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2019 CaRMS unfilled spots

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1 hour ago, shematoma said:

Connections and networking have little to do with "merit." That's like saying you deserved your residency because your uncle happened to be the program director.

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6 minutes ago, monocle said:

 

There is no reason why CMGs should match preferentially. It is a merit based system. There is no obligation to match you just because you graduated from a medical school located in Canada.

The bottom line is,  the IMG was a better candidate than you. If you look down upon graduates from other countries ("couldn't get in" etc.) maybe you need to reflect on how you're getting beaten by a person subjectively "inferior" to you. Having a CMG-only anything beyond separate streams is positive discrimination.

I understand your intention but I don't think you have considered the long term implications of moving towards that system. As it stands right now, the supply for people wanting to be Doctors >>>>> demand (in terms of positions available), so there has to be a bottleneck somewhere to triage the entry. Currently, the bottleneck chosen is basically entry into Canadian Med School (which then allows you to get priority in Carms). If they remove this, then anyone with the money or willingness to accumulate will just go to the cash-grab INTL schools due to their easy entry and availability of spots, and you will end up with 10,000+ candidates with massive debt fighting for around 1,000 residency spots every year. 

 

The merit-based system exists. It's your entry to Canadian schools. By choosing to study elsewhere and then reapply, you're just adding to the supply > demand (residency spots) surplus. Opening up the spots to everyone else equally is a one-way ticket to messing up the profession as a whole. 

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1 minute ago, Aetherus said:

Sure, it is a superficial merrit base system. However, it is a system based on no objective comparison standards. 

Also the connection you speak of can reflect effort but can also be a reflection of nepotism. How do you compete with an applicant who’s parent is the program director?

Which is why there has to be a board exam with actual scores that matter. At least when people fail and don't match, it's no longer a big deal.

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Just now, monocle said:

That isn't a connection, that is nepotism. A connection is a relationship of trust and competency you build over a long period of time e.g. being exceptional at an elective. 

That's merit.

You're making up definitions now.

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1 minute ago, medigeek said:

Which is why there has to be a board exam with actual scores that matter. At least when people fail and don't match, it's no longer a big deal.

I don’t know if board exams would fix anything. Sure it would add objective measurement, but I doubt that the board exam would necessarily correlate with how good a clinician you are. 

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10 hours ago, beeboop said:

https://www.carms.ca/pdfs/5drz57PbwqT_R1_1_OverviewByDiscipline_EN.pdf

what an absolutely brutal match...almost no IM or psych spots in round 2. Good luck to those that are going through it!

I am late to the party here but wow that is brutal - one surgical spot in the county as well. 

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1 hour ago, bigboydyo said:

I understand your intention but I don't think you have considered the long term implications of moving towards that system. As it stands right now, the supply for people wanting to be Doctors >>>>> demand (in terms of positions available), so there has to be a bottleneck somewhere to triage the entry. Currently, the bottleneck chosen is basically entry into Canadian Med School (which then allows you to get priority in Carms). If they remove this, then anyone with the money or willingness to accumulate will just go to the cash-grab INTL schools due to their easy entry and availability of spots, and you will end up with 10,000+ candidates with massive debt fighting for around 1,000 residency spots every year. 

 

The merit-based system exists. It's your entry to Canadian schools. By choosing to study elsewhere and then reapply, you're just adding to the supply > demand (residency spots) surplus. Opening up the spots to everyone else equally is a one-way ticket to messing up the profession as a whole. 

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2 minutes ago, Aetherus said:

I don’t know if board exams would fix anything. Sure it would add objective measurement, but I doubt that the board exam would necessarily correlate with how good a clinician you are. 

If you can't pass a clinical medicine board exam, you can't also argue that you are competent enough to practice. Lets not sugar coat things here. My argument is that at least we can blame not matching to failure on the boards. It provides something objective rather than how well someone liked you on an elective. 

