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2019 CaRMS unfilled spots

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31 minutes ago, xiphoid said:

From what I understand, Health Canada got rid of providing SoNs depending on the specialty that Canadians were pursuing in the US. Statement of Needs themselves however are still needed to pursue residency in the US (https://www.canada.ca/en/health-canada/services/health-care-system/health-human-resources/statements-need-postgraduate-medical-training-united-states.html). Basically, whereas in the past no Canadian was ever allowed to pursue a neurosurgery residency in the US for example (because it was not on the approved list of specialties that Health Canada would provide a SoN for), now it is just first come first serve regardless of what specialty someone matched into. There might still a limited number?

 

Yeah, I was quick to believe it as I was just hoping they weren't requiring those anymore. Last year there was at least one person I know that matched, but applied late for the SoN and was not granted one. 

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On 3/1/2019 at 6:23 PM, xiphoid said:

From what I understand, Health Canada got rid of providing SoNs depending on the specialty that Canadians were pursuing in the US. Statement of Needs themselves however are still needed to pursue residency in the US (https://www.canada.ca/en/health-canada/services/health-care-system/health-human-resources/statements-need-postgraduate-medical-training-united-states.html). Basically, whereas in the past no Canadian was ever allowed to pursue a neurosurgery residency in the US for example (because it was not on the approved list of specialties that Health Canada would provide a SoN for), now it is just first come first serve regardless of what specialty someone matched into. There might still a limited number?

 

On 3/1/2019 at 6:56 PM, vascular said:

Yeah, I was quick to believe it as I was just hoping they weren't requiring those anymore. Last year there was at least one person I know that matched, but applied late for the SoN and was not granted one. 

No more quotas.. I literally saw this advertised by Health Canada a while ago lol

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Yeah I also stumbled upon the official tweet a few months back haha:

https://twitter.com/GovCanHealth/status/1039544227351412736?fbclid=IwAR0g5KVaFGntwdcHrBC-GEBN-JvV09mAGYwvnrx2Tc6fozEi2kqIzwQ3NfI

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18 hours ago, Edict said:

I think the real reason Canadian medical students may bash CSAs is not because of the education, its because of the quality of candidate they accept. No one doubts that local Australia medical schools aren't doing good teaching, but people believe that those with lower GPAs/MCAT scores were able to escape to get trained elsewhere and want to come back and take what many CMGs feel they deserve first dibs on because they had more competitive applications. Going to Melbourne is not going to make you a good medical student if you weren't as good a student to begin with. 

Ultimately, it is not always a training issue, it is simply an issue with skipping the line. 

The other issue as mentioned in other posts is the issue of cost. In essence, some CMGs are unhappy that Canadians who aren't as competitive applicants, but are wealthy enough to afford the tuition that Australian and Irish medical schools charge, want to essentially use their money, give it to a foreign country and skip the line ahead of Canadians who may had to re-apply and improve their apps to get a chance at. 

That makes sense, I agree with you to an extent. Good study habits/self discipline is crucial to academic success, whether one is in medical school or not. The extremely high attrition rates in Caribbean medical schools for instance is probably a reflection of the quality of candidates they accept (I mean for profit diploma mills let's be honest what can we expect?). However life is unpredictable and circumstances that impact a persons ability to do exceedingly well in undergrad do occur. I won't get into my own personal story but there was a family related matter that significantly impacted me, and as a result,  my education. I have doubts about getting into a Canadian medical school now because of my lowish A- average and lack of a full course load outside of my final year.  So I have seriously considered taking the Irish or Australian route despite the challenges of coming back (I'd probably just study for the USMLE's if I did this). But surely you understand why I might be sympathetic to those who decide to pursue this avenue? I definitely think that there are different types of candidates who go outside of Canada for medicine, I wouldn't characterize all of them as being low quality. After all, some  have competitive stats but did not have luck here.

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4 hours ago, #YOLO said:

yup i know a buncha people that lawyered up and got outta  ROS without having to pay that crazy price tag if u break the contract

 The best way to recruit long-term physicians in under-served areas is to have dedicated Canadian medical school positions for potential medical students from those communities. Several medical school has been adopting this policy and the retention rate is much better than IMGs who often try to "play around" their ROS (NOSM for example).

