Jump to content
Premed 101 Forums
jlkhhylyiluh6

2019 CaRMS unfilled spots

Recommended Posts

43 minutes ago, xiphoid said:

@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.

This is the core issue that all the complainers on here don't seem to recognize. Those aren't spots taken from the CMG pool and given to IMGs. They were new positions separately funded by the health ministries and added specifically for IMGs, and all come with a return of service contract. I don't think many CMGs would be up for that idea. But if they are, then you could make the second IMG stream competitive for CMGs as well. 

Edited by leviathan

Share this post


Link to post
Share on other sites
15 hours ago, leviathan said:

This is the core issue that all the complainers on here don't seem to recognize. Those aren't spots taken from the CMG pool and given to IMGs. They were new positions separately funded by the health ministries and added specifically for IMGs, and all come with a return of service contract. I don't think many CMGs would be up for that idea. But if they are, then you could make the second IMG stream competitive for CMGs as well. 

To the extent you characterize people as "complainers," maybe they have good cause. Let's look at some data.

In 2008, there were 2,136 CMG graduates and 2,379 positions available, for a 1.11 ratio. Last year, the same numbers were 2,923 CMG graduates and 2,974 positions available, a ratio of 1.02. As mentioned in a previous post, that includes Quebec which has a surplus of residency spots, so if you exclude Quebec the ratio is more like 0.98.

And yet, over the same period, IMG positions increased from basically zero in 2006 to 343 in 2018.

Clearly, the growth of positions for CMGs hasn't kept pace with the growth in numbers of CMGs, whereas IMGs went from basically no dedicated quota to having 343 spots reserved just for them.

So yes these spots were "created" for IMGs, but essentially they came at the expense of expanding CMG positions to keep up with increased medical school enrollment. The government has limited money after all, and the claim is that hospitals in this country have limited training capacity. So what goes to IMGs comes at the expense of spots for CMGs.

Share this post


Link to post
Share on other sites

Also, if the government has no money to expand residency spots where many residents really act as a workforce multiplier for attending level staff, expanding residency positions as the “cheaper” option will only shift the backlog to attending positions as the government will choose not to hire as many. Or at least can’t, at current rates. So if you see this coming, I would bet on sequential heavy downward pressure on take home pay. I am a personal advocate for decreased MD spots with the current system, and for resurrection of the general licensure system which puts negotiating power, geographic and life flexibility back in residents hands.

Share this post


Link to post
Share on other sites
15 minutes ago, ChemPetE said:

Also, if the government has no money to expand residency spots where many residents really act as a workforce multiplier for attending level staff, expanding residency positions as the “cheaper” option will only shift the backlog to attending positions as the government will choose not to hire as many. Or at least can’t, at current rates. So if you see this coming, I would bet on sequential heavy downward pressure on take home pay. I am a personal advocate for decreased MD spots with the current system, and for resurrection of the general licensure system which puts negotiating power, geographic and life flexibility back in residents hands.

Agreed. One of the things that I agreed with Quebec's former health minister Barrette despite him not being very popular among the medical community was he understood the doctor unemployment and underemployment issue and addressed the root cause, which is excessive MD enrolment. He shaved MD spots across all 4 Qc schools for a duration of 3 years to cut ~50 spots in total. Whether that's too little or too much is subjective, but he was good with the issue recognition. Also, primary care is also undervalued and fee relativity does play an issue when medical students decide on specialties. Provinces need to address this in order to shepherd more MD students to go into primary care, which is really where the need truly lies.

Share this post


Link to post
Share on other sites
48 minutes ago, la marzocco said:

Agreed. One of the things that I agreed with Quebec's former health minister Barrette despite him not being very popular among the medical community was he understood the doctor unemployment and underemployment issue and addressed the root cause, which is excessive MD enrolment. He shaved MD spots across all 4 Qc schools for a duration of 3 years to cut ~50 spots in total. Whether that's too little or too much is subjective, but he was good with the issue recognition. Also, primary care is also undervalued and fee relativity does play an issue when medical students decide on specialties. Provinces need to address this in order to shepherd more MD students to go into primary care, which is really where the need truly lies.

