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jayessl

IMG and CARMS residency

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As an IMG who matched to a specialty through CaRMS, I believe it would be most fair to have iterations separated by applicant status. That is, Canadian med students should have one match, and then IMGs should be allowed to compete for the left-over spots. However, the only way that would work is by the following conditions being satisfied:

a) severely limiting Canadians from going abroad to study and by allowing foreign IMGs a chance to try and match BEFORE moving their families to Canada and gaining status. That way if they don't secure a spot, they can go elsewhere (similar to how the US does it)

b) Letting all IMG applicants know that they're most likely going to be limited to Family Med or Pathology (IF spots are even available) before they even go abroad to study/immigrate.

However, there are a few real-world issues which make the aforementioned difficult: One problem that I've become aware of recently is that Immigration Canada is not fully informing IMG immigrants of the realities of trying to work as a doctor here, as many of my IMG colleagues say they had no idea how competitive it would be before they already uprooted their families and made the move. The immigration process for foreign docs and their families would have to change. Regarding CSAs, another problem is that you can't really tell people not to go abroad to study. If I'm not mistaken, at the moment there are more Canadians studying medicine abroad than there are studying within Canada, many of whom were competitive for medical school in Canada but were waitlisted numerous times or whatnot. Not offering them an opportunity to come back may lead to a rather large brain-drain for Canada, as most of these individuals end up in the US.

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32 minutes ago, adrenergic24 said:

As an IMG who matched to a specialty through CaRMS, I believe it would be most fair to have iterations separated by applicant status. That is, Canadian med students should have one match, and then IMGs should be allowed to compete for the left-over spots. However, the only way that would work is by the following conditions being satisfied:

a) severely limiting Canadians from going abroad to study and by allowing foreign IMGs a chance to try and match BEFORE moving their families to Canada and gaining status. That way if they don't secure a spot, they can go elsewhere (similar to how the US does it)

b) Letting all IMG applicants know that they're most likely going to be limited to Family Med or Pathology (IF spots are even available) before they even go abroad to study/immigrate.

However, there are a few real-world issues which make the aforementioned difficult: One problem that I've become aware of recently is that Immigration Canada is not fully informing IMG immigrants of the realities of trying to work as a doctor here, as many of my IMG colleagues say they had no idea how competitive it would be before they already uprooted their families and made the move. The immigration process for foreign docs and their families would have to change. Regarding CSAs, another problem is that you can't really tell people not to go abroad to study. If I'm not mistaken, at the moment there are more Canadians studying medicine abroad than there are studying within Canada, many of whom were competitive for medical school in Canada but were waitlisted numerous times or whatnot. Not offering them an opportunity to come back may lead to a rather large brain-drain for Canada, as most of these individuals end up in the US.

I'm confused, are your IMG colleagues moving to Canada before matching? Or are these foreign trained docs (ie completed residency) who move to Canada before obtaining a job? I'd argue that it isn't the responsibility of Immigration Canada to determine the competitiveness of a job market, rather it's the responsibility of the immigrant to make sure they have a job lined up before immigrating. Plus I thought having a job in a country you're moving to is required for immigration unless things have changed since I moved.

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56 minutes ago, adrenergic24 said:

As an IMG who matched to a specialty through CaRMS, I believe it would be most fair to have iterations separated by applicant status. That is, Canadian med students should have one match, and then IMGs should be allowed to compete for the left-over spots. However, the only way that would work is by the following conditions being satisfied:

a) severely limiting Canadians from going abroad to study and by allowing foreign IMGs a chance to try and match BEFORE moving their families to Canada and gaining status. That way if they don't secure a spot, they can go elsewhere (similar to how the US does it)

b) Letting all IMG applicants know that they're most likely going to be limited to Family Med or Pathology (IF spots are even available) before they even go abroad to study/immigrate.

However, there are a few real-world issues which make the aforementioned difficult: One problem that I've become aware of recently is that Immigration Canada is not fully informing IMG immigrants of the realities of trying to work as a doctor here, as many of my IMG colleagues say they had no idea how competitive it would be before they already uprooted their families and made the move. The immigration process for foreign docs and their families would have to change. Regarding CSAs, another problem is that you can't really tell people not to go abroad to study. If I'm not mistaken, at the moment there are more Canadians studying medicine abroad than there are studying within Canada, many of whom were competitive for medical school in Canada but were waitlisted numerous times or whatnot. Not offering them an opportunity to come back may lead to a rather large brain-drain for Canada, as most of these individuals end up in the US.

a) The problem with that is that Canadians pursue medicine at a higher rate than Americans do. It is already almost twice as hard to get into medical school in Canada than in the US and in the US there still are thousands of leftover spots each year with shortages in many medical specialties. Whereas in Canada, we really only have shortages in rural areas in certain specialties and we really don't need IMGs much. So, it really wouldn't be wise to open up the application to even more foreign IMGs, many of whom would not even have Canadian experience before coming to Canada if they were to successfully match. It also likely wouldn't change things much because programs would still prefer those who have Canadian experience or ties most likely, but it would hurt all the people who would think they have a chance but really don't and waste their time and money applying. 

