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jayessl

IMG and CARMS residency

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23 minutes ago, QueenStan said:

That's why I think the QUARMS program at Queens is such a missed opportunity. Region lock it to rural Ontario and look for low SES / racially diverse candidates. 

Honestly, i think the rural recruitment stuff is very hit or miss. If they don't end up wanting to do Family medicine, they are most likely going to be training in a big city in a 5 year royal college program...and guess what, most often they will need to be in bigger places.  Most of the rural students at my school, end up not doing FM and staying in big cities, or if they do FM, many still will move to the big cities.  The love of outdoors can only go so far for some people, especially if they don't already have a spouse and are actively looking for one etc. 

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2 minutes ago, JohnGrisham said:

Honestly, i think the rural recruitment stuff is very hit or miss. If they don't end up wanting to do Family medicine, they are most likely going to be training in a big city in a 5 year royal college program...and guess what, most often they will need to be in bigger places.  Most of the rural students at my school, end up not doing FM and staying in big cities, or if they do FM, many still will move to the big cities.  The love of outdoors can only go so far for some people, especially if they don't already have a spouse and are actively looking for one etc. 

Is the NOSM program not as successful as they advertise in retaining rural physicians? I know they have general specialties but nothing fancy like plastics, ophtho, ENT, etc. Regional campuses at McMaster are a massive failure at retaining students in their regions (despite doing everything they can to take care of such students during their schooling). These students are forced there and had no choice in the matter. 

How much is the ROS fine? I had no idea the terms were so loose. Everywhere but Toronto and Ottawa? Seriously? London and Hamilton count? When I think of someone doing a ROS I don't imagine them being a staff at Victoria Hospital...

If I ran CaRMS, I would have first 2 iterations with CMGs only and 1/2 iterations with IMGs for the remaining spots. No programs will be able to designate IMG spots for the later rounds. 

I wonder what the % of CSA v.s. immigrant IMGs are. I believe there will be an overwhelming %of CSAs which defeats the purpose of IMGs. If you're a Canadian high school or undergraduate student who doesn't want to apply or couldn't get admitted, you could study in Ireland/England/Australia/Carrib (programs targeted at foreign students are very different in terms of intensity to programs training local physicians) and apply back for CaRMS. Since you could afford the studies abroad, you're likely rich and well connected. You use your connections to secure a spot in your desired specialty in CaRMS (I know an Ortho gunner at RCSI who left Western after 1st year whose father is an Ortho staff at UofT, etc.). You finish your specialty and your parents pay off your ROS fine and voila you made it as a board certified Canadian physician without doing any of the work - the system is so fucking broken

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23 minutes ago, swoman said:

Is the NOSM program not as successful as they advertise in retaining rural physicians? I know they have general specialties but nothing fancy like plastics, ophtho, ENT, etc. Regional campuses at McMaster are a massive failure at retaining students in their regions (despite doing everything they can to take care of such students during their schooling). These students are forced there and had no choice in the matter. 

How much is the ROS fine? I had no idea the terms were so loose. Everywhere but Toronto and Ottawa? Seriously? London and Hamilton count? When I think of someone doing a ROS I don't imagine them being a staff at Victoria Hospital...

If I ran CaRMS, I would have first 2 iterations with CMGs only and 1/2 iterations with IMGs for the remaining spots. No programs will be able to designate IMG spots for the later rounds. 

I wonder what the % of CSA v.s. immigrant IMGs are. I believe there will be an overwhelming %of CSAs which defeats the purpose of IMGs. If you're a Canadian high school or undergraduate student who doesn't want to apply or couldn't get admitted, you could study in Ireland/England/Australia/Carrib (programs targeted at foreign students are very different in terms of intensity to programs training local physicians) and apply back for CaRMS. Since you could afford the studies abroad, you're likely rich and well connected. You use your connections to secure a spot in your desired specialty in CaRMS (I know an Ortho gunner at RCSI who left Western after 1st year whose father is an Ortho staff at UofT, etc.). You finish your specialty and your parents pay off your ROS fine and voila you made it as a board certified Canadian physician without doing any of the work - the system is so fucking broken

http://www.health.gov.on.ca/en/pro/programs/hhrsd/physicians/docs/RE_ROS_Q_A.pdf

What is the penalty for breaching the ROS Agreement?

