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GTA = automatic rejection?

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Oddly enough, the issue of rural applicants and urban med schools is the subject of one of the articles in the debut edition of openmedicine.ca - a new journal that has come out of last year's kerfuffle at the CMAJ.

 

The Open Medicine server seems to have recovered from the initial beating it took this morning when the journal's debut was featured in the mainstream Canadian media, so here's the article:

 

http://www.openmedicine.ca/article/viewFile/52/17

 

Not affiliated with the authors or the journal, just putting a plug in for them...

 

pb

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you guys keep bringing up the same point

 

"why only attack nosm other schools have their own criteria blah blah blah"

 

FOR THE MILLIONTH TIME YES I AGREE

 

and about the whole because we're from ontario we feel entitled, i'm sorry did you just pull that out of thin air

do you feel entitled to get into NOSM just because you're from rural ontario???

 

AND PLEASE TELL ME HOW NOSM ISN'T DISCRIMINATING??

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I think that what NOSM is doing is just fine. In fact, when asked about how to solve the rural shortage, I mentioned that having a school whose mandate was to graduate rural physicians is a good start.

 

I recognize that these underserved communities need physicians, and I have no problems with NOSM's mandate - which necessarily requires that they recruit students from rural communities b/c studies have shown that rural students are more likely to return to rural communities (that, or they force every student to sign a contract that requires them to practice in rural ON for a certain number of years, obviously this is not a good option) - it may not always be the case, be the key word is "more likely". This seems to be the best way to address the shortage so far. There are so many other schools out there, and NOSM is only one - why are you so disgruntled at their admissions policy, given their mandate and the reason the school was created in the first place?

 

And to add my 2 cents - giving preference is the same thing as discriminating or bias. In the cases of Maritime "preference", SWOMEN "preference", Ottawa resident francophone/billingual "preference", Rural "preference", and In province "preference" - of course, the schools have a mission, a purpose, and a GOAL of admitting MORE "preferred" students. As a result, they will have to (and indeed DO) devise a scoring system that discriminates/biases or whatever you want to call it, against students that are not from any of their "preferred" categories. Do I have a problem with this? Of course not, it's not like this is discrimination based on race or religion or sex or something. In the case of the Maritimes, if there were no selection preference and all spots were opened to all Canadians, then it may very well result in the majority of their class being filled by Ontario residents who will likely leave the Maritimes after graduation. If you look at thes schools with IP quotas - such as Memorial and Manitoba, you'll notice that the OOP applicants always outnumber the IP applicants to start, so if they didn't have a discriminating admissions policy, their classes would be likely filled with OOP students just due to random chance. To say there is no bias or discrimination, is a bit naive - since these schools make it blatantly clear what their mission is and what their admissions policies are. They make it VERY CLEAR on their website that if you are not from a "prefered" category, you are indeed subjected to higher GPA and MCAT standards - and when they post the average gpa and MCAT scores of matriculating students, broken down by "prefered" and "non-prefered", there is always a discrepancy b/w the averages where the students from the "prefered" categories have the lower averages -> there is a bias. But I think it is justified.

 

 

"Do I have a problem with this? Of course not, it's not like this is discrimination based on race or religion or sex or something"

 

that SOMETHING is where people grew up, which, just like race, sex, and for the most part religion, is not under the control of the person

 

it's discrimination

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"Do I have a problem with this? Of course not, it's not like this is discrimination based on race or religion or sex or something"

 

that SOMETHING is where people grew up, which, just like race, sex, and for the most part religion, is not under the control of the person

 

it's discrimination

 

Yes - it's discrimination but why are you upset about it?

 

Would you be happier if NOSM did not favor rural applicants? Do you know what would happen if they did not? Their classes would be primarily filled with urban students and their mandate to graduate rural physicians who will willingly work in Northern ON would never be met. Not b/c rural applicants are less qualifed, it's b/c they would be WAY outnumbered in the applicant pool.

 

There is a real shortage of rural physicians - and this becomes 100 times worse in the remote north. There is also a real shortage of family physicians.