I don't understand why no government/licensing body has considered this: require all medical schools to give their medical students an R1 spot if they can't match. At the end of that R1 year, they can receive a restricted license (permanently restricted unless they complete a CFPC/RCPSC/ACGME-certified residency) to practice as generalists in rural/underserved areas (+/- lower the amount they can bill) but retain access to the second round of the match as current physicians (who've completed a full residency) do. Yes, there's the argument that rural areas will then not be receiving proper care, but if it's a slightly less trained doctor vs no doctor, I'd say that's a no-brainer... especially when you're willing to bring in NPs, who get substantially less clinical training, to those same areas. In that way, you make the CFPC happy (family med retains whatever prestige they got when the rotating internship went away), you make the rural areas/voters happy (they get Drs), you make the people who'd otherwise go unmatched... well, less sad (earning $$ with the potential to enter the second round >> accruing debt with the potential to enter the second round). It's basically a compromise between bringing back the rotating internship (which the CFPC would be heavily against) and doing nothing (which results in unmatched grads). There is, of course, the argument that doing so would make the R1 year a de facto requirement as programs might elect not to fill seats in the first round to see what they can get in the second, but I haven't seen that being a problem in the US, where you can get an unrestricted license after an R1.

Share this post


Link to post
Share on other sites

On a somewhat related note, anyone regret their decision to pursue medicine vs other fields? The match is so competitive and brutal, the job market is poor, might have to live in the middle of nowhere, long training and work hours and to top it all, the government is always trying to screw us with cuts.... I guess the grass is always greener on the other side.

Share this post


Link to post
Share on other sites
1 hour ago, peace2014 said:

On a somewhat related note, anyone regret their decision to pursue medicine vs other fields? The match is so competitive and brutal, the job market is poor, might have to live in the middle of nowhere, long training and work hours and to top it all, the government is always trying to screw us with cuts.... I guess the grass is always greener on the other side.

I don't regret doing medicine personally. I will say that the grass is greener on the other side for some people. I think medicine is a career path that offers job stability and good income. However, people really underestimate how well you can do in other fields and vocations. I'm not saying all medical students would be amazing at every other job as I know many colleagues who are only good at medicine. However, my professional friends that put in a similar amount of effort and time into perfecting their craft do very well for themselves and many do better than me. Perhaps they don't have the same prestige or social cachet that I have but I don't think it matters much to them and it also doesn't really matter for me and many doctors. 

Share this post


Link to post
Share on other sites
2 hours ago, insomnias said:

I don't understand why no government/licensing body has considered this: require all medical schools to give their medical students an R1 spot if they can't match. At the end of that R1 year, they can receive a restricted license (permanently restricted unless they complete a CFPC/RCPSC/ACGME-certified residency) to practice as generalists in rural/underserved areas (+/- lower the amount they can bill) but retain access to the second round of the match as current physicians (who've completed a full residency) do. Yes, there's the argument that rural areas will then not be receiving proper care, but if it's a slightly less trained doctor vs no doctor, I'd say that's a no-brainer... especially when you're willing to bring in NPs, who get substantially less clinical training, to those same areas. In that way, you make the CFPC happy (family med retains whatever prestige they got when the rotating internship went away), you make the rural areas/voters happy (they get Drs), you make the people who'd otherwise go unmatched... well, less sad (earning $$ with the potential to enter the second round >> accruing debt with the potential to enter the second round). It's basically a compromise between bringing back the rotating internship (which the CFPC would be heavily against) and doing nothing (which results in unmatched grads). There is, of course, the argument that doing so would make the R1 year a de facto requirement as programs might elect not to fill seats in the first round to see what they can get in the second, but I haven't seen that being a problem in the US, where you can get an unrestricted license after an R1.

Don't think the government and licensing body is overly concerned with unmatched students. It's very low on their priority list. I think bringing back the R1 unrestricted license like the US would help alleviate a lot of issues. I honestly find it hard to believe that doctors who completed R1 could not through self-study be educated enough to do very basic clinics or even just administrative work that requires a medical license. 

Share this post


Link to post
Share on other sites
7 minutes ago, sWOMEN said:

Pardon my ignorance but why would CFPC be against the rotating internship?

In the old days, graduates of the rotating internship could practice as GP's without any additional training, thus eroding the standing of family doctors since there was little benefit in specializing in family practice for 2 years if you could do the same job with just the 1 year internship. When the rotating internship was eliminated, family medicine became established as its own "specialty" and only people certified by the CFPC could practice as GP's.

So if people can get an independent license with just a 1 year internship, family doctors would start having more competition. Thus, they are not keen to having the internship come back. Unless maybe family medicine becomes a 2 year specialty on TOP of doing the internship, which by itself wouldn't grant an independent license but is merely an intermediate step towards a longer specialty.

Share this post


Link to post
Share on other sites

Thing is, if we don’t have a general licensure option, the CFPC should ensure availability of swap to a FM for every practitioner/resident that wants to. That would solve so much. But of course they would never do so and there’s isn’t the capacity to do so.

Share this post


Link to post
Share on other sites
On 3/5/2019 at 12:08 AM, peace2014 said:

On a somewhat related note, anyone regret their decision to pursue medicine vs other fields? The match is so competitive and brutal, the job market is poor, might have to live in the middle of nowhere, long training and work hours and to top it all, the government is always trying to screw us with cuts.... I guess the grass is always greener on the other side.

