Untrained And Unemployed: Medical Schools Churning Out Doctors Who Can't Find Residencies And Full Time Positions

[amichel]

This happens in every other profession. Especially with PhDs and research.

Ugh, once again. I'm not going to get into the main argument here, but just because something has always happens doesn't mean no one should consider changing it.

[indefatigable]

I do agree that IMGs may bring diversity, and some may be very qualified applicants (like ones that came from Ivy-league American schools) but if we do that, I think that we should lower the number of spots for Canadian medical schools first...so we're not left with MDs without residencies.

A small technical point - us md graduates are not considered IMG. IMG refers to Carribean, Australia, ... Understanding non-matched students is important: us residency is based more on mle test scores - here more clinical evaluations, interview,etc... So why is it happening? Personally - it seems one has to be flexible. Reading all of this is I think a sobering cautionary tale. Although I have more ties to Toronto than various other places, I doubt I will look there...

[Organomegaly]

98% of Canadian medical students matched this year, so to say an "abundance" did not match is pushing it.

 

The argument for giving IMGs equal access is first, that the best applicants should be given priority, i.e. matching should be a meritocracy, and second that we can "steal" another country's trained MD without having to pay a cent for their subsidized medical education.

 

I think that giving IMGs some access (with a huge bottleneck) will indeed allow us to recruit some excellent talent from abroad.

 

But to give IMGs and CMGs EQUAL access across the board is ludicrous. Plenty of Canadians studying abroad were not able to study here because they were not qualified enough to gain admission here. I'd be pretty upset if my high school friend who went to a Eastern European medical school out of grade 12 with a low 70s average had equal access to residency positions as I did. Not everyone can be a Canadian physician. Give the rights to the people who were good enough to get in here, and for whom taxpayers have invested in. And if you find a truly exceptional IMG, take them for the extra talent and essentially saved money - but for goodness sake don't fill the system with arguably subpar ones.

[oshaku]

You don't need to tell me how hard it is to adjust to a new culture...

 

What happens when you breach a contract? As Gohan mentioned, according to Canadian law, you pay a fine, and/or your lose some of your credits. Better yet, I would love to see a system in which if these foreign doctors refuse to stay in the rural areas for five years according to the contract just because they don't like that place, then they lose their licence to practice (not forever, but for an x amount of years).

 

BTW this is not me being xenophobia. This is called you make a promise and you keep it. The original intention of introducing foreign doctors is to serve these under-served rural areas because we have a shortage of doctors specifically in those areas, but, and I want to re-emphasize this point, not because we have a shortage of doctors in other non-rural areas. By not enforcing this contract, we are not only defeating the original purpose of introducing foreign doctors and not helping our rural population, we are also saturating the non-rural areas where we don't need more doctors.

 

Also please remember that these doctors know about what's in the contract before they agreed to come to Canada. Again, nobody is forcing them to sign the contract. So they are fully aware of their commitment. So let me ask you this, what do you call someone who promises he/she will do something for sure but later on refuses to keep the promise?

 

Maybe you want to argue that the contract is not fair, is evil, is against human rights. I disagree. I said before that Canadian doctors are paid and treated much better than those in a lot of other countries. I grew up in China. In China, doctors are paid like slaves. In China, doctors get stabbed if they can't cure the patients (not always obviously). People don't respect doctors in China. Therefore, for a Chinese doctor to come here and practice, I personally think it's a step up. Just look at how many Chinese-trained doctors write USMLE each year. So for them to spend 3-5 years in a rural area to practice, what's wrong with that? They still get a significant pay raise in the end. They can move to wherever they want after the contract period. What's so evil about that? You can't even commit 3-5 years to serve some under-served population but you want another country to accept you and offer you a pay raise right away? What kind of free lunch is that?

 

As someone who signed a contract to work in a foreign country for x years and then broke it, sometimes you don't know exactly what you've signed on to.  Sometimes promises made by the institution aren't upheld by the government itself or not upheld to the level you expected. 

