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

[MD2015]

uwopremed

 

We don't live in North Korea which is a vile and appalling place to live. We live in Canada, a democracy, where, although we are all treated equally under the law, we each come from our own socio-economic backgrounds. Some of us come from rich families, some from middle class and others, like myself, from poor families. Applying to med school in Canada is equivalent to entering the lottery. We each try to gain an advantage over others in the applicants' pool, by GPA, ECs, MCAT, LORs, whatever. Many good candidates never make it for whatever reason. Some go abroad and borrow or use family money, or both. All is fair game. This is neither vile nor appalling. Nor is applying to return as an IMG. If you wish to change the system, good luck to you.Your unhappiness is what you have to live with.

 

And that appalls me. 

[JohnGrisham]

OK there uwopremed, thanks for your most excellent of contributions you're a beacon of hope for those struggling to become a cmg

[GrouchoMarx]

Let's not gang up on uwopremed