost you time/money.

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On 8/21/2018 at 9:02 PM, neuroscience_nerd said:

I have been in family med residency in Canada for the past year. It was not what I wanted at all (ranked second to last in CaRMS). I have been trying to switch into psychiatry unsuccessfully due to lack of funding. I have been told by psych program directors that I have a strong application and would be an "excellent psychiatrist", but the funding for extra seats is just not there.

I am completely miserable in my current residency and have taken much time off already on stress leave because of how it is affecting my wellbeing. I am seriously considering dropping out altogether and declaring bankruptcy because I am THAT unhappy. I also have a medical problem that makes the surgical competencies of family med nearly impossible to achieve. Hence, my hopelessness.

I am looking for all alternatives before quitting altogether. I am considering writing the USMLE to apply for Psychiatry. I would appreciate opinions and advice on this.

gah that sucks, and is not a great situation to be in to say the least. 

I am guessing that the issue is no one has left a 5 year program to family to free up the extra funding required to move into psych? You mention directors plural so you much have reached out to other schools to explore you options? That is very annoying - you would think somewhere there is a someone that dropped to family to free up something. If I am pushing on that a bit it is only because it is the best option. How have you approached that so far?

Ideally you would find something inside of our system - not that the USMLE is a bad option but I am not sure how leaving a program in the middle works with that and it will cost a chunk of time at the very least. 

You have to be careful with the bankruptcy option as well as student loans are not discharged automatically in that - the asset (your education) remains so the debit incurred (the LOC) is not necessarily cleared.  That is a small point because hopefully you can avoid that entire scenario.  

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1 hour ago, rmorelan said:

gah that sucks, and is not a great situation to be in to say the least. 

I am guessing that the issue is no one has left a 5 year program to family to free up the extra funding required to move into psych? You mention directors plural so you much have reached out to other schools to explore you options? That is very annoying - you would think somewhere there is a someone that dropped to family to free up something. If I am pushing on that a bit it is only because it is the best option. How have you approached that so far?

Ideally you would find something inside of our system - not that the USMLE is a bad option but I am not sure how leaving a program in the middle works with that and it will cost a chunk of time at the very least. 

You have to be careful with the bankruptcy option as well as student loans are not discharged automatically in that - the asset (your education) remains so the debit incurred (the LOC) is not necessarily cleared.  That is a small point because hopefully you can avoid that entire scenario.  

That’s right, I haven’t heard of anyone especially in psych that has transferred out into family. There was someone who wanted to match family in second round CaRMS this year but matched the psych spot I interviewed for and ranked highly instead. I know people say they weigh it in favour of the applicant’s rankings but it seems to be the opposite. The program director alluded to ranking him #1 and me as #2.

I am just so frustrated and depressed about everything. I really worry I will be the next Robert Chu because of this fucked up CaRMS system :(

Also, yes I have contacted every Canadian med school with a psych residency program over the past year (some multiple times) and not one had capacity to accept an inter-provincial transfer. I also contacted program directors for schools I applied to in first round CaRMS last year and no one had left their psych program.

Edited by neuroscience_nerd

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4 hours ago, Med0123 said:

My general advice is if you consider writing USMLE, you just should do it.

However in your case, do you seriously consider to do a full 4-5 years residency in the US, far from your family, with all the financial burden it will incur? I think you should do some soul searching, I am not sure USMLE will change anything in your case, and will just cost you time/money.

To be honest I don’t have any family in Canada that’s in my life besides my mom. Not many friends either. I just want to start it all over again. I am working on these things with a specific type of counselling too, but ultimately I do not believe I will be able to complete family medicine residency.

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18 minutes ago, neuroscience_nerd said:

That’s right, I haven’t heard of anyone especially in psych that has transferred out into family. There was someone who wanted to match family in second round CaRMS this year but matched the psych spot I interviewed for and ranked highly instead. I know people say they weigh it in favour of the applicant’s rankings but it seems to be the opposite. The program director alluded to ranking him #1 and me as #2.

I am just so frustrated and depressed about everything. I really worry I will be the next Robert Chu because of this fucked up CaRMS system :(

Also, yes I have contacted every Canadian med school with a psych residency program over the past year (some multiple times) and not one had capacity to accept an inter-provincial transfer. I also contacted program directors for schools I applied to in first round CaRMS last year and no one had left their psych program.

they don't have to leave psych - just anyone leaving a 5 year program can free up the funding - that is really annoying though that something hasn't lined up. 