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1 hour ago, adrenergic24 said:

If I'm not mistaken, at the moment there are more Canadians studying medicine abroad than there are studying within Canada, many of whom were competitive for medical school in Canada but were waitlisted numerous times or whatnot

Yeah, sorry...you are mistaken. Many of them were not competitive for med in canada or went straight out of high school. 

 

But this discussion has been had over and over in many other threads.

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6 hours ago, QueenStan said:

I'm confused, are your IMG colleagues moving to Canada before matching? Or are these foreign trained docs (ie completed residency) who move to Canada before obtaining a job?

As far as I am aware, you need to be either a PR or a citizen in order to be eligible to apply to CaRMS. So applicants have already gone through the immigration process, brought their families, etc., before they are allowed to apply. This is different form the US, for example, where no such requirement exists and you can train on a visa. 

 

6 hours ago, QueenStan said:

it's the responsibility of the immigrant to make sure they have a job lined up before immigrating

I held the same view up until a recent conversation I had with a friend, who suggested that Canada is so uniquely difficult to secure a residency training spot in that many don't even fathom how hard it could be. They just assume it's doable with enough work and move here regardless. And the truth is that in the rest of the world, the difficulty of equivalating your medical training varies, but is at worst 'doable with effort'. And this is including the US (approx 50% match rate across all specialties, and much higher if you're applying to FM) which is globally known to be 'hard' to get into. Is it technically their fault for the checking before? Sure. But I completely understand why many don't given the above perspective.

EDIT: I think it would make sense to have immigration Canada forward a copy of IMG match data to medical applicants to submit an immigration form to ensure they're fully informed.

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5 hours ago, Edict said:

Whereas in Canada, we really only have shortages in rural areas in certain specialties and we really don't need IMGs much.

Would it make sense to then reserve IMG spots only for these rural areas and with longer return of service contracts? 

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1 hour ago, adrenergic24 said:

Would it make sense to then reserve IMG spots only for these rural areas and with longer return of service contracts? 

Yeah, I think longer RoS contracts would be better without a doubt, especially ones that have teeth because right now you can fulfill your RoS by getting any academic job, so the RoS in effect only excludes people from working at a Toronto/Ottawa Community Hospital which is what, like MGH, NYGH, Trillium? Even Richmond Hill is RoS. Half of Canada would be happy to do RoS in that case. 

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8 hours ago, Edict said:
 
 
 
7 hours ago, Edict said:

Whereas in Canada, we really only have shortages in rural areas in certain specialties and we really don't need IMGs much. 

Rural FM programs are becoming more popular and it makes me wonder why these programs still have spots reserved for IMGs in the first round vs. making the IMG seats competitive for all. Lots of programs would have all of their spots fill with CMGs in addition to some CMGs being turned down. UBC FM dedicates ~half their seats to IMGs that would easily be filled by CMGs. All of the AB rural FM programs filled this year in first round with lots of applicants falling further down their rank list. It doesn't make sense to me why PGME programs will send away their in province students that want to stay but still reserve spots solely for IMGs. Would it make more sense for seats previously reserved for IMGs in first round be competitive for all like what Saskatchewan has done? 

2 hours ago, adrenergic24 said:

Would it make sense to then reserve IMG spots only for these rural areas and with longer return of service contracts? 

I don't think having spots tied to ROS do anything. I also don't agree with having ROS seats for IMGs only that CMGs would also want to be eligible for (ie. UBC FM). ROS are typically tied to areas for a reason and people will just move or buy out their contract when they can. Makes more sense to promote rural medicine (both FM and specialty) and show students what each area has to offer. 

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3 hours ago, Edict said:

Yeah, I think longer RoS contracts would be better without a doubt, especially ones that have teeth because right now you can fulfill your RoS by getting any academic job, so the RoS in effect only excludes people from working at a Toronto/Ottawa Community Hospital which is what, like MGH, NYGH, Trillium? Even Richmond Hill is RoS. Half of Canada would be happy to do RoS in that case. 