Regrets right here. Although mine are driven by issues that arise after residency (terrible location of my job, inability to change jobs due to lack of avaliable positions, bullying and/or incompetent coworkers, negligent/incompetent health authority etc.).

Share this post


Link to post
Share on other sites
On 3/4/2019 at 10:49 PM, insomnias said:

I don't understand why no government/licensing body has considered this: require all medical schools to give their medical students an R1 spot if they can't match. At the end of that R1 year, they can receive a restricted license (permanently restricted unless they complete a CFPC/RCPSC/ACGME-certified residency) to practice as generalists in rural/underserved areas (+/- lower the amount they can bill) but retain access to the second round of the match as current physicians (who've completed a full residency) do. Yes, there's the argument that rural areas will then not be receiving proper care, but if it's a slightly less trained doctor vs no doctor, I'd say that's a no-brainer... especially when you're willing to bring in NPs, who get substantially less clinical training, to those same areas. In that way, you make the CFPC happy (family med retains whatever prestige they got when the rotating internship went away), you make the rural areas/voters happy (they get Drs), you make the people who'd otherwise go unmatched... well, less sad (earning $$ with the potential to enter the second round >> accruing debt with the potential to enter the second round). It's basically a compromise between bringing back the rotating internship (which the CFPC would be heavily against) and doing nothing (which results in unmatched grads). There is, of course, the argument that doing so would make the R1 year a de facto requirement as programs might elect not to fill seats in the first round to see what they can get in the second, but I haven't seen that being a problem in the US, where you can get an unrestricted license after an R1.

The thing is the government prefers NPs vs physicians. They don't care about quality of care. 

NPs are employees through and through. They are used to being in a subserviant employee role from thier time as nurses. They don't question what the government says/does, they don't complain publicly, they don't push back against stupid decisions and they don't question government interference in clinical decision making. Politically for governments and health authorities, they are much more favourable. 

Never make the mistake that health authorities or the government actually care about patients or outcomes. 

Share this post


Link to post
Share on other sites
9 hours ago, NLengr said:

The thing is the government prefers NPs vs physicians. They don't care about quality of care. 

NPs are employees through and through. They are used to being in a subserviant employee role from thier time as nurses. They don't question what the government says/does, they don't complain publicly, they don't push back against stupid decisions and they don't question government interference in clinical decision making. Politically for governments and health authorities, they are much more favourable. 

Never make the mistake that health authorities or the government actually care about patients or outcomes. 

I think there's also an issue of optics. I think that the government (and the public in general) are okay with paying the kind of salaries NPs make as it "looks more reasonable" than paying what physicians bill even if we are more efficient and cost the system less money.

I think people don't like doctors making the $200k-500k+ that most physicians make but are very okay with a nurse making $100-150k+ even if a physician could do the work of multiple NPs. 

However, I will play devil's advocate and say that NPs are very useful in the sense that they will go where many doctors are reluctant to work. Medicine is a profession that needs to consider social needs and if you have a doctor shortage in undesirable locations, those people still deserve care and NPs fill that gap. 

Share this post


Link to post
Share on other sites
2 hours ago, blah1234 said:

I think there's also an issue of optics. I think that the government (and the public in general) are okay with paying the kind of salaries NPs make as it "looks more reasonable" than paying what physicians bill even if we are more efficient and cost the system less money.

I think people don't like doctors making the $200k-500k+ that most physicians make but are very okay with a nurse making $100-150k+ even if a physician could do the work of multiple NPs. 

However, I will play devil's advocate and say that NPs are very useful in the sense that they will go where many doctors are reluctant to work. Medicine is a profession that needs to consider social needs and if you have a doctor shortage in undesirable locations, those people still deserve care and NPs fill that gap. 

Doctors of BC president wrote in his blog: 

"Today there are increasing numbers of medical students going unmatched after the first round—202 last year—a situation exacerbated by the added competition of hundreds of international medical graduates who are eligible for the second round. Further, those who remain unmatched re-enter the following year, causing an exponential increase of applicants relative to positions. Without commenting on legalities, the repatriation of Canadians and the case of others medically trained abroad, it is clear that this stress is felt by medical students who are pressured to choose a career path early in their studies in order to remain competitive for future matches."

https://www.doctorsofbc.ca/presidents-blog/fear-and-hoping-medical-school-finding-more-match

Share this post


Link to post
Share on other sites
3 hours ago, blah1234 said:

I think there's also an issue of optics. I think that the government (and the public in general) are okay with paying the kind of salaries NPs make as it "looks more reasonable" than paying what physicians bill even if we are more efficient and cost the system less money.

