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Surgery for IMG?


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No, The Hunger Games said that. (...ish)

 

 

You claimed to be "someone who matched to Canada without connections" but never stated what program you matched to. You lead us to believe that your point is reinforced by that fact but never stated that you are actually in surgery.

 

But I agree that the odds are tough. I would specifically disagree with you and say that the odds are in fact DISMAL. Somebody will match to those spots, but if you want plastics as an IMG you have to be the best or second best applicant in the pool. (And yes, there are years that Ottawa and Toronto have interviewed people - IMGs - and then left the spots empty until round 2, and not picked an IMG. This is evident on the CaRMS stat pages - 1 IMG spot left after round 1, then not an IMG filling it in round 2.)

 

Just as an example of the quality of the applicants applying sometimes:

 

I know a couple of people who matched to a surgical sub specialty spot as an IMG.

 

One was a fully qualified specialist in their home country, plus had a Canadian fellowship, Masters of Surgery and had worked in Canada for 3 years prior to residency as an clinical associate.

 

The second person was also a fully qualified specialist in their home country, plus had 2 Canadian Fellowships, and a US fellowship in ICU.

 

So the competition can be very very tough. I also know a couple people who matched from overseas into surgical spots who weren't as qualified, so it's not impossible, just very very very hard.

 

I can tell you that for one IMG spot for my surgical subspecialty, the residents of that program told me they received over 125 applications.

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You claimed to be "someone who matched to Canada without connections" but never stated what program you matched to. You lead us to believe that your point is reinforced by that fact but never stated that you are actually in surgery.

I was simply responding to someone saying the only way you can get a spot is if you have connections. That's completely false. Maybe you didn't read the rest of the thread where I said "At any rate, I still agree with Brooks and others that it's virtually impossible to match into something like gen surg as an IMG. That said, those ~6 spots have to go to somebody every year, and the number of truly competitive applicants who are gunning for and apply to surgery every year isn't necessarily that high. "

 

And the stats speak for themselves. The odds of matching for surgery are about 10% based on applicants/matches. For the record I am in Internal Med which is about 14% in 2012, so the lack of connections is still relevant.

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  • 3 weeks later...

I'm going to try to answer the original posters question a bit more directly and then talk a bit generally about the factors that actually come into play. I'm an IMG who matched to a surgical specialty (or "subspecialty" as this thread has been calling it) without any nepotism or inappropriate considerations as I think they've been described in this forum. The vast majority of the successful applicants I've met have had no significant external factors that influenced their selection other than what they brought to the table themselves.

 

To clarify for everyone a subspecialty is a qualification obtained through a fellowship after an RCPSC residency. General surgery, ortho, vascular (in some cases), plastics (in most cases), cardiac surg, etc are all surgical specialties. A subspecialty is something like breast oncology, microsurgery, or arthroplasty.

 

Here are you approximate chances for matching successfully into a surgical specialty with some obvious give-and-take depending on the particular specialty. These numbers are subjective and based on my experiences with the last 3 years of matching from an perspective inside my program in Ontario. As always with my posts, I only know the system in Ontario where the majority of the IMG surgical spots exist. The facts may be very different elsewhere.

 

For all IMGs who apply the chances are about 100:1 for an overall successful match into your discipline of choice. That chance drops at best to about 2:1 in the ideal situation. This is the ideal situation: you grew up in Canada, you are a current year graduate, have completed an undergraduate degree, you've attended a European (preferably Western)medical school, and have been very impressive in an onsite elective in your chosen specialty with a Preceptor who will advocate strongly for you during the CaRMS process.

 

Other than trying to change halfway through the elective process--or the absurd suggestion of re-applying to a Canadian medical school--there is one more Canadian path to consider. Match to a less competitive 5 year specialty like IM. Prove you are a stellar resident in the first year and transfer to the surgical program of your choice. In your situation I would advocate strongly for this path unless you feel you can cultivate a strong Staff advocate who is involved in the Resident selection process.