They don't really care what you rank - just like you shouldn't care (in terms of your ordering) what they rank. 

Don't let it get anywhere near the Dr. Chu situation - that fires off a ton of alarm bells already - I know you are working with the school but seriously take care of yourself. One way or the other a solution has to be found for all of this.

The lack of available funding and flexibility are real problems.  I am not sure it is so much CARMS as any system acting within this sort of limitation can cause these sorts of problems. May be something like the US with internship where you differ the selection of a specialty until after med school could help also make sure people end up in fields they like. We have to do a better job of explaining the rules of CARMS as well (sometimes it IS better to go unmatched than to take something - but they really push you away from that option). 

I really hope something in Canada opens up, and keep at that I would say. With that aside there is still the USMLE to open up the US as an option. It can and has been done. 

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On 8/27/2018 at 4:07 PM, neuroscience_nerd said:

That’s right, I haven’t heard of anyone especially in psych that has transferred out into family. There was someone who wanted to match family in second round CaRMS this year but matched the psych spot I interviewed for and ranked highly instead. I know people say they weigh it in favour of the applicant’s rankings but it seems to be the opposite. The program director alluded to ranking him #1 and me as #2.

I am just so frustrated and depressed about everything. I really worry I will be the next Robert Chu because of this fucked up CaRMS system :(

Also, yes I have contacted every Canadian med school with a psych residency program over the past year (some multiple times) and not one had capacity to accept an inter-provincial transfer. I also contacted program directors for schools I applied to in first round CaRMS last year and no one had left their psych program.

That person must have ended up not getting their family ranks. For example, if their family medicine programs they applied to did not want him, and he ranked that psych program 8th, that psych program would become their #1 rank if the previous 7 programs don't take them. At that point it doesn't matter if you rank that program your #1 rank because the program's rank list then breaks the tie. 

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31 minutes ago, Edict said:

That person must have ended up not getting their family ranks. For example, if their family medicine programs they applied to did not want him, and he ranked that psych program 8th, that psych program would become their #1 rank if the previous 7 programs don't take them. At that point it doesn't matter if you rank that program your #1 rank because the program's rank list then breaks the tie. 

Yeah exactly - that person was basically rejected from every spot above the psych one they selected. 

The ranking aspect etc I don't think is actually CARMS weakness. It is actually fair in that regard within the constraints of the system. The problem is the constraints themselves.

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4 hours ago, rmorelan said:

Yeah exactly - that person was basically rejected from every spot above the psych one they selected. 

The ranking aspect etc I don't think is actually CARMS weakness. It is actually fair in that regard within the constraints of the system. The problem is the constraints themselves.

I agree, once I finally wrapped my head around the rank list, it made total sense. Program's rank lists do matter a lot, but so does your own. In essence, the way CaRMS works is it does not punish you for ranking your moonshots. You can rank a program you didn't even interview at on CaRMS as your first choice and it would have absolutely no effect on your ability to match to your other ranks. The strategy for every applicant is trying to convince programs that they want to go there since you want all programs to put you high up on their rank list. 

What happens is the algorithm can run through a list any which way, they could even go through alphabetically. You might think then those with the last name starting with A have an advantage since they get first dibs. However, that isn't how it works. As long as there is an open spot, you get it, which they call "provisionally matched", until someone else bumps you from that spot. The program would run through that list over and over again until every last possible option is exhausted. 

 

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51 minutes ago, Edict said:

I agree, once I finally wrapped my head around the rank list, it made total sense. Program's rank lists do matter a lot, but so does your own. In essence, the way CaRMS works is it does not punish you for ranking your moonshots. You can rank a program you didn't even interview at on CaRMS as your first choice and it would have absolutely no effect on your ability to match to your other ranks. 

 

What happens is the algorithm can run through a list any which way, they could even go through alphabetically. You might think then those with the last name starting with A have an advantage since they get first dibs. However, that isn't how it works. As long as there is an open spot, you get it, which they call "provisionally matched", until someone else bumps you from that spot. The program would run through that list over and over again until every last possible option is exhausted. 

 

yeah - it is actually the mathematically best way of doing things. I mean that literally and that is provable even. Gotta love nobel prize level economic algorithms

when the system it is the best way to do things, but that doesn't mean the underlying system is perfect. The idea that there must be exactly so many of each type of doctor each year is very inflexible. 

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