 

Sometimes being a doctor in Canada isn't a step up, sometimes these doctors come from situation where they are well paid and well respected and leaving their home countries for political reasons.  Sometimes foreign doctors come to Canada and end up driving taxis.  

 

I never used the words evil or not fair or against human rights when referring to ROS contracts.  Why would you even think that?  I do however think that stripping a person's license for x-number of years if they don't fulfill a ROS contract is a bit draconian.  As Gohan pointed out, there are already monetary consequences to breaking the contract.  There are lots of "soft" consequences as well.  In particular, the fact that the ROS was never completed with raise eyebrows for every subsequent job they apply to, there might be other consequences as well if the rural service was part of residency training.

 

With the importance of contracts in society, nobody breaks them on a whim.  Personal experience here: the changes in my life that contract brought drove me to the deepest episode of depression I've ever experienced and I'm still dealing with the psychological effects after more than two years.  Not only that, but *everybody* asks about it.  It means re-explaining why I quit over and over again to everyone.  It doesn't seem like a experience unique to me as I've been meeting other people took an overseas work contract, some of whom left their contract midway as I did, and they speak of a similar experience. 

 

Nobody is saying xenophobia, but sometimes we need to remember foreigners are people too with just as many psychological needs as everyone else and they should have the dignity to be able to say "this job is killing me inside and I need to do something about it" without the risk of losing their license.  

[evans]

This happens in every other profession. Especially with PhDs and research.

 

 

This is a fallacious argument, in the form of Tu quoque. Next.

 

https://en.wikipedia.org/wiki/Whataboutism

https://en.wikipedia.org/wiki/Tu_quoque

[evans]

98% of Canadian medical students matched this year, so to say an "abundance" did not match is pushing it.

 

The argument for giving IMGs equal access is first, that the best applicants should be given priority, i.e. matching should be a meritocracy, and second that we can "steal" another country's trained MD without having to pay a cent for their subsidized medical education.

 

I think that giving IMGs some access (with a huge bottleneck) will indeed allow us to recruit some excellent talent from abroad.

 

But to give IMGs and CMGs EQUAL access across the board is ludicrous. Plenty of Canadians studying abroad were not able to study here because they were not qualified enough to gain admission here. I'd be pretty upset if my high school friend who went to a Eastern European medical school out of grade 12 with a low 70s average had equal access to residency positions as I did. Not everyone can be a Canadian physician. Give the rights to the people who were good enough to get in here, and for whom taxpayers have invested in. And if you find a truly exceptional IMG, take them for the extra talent and essentially saved money - but for goodness sake don't fill the system with arguably subpar ones.

 

Mostly agree.

 

I'm fine with you plan, so long as the govt cuts the number of spots of medicine, in proportion to how many IMGs they plan to take on.

 

ie: it makes no sense to train 100 doctors, for 100 residency spots, but then decide to let 5 residency spots go to IMGs. It's a waste of time and money.

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[rmorelan]

Tough problem of course - although I will say the article not mentioning anything about 98% of the people do getting something - a stable number by the way over 15 years - is not exactly presenting a balanced article. Of the 2% that don't match a big chunk of those have a very predictable reason for it - restricted the number of centres for whatever reason or tried to go for a highly competitive field with no back up. There are some cases of gezzz why did that person not match (I mean come on, really? type of situations) - and it really sucks - but they are rare.

 

The match will never be a 100% - there will always be people that want something and won't get it because the schools/programs themselves don't like that candidate more than another one. Of course because you want to be a XYZ doc doesn't mean you should absolutely get to do that.

 

The bigger issue which was mentioned is simply the mismatch of trainees in particular areas to the actual job market. It is often really hard to predict that  - you pick your specialty 8 years or so prior to entering the job market in a field where really there are only a relatively small number of people working in your area. Very hard to predict needs. Of course very hard doesn't mean not try and Canada really doesn't even put enough effort into that area, and really needs to step up its game. The old argument of why train people not to have jobs holds. Plus the system is more than willing to let smart/hard working type A personalities who have done nothing but achieved success to that point in life go forward thinking - meh odds, I beat odds for breakfast, let's do this!!! - aaaannnndddd not get a job a decade later.