o If a participant breaches the ROS Agreement it terminates, subject to the ministry’s discretion, and the participant must repay an amount generally consisting of:

 The total amount of training costs;

 Administrative costs; and

 Interest accrued on the total repayment amount.

o Individuals in breach of the ROS Agreement must pay the amount owing in full. However, the ministry is committed to balancing the fiscal responsibility to Ontarians and will seek a resolution that does not cause undue hardship. The ministry may at its discretion provide individuals with payment alternatives, such as a repayment schedule or an installment plan according to the debtor’s financial capacity.

It is not clear what the fines are, but it seems that the MOH is very reasonable and understanding of people breaking their RoS contracts and negotiate for fines.

It seems that the easiest way is to get an academic appointment with a letter of support, with no financial penalty. 

I wonder who makes up the rules, the RoS rules seem to be very favorable in Ontario; an unmatched CMG would be so happy to match to IMG spots with RoS contracts, if more spots are opened up for CMG in the 2nd iteration or a competitive stream for all (IMG/CMGs in the 2nd round). 

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8 hours ago, NLengr said:

ROS agreements vary by province. The Ontario one is very very loose in its rules.

Also, with the exception of Northern Ontario, what is called "rural" in Ontario would hardly qualify as rural in many other parts of the country. 

Haha yes. Most of the province is considered “rural” and falls under programs like ROMP, ERMEP, etc. 

If a city is in the GTA (Milton, Richmond Hill) or large enough to support an independent university (not necessarily a satellite campus) (Peterborough, Guelph, etc.) it’s not rural in my opinion. Despite this though, many people are only interested in living in 2-3 cities in the country, and define things as either GTA or rural. I grew up in an independent mid sized city, and we were hard pressed for doctors (like 3 months to get in to see your fam dr.) I’m starting to understand why. That’s probably why the ROS terms are so loose - those mid sized places need to incentivize doctors to come too, even if truly rural places need them even more. 

As someone who is very interested in mid-sized cities (say 100-300k), it’s actually a little odd how centralized the medical system is. If I want to do any academic medicine, my choices in Ontario in that range are Kingston and maybe London. If I want to go literally anywhere else, I lose the option to do any research or teaching. 

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4 hours ago, JohnGrisham said:

Yep, and odds are that many of the IMGs that are original Canadians who match are wealthy. I know  2 personally who have gone through the buy out process, 1last year, 1 going through it right now. Both did residency in Ontario.  Maybe other provinces are stricter?  i don't blame them, if I had money and was in that situation - why wouldn't you do the same? They are for most purposes purposes playing by the rules, as the system allows them to buy out.

I told my wife today that if we ever win the lottery I am immediately tendering my resignation and moving back to civilization ASAP. I don't care if I never practice medicine again. 

We spent the weekend in our home city and were driving back to the rural town we live in so I was feeling a bit depressed. Hahaha

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2 hours ago, LittleDaisy said:
 
 
 
2 hours ago, LittleDaisy said:

research studies have shown that medical students from rural areas tend to return to practice in their hometown than an IMG who stays there for 5 years miserably, buy out of the contract, or play around the contract. 

Medical schools seem to be focusing more on this by having spots for rural students and working with organizations that promote rural medicine. The problem is that residency programs DGAF about being accountable to the communities they work in. Lots of people in my class from a rural/regional area desperate for family physicians want to go back and practice there, but they didn't get interviews at that program despite emphasizing their plan to stay in the area. They were all strong candidates with no red flags told by career advisors that they were all on the right track. I don't understand why so many qualified applicants that are committed to staying in the area would be turned down. It just does a disservice to all of the patients in the area without family doctors. 

 
 
1
1 hour ago, swoman said:

If I ran CaRMS, I would have first 2 iterations with CMGs only and 1/2 iterations with IMGs for the remaining spots. No programs will be able to designate IMG spots for the later rounds. 