There are increasing IMGs who are not adhering to their ROS, and you just need a support letter from your colleagues to work in academic hospitals in urban area; it's not hard and very easy to play around. 

I think that it's frustrating that the government is opening IMG residency position due to lawsuits and the public pressure, who often thinks there is a lack of physicians. The truth is that the healthy care system and the job market is poorly planned, where we have highly skilled surgical residents going down to USA for jobs. The government could not afford to have more surgeons or anesthesiologists in the OR; it's a systematic issue. 

Having IMG positions have not changed the lack of physicians in underserved areas. It's interesting to state that the IMG who matched, are CSAs from affluent families with strong connections , not IMGs who were born and were physicians in their home country. The CarMS definitely favours CSAs over IMGS born abroad, which in itself is discriminating. 

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20 hours ago, xiphoid said:

Everything you said in the first part is very true. Then you completely lost my support with the second part. Yes, people who do very well at UK and Aussie medical schools (not just passing, but in the top 10-20% let's say) likely would have done well in a Canadian system too. However, the fact that Canadian medical school admissions skews towards applicants with higher SES is not solved by Irish and Aussie schools. These schools have really high tuitions (made worse by the exchange rate in recent years) and few Canadian banks offer any sort of LOC for students pursuing medical school abroad. Generally, the people who are accessing medical school through this route are from high SES families (in my opinion, generally from higher SES than the average med student at a Canadian school) and many have parents or extended family practicing medicine in Canada. By your logic in the first part, these students are advantaged in gaining med school admissions already in Canada. Those are truly disadvantaged in Canada rarely have the means to pursue medicine abroad and do eventually end up pursuing alternate career paths after repeated attempts to get in here, even if they too, like their often wealthy CSA counterparts, "truly feel medicine is their calling".

 

You're right about the tuition and SES. This is undeniable. However there are other factors I meant. First not all international medical schools have insanely high tuition. Australia and Ireland, yes, but Poland for example is probably comparable to the cost of U of T. Also many who do go abroad are non traditional and had other careers/savings/spouses who are willing to support them. Banks do offer lines of credits for international medical schools, however, these often require a co-signer who is willing to put up collateral. So some parents will stick their necks out. 

 

https://www.carms.ca/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf

Please scroll to slide 22 for the relevant data. Keep in mind this was a survey conducted in 2010 but it gives you a general idea. Bank loans/personal savings/and government grants make up large portions regarding how CSA's finance their education.

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5 hours ago, NLengr said:

ROS's do shit all to solve rural recruitment issues long term in truly rural areas. People wiggle out of the ROS or leave the rural area as soon  as it is up. You just end up with a revolving door. 

The issue with rural recruitment is most rural places are dying towns with little on the go to do in your downtime. People (not just physicians) just don't want to be there. I should know, I'm a rural surgical specialist and I HATE working in this place. 

100% agreed - ROS ("the stick") are a poor solution to rural retention issues, regardless of who fulfills them - CMG or IMG/CSA. From an Australian GP point-of-view: we have developed more of a "carrot" strategy, with several states such as Queensland and New South Wales offering a postgraduate Rural Generalist Pathway and which will soon roll out nationwide, as well as very generous Commonwealth annual bonuses to GPs who practice in rural areas. And we still have problems retaining rural GPs. It is a very complex problem to tackle, to state the obvious.

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34 minutes ago, LittleDaisy said:

 The best way to recruit long-term physicians in under-served areas is to have dedicated Canadian medical school positions for potential medical students from those communities. Several medical school has been adopting this policy and the retention rate is much better than IMGs who often try to "play around" their ROS (NOSM for example).

 There are increasing IMGs who are not adhering to their ROS, and you just need a support letter from your colleagues to work in academic hospitals in urban area; it's not hard and very easy to play around. 