 

If you are given published research demonstrating that rural students are more likley to go back and practice in rural locations, while urban students are not, what would you suggest the government and school administrators do to solve this very large disparity in healthcare?

 

I'd like to hear your ideas - perhaps you have a solution to this that does not include any favoring at all.

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Flood the system with IMG's. I think its time! No significant rural shortage will be met in Canada unless this is also done. Obviously some conditions need to be met before this is done (ie. not take drs from countries with shortages, preference for canadians citizens that studied abroad, crediting the schools, opening up post training etc). In my opinion, which ever way you cut it its the only way that Canada will solve their doctor shortage problem. Yes the extra 56 grads from NOSM will help, assuming they stay in the area (I know that not all r planning to). Being thousands of Drs short in Ontario, there is no way that the province can meet the need with opening a few hundred spots for undergrad......anyone disagree?

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Yes - it's discrimination but why are you upset about it?

 

Would you be happier if NOSM did not favor rural applicants? Do you know what would happen if they did not? Their classes would be primarily filled with urban students and their mandate to graduate rural physicians who will willingly work in Northern ON would never be met. Not b/c rural applicants are less qualifed, it's b/c they would be WAY outnumbered in the applicant pool.

 

There is a real shortage of rural physicians - and this becomes 100 times worse in the remote north. There is also a real shortage of family physicians.

 

If you are given published research demonstrating that rural students are more likley to go back and practice in rural locations, while urban students are not, what would you suggest the government and school administrators do to solve this very large disparity in healthcare?

 

I'd like to hear your ideas - perhaps you have a solution to this that does not include any favoring at all.

yes i believe in not favouring at all

do i have a solution? not really

But i have some suggestions that could work

i mentioned monetary incentives as one method

I also believe that if NOSM makes its program even more rural oriented maybe it could persuade people through education to stay and practice in rural communities

 

I don't think it is any university's job to assume what people will do with their education, if the person is qualified for the position that's all that matters

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yes i believe in not favouring at all

do i have a solution? not really

But i have some suggestions that could work

i mentioned monetary incentives as one method

I also believe that if NOSM makes its program even more rural oriented maybe it could persuade people through education to stay and practice in rural communities

 

I don't think it is any university's job to assume what people will do with their education, if the person is qualified for the position that's all that matters

 

I don't think it would be possible for NOSM to be more rural oriented. Based on conversations with NOSM students, the material on the website and the tour, the school definitely makes rural medicine a priority. I don't know the curriculum at other schools, but I'm assuming not all schools have students doing a mandatory aboriginal-community placement first year and a rural placement in the second year. Clearly the school stresses those aspects. In addition, one of the five themes of the curriculum is based on learning the reality of rural and northern health care, learning about cultural issues unique to the North and the reality of rural practice. The Dean is a leading figure in the field of rural medicine, as are many of the other administrators.

 

The problem with monetary incentives is that it brings doctors in, that is, it's good for recruitment, but it's not necessarily effective for retention. You can lead a horse to water but you can't make them drink. If someone doesn't fit to a particular area or city, it doesn't matter how much you pay them. They won't stay, won't want to raise their children there or practice there. The key in my opinion is to help make students part of the community. Get them involved and forming relationships and partnerships with people. That is the important thing. If people already have links with the community that's a step up.

 

The only way I can see the program getting more rural-based is to drop the students off the second week of school in a pasture in the middle of Northern Ontario beside a couple cows and maybe a moose and have them live there for a few months...living in a tent...and eating poutine and blueberries. The problem with this is that the med students wouldn't be prepared to practice in a city environment. Although NOSM does have a rural-mandate, it also must provide training for those people who want to work in urban environments (Sudbury, Thunder Bay, North Bay, the Sault) and those who might ultimately want to move south to other cities. I think they have a pretty good balance. :)

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The only way I can see the program getting more rural-based is to drop the students off the second week of school in a pasture in the middle of Northern Ontario beside a couple cows and maybe a moose and have them live there for a few months...living in a tent...and eating poutine and blueberries.

 

 

Well, now at least I understand why they feed us poutine once a week at lunchtime. I always wondered about that! You can consider our northern exposure now complete.