I wonder what the % of CSA v.s. immigrant IMGs are. I believe there will be an overwhelming %of CSAs which defeats the purpose of IMGs. If you're a Canadian high school or undergraduate student who doesn't want to apply or couldn't get admitted, you could study in Ireland/England/Australia/Carrib (programs targeted at foreign students are very different in terms of intensity to programs training local physicians) and apply back for CaRMS. Since you could afford the studies abroad, you're likely rich and well connected. You use your connections to secure a spot in your desired specialty in CaRMS (I know an Ortho gunner at RCSI who left Western after 1st year whose father is an Ortho staff at UofT, etc.). You finish your specialty and your parents pay off your ROS fine and voila you made it as a board certified Canadian physician without doing any of the work - the system is so fucking broken

100% keep 2 rounds of CaRMS for CMGs only and only after let IMGs/CSAs compete for the leftover spots. There are CMGs that would happily stay in the region they matched to for years/decades without a ROS so why attach ROS to positions that will only result in a temporary physician for that area?

I was shocked when I realized how far nepotism and connections can get someone in CaRMS. From phone calls being made to get interviews to having well connected parents on faculty resulting in questionable match results. The worst part is medical students can't report any of this because they're competing for the same spots. The whole process should be subject to random audits to account for this, but it would never happen because it would make public how problematic the entire match process is.

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39 minutes ago, NLengr said:

I told my wife today that if we ever win the lottery I am immediately tendering my resignation and moving back to civilization ASAP. I don't care if I never practice medicine again. 

We spent the weekend in our home city and were driving back to the rural town we live in so I was feeling a bit depressed. Hahaha

Look on the bright side. You're only a drive away.

Imagine being stuck in thunder bay or ft McMurray

And its clear to see the nepotism particularly with legacy positions in lucrative fields like derm oph and radiology, while family and path and psych are left to the brownskins and lowborn(i say this as a lowborn brownskin. Dont @ me)

 

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13 hours ago, GrouchoMarx said:

Look on the bright side. You're only a drive away.

Imagine being stuck in thunder bay or ft McMurray

And its clear to see the nepotism particularly with legacy positions in lucrative fields like derm oph and radiology, while family and path and psych are left to the brownskins and lowborn(i say this as a lowborn brownskin. Dont @ me)

 

4 hour drive is better than a 8 hour flight. But 4 hour drive when you have two kids is still pretty restrictive.

That being said, Fort Mac and Thunder Bay are literally sprawling metropolises that way bigger than where I am now. I'd kill for the amenities of those places.

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1 hour ago, NLengr said:

I told my wife today that if we ever win the lottery I am immediately tendering my resignation and moving back to civilization ASAP. I don't care if I never practice medicine again. 

We spent the weekend in our home city and were driving back to the rural town we live in so I was feeling a bit depressed. Hahaha

Obviously i don't know anything about your financial situation, but suredly as staff you could make a significant enough dent in your loans after 5-10 years that you can easily move back to a big city and just deal with scraps of work if the specialty is hardpressed for jobs. Drop in lifestyle sure, but not insurmountable at least from a generic perspective.

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2 hours ago, GrouchoMarx said:

And its clear to see the nepotism particularly with legacy positions in lucrative fields like derm oph and radiology, while family and path and psych are left

Lol you would think so. All of the examples of shady things I heard about this year all applied to FM.

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2 hours ago, JohnGrisham said:

Obviously i don't know anything about your financial situation, but suredly as staff you could make a significant enough dent in your loans after 5-10 years that you can easily move back to a big city and just deal with scraps of work if the specialty is hardpressed for jobs. Drop in lifestyle sure, but not insurmountable at least from a generic perspective.

I think that Nlengr works in a surgical specialty and it's hard for him to find jobs nowadays with restricted OR everywhere. 

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10 hours ago, LittleDaisy said:

I think that Nlengr works in a surgical specialty and it's hard for him to find jobs nowadays with restricted OR everywhere. 

Bingo.

The only jobs that seem open at the current time are jobs that are just as bad as the one I am in (super rural, bad environment etc.).

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1 hour ago, NLengr said:

Bingo.

The only jobs that seem open at the current time are jobs that are just as bad as the one I am in (super rural, bad environment etc.).

Yeah that sucks for you, I hope that you find something a bit closer to your home city in the near future. 