RoS contracts are very easy to be overturned by having academic positions with a letter of reference, which defeat the purpose of RoS in the first place. I believe MOH is very flexible by stating working anywhere else beside Toronto and Ottawa to be return of service- i.e: working in Ajax, Vaughan, Richmond hill which are part of GTA. 

I've heard that you can easily pay the penalty fines to not work in RoS areas or negotiate with the MOH.

So if having IMG spots are to serve the underserved population in the rural area, it actually makes more sense to recruit more rural applicants into Canadian medical school in the first place, the retention rate is much higher IMO. 

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9 minutes ago, LittleDaisy said:

RoS contracts are very easy to be overturned by having academic positions with a letter of reference, which defeat the purpose of RoS in the first place. I believe MOH is very flexible by stating working anywhere else beside Toronto and Ottawa to be return of service- i.e: working in Ajax, Vaughan, Richmond hill which are part of GTA. 

I've heard that you can easily pay the penalty fines to not work in RoS areas or negotiate with the MOH.

So if having IMG spots are to serve the underserved population in the rural area, it actually makes more sense to recruit more rural applicants into Canadian medical school in the first place, the retention rate is much higher IMO. 

Yes, I agree with this. I used to really think that medicine was a challenging profession that required high academic performance to master, but its simply not the case. Truth be told, the best doctor is someone who is good and consistent rather than a genius who intermittently messes up. With this in mind, the rationale to recruit IMGs is lessened. Apart from a few academic positions, we really don't need "the best in the world", what we need are people who are going to perform well and stay in their communities, so rural recruitment is better. With that being said, i think rural students should still be subjected to rural return of service that is difficult to negotiate out of. This shouldn't end up being a backdoor for people to move to the city either. 

 

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12 minutes ago, Edict said:

i think rural students should still be subjected to rural return of service that is difficult to negotiate out of

I don't think ROS work and I don't think they're a solution to physician shortages in certain areas. I also don't think it's fair to slap a ROS on a student entering medical school before they've gotten the chance to explore specialties. 

Recruiting more rural students is one step, but medical schools need to focus on promoting rural medicine and also ensuring there are enough rural FM spots to meet demand. I think almost all residencies should have a "rural" component, even if it's rotations at a regional center vs. urban academic center. 

Having someone trapped by a ROS in an area they don't want to work in would just make for a miserable physician that will try to leave as soon as the ROS is over. Physician recruitment needs to be reexamined. Some rural communities that aren't really that desirable to live in have been very successful with this and haven't needed to rely on ROS agreements.

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20 hours ago, jayessl said:

What are your opinions on IMG students taking CARMS spots in Canada?

I'm pro IMG's. Our system treats them absurdly - much more than any other country out there. As a Canadian grad, I simply don't believe our education is that much better than the rest of the developed world (although definitely better than the third world).

It is very difficult for me to accept that countries with superior healthcare systems are somehow producing inferior doctors. Sounds more like something we would tell ourselves to preserve our jobs and income rather than a statement based on fact.

https://interactives.commonwealthfund.org/2017/july/mirror-mirror/

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15 hours ago, Edict said:

Yeah, I think longer RoS contracts would be better without a doubt, especially ones that have teeth because right now you can fulfill your RoS by getting any academic job, so the RoS in effect only excludes people from working at a Toronto/Ottawa Community Hospital which is what, like MGH, NYGH, Trillium? Even Richmond Hill is RoS. Half of Canada would be happy to do RoS in that case. 

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. 

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11 hours ago, photato said:

I don't think ROS work and I don't think they're a solution to physician shortages in certain areas. I also don't think it's fair to slap a ROS on a student entering medical school before they've gotten the chance to explore specialties. 

Recruiting more rural students is one step, but medical schools need to focus on promoting rural medicine and also ensuring there are enough rural FM spots to meet demand. I think almost all residencies should have a "rural" component, even if it's rotations at a regional center vs. urban academic center. 

Having someone trapped by a ROS in an area they don't want to work in would just make for a miserable physician that will try to leave as soon as the ROS is over. Physician recruitment needs to be reexamined. Some rural communities that aren't really that desirable to live in have been very successful with this and haven't needed to rely on ROS agreements.

Being in a rural location when you have no desire to be there is terrible. I live that reality every day. 