7 minutes ago, bigboydyo said:

I understand your intention but I don't think you have considered the long term implications of moving towards that system. As it stands right now, the supply for people wanting to be Doctors >>>>> demand (in terms of positions available), so there has to be a bottleneck somewhere to triage the entry. Currently, the bottleneck chosen is basically entry into Canadian Med School (which then allows you to get priority in Carms). If they remove this, then anyone with the money or willingness to accumulate will just go to the cash-grab INTL schools due to their easy entry and availability of spots, and you will end up with 10,000+ candidates with massive debt fighting for around 1,000 residency spots every year. 

 

The merit-based system exists. It's your entry to Canadian schools. By choosing to study elsewhere and then reapply, you're just adding to the supply > demand (residency spots) surplus. Opening up the spots to everyone else equally is a one-way ticket to messing up the profession as a whole. 

Ironically IMGs have to take a couple board exams and only the highest scores get interviewed. You could have 500 or 50,000 applicants and they still interview the same number every year. 

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5 minutes ago, monocle said:

I read through your post but I'm failing to understand why you think going to an international school would make you a more competitive candidate in a merit based system.

A real merit based system favours the best candidate. It doesn't matter if you're from Taiwan, the Congo or Canada - you will match if you're good. If CMGs are truly superior doctors and are more qualified for a spot, why would "flooding the market" make any difference?

The solution is simple: Canada needs more residency positions if they want everyone to match.

The argument currently is: THERE IS NO OBLIGATION FOR YOU TO MATCH, it is up to you to be competitive and good enough to match. Picture this happening in any other career pathway e.g. "I want a position in Google because I graduated from a US university. The international guy who won accolades for his work should only get in if I don't get it".

Tech is nothing like medicine, especially since the Canadian medical system is regulated by the government. The argument is that since the taxpayers fund pretty much all the training and services, they should benefit Canadians by giving CMG jobs. Only if the system was completely privatised by a corporation would it be like tech where if you got a degree from Asia, you can practice here with no problems. 

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1 hour ago, peace2014 said:

Tech is nothing like medicine, especially since the Canadian medical system is regulated by the government. The argument is that since the taxpayers fund pretty much all the training and services, they should benefit Canadians by giving CMG jobs. Only if the system was completely privatised by a corporation would this ever happen. 

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IMGs complain that it isn't a level playing field. They get less spots than CMGs. But maybe what IMGs should be complaining about is that the countries where they do medical school, i.e. Ireland, Caribbean, etc. don't accept them for residencies. These countries were happy to take your $300,000 for your medical training, only to dump you back to Canada to try to get a residency spot. Why don't they take these students and train them for residency? Isn't it the ultimate injustice that they're willing to take your money and give you book training but refuse to give you the practical training you need to become a doctor?

And that's the real problem. CMGs can't expect to get residencies anywhere other than Canada. If the world was truly a meritocracy we should be able to compete for residencies anywhere in the world. But the playing field isn't level. The system needs to provide enough spots for CMGs, otherwise we are wasting taxpayer money running medical schools in the first place.

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12 minutes ago, monocle said:

I read through your post but I'm failing to understand why you think going to an international school would make you a more competitive candidate in a merit based system.

A real merit based system favours the best candidate. It doesn't matter if you're from Taiwan, the Congo or Canada - you will match if you're good. If Canadians are truly better superior and are more qualified for a spot, why would "flooding the market" make any difference?

The solution is simple: Canada needs more residency positions if they want everyone to match. (The argument currently is: that is not an obligation, it is up to you to be competitive and good enough to match.)

I don't think going to an international school would make someone more competitive. Let me reiterate the issue this way:

Healthcare budget + physician body's interest in maintaining physician income and responsibilities limit total amount of physicians that can be produced ==> limited residency spots

As you suggest, qualified people (anyone with some form of MD) should be able to freely compete for these spots. However, given the amount of time, $ (debt) and commitment it takes to even get to that point, there is serious damage when people go unmatched. Given the high amount of ppl wanting to become doctors when compared to the number of spots available, you are likely to  have 10,000 MDs compete for 1,000 spots, which guarantees at least 9,000 people will be stuck in a rut after taking on all of this debt + schooling. (these are rough numbers but I believe they are fairly representative)

The way the current system circumvents this is by shifting the bottleneck of 10,000 to 1,000 in the form of admission to Canadian MD schools, where if you fail to get into it, the setback isn't too significant -- at worst, <$5k loss in terms of Med App prep, and an undergrad degree that can help you get into another field. Once you pass this barrier and get into CAN med, you are "guaranteed" a residency spot due to Carms favoring you and therefore allowing you not worry too much about then taking on the debt and years of commitment  needed to get your MD.