 I think that it's frustrating that the government is opening IMG residency position due to lawsuits and the public pressure, who often thinks there is a lack of physicians. The truth is that the healthy care system and the job market is poorly planned, where we have highly skilled surgical residents going down to USA for jobs. The government could not afford to have more surgeons or anesthesiologists in the OR; it's a systematic issue. 

Having IMG positions have not changed the lack of physicians in underserved areas. It's interesting to state that the IMG who matched, are CSAs from affluent families with strong connections , not IMGs who were born and were physicians in their home country. The CarMS definitely favours CSAs over IMGS born abroad, which in itself is discriminating. 

I agree with the notion that there is a need to recruit long-term physicians in underserved area such an Northern Ontario and also the fact that NOSM has been doing a good job recently. 
i also agree with the fact that some IMGs may not adhere to their ROS and pay their way out of it or work right outside the GTA. As you likely know, ROS states you can't work in an urban area.
- Why did Sask FM end up with so many seats vacant in the competitive stream this season? or last? or every year pretty much? Did you know Sask healthcare system consists of 53% IMGs? The reason is CMGs don't want to go there and they end up filling spots with IMGs

-I believe someone mentioned earlier that CMGs would be happy to take rural FM spots. Some perhaps; others, they wouldn't be happy to take them, they might piggyback on it until they can transfer into their specialty of choice or attempt to transfer out to an urban location. It JUST happened; that spot could have gone to someone that would have happily completed their FM training

- As far as highly skilled surgical residents heading down to the states; It just so happens there are more positions available down south for it. It also happens to be lucrative. It also does not mean IMGs are taking away from the funding for those spots. If you think about it, Foreign Fellows coming from places like Bahrain, Saudi Arabia or Qatar for example are subsidizing residency positions here with the amount of cash paid to Canadian universities. Are you opposed to that as well? I assure you our taxes are not funding those positions.

- Not every CSA comes from well off families with strong connections. There are a few; and yes, I went to school with them. But for myself, I took a LoC independently and pay interest on it monthly. For the expenses that could not be covered by the LoC, I took time off, worked and paid off the tuition fees and other expenses. That resulted in my application not looking so hot. I'm not the only one that has gone through this. Please don't draw a circle around all CSAs.

There is a good reason to pause and ponder why our healthcare system is so reliant on foreign fellows/residents and how it would leave us crippled if they were to leave tomorrow? Those spots, if funded by our gov't would keep physicians in house. The misdirected hate towards CSA/IMGs aren't doing us any favour.
I apologize for venting. Lets stop the blame game.

 

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Any advice on swapping into family medicine? I matched to a 5 year specialty in a very undesirable location. I'm also interested if lab medicine allows location transfers?

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38 minutes ago, 2019CaRMS said:

Any advice on swapping into family medicine? I matched to a 5 year specialty in a very undesirable location. I'm also interested if lab medicine allows location transfers?

sask or mani?

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1 hour ago, 2019CaRMS said:

Any advice on swapping into family medicine? I matched to a 5 year specialty in a very undesirable location. I'm also interested if lab medicine allows location transfers?

you will have to wait at least 6 months into your residency.

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1 hour ago, 2019CaRMS said:

MUN but my family is in interior BC and eastern Alberta.

More worried about 5 years away from an ill family member

ah its tought in that case. if your sure you wanna switch and do family i'd say get on it ASAP. some programs wont let you, some will. the pro is if u are able to switch early you usually will only have a few months of being off cycle. 

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2 hours ago, 2019CaRMS said:

Any advice on swapping into family medicine? I matched to a 5 year specialty in a very undesirable location. I'm also interested if lab medicine allows location transfers?

What specialty did you match into? Im interested in switching out of family. There’s a couple postings on www.residentransfer.com too but not sure about BC. Even if we cant transfer right away, transferring in dec seems better late than never 

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38 minutes ago, #YOLO said:

ah its tought in that case. if your sure you wanna switch and do family i'd say get on it ASAP. some programs wont let you, some will. the pro is if u are able to switch early you usually will only have a few months of being off cycle. 

Who do I talk to?

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18 minutes ago, 2019CaRMS said:

Who do I talk to?

you have to wait at least 6 months into your residency and the people to talk with is your PGME. I would not inform your matched program about your plans.