 

Big issue as well - particular in surg/internal fields - is the entire system just relies on having so many trainees to actually run things. You cannot easily say stop taking ENT residents at a centre - doesn't mean you shouldn't but that it is in fact hard. Other than the obvious having staff on first line call the machinery to train people works best with predictable numbers each year. There has been a disincentive in programs to cut numbers as a result and no one to make them actually do it. 

 

The idea that just because we have a waitlist though in a particular area meaning we should automatically hire more docs/open more ORs/bed/hire more support staff unfortunately doesn't really work in our system. We are maxed out here - they money has to come from somewhere - and while you can always find examples of inefficiency there isn't magic money lying around to be spent. We have to make choices.

 

(oh and we don't have 4.6 million people without a family doc - that number fails to mention that not everyone is actually seeking one. I for instance don't have a family doctor so am apart of that statistic. I haven't sought one out or needed one etc.)

 

as a side note - I love the common remark of older doctors not retiring they always thrown in there as well - those doctors are quite often the most experienced and skilled people. There is a reason we look up to them in the medical field - success is usually tied to experience, and those guys have it. Plus their long tenure isn't a surprise or anything new. People in medicine often work much later than most and always have. They should leave when they are not able to provide a high level of care or when they want to.

[indefatigable]

This happens in every other profession. Especially with PhDs and research.

The PhD system is really broken. The chances for say an academic job in some disciplines for a starting student may be much less than 10%. A phd in chemistry who gets a job as an accountant is considered successfully trained under the current system. Especially in Canada, a PhD often doesn't mean much. Some areas like economics have good job markets, but teaching high school after PhD and multiple post-docs may not really be indicative of a functional system. In bio especially, PhDs and even post-docs are sometimes viewed as inexpensive labor. The foreign trained has more to do with prestige - in general academia is a hierarchy based on prestige.

[武田信玄]

This happens in every other profession. Especially with PhDs and research.

PhD is a ponzi scheme, let's not turn MD into PhD.

[武田信玄]

As someone who signed a contract to work in a foreign country for x years and then broke it, sometimes you don't know exactly what you've signed on to.  Sometimes promises made by the institution aren't upheld by the government itself or not upheld to the level you expected. 

 

Sometimes being a doctor in Canada isn't a step up, sometimes these doctors come from situation where they are well paid and well respected and leaving their home countries for political reasons.  Sometimes foreign doctors come to Canada and end up driving taxis.  

 

I never used the words evil or not fair or against human rights when referring to ROS contracts.  Why would you even think that?  I do however think that stripping a person's license for x-number of years if they don't fulfill a ROS contract is a bit draconian.  As Gohan pointed out, there are already monetary consequences to breaking the contract.  There are lots of "soft" consequences as well.  In particular, the fact that the ROS was never completed with raise eyebrows for every subsequent job they apply to, there might be other consequences as well if the rural service was part of residency training.

 

With the importance of contracts in society, nobody breaks them on a whim.  Personal experience here: the changes in my life that contract brought drove me to the deepest episode of depression I've ever experienced and I'm still dealing with the psychological effects after more than two years.  Not only that, but *everybody* asks about it.  It means re-explaining why I quit over and over again to everyone.  It doesn't seem like a experience unique to me as I've been meeting other people took an overseas work contract, some of whom left their contract midway as I did, and they speak of a similar experience. 

 

Nobody is saying xenophobia, but sometimes we need to remember foreigners are people too with just as many psychological needs as everyone else and they should have the dignity to be able to say "this job is killing me inside and I need to do something about it" without the risk of losing their license.  

Again, if working in rural areas in a foreign country brings such a mental stress for many foreign doctors, then we should get rid of this IMG program in the first place and find some other ways to solve our rural doctor shortage crisis.

[武田信玄]

The government didn't have to pay for their education

Here we go with the cost of training argument. If that's the case, then let's just get rid of all CMGs. This way we don't have to spend a single cent.