Of course, I agree with you that its not perfectly competitive at the level of residency, but I hope that you can at least understand the reasoning behind it being the case

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1 minute ago, monocle said:

IMGs are canadians. They're either citizens, or PRs who will become citizens. They will and do pay their taxes as well.

RE: your privatisation statement: Let's take the example of the UK. The National Health Service (NHS) is free at the point of care and offers much more free service than the Canadian healthcare system (almost free prescriptions for all, physio, more scope for non-essential treaments). There is zero discrimination when applying for a job. A person who isn't even a citizen or a PR can apply to a job and beat you out even if you're a UK graduate. Nobody complains because it is seen as fair - they were just better than you.

I'm sorry but both the "taxpayer" and "privatization" arguments aren't convincing.

We need to limit tax payer funded residency spots in Canada to Canadian medical students. There is absolutely no reason an IMG should receive a spot when Canadians studying in Canada are going unmatched. It's wasting hundreds of thousands of tax payer dollars, and it makes zero sense. 

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1 hour ago, shematoma said:

IMGs complain that it isn't a level playing field. They get less spots than CMGs. But maybe what IMGs should be complaining about is that the countries where they do medical school, i.e. Ireland, Caribbean, etc. don't accept them for residencies. These countries were happy to take your $300,000 for your medical training, only to dump you back to Canada to try to get a residency spot. Why don't they take these students and train them for residency? Isn't it the ultimate injustice that they're willing to take your money and give you book training but refuse to give you the practical training you need to become a doctor?

And that's the real problem. CMGs can't expect to get residencies anywhere other than Canada. If the world was truly a meritocracy we should be able to compete for residencies anywhere in the world. But the playing field isn't level. The system needs to provide enough spots for CMGs, otherwise we are wasting taxpayer money running medical schools in the first place.

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1 minute ago, shematoma said:

IMGs complain that it isn't a level playing field. They get less spots than CMGs. But maybe what IMGs should be complaining about is that the countries where they do medical school, i.e. Ireland, Caribbean, etc. don't accept them for residencies. These countries were happy to take your $300,000 for your medical training, only to dump you back to Canada to try to get a residency spot. Why don't they take these students and train them for residency? Isn't it the ultimate injustice that they're willing to take your money and give you book training but refuse to give you the practical training you need to become a doctor?

And that's the real problem. CMGs can't expect to get residencies anywhere other than Canada. If the world was truly a meritocracy we should be able to compete for residencies anywhere in the world. But the playing field isn't level. The system needs to provide enough spots for CMGs, otherwise we are wasting taxpayer money running medical schools in the first place.

IMGs mainly aim for the US. And we fix the problem by cutting med school seats + mobilizing schools to help applicants plan their applications better. 

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1 hour ago, tavenan said:

We need to limit tax payer funded residency spots in Canada to Canadian medical students. There is absolutely no reason an IMG should receive a spot when Canadians studying in Canada are going unmatched. It's wasting hundreds of thousands of tax payer dollars, and it makes zero sense. 

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50 minutes ago, LittleDaisy said:

I disagree that we should restrict IMG spots to CSAs; it's discriminatory in nature by preferring IMGs who were born in Canada. If you did not do your medical school in North America, you are IMG, period. 

If you are CSA, and you could not get into North American Medical Schools, and coming back thinking that you SHOULD get a residency spot. I am sorry to say that we should not jeopardize a IMG's chance of matching over that of CMGs, who was selected among thousands of applicants, who went through 4-5 years of rigorous and excellent medical school training, and worked hard during 2 years of clerkship, compared to <<observation>> in other countries. 

I am sorry, but in any circumstance, I think that the government should prioritize the residency match success for Canadian Medical Students. 