The solution to rural healthcare is likely some mix of increasing primary care (family docs mostly and NPs in the case of small remote villages) and reducing infrastructure and concentrating specialists (honestly, rural healthcare where you try to offer advanced care in rural areas is a HUGE money pit that is likely unsustainable in our current system). That's the conclusion myself and many of the other physicians in my province have come to. Unfortunately, political will is lacking because the needed action is political suicide (need to be re-elected, gotta get that sweet pension).

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17 hours ago, Edict said:

Yeah, I think longer RoS contracts would be better without a doubt, especially ones that have teeth because right now you can fulfill your RoS by getting any academic job, so the RoS in effect only excludes people from working at a Toronto/Ottawa Community Hospital which is what, like MGH, NYGH, Trillium? Even Richmond Hill is RoS. Half of Canada would be happy to do RoS in that case. 

Or you can buy your way out of the contract. Not that i agree with ROS anyways, but if you can buy your way out...whats the point?

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I'm doing ROS in a mixed rural/urban area in Ontario. I like it and will eventually settle here. I didn't grow up in a rural setting though, so it's been an adjustment. Unfortunately, this adjustment is more than what most people are willing to make or even consider, regardless of how high physician needs an area is. 

There is no shortage of doctors in terms of absolute numbers. There might come a day when there's an adequate distribution of physicians, but that day isn't today, hence the need for ROS obligations, IMGs, and their ongoing participation in CaRMS.

After completion of their contract, what proportion of doctors continue to practice in the area they did ROS in? If there's an actual stat someone can reference I'd like to know.

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17 minutes ago, JohnGrisham said:

Or you can buy your way out of the contract. Not that i agree with ROS anyways, but if you can buy your way out...whats the point?

It let's wealthy people off the hook. People with med school debt are still screwed. 

Wealthy people aren't going to allow their children to be stranded in some backwoods town slaving away for an ROS. 

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On 5/19/2019 at 12:10 PM, adrenergic24 said:

As an IMG who matched to a specialty through CaRMS, I believe it would be most fair to have iterations separated by applicant status. That is, Canadian med students should have one match, and then IMGs should be allowed to compete for the left-over spots. However, the only way that would work is by the following conditions being satisfied:

a) severely limiting Canadians from going abroad to study and by allowing foreign IMGs a chance to try and match BEFORE moving their families to Canada and gaining status. That way if they don't secure a spot, they can go elsewhere (similar to how the US does it)

b) Letting all IMG applicants know that they're most likely going to be limited to Family Med or Pathology (IF spots are even available) before they even go abroad to study/immigrate.

However, there are a few real-world issues which make the aforementioned difficult: One problem that I've become aware of recently is that Immigration Canada is not fully informing IMG immigrants of the realities of trying to work as a doctor here, as many of my IMG colleagues say they had no idea how competitive it would be before they already uprooted their families and made the move. The immigration process for foreign docs and their families would have to change. Regarding CSAs, another problem is that you can't really tell people not to go abroad to study. If I'm not mistaken, at the moment there are more Canadians studying medicine abroad than there are studying within Canada, many of whom were competitive for medical school in Canada but were waitlisted numerous times or whatnot. Not offering them an opportunity to come back may lead to a rather large brain-drain for Canada, as most of these individuals end up in the US.

I hate how pathology is a dumping ground for imgs. 

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Just now, NLengr said:

It let's wealthy people off the hook. People with med school debt are still screwed. 

Wealthy people aren't going to allow their children to be stranded in some backwoods town slaving away for an ROS. 

Are ros legal?

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48 minutes ago, NLengr said:

It let's wealthy people off the hook. People with med school debt are still screwed. 

Wealthy people aren't going to allow their children to be stranded in some backwoods town slaving away for an ROS. 

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.

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2 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.

It is very easy to buy out of the contract, some end up paying less than the stated fines. The RoS is very flexible stating that you can't work in the city of Toronto and Ottawa, but you can practice anywhere you want in Ontario for 5 years.

If the MOH or the government's argument for recruiting more IMGs over CMGs are for RoS and enforcing IMGs in under-served rural areas, it certainly is not working. 

I agree that we shouldn't force rural medical students to sign a RoS, but 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. 

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19 minutes ago, LittleDaisy said:

It is very easy to buy out of the contract, some end up paying less than the stated fines. The RoS is very flexible stating that you can't work in the city of Toronto and Ottawa, but you can practice anywhere you want in Ontario for 5 years.

If the MOH or the government's argument for recruiting more IMGs over CMGs are for RoS and enforcing IMGs in under-served rural areas, it certainly is not working. 

I agree that we shouldn't force rural medical students to sign a RoS, but 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. 

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. 

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