 

On a serious note, we pay money to train our own doctors because our MD training program is better, because our residency program is better, because the quality of CMGs are better than most IMGs on average. It's absurd to trade quality over money, especially when you are dealing with people's lives.

[3change]

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[rmorelan]

Here we go with the cost of training argument. If that's the case, then let's just get rid of all CMGs. This way we don't have to spend a single cent.

 

On a serious note, we pay money to train our own doctors because our MD training program is better, because our residency program is better, because the quality of CMGs are better than most IMGs on average. It's absurd to trade quality over money, especially when you are dealing with people's lives.

 

ok true...but in the end we don't accept the "average" IMG in our system do we?

 

the truth is we seek out the best we can find from around the world for much of it. So to be fair how does the "average" CMG compare to the top IMGs we can attract - and I mean objectively top with top of the line test scores, often people that already have completed residency in that field and even practised in it, published 20+ high end journal articles in the field, have very high end advanced degrees...... These people are smart, motivated (a level of motivation that borders on desperation almost), and extremely hard working.

 

They are often embarrassingly good at what they do is my point. Not always, not in all areas, but in enough that I have to point that out. They make me work harder because I feel so stupid in comparison that it makes me wonder why we are in the same program. I am deadly serious about that.

 

As an example of the top of my head for radiology I know of 3 resident IMGs that completed Canadian fellowship training in radiology who then became IMG residents (so one week I am reporting to them, having them teach us in rounds, and then the following week I am more senior to them). That is the kind of thing we are talking about here.

 

So why do we take them? Simply because they are extremely good - quite often arguably better than the average CMG and on top of that they don't cost us anything to train, and often we can get them to work where we don't want to.

[rmorelan]

"78 per cent of the ENT specialists who graduated last year failed to find a position, with another 30 about to come on the market."

 

Is this number real?

 

this is the problem with fields with same numbers of people in it, and sub sub specialized. Doesn't take much to really mess up the situation.

[sleeping_sickness]

deleted

[rmorelan]

While statistically a 98% CMG match rate is pretty good (and has been steady at around this number for years as per carms reports) this means that over 200 CMGs are not matching annually (which is higher than what carms is saying). This makes for a lot of unmatched CMGs kicking around. The saddest part is that some of them never match.  

 

CARMS is saying:

39 people didn't match last year at the end of round 2. 

54 the year before.

 

where is the 200 number coming from?

[A-Stark]

It's true that the match rate has held reasonably steady, but because of the increase in medical school spaces, the absolute numbers are significantly bigger. And it is absolutely true that there has been a greater proportion and number of spots aimed at IMGs in the past few years. 

 

I have yet to meet an IMG who is any kind of "star" resident. Many of them are perfectly comparable to CMGs. Others arrive with significant skill gaps and struggle. 

[sleeping_sickness]

CARMS is saying:

39 people didn't match last year at the end of round 2. 

54 the year before.

 

where is the 200 number coming from?

bad math, sorry

[indefatigable]

ok true...but in the end we don't accept the "average" IMG in our system do we?

 

the truth is we seek out the best we can find from around the world for much of it. So to be fair how does the "average" CMG compare to the top IMGs we can attract - and I mean objectively top with top of the line test scores, often people that already have completed residency in that field and even practised in it, published 20+ high end journal articles in the field, have very high end advanced degrees...... These people are smart, motivated (a level of motivation that borders on desperation almost), and extremely hard working.

 

They are often embarrassingly good at what they do is my point. Not always, not in all areas, but in enough that I have to point that out. They make me work harder because I feel so stupid in comparison that it makes me wonder why we are in the same program. I am deadly serious about that.

 

As an example of the top of my head for radiology I know of 3 resident IMGs that completed Canadian fellowship training in radiology who then became IMG residents (so one week I am reporting to them, having them teach us in rounds, and then the following week I am more senior to them). That is the kind of thing we are talking about here.