40 minutes ago, medigeek said:

But I'm suggesting a realistic solution that could pass in court. Outside the legal domain, the public and politicians have far more sympathy for IMGs.

With that said, I do agree fully in principle. Outside the realm of american MD DO schools I don't trust training elsewhere. I know caribbean schools rotate in the US but there is major inconsistency in the training. 

And of course American grads are entitled to CMG spots because CMGs can apply to the US freely. 

Already went to the courts on this whole IMG/CSA matter - you can't carve out CSA as a distinct category.

[8]        The Canadian Residency Matching Service has two parallel streams for residency positions.  The first stream is the Canadian Medical Graduate stream, which is for graduates of Canadian medical schools and Canadian citizens who graduate from accredited American medical schools.  The second is the IMG stream, which is for graduates of international medical schools who meet the necessary eligibility criteria.  Canadian citizens in the IMG stream are referred to as Canadians Studying Abroad or “CSAs”.

[9]        The 2008 and 2010 BC Government Throne speeches stated that government would increase access to medical residencies for CSAs.[2] 

[10]      In December 2011, the Ministry, the Ministry of Advanced Education and UBC prepared a briefing document.  It states in part:

Question: Shouldn't we be giving CSAs preferential treatment over naturalized IMGs; after all, they grew up here?                     

Given that the greatest barrier for IMGs/CSAs to access postgraduate training positions in Canada is the fact that international medical school education and training is not necessarily comparable or equivalent to Canadian medical school education, there are no measures that could be introduced to privilege or otherwise treat differently CSAs who apply for postgraduate training positions in Canada or BC.  CSAs must be treated in the same manner as all other IMGs. To do otherwise would breach human rights and Canadian Charter legislation.[3]

[11]      Shortly thereafter, MLA Moira Stilwell sent a letter and provided a report to the Minister of Health Services recommending that the policies and regulations for CSAs be identical to those in place for Canadian and American trained medical school graduates.  It states in part:

The Ministry of Health Services and the UBC Faculty of Medicine maintain that BC medical students studying abroad must be treated the same as immigrant physicians applying to the BC IMG program because to do otherwise would be a violation of human rights and the Canadian Charter of Rights.  Yet no argument to clarify the position has been provided...[4]

[12]      CSAs remain part of the IMG stream.  The number of IMG residency positions has significantly increased since 2011, and the Ministry has recently opened a new pathway for IMG family physicians to get their license to practice in BC.  However, it is still advantageous to be in the Canadian Medical Graduate stream rather than the IMG stream.[5]

[13]      The applicant is affected by the policy that separates the Canadian Residency Matching Service process into two streams.[6]  It is apparent from the materials that she is particularly concerned that CSAs do not get to compete for the initial Canadian Medical Graduate stream postings.

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5 minutes ago, la marzocco said:

 

Already went to the courts on this whole IMG/CSA matter - you can't carve out CSA as a distinct category.

[8]        The Canadian Residency Matching Service has two parallel streams for residency positions.  The first stream is the Canadian Medical Graduate stream, which is for graduates of Canadian medical schools and Canadian citizens who graduate from accredited American medical schools.  The second is the IMG stream, which is for graduates of international medical schools who meet the necessary eligibility criteria.  Canadian citizens in the IMG stream are referred to as Canadians Studying Abroad or “CSAs”.

[9]        The 2008 and 2010 BC Government Throne speeches stated that government would increase access to medical residencies for CSAs.[2] 

[10]      In December 2011, the Ministry, the Ministry of Advanced Education and UBC prepared a briefing document.  It states in part:

Question: Shouldn't we be giving CSAs preferential treatment over naturalized IMGs; after all, they grew up here?                     