Back to the original topic, I wonder why is MOH in Ontario so flexible with RoS with IMGs, when there are unmatched CMGs who are willing to do rural family medicine and willing to abide by RoS. If they do want more rural family physicians, the best bet through the past research is to recruit rural applicants from the get go since medical school. If you have no ties to the rural community, and all your family is in the city, no wonder IMGs go back to practice in urban area after their RoS is up or just play around their RoS contracts!

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4 hours ago, NLengr said:

Bingo.

The only jobs that seem open at the current time are jobs that are just as bad as the one I am in (super rural, bad environment etc.).

There are talks among Orthos that the job market seems to be improving over the next 5-7 years as the baby boomer crowd retires.

Are you actively looking for opportunities to move to a more desirable location? Would most surgical groups prefer to hire newly minted fellowship graduates, or (older) graduates (like yourself) assuming similar qualifications?

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6 hours ago, ArchEnemy said:

There are talks among Orthos that the job market seems to be improving over the next 5-7 years as the baby boomer crowd retires.

Are you actively looking for opportunities to move to a more desirable location? Would most surgical groups prefer to hire newly minted fellowship graduates, or (older) graduates (like yourself) assuming similar qualifications?

They said the same thing 5 years ago too ;)

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18 hours ago, ArchEnemy said:

There are talks among Orthos that the job market seems to be improving over the next 5-7 years as the baby boomer crowd retires.

Are you actively looking for opportunities to move to a more desirable location? Would most surgical groups prefer to hire newly minted fellowship graduates, or (older) graduates (like yourself) assuming similar qualifications?

 

11 hours ago, JohnGrisham said:

They said the same thing 5 years ago too ;)

I'm curious how hiring takes into account the backlog. I have to imagine that the reams of residents we train year after year that are forced to do locums or whatever for years are still in the running for desirable posts. Not sure if that improves the situation at all for new grads.

I remember being told during medical school that the hiring situation for many specialties would improve when we finished and yet that was years ago and not much has changed. 

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I distinctly recall the story of a newly minted orthopod who completed at least one US fellowship (maybe 2?) and had returned to Canada to busy playing PlayStation since he couldn’t even secure a locum due to saturation—that was 2012 or 2013ish. Things haven’t improved. 

Those surgeons “retiring” were still going strong with plans for another 10+ years of practise ahead.  So far the only ones I heard that stopped working were ones that passed away unexpectedly. Last I heard from my pgy5 ortho colleagues is that the staff still have plans for 10+ years of working. The  “jobs” many have secured are clinics and vacation coverage :(

This all underlined the importance of going in eyes wide open. 

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6 hours ago, blah1234 said:

 

I'm curious how hiring takes into account the backlog. I have to imagine that the reams of residents we train year after year that are forced to do locums or whatever for years are still in the running for desirable posts. Not sure if that improves the situation at all for new grads.

I remember being told during medical school that the hiring situation for many specialties would improve when we finished and yet that was years ago and not much has changed. 

so hard to predict all that because fields change, and financial situations change. One thing that constantly pops up is people underestimating how long doctors stay in the game. Ha we collectively aren't the retiring types. 

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On 5/22/2019 at 2:19 PM, rmorelan said:

so hard to predict all that because fields change, and financial situations change. One thing that constantly pops up is people underestimating how long doctors stay in the game. Ha we collectively aren't the retiring types. 

It's good work. Lucrative and makes a difference. Of course we're gonna keep doing it

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The senior surgeons keep the lucrative parts of the job that they like (operating) and the scraps are left for newer grads to pick up (call, clinic, admin duties). I will believe a staff surgeon retiring when I see it. Many never officially do and the ones that are are in their mid 70s (and honestly imo could still be operating if they want to)

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On 5/25/2019 at 7:58 PM, swoman said:

The senior surgeons keep the lucrative parts of the job that they like (operating) and the scraps are left for newer grads to pick up (call, clinic, admin duties). I will believe a staff surgeon retiring when I see it. Many never officially do and the ones that are are in their mid 70s (and honestly imo could still be operating if they want to)

I know at least one who retired from my residency program. He was around 65.

The other surgeon who works with me at my current job is retiring in 15 months at 60 years old.

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