 

Now, to speak more generally. There are complications that occur every year thanks to the CaRMS process. Programs pick how many applicants to rank based on how convinced they are that the applicants they'd prefer will rank them highly. This is generally referred to as ranking shallowly or deeply. Toronto fills up all of it's spots in the first round because they have a culture of ranking deeply in most programs. In other words, they may rank twenty or thirty people for one or two spots. When the match runs they fill their program; the trade-off is they may get someone that was marginal for one reason or other. A shallower program may only rank one or two people for their one or two spots running the risk of a CaRMS disaster. Again this is a cultural thing and if you look back over the last few years of CaRMS you'll see programs that match no one in the first round. Failure to match applicants is due to employing the shallow strategy and the programs misreading the intent of their selected applicants. The program then scrambles to select a different set of people in the second round as chances are the set of people they were looking at in the first round have either matched to their back-ups or in the US. Most programs are highly adverse to participating in the second round due to the perceived loss of esteem and the practical amount of time and work it requires. Some of the smaller programs will not bother as they do not view residents as a necessity. The ability to not match anyone is usually restricted to small programs in specialties that have small numbers of in patients and emergency consults.

 

The idea that programs 'save' and IMG spot for a CMG is highly unlikely. Very rarely does a well qualified CMG appear to take an unmatched IMG spot. The best reason is funding. IMGs and CMGs are funded by different pools from the Ontario government. You can't just use that funding for a CMG. The number of residency positions is negotiated between the program and the post graduate studies department. There's some give and take on the final numbers every year and a program can conceivably make a spot for a well qualified applicant they like. Additionally, no Canadian medical student in their right mind would not participate in the first round, or not include a backup program, on the word of a program director claiming to be saving a second round spot. It makes no sense considering the high first choice match rate.

 

There are two types of contacts. The type that is important for CaRMS and matching to surgical specialties is the contact that you personally have made on electives. Family contacts really don't count for much. At best they may help you get an elective but after that everyone is in the same boat. Many medical students without family contacts appear on electives and have the same chance as anyone else to make an outstanding impression.

 

From the first day of residency, surgical residents have enormous clinical and academic responsibilities. I found medical school a walk in the park compared to my life now. No program takes a chance on any medical student about whom they have a single reasonable doubt. Every single RCPSC failure reflects incredibly negatively on the program and again no program will take a chance on an unknown medical student. When the program is ranking applicants you absolutely need a Staff member at the table to push you onto and up the rank list otherwise you're not matching. The Staff have to defend their support against other Staff pushing their preferences. Saying I golf with applicants X's Dad is not going to help.

 

Programs do no necessarily prefer a CMG to an IMG. There are a few reasons. Financially, the Ontario government pays the University more to train an IMG than a CMG. This is true regardless of when in the CaRMS process you match. I think this is a minor factor but it certainly exists. Regardless, for the reasons stated above a surgical program will always take a known IMG over an unknown CMG. This is mitigated slightly by the tendency of CMGs to arrive with a contactable referee that is known to the program as the surgical community in Canada is tiny. That small town familiarity may equally get a CMG blacklisted across the country but that's not relevant to the current thread. No matter what, an IMG applicant absolutely needs a strong advocate on the selections committee to push for her or him. At this point in your career it is up to you the applicant to secure that advocate and a family connection really won't help much. You absolutely need a strong advocate on the selections committee to push for you. At this point in your career it is up to you the applicant to secure that advocate and a family connection really won't help much.

 

The conclusion is that CMGs are not always a failsafe choice and programs know this. They feel a bit more secure about the academic abilities of the CMG but the personal and clinical aspects are a toss up. There is, surprisingly for me at least, a very slight preference for the personality of Canadians who studied abroad as they are considered a bit exotic and a bit more humble than their CMG colleagues (as I think this thread demonstrates).

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Other than trying to change halfway through the elective process--or the absurd suggestion of re-applying to a Canadian medical school--there is one more Canadian path to consider. Match to a less competitive 5 year specialty like IM. Prove you are a stellar resident in the first year and transfer to the surgical program of your choice. In your situation I would advocate strongly for this path unless you feel you can cultivate a strong Staff advocate who is involved in the Resident selection process.

 

I don't disagree with much of what you wrote, but this strikes me as a very high risk strategy. Particularly for matching to something like IM, you'd be in a program which might have at most one elective block, probably later in the year, where it would look mighty odd if you organized any surgery elective apart from gen surg.