Given that the greatest barrier for IMGs/CSAs to access postgraduate training positions in Canada is the fact that international medical school education and training is not necessarily comparable or equivalent to Canadian medical school education, there are no measures that could be introduced to privilege or otherwise treat differently CSAs who apply for postgraduate training positions in Canada or BC.  CSAs must be treated in the same manner as all other IMGs. To do otherwise would breach human rights and Canadian Charter legislation.[3]

[11]      Shortly thereafter, MLA Moira Stilwell sent a letter and provided a report to the Minister of Health Services recommending that the policies and regulations for CSAs be identical to those in place for Canadian and American trained medical school graduates.  It states in part:

The Ministry of Health Services and the UBC Faculty of Medicine maintain that BC medical students studying abroad must be treated the same as immigrant physicians applying to the BC IMG program because to do otherwise would be a violation of human rights and the Canadian Charter of Rights.  Yet no argument to clarify the position has been provided...[4]

[12]      CSAs remain part of the IMG stream.  The number of IMG residency positions has significantly increased since 2011, and the Ministry has recently opened a new pathway for IMG family physicians to get their license to practice in BC.  However, it is still advantageous to be in the Canadian Medical Graduate stream rather than the IMG stream.[5]

[13]      The applicant is affected by the policy that separates the Canadian Residency Matching Service process into two streams.[6]  It is apparent from the materials that she is particularly concerned that CSAs do not get to compete for the initial Canadian Medical Graduate stream postings.

Fair enough but that only addresses a very minor solution point I brought up. The bread and butter is cutting med school seats. You can't add residency spots without adding to the unemployed physician count. 

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1 hour ago, sWOMEN said:

I entirely agree that CSAs should be treated the same as other IMGs. Other IMGs studied in their home countries and attempt to immigrate to Canada and many practice at a lower level here (e.g. internal medicine --> family). CSAs could not get into a Canadian medical school and choose to study abroad where anyone with a pulse and a chequebook can get a medical degree. I would be curious to see how many CSAs matching back (esp. in competitive specialities) are through nepotistic avenues. 

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10 minutes ago, monocle said:

Again, if someone with just a "pulse and a chequebook" is outperforming you, maybe you need to take some time out to reflect on this. It's either that or continue living the delusion that everyone but CMGs are getting in through nepotistic avenues. 

"The greatest barrier for IMGs to access postgraduate training positions in Canada is the fact that international medical school education and training is not necessarily comparable or equivalent to Canadian medical school education." <-- see the case I cited above; i.e., not my words. 

The fact is that Canadian and USMD schools are LCME-accredited. If meritocracy is to be applied strictly, then we should get those IMG-schools LCME and CACMS accredited. Maybe then we can have the discussion about unification of the streams. 

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3 minutes ago, la marzocco said:

"The greatest barrier for IMGs to access postgraduate training positions in Canada is the fact that international medical school education and training is not necessarily comparable or equivalent to Canadian medical school education." <-- see the case I cited above; i.e., not my words. 

The fact is that Canadian and USMD schools are LCME-accredited. If meritocracy is to be applied strictly, then we should get those IMG-schools LCME and CACMS accredited.

Fair enough, that could be something you might have an argument for - but then again, IMGs sit several supplemental exams such as the NAC OSCE/BC IMG/MCCEE etc. to assess their equivalence quantitatively.

Regardless, the only real solution to the problem of candidates not matching is to increase the number of spots or decrease the number of medical students coming out of medical school. I don't think international graduates have much to do with Canadians not matching. I can understand the frustrations of a CMG feeling like they were overlooked when an IMG gets a spot (from their own stream) despite this.

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28 minutes ago, monocle said:

Again, if someone with just a "pulse and a chequebook" might be outperforming a CMG, maybe you need to take some time out to reflect on this. It's either that or continue believing CSAs are getting in through nepotistic avenues. 

Buddy I don't know what year you're in but I've personally witnessed too much nepotism and corruption leading to CMG's and IMG's with rich parents and connections landing spots that are coveted by excellent Canadians studying in Canada. There is zero excuse for this. 

A medical education in Canada or the US is NOT equivalent to a medical education in some Caribbean or European school. Your daddy's checkbook also should not determine whether or not you're going to be a doctor. If you want to practice medicine in Canada, stay here and go through the system like everyone else. I will always advocate for  limiting ALL residency spots, which are funded by CANADIAN tax payers, to only CANADIAN medical students studying and paying taxes in CANADA. Anything else is utter madness. 