I think people don't like doctors making the $200k-500k+ that most physicians make but are very okay with a nurse making $100-150k+ even if a physician could do the work of multiple NPs. 

However, I will play devil's advocate and say that NPs are very useful in the sense that they will go where many doctors are reluctant to work. Medicine is a profession that needs to consider social needs and if you have a doctor shortage in undesirable locations, those people still deserve care and NPs fill that gap. 

In my province at least, the places NPs have replaced family docs are places so remote you could easily argue they shouldn't have a physician there anyway due to a tiny population. In those cases, an NP provides a useful intermediate between a full physician and a RN (or nothing).

Share this post


Link to post
Share on other sites
13 hours ago, NLengr said:

Regrets right here. Although mine are driven by issues that arise after residency (terrible location of my job, inability to change jobs due to lack of avaliable positions, bullying and/or incompetent coworkers, negligent/incompetent health authority etc.).

Ortho, ENT or Uro?

Share this post


Link to post
Share on other sites
1 hour ago, sWOMEN said:

Why is ENT so competitive if job prospects are shit vs Plastics and Ophtho its surgical counterparts in competitiveness 

Small surgical subspecialty, students want to think job market will be better in 9 years (1st years), students don't believe job market is bad, something they think they'll love, and/or $$. Some reasons I have heard but I'm sure there are more. But I would say the same for plastics.

Share this post


Link to post
Share on other sites
1 hour ago, IMislove said:

Small surgical subspecialty, students want to think job market will be better in 9 years (1st years), students don't believe job market is bad, something they think they'll love, and/or $$. Some reasons I have heard but I'm sure there are more. But I would say the same for plastics.

I've heard, oh the job market will be so much better in 8-9 years when im done residency :) so many damn times. 

Share this post


Link to post
Share on other sites

 

9 hours ago, IMislove said:

Small surgical subspecialty, students want to think job market will be better in 9 years (1st years), students don't believe job market is bad, something they think they'll love, and/or $$. Some reasons I have heard but I'm sure there are more. But I would say the same for plastics.

The time duration is what makes this particularly complex - I mean to really "gun" for one of these highly competitive fields you have to start early - so you really are looking 10 or 11 years down the road for a first year  (ha, 9 years wouldn't include fellowships - maybe more than one - which you are going to need. Not to mention any side trips for a masters or whatever). No one has a clear idea of what the market will look like then. 

Share this post


Link to post
Share on other sites
4 hours ago, rmorelan said:

 

The time duration is what makes this particularly complex - I mean to really "gun" for one of these highly competitive fields you have to start early - so you really are looking 10 or 11 years down the road for a first year  (ha, 9 years wouldn't include fellowships - maybe more than one - which you are going to need. Not to mention any side trips for a masters or whatever). No one has a clear idea of what the market will look like then. 

To be fair, very few specialties have seen an improvement in their job outlook. Ortho has had employment difficulties since at least 2006-2007 and neurosurgery even earlier. I don't see the employment outlook improving in the near future for both specialties unless something radically changes.

Share this post


Link to post
Share on other sites

Any idea why so many neuro spots were leftover this time around? I know that historically, MUN and Sask tend to have 1 or 2 spots in the second round, but 5 total?! Seems strange to me when comparing the number of applicants (50ish) to the number of spots (40ish). 

Share this post


Link to post
Share on other sites
3 hours ago, btdubs said:

Any idea why so many neuro spots were leftover this time around? I know that historically, MUN and Sask tend to have 1 or 2 spots in the second round, but 5 total?! Seems strange to me when comparing the number of applicants (50ish) to the number of spots (40ish). 

Likely people in some centres not wanting to spend 5+ years away from their preferred centres. Would rather match alternate specialty then move from Calgary to MUN for example. 

EDIT: not that there is anything wrong with MUN, but some with strong ties to a region may not want to uproot as far as cross-country, versus adjacent provinces with shorter flight times.

Share this post


Link to post
Share on other sites
36 minutes ago, JohnGrisham said:

Likely people in some centres not wanting to spend 5+ years away from their preferred centres. Would rather match alternate specialty then move from Calgary to MUN for example. 

Fair assumption. I noticed an IMG spot carried over this round too... never seen that before in neuro. 

Share this post


Link to post
Share on other sites
2 hours ago, JohnGrisham said:

Likely people in some centres not wanting to spend 5+ years away from their preferred centres. Would rather match alternate specialty then move from Calgary to MUN for example. 

EDIT: not that there is anything wrong with MUN, but some with strong ties to a region may not want to uproot as far as cross-country, versus adjacent provinces with shorter flight times.

This is probably true of people in most if not all specialties... how does it explain the neuro spots in particular?

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...