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On 3/1/2019 at 12:58 PM, la marzocco said:

Maybe @tere can chime in here, but CMGs used to take up quite a few residency spots in the US - that is, they matched quite well in NRMP, but at some point in the past little while, this dropped off and we only send ~10 max CMGs to the US each year. 

And many of these recently have been prior year graduates.

On 3/1/2019 at 1:05 PM, vascular said:

perhaps has something to do with the earlier CaRMS match than the US match in March, therefore taking you out of contention for the NRMP. By that time we are already in the second iteration.
I believe more CMGs need to start taking the Steps, especially if they prefer to apply to specialties. SON has been an issue though, unsure how many were allocated this year.

Surprisingly, CaRMS was earlier in 2003 too, when many more CMGs matched to the US.  (la marzocco and I looked at this here) 

http://forums.premed101.com/topic/103148-ontarios-53-extra-residency-spots/?page=2

There's still a weak preference for US citizens MG even vs Canadian citizen with US MD from what I've heard.  That being said, I know of a JHU neursurg match from Canadian USMG.  

Generally speaking, Step 1 doesn't make one competitive in Canada but it's essential for US matching.  In fact, prepping Step 1 might come at the expense of other activities that would help CaRMS competitiveness.  For Canadian med students seriously considering the US for competitive specialties, I think it may be best to go the prior year graduate route which seems to have been successful recently.  This would mean either taking an extra year or attempting to match after a Canadian residency and prepping Step 1 after M3/M4.

 In such cases, clearly it's important to look at the options available at home school, in terms of extra clerkship etc...  Also one shouldn't expect to match into competitive US locations - but rather somewhere in the US.  Step 2 is maybe more easily prepped during clerkship.   

Nonetheless, I know of very competitive CMG CaRMS matches that prepped Step 1 between M2/M3 but without intent of US residency applications.

 

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5 hours ago, 2019CaRMS said:

Who do I talk to?

get in touch with your PGME asap. dont tell ur program until things get going. a lot of programs say u need to wait 6 months before transfering. get the process going though. i know of people who were able to get everything arranged so they could switch out by december, and got 3-4 months credit from rotations they did already, only making them off cycle for 1-2 months. 

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On 3/1/2019 at 10:08 AM, xiphoid said:

For those of us who feel like CaRMS shouldn't be reserving IMG spots when quite a few current year CMGs are not getting matched, this is in essence the problem. Most CMGs do not stand a realistic chance of matching to residency in any other country except our own because other countries are prioritizing their own grads before others.

This is not necessarily true everywhere. Our neighbours to the south have a fully competitive residency application system. IMGs or USMGs can apply for positions equally, based off merit, and based off more objective data like USMLE scores. As a taxpayer, if a higher qualified IMG (who paid for their own training) takes the spot over a CMG whose training I funded, I haven't lost anything, as long as someone filled that residency seat. 

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21 minutes ago, leviathan said:

This is not necessarily true everywhere. Our neighbours to the south have a fully competitive residency application system. IMGs or USMGs can apply for positions equally, based off merit, and based off more objective data like USMLE scores. As a taxpayer, if a higher qualified IMG (who paid for their own training) takes the spot over a CMG whose training I funded, I haven't lost anything, as long as someone filled that residency seat. 

IMGs can apply - but they're almost never on the same footing at USMGs, regardless of scores.  With very few exceptions IMGs in the US will match only to FM and IM (which itself is different than in Canada).  USMGs tend to avoid FM and IM - hence the IMG opportunity (combined with the fact there are more residency spots than US graduates).  While on the surface it appears the US is much more open, IMGs are rarely outcompeting USMGs for competitive specialties and tend to match disciplines and locales that USMGs don't really go for.  

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7 minutes ago, tere said:

IMGs can apply - but they're almost never on the same footing at USMGs, regardless of scores.  With very few exceptions IMGs in the US will match only to FM and IM (which itself is different than in Canada).  USMGs tend to avoid FM and IM - hence the IMG opportunity (combined with the fact there are more residency spots than US graduates).  While on the surface it appears the US is much more open, IMGs are rarely outcompeting USMGs for competitive specialties and tend to match disciplines and locales that USMGs don't really go for.  