 

So why do we take them? Simply because they are extremely good - quite often arguably better than the average CMG and on top of that they don't cost us anything to train, and often we can get them to work where we don't want to.

It sounds a bit similar to the PhD system. I don't doubt that the IMGs may be very hard-working. After all, seeking opportunity in a foreign country where one has to be likely "better" than a possible domestic candidate is strong motivation. Depending on their circumstances, Canada may be a much more promising place. While on some level "good" for the system, in the PhD or postdoc case it can get extreme - working 70+ hours a week for negligible job prospects and rewards. In the long run, it's a managerial strategy to increase labour productivity. Of course, after tenure there is no pressure to keep producing in academia. The letter in the link I think summarizes the ethos for (some) post-docs - for probably about 30K a year.

 

http://www.chemistry-blog.com/2010/06/22/something-deeply-wrong-with-chemistry/

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[indefatigable]

.

[Username92]

Personally, I don't care if IMG's are better/more experienced than Canadian med graduates - following this logic, I'm pretty sure we could fill out all the residency/jobs positions in Canada with IMG's from other first, second or third world countries, since a lot of them would be willing to live here and are much more experience than our recent med graduates.

 

As for CSA's (Canadians studying abroad) - sorry fellah, if you didn't make it to medical school in Canada and think you can be a ''MD'' with your 3.2 gpa or whatever just because you churned out a ridiculous amount of money to go elsewhere, I think you're wrong. We read about the ''hardships'' of Canadians who study abroad and want to come back - Hey, nobody forced you go to elsewhere, and nobody should take you back just because you have a diploma from an institution many thousands of miles away that is in NO way affiliated with the Canadian medical school system.

[evans]

These IMG arguments are quite strange.

 

Okay, say you want to take the best of the best IMGs. From every international school in the world. (And these IMGs are likely to NOT be Canadians as if they were so incredibly bright, they would have gotten into some Canadian Med School)

 

• What follows is that you are creating a system that relies on the foreign talent of international medical graduates
• Is this ethical? Many countries struggle to train doctors. I have a friend from a particular region in Africa where the government paid for all of their students to study abroad. Every one of those students and doctors that don't return is devastating for them

 

Moreover, current practices of letting in IMGs are creating a much huger problem in my opinion:

• Having IMG spots open for those Canadians and RELYING on the fact that there will be Canadians who choose to study abroad will: create an incentive for students to study medicine internationally
• There are 3500 Canadians studying medicine abroad. How many of them will you think can come back?
• The fact that we are creating a de facto route for Canadians (who have the money to study medicine in Ireland) is adding to the problem of Canadians who study medicine elsewhere and can't do residency anywhere

[JohnGrisham]

Personally, I don't care if IMG's are better/more experienced than Canadian med graduates - following this logic, I'm pretty sure we could fill out all the residency/jobs positions in Canada with IMG's from other first, second or third world countries, since a lot of them would be willing to live here and are much more experience than our recent med graduates.

 

As for CSA's (Canadians studying abroad) - sorry fellah, if you didn't make it to medical school in Canada and think you can be a ''MD'' with your 3.2 gpa or whatever just because you churned out a ridiculous amount of money to go elsewhere, I think you're wrong. We read about the ''hardships'' of Canadians who study abroad and want to come back - Hey, nobody forced you go to elsewhere, and nobody should take you back just because you have a diploma from an institution many thousands of miles away that is in NO way affiliated with the Canadian medical school system.

Except many IMGs who are studying abroad are 3.5+ or at times near 4.0.

 

Don't kid yourself into thinking that you or I are any more special than many of those who have to go abroad.  Getting into a Canadian school, is a lot of luck more than anything. Basic supply and demand - there are way too many qualified applicants for seats. And sometimes those who don't make it into a Canadian school, still have the desire to be a doctor - and take a harder route elsewhere to reach it.

 

But yes, it is a conscious decision and they should know the current political climate and restrictions they may or may not face in wanting to return. Thats why I always tell people to look at USMD and USDO schools first before elsewhere, based purely on the politics of it all in ultimately securing a residency slot.