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Hahahahah. Let's turn this controversial thread into a thread discussing the merits of poutine...and blueberries. It's the Northern way! Oh and we talk about the weather. Sudbury had a higher temperature than Toronto today. And did you know that Sudbury has, on average, the most sunniest days in Canada? It says so in the Cambrian course calendar..and I believe them.

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So there is actually a "Weather Winners" web page on the Environment Canada web site. Link is:

http://www.on.ec.gc.ca/weather/winners/element.cfm

 

Thunder Bay and Sudbury don't win any top honours for sunniest year-round...BUT Thunder Bay comes in at 18 and Sudbury comes in at 45 so take that :P

 

That site is pretty neat...Apparently Alberta and Saskatchewan (Medicine Hat and Estevan) get the most sun respectively per year.

 

LtD :)

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Hey all,

 

I'm a graduating law student who has been sort of thinking of applying to meds in the coming years, although I anticipate that I will stick with a career in the law. I just read through this entire thread and while I was somewhat disheartened by the immaturity and sense of entitlement displayed by some posters, I was also impressed to learn about how NOMS and the Ontario government is actually doing something to improve health-care in underserviced areas of this province.

 

While I do not think she is even worthy of being responded too, I just wanted to tell DrJaneDoe that she has a lot of growing up to do. You have expressed opinions that reek of an elitist attitude and a lack of respect for the true realities of Canadian society. Go ahead and backpedal and claim differently all you want, but this is my opinion and clearly the opinion of many of the posters on this board. If we are wrong, then may I suggest you take a course or two that emphasize written communication skills. Please do not bother to respond to this as I will not engage in a tit-for-tat discussion, I just hope that if you are going to be a physician that you will be better prepared as an individual than you are right now.

 

First of all - discrimination. Allow me to draw on my legal background and provide a definition better than what was found on dictionary.com (this is a wiki site folks and you should never quote it in any official manner, seeing how I could post on dictionary.com that discrimination is a form of mating dance performed by elephants). The Canadian Charter of Rights and Freedoms (which I quote with the caveat that it does NOT apply to the actions of NOMS, which is a legal argument, but we can still follow the values enunciated in the document) addresses matters of equality in s. 15:

 

15. (1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

 

(2) Subsection (1) does not preclude any law, program or activity that has as its object the amelioration of conditions of disadvantaged individuals or groups including those that are disadvantaged because of race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

 

The means of applying this section was explained by the Supreme Court in the case of Law v. Canada:

 

1. Did the law, program, or activity impose differential treatment between the claimant and a comparator group? That is, was a distinction created between the groups in purpose or effect?

2. If so, was the differential treatment based on enumerated or analogous grounds?

3. If so, did the law in question have a purpose or effect that is discriminatory within the meaning of the equality guarantee?

 

 

We could probably get past the first part of the rest given that there is differential treatment between the comparator group (residents of NO) and the rest of the population. The second part of the the test looks to see if this is a legitimate grounds to find differentiation. For simplicity, and since we are debating policy and not the letter of the law, let's say the ground is legit. The third part of the test looks at the second part of s. 15. From the perspective of the disadvantaged group (in this case non-NO med applicants), Law v. Canada suggests we look at the following factors and analyze based on a contextual approach (meaning we consider the matter holistically based on the facts of the case):

 

1. pre-existing disadvantage

2. correlation between the grounds of the claim and the actual needs, capacities, and circumstances

3. ameliorative purpose or effect of the law on more disadvantaged groups

4. nature and scope of interest

 

I think #3 is the big one here. Weigh the fact that NO residents are underserved and this policy seeks to solve the problem against the debatedly-disrciminatory practice of not admitting a few kids with a higher GPA to med school. As a Canadian citizen, I am willing to make this trade.

 

See next post for other considerations.