 

Regarding the "saving" of an IMG spot for a CMG, I only know of one example of a friend who got the second round IMG spot at what was originally her first choice program, and only after she had most of our school's staff in that specialty call and specifically advocate her. As you say, it's a small community. Those results aren't typically for the second round.

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I'm going to try to answer the original posters question a bit more directly and then talk a bit generally about the factors that actually come into play. I'm an IMG who matched to a surgical specialty (or "subspecialty" as this thread has been calling it) without any nepotism or inappropriate considerations as I think they've been described in this forum. The vast majority of the successful applicants I've met have had no significant external factors that influenced their selection other than what they brought to the table themselves.

 

To clarify for everyone a subspecialty is a qualification obtained through a fellowship after an RCPSC residency. General surgery, ortho, vascular (in some cases), plastics (in most cases), cardiac surg, etc are all surgical specialties. A subspecialty is something like breast oncology, microsurgery, or arthroplasty.

 

Here are you approximate chances for matching successfully into a surgical specialty with some obvious give-and-take depending on the particular specialty. These numbers are subjective and based on my experiences with the last 3 years of matching from an perspective inside my program in Ontario. As always with my posts, I only know the system in Ontario where the majority of the IMG surgical spots exist. The facts may be very different elsewhere.

 

For all IMGs who apply the chances are about 100:1 for an overall successful match into your discipline of choice. That chance drops at best to about 2:1 in the ideal situation. This is the ideal situation: you grew up in Canada, you are a current year graduate, have completed an undergraduate degree, you've attended a European (preferably Western)medical school, and have been very impressive in an onsite elective in your chosen specialty with a Preceptor who will advocate strongly for you during the CaRMS process.

 

Other than trying to change halfway through the elective process--or the absurd suggestion of re-applying to a Canadian medical school--there is one more Canadian path to consider. Match to a less competitive 5 year specialty like IM. Prove you are a stellar resident in the first year and transfer to the surgical program of your choice. In your situation I would advocate strongly for this path unless you feel you can cultivate a strong Staff advocate who is involved in the Resident selection process.

 

Now, to speak more generally. There are complications that occur every year thanks to the CaRMS process. Programs pick how many applicants to rank based on how convinced they are that the applicants they'd prefer will rank them highly. This is generally referred to as ranking shallowly or deeply. Toronto fills up all of it's spots in the first round because they have a culture of ranking deeply in most programs. In other words, they may rank twenty or thirty people for one or two spots. When the match runs they fill their program; the trade-off is they may get someone that was marginal for one reason or other. A shallower program may only rank one or two people for their one or two spots running the risk of a CaRMS disaster. Again this is a cultural thing and if you look back over the last few years of CaRMS you'll see programs that match no one in the first round. Failure to match applicants is due to employing the shallow strategy and the programs misreading the intent of their selected applicants. The program then scrambles to select a different set of people in the second round as chances are the set of people they were looking at in the first round have either matched to their back-ups or in the US. Most programs are highly adverse to participating in the second round due to the perceived loss of esteem and the practical amount of time and work it requires. Some of the smaller programs will not bother as they do not view residents as a necessity. The ability to not match anyone is usually restricted to small programs in specialties that have small numbers of in patients and emergency consults.

 

The idea that programs 'save' and IMG spot for a CMG is highly unlikely. Very rarely does a well qualified CMG appear to take an unmatched IMG spot. The best reason is funding. IMGs and CMGs are funded by different pools from the Ontario government. You can't just use that funding for a CMG. The number of residency positions is negotiated between the program and the post graduate studies department. There's some give and take on the final numbers every year and a program can conceivably make a spot for a well qualified applicant they like. Additionally, no Canadian medical student in their right mind would not participate in the first round, or not include a backup program, on the word of a program director claiming to be saving a second round spot. It makes no sense considering the high first choice match rate.

 

There are two types of contacts. The type that is important for CaRMS and matching to surgical specialties is the contact that you personally have made on electives. Family contacts really don't count for much. At best they may help you get an elective but after that everyone is in the same boat. Many medical students without family contacts appear on electives and have the same chance as anyone else to make an outstanding impression.