You make it seem like IMG's and CMG's are beating out Canadian students because they're somehow magically more qualified or are better candidates. From my own experience, this is absolutely positively NOT the case in the overwhelming majority of cases. You have so many excellent candidates for such few spots that you could probably randomly select a group of them and you'll still be good to go. Seeing as how this is the case, everything else comes down to preference. As it happens, my preference is to prioritize tax paying Canadians, whereas Joe the millionaire's preference is to write a $300K check for his son to go to the Caribbean and then have him come back and take a spot from a Canadian student.

This will never pass in Canada though, as the rich and well connected have advantages in every other aspect of society, and have to make sure that they have an upper leg in medicine too. It's frankly sickening to see this. Corruption is absolutely deteriorating every aspect of our society, slowly but surely. 

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5 minutes ago, tavenan said:

Buddy I don't know what year you're in but I've personally witnessed too much nepotism and corruption leading to CMG's and IMG's with rich parents and connections landing spots that are coveted by excellent Canadians studying in Canada. There is zero excuse for this. 

A medical education in Canada or the US is NOT equivalent to a medical education in some Caribbean or European school. Your daddy's checkbook also should not determine wheter or not you're going to be a doctor. If you want to practice medicine in Canada, stay here and go through the system like everyone else. I will always advocate for  limiting ALL residency spots, which are funded by CANADIAN tax payers, to only CANADIAN medical students studying and paying taxes in CANADA. Anything else is utter madness. 

This will never pass in Canada though, as the rich and well connected have advantages in every other aspect of society, and have to make sure that they have an upper leg in medicine too.

Like anything, any changes need to be evidence-based, not based on anecdotes.

E.g. are there any confounders? Do the children of rich parents also have more opportunities to excel at things like research, networking etc.? Do they have better social skills? Is this actually happening to the level where it skews the entire match in the first place?

Regardless, a vast majority of CMGs are matching to positions in Canada. It is very unfortunate that some people do not match and I do understand how this is disastrous. The reasons for this need to be looked at properly and changes implemented as required. 

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2 minutes ago, tavenan said:

Buddy I don't know what year you're in but I've personally witnessed too much nepotism and corruption leading to CMG's and IMG's with rich parents and connections landing spots that are coveted by excellent Canadians studying in Canada. There is zero excuse for this. 

A medical education in Canada or the US is NOT equivalent to a medical education in some Caribbean or European school. Your daddy's checkbook also should not determine wheter or not you're going to be a doctor. If you want to practice medicine in Canada, stay here and go through the system like everyone else. I will always advocate for  limiting ALL residency spots, which are funded by CANADIAN tax payers, to only CANADIAN medical students studying and paying taxes in CANADA. Anything else is utter madness. 

This will never pass in Canada though, as the rich and well connected have advantages in every other aspect of society, and have to make sure that they have an upper leg in medicine too.

I'm all for defending our own but lets stay on planet reality. Not in a million years would I have gone to the Caribbean but they do their rotations in the US and ultimately have to pass (do well on) the USMLEs which is the peak level of medical knowledge globally. Europe/Australia do have shady clinical training though as anything outside of Canada/USA I'd be skeptical towards. 

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12 minutes ago, medigeek said:

I'm all for defending our own but lets stay on planet reality. Not in a million years would I have gone to the Caribbean but they do their rotations in the US and ultimately have to pass (do well on) the USMLEs which is the peak level of medical knowledge globally. Europe/Australia do have shady clinical training though as anything outside of Canada/USA I'd be skeptical towards. 

I'm not the one that's not staying on this planet for suggesting we prioritize Canadians in Canada. This whole discussion has been shifted in this way to make perfectly common sense proposals seem radical. No, if you're arguing that CMG's and IMG's who weren't good enough to attend medical school in Canada and left the country should be prioritized over perfectly qualified Canadian medical students, then you're the one not living in this planet. Again, I have no interest in helping rich well connected students use their connections and money to take spots from Canadians in Canada. It's like throwing Canadian tax payer money down the well. 

And unless you think there has been a serious degradation in the quality of Canadian medical school graduates in the past 10 years, you have to agree that the quality of the student pool is not the problem, as this issue of students going unmatched was basically nonexistent a decade ago. 

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