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Ignoring the legal talk, let's consider this matter based on pure government policy. First of all, I find it hard to debate the fact that non-NO residents are more likely to not want to practice in NO. Obviously a sociologist could better handle these arguments, but it just seems like common sense. As a Toronto resident, the lifestyle in NO just does not appeal to me and I feel most in my social circle would agree. There are similar difficulties finding lawyers for those areas while the Toronto legal market is oversaturated. Monetary incentives can only go so far. When it comes down to it, most would rather have their preferred lifestyle than any amount of cash. Furthermore, even if some can be enticed by cash, this does not necessarily mean they will stick around or will become the type of doctor (with roots in the community) that is needed in NO.

 

The argument that universities should admit only the most "qualified" (note the quotes) students, defined by numerical indices, is laughable. Universities are created, from my perspective, for two distinct purposes. One purpose is to provide opportunities for those who live in the community in which the university serves. The other is to benefit the community surrounding the university. Obviously the term "community" can have varied definitions - it could be a local area, a national area, or even the world community as a whole, it depends on the purpose of the institution. Nevertheless, universities are around to serve a function and are not pure businesses (although I wonder about some MBA programs). The government has the right to define the function of a particular university. The function of NOMS is to solve the physician-shortage in NO, and this is just fine by me.

 

The argument that numerical scores make better physicians is a silly one. The purpose of a medical school is to train physicians - and I would hope they do not graduate poor ones. GPA requirements provide the schools with some indicators as to the type of student they are getting, but I fail to see how these factors define the type of doctor one will become. Just because you got an A in first-year chemistry and someone else got a B+ does not tell me who will be a better physician. Let's allow medical schools to decide who will be good doctors and allow them to do the necessary training - or maybe we should just award an MD to everyone with a 3.95 GPA and have them skip the whole med school routine? Also, the fact that schools do look at softer factors indicates that they recognize that how well you wrote a few exams when you were 19 is not fully-indicative of how you will perform in a program.

 

My final point goes back to the argument made several times on this thread - urban kids have more inherent opportunities to succeed. The numbers ae quite staggering - you are more likely to go to university coming from certain urban communities than you are coming from a more rural community (be it NO or a farming community a couple hours outside of the city), and even certain areas within an urban community (more kids go to university coming from Forest Hill than from Marc Garneau). This does not mean urban kids are "smarter" IQ-wise or better people, just that they have been provided with the opportunities to succeed. Having parents that attended university is a big factor, as is having the financial resources to focus on school and not have to work to support the family - not everyone can goof off at Western for four years, but the fact is those that can are more likely to enter a professional program. In many ways this is society's way of discriminating - and perhaps NOMS is one way of closing the gap. Please don't bother with the argument that you had no control over this - it does not negate the fact that things may have been easier for you than for others. I also fully recognize that things may not have been easy for everyone, and many kids find a way to succeed despite facing roadblocks, but ideally (and I realize this may not be reality) will find a way to equalize - and maybe NOMS is the first step in doing this.

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Wow, Lawdude...well done!!! You have said everything that has been going through my mind these last few weeks while reading this thread but you said it with such grace and finesse! The posts by Dr. JaneDoe have been extremely ignorant and inconsiderate to the problems Northern rural Canada is facing. You did a great job at summing all that up with alot of evidence. Thanks alot for replying with such maturity and I love the fact that you are from TO but still acknowledge the importance of NOSM's goal. Great job!

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Ignoring the legal talk, let's consider this matter based on pure government policy. First of all, I find it hard to debate the fact that non-NO residents are more likely to not want to practice in NO. Obviously a sociologist could better handle these arguments, but it just seems like common sense. As a Toronto resident, the lifestyle in NO just does not appeal to me and I feel most in my social circle would agree. There are similar difficulties finding lawyers for those areas while the Toronto legal market is oversaturated. Monetary incentives can only go so far. When it comes down to it, most would rather have their preferred lifestyle than any amount of cash. Furthermore, even if some can be enticed by cash, this does not necessarily mean they will stick around or will become the type of doctor (with roots in the community) that is needed in NO.