 

From the first day of residency, surgical residents have enormous clinical and academic responsibilities. I found medical school a walk in the park compared to my life now. No program takes a chance on any medical student about whom they have a single reasonable doubt. Every single RCPSC failure reflects incredibly negatively on the program and again no program will take a chance on an unknown medical student. When the program is ranking applicants you absolutely need a Staff member at the table to push you onto and up the rank list otherwise you're not matching. The Staff have to defend their support against other Staff pushing their preferences. Saying I golf with applicants X's Dad is not going to help.

 

Programs do no necessarily prefer a CMG to an IMG. There are a few reasons. Financially, the Ontario government pays the University more to train an IMG than a CMG. This is true regardless of when in the CaRMS process you match. I think this is a minor factor but it certainly exists. Regardless, for the reasons stated above a surgical program will always take a known IMG over an unknown CMG. This is mitigated slightly by the tendency of CMGs to arrive with a contactable referee that is known to the program as the surgical community in Canada is tiny. That small town familiarity may equally get a CMG blacklisted across the country but that's not relevant to the current thread. No matter what, an IMG applicant absolutely needs a strong advocate on the selections committee to push for her or him. At this point in your career it is up to you the applicant to secure that advocate and a family connection really won't help much. You absolutely need a strong advocate on the selections committee to push for you. At this point in your career it is up to you the applicant to secure that advocate and a family connection really won't help much.

 

The conclusion is that CMGs are not always a failsafe choice and programs know this. They feel a bit more secure about the academic abilities of the CMG but the personal and clinical aspects are a toss up. There is, surprisingly for me at least, a very slight preference for the personality of Canadians who studied abroad as they are considered a bit exotic and a bit more humble than their CMG colleagues (as I think this thread demonstrates).

 

While I agree with most of your points, I can attest that any preference for IMG "personality" is not universal. It in no way exists in my program. In fact, I would say that it is the opposite where I am, except it's stronger than a "slight" preference toward CMGs.

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Regarding the "saving" of an IMG spot for a CMG, I only know of one example of a friend who got the second round IMG spot at what was originally her first choice program, and only after she had most of our school's staff in that specialty call and specifically advocate her. As you say, it's a small community. Those results aren't typically for the second round.

 

I also know a CMG who was given an IMG spot in my specialty after she/he did not match first round in the same specialty.

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I also know a CMG who was given an IMG spot in my specialty after she/he did not match first round in the same specialty.

 

Again, I only speak for Ontario. I can tell you that 'given an IMG spot' isn't accurate given the funding situation here. The appropriate way of looking at it is an extra CMG spot was created for whomever (likely funding from another program that wasn't planning to fill a CMG spot) and an IMG spot went unfilled. Extra spots get created for CMGs who get caught in a CaRMS probability mismatch and need to get matched every year. A number of Canadian grads find their way into programs after the match. Given that stipulation I'd totally agree that programs pick people they like and often negotiate extra spots for them. The numbers are much more flexible than people realize. Every year my program goes into the match stating they plan to take BETWEEN X and Y number of new residents.

 

 

In terms of IMG preference, I'll give you it may absolutely be program dependant. I'm really not looking to start a war here. I included that comment in response to a something specific one Staff mentioned to me last week. It honestly took me totally by surprise so it's still fresh in my mind. Prior to that I'd have said the overall impression is neutral to negative as other people have mentioned.

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I don't disagree with much of what you wrote, but this strikes me as a very high risk strategy. Particularly for matching to something like IM, you'd be in a program which might have at most one elective block, probably later in the year, where it would look mighty odd if you organized any surgery elective apart from gen surg.

 

Regarding the "saving" of an IMG spot for a CMG, I only know of one example of a friend who got the second round IMG spot at what was originally her first choice program, and only after she had most of our school's staff in that specialty call and specifically advocate her. As you say, it's a small community. Those results aren't typically for the second round.

 

Agreed very risky, but so is exclusively going for a highly competitive surgical specialty. I envisioned it more as have one surgical elective and do everything else in IM.

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