Which would be the exact same scenario in Canada if we had a competitive application process. It would be very unusual for an IMG to be ranked higher than a CMG. But there are exceptionally good IMGs, and there are also exceptionally bad CMGs where that would happen. Especially as it is notoriously easy to make it through med school in Canada once you get that acceptance letter. As a Canadian citizen and tax payer, I would want the best doctor looking after me, regardless of where they trained. On the flipside as a Canadian physician, I do feel we owe it to our CMGs to give them a reasonable guarantee of a training position. 

Edited by leviathan

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38 minutes ago, leviathan said:

This is not necessarily true everywhere. Our neighbours to the south have a fully competitive residency application system. IMGs or USMGs can apply for positions equally, based off merit, and based off more objective data like USMLE scores. As a taxpayer, if a higher qualified IMG (who paid for their own training) takes the spot over a CMG whose training I funded, I haven't lost anything, as long as someone filled that residency seat. 

You haven't lost anything in that particular case, but you're losing out as a taxpayer by supporting a training system that regularly leaves qualified CMG candidates unmatched year after year. You could save money by cutting CMG spots and still getting the same results. That's the source of waste. If you gave those unmatched candidates just 2 more years of training in FM, they could be a fully functioning doctor rather than unemployed and unable to repay their student loans.

The US has a "fully competitive" system with caveats. Last year the NRMP had ~18,000 USMD graduates apply and a total ~33,000 residency spots. There's a lot more wiggle room for IMGs and US DOs to compete for spots.

In Canada last year, we had 2,965 CMG spots and 2,923 CMG applicants. And that's including Quebec, where there's a huge surplus of residency spots. If you remove Quebec, there are more CMG applicants than spots. So unlike the US, there wasn't even a theoretical possibility of all CMGs being matched because there weren't numerically enough spots. Very different than the NRMP system. If Canadian governments hugely increased residency spots so that there are almost 2x as many total spots as CMG applicants, it would be a different story and much easier to justify open season for IMGs.

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10 hours ago, cacaonibs said:

https://www.nodocsleftbehind.com

  • No Docs Left Behind is advocating for two solutions: For B.C. to boost the number of positions available to 317, and create any needed residency positions for all unmatched medical graduates each year.
  • UBC medical students to meet with B.C. provincial government on Monday to discuss the issue of unmatched medical graduates.

Also if possible, those who matched should help those unmatched advocate. Support and solidarity is needed and much appreciated by those unmatched. 

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13 hours ago, leviathan said:

Which would be the exact same scenario in Canada if we had a competitive application process. It would be very unusual for an IMG to be ranked higher than a CMG. But there are exceptionally good IMGs, and there are also exceptionally bad CMGs where that would happen. Especially as it is notoriously easy to make it through med school in Canada once you get that acceptance letter. As a Canadian citizen and tax payer, I would want the best doctor looking after me, regardless of where they trained. On the flipside as a Canadian physician, I do feel we owe it to our CMGs to give them a reasonable guarantee of a training position. 

@shematoma hit it on the head. The ratio between the number of CMGs and the number of residency spots is the main problem in Canada. However, given that the government is unwilling to fund additional residency spots (or at least not to the tune of a few thousand extra spots when they're resistant to even add 5-10 spots), we can't hold a competitive match in Canada and expect to have the same results as the US. The other way to tackle this numbers problem directly is by decreasing the number of medical students, which is also very unlikely to happen (I've heard quite a few premeds advocating for more spots without them realizing the downstream effects it would have). Given those constraints, redirecting current IMG spots for CMG spots would help the ratio between CMGs and residency positions. That or we as a society need to start accepting that a MD is useful for a lot more than just clinical practice like the US has. A good portion of US MDs (especially at top tier schools such as Stanford) choose, as their first choice, to not do a residency to pursue cutting-edge (and quite nicely-paying) work in the industry. There really doesn't seem to be much one can do in Canada with a MD and no residency.

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