 

The argument that universities should admit only the most "qualified" (note the quotes) students, defined by numerical indices, is laughable. Universities are created, from my perspective, for two distinct purposes. One purpose is to provide opportunities for those who live in the community in which the university serves. The other is to benefit the community surrounding the university. Obviously the term "community" can have varied definitions - it could be a local area, a national area, or even the world community as a whole, it depends on the purpose of the institution. Nevertheless, universities are around to serve a function and are not pure businesses (although I wonder about some MBA programs). The government has the right to define the function of a particular university. The function of NOMS is to solve the physician-shortage in NO, and this is just fine by me.

 

The argument that numerical scores make better physicians is a silly one. The purpose of a medical school is to train physicians - and I would hope they do not graduate poor ones. GPA requirements provide the schools with some indicators as to the type of student they are getting, but I fail to see how these factors define the type of doctor one will become. Just because you got an A in first-year chemistry and someone else got a B+ does not tell me who will be a better physician. Let's allow medical schools to decide who will be good doctors and allow them to do the necessary training - or maybe we should just award an MD to everyone with a 3.95 GPA and have them skip the whole med school routine? Also, the fact that schools do look at softer factors indicates that they recognize that how well you wrote a few exams when you were 19 is not fully-indicative of how you will perform in a program.

 

My final point goes back to the argument made several times on this thread - urban kids have more inherent opportunities to succeed. The numbers ae quite staggering - you are more likely to go to university coming from certain urban communities than you are coming from a more rural community (be it NO or a farming community a couple hours outside of the city), and even certain areas within an urban community (more kids go to university coming from Forest Hill than from Marc Garneau). This does not mean urban kids are "smarter" IQ-wise or better people, just that they have been provided with the opportunities to succeed. Having parents that attended university is a big factor, as is having the financial resources to focus on school and not have to work to support the family - not everyone can goof off at Western for four years, but the fact is those that can are more likely to enter a professional program. In many ways this is society's way of discriminating - and perhaps NOMS is one way of closing the gap. Please don't bother with the argument that you had no control over this - it does not negate the fact that things may have been easier for you than for others. I also fully recognize that things may not have been easy for everyone, and many kids find a way to succeed despite facing roadblocks, but ideally (and I realize this may not be reality) will find a way to equalize - and maybe NOMS is the first step in doing this.

 

I agree with most of what you said - and I'm not sure if this is even a disagreement, or just my own opinion...another point added to yours if you will - however, I do not think that this discrimination can ever be eliminated. It is similar to what is being said and done in the US with URM groups, but not exactly the same - although I'm no expert and I don't know all the issues.

 

What I would like to say is that, in our society is based upon capitalism - there is always going to be inequalities. There are those who win and those who lose and unfortunately, despite the efforts of people like Bono, not everyone can get an equal piece of the pie. This is a fact of life, and is a result of how our society, locally and globally, functions. Systemic discrimination is something that is very difficult to eliminate, and I don't think that NOSM or the OMSAS box that you can check off to declare yourself rural will evne take us one little step closer towards equality for the disadvantaged - "disadvantaged" will always be with us, and while we can be more "fair" by taking this into account, to completely solve the problem is impossible. I know this is cynical....

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I don't disagree with you - completely eliminating discrimination would be next to impossible. Furthermore, attempts to equalize one group may result in another group being disadvantaged.

 

It's still nice to think about in theory.

 

NOMS, however, is not really looking to eliminate discrimination but rather to address a clear health-care need in Ontario. The goals are more practical.

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Wow, Lawdude...well done!!! You have said everything that has been going through my mind these last few weeks while reading this thread but you said it with such grace and finesse! The posts by Dr. JaneDoe have been extremely ignorant and inconsiderate to the problems Northern rural Canada is facing. You did a great job at summing all that up with alot of evidence. Thanks alot for replying with such maturity and I love the fact that you are from TO but still acknowledge the importance of NOSM's goal. Great job!

IGNORANT LOL

haha, sorry that I don't sugar coat what I have to say, I get straight to the point

you haven't brought anything useful to this discussion so please don't jump in and judge whether or not my argument is ignorant or inconsiderate. Just because my argument doesn't coincide with your opinions gives you no right to call my points ignorant or inconsiderate. At least if you're going to criticize what I said at least provide some evidence to prove me wrong. Because as far as I'm concerned you're the only one coming off as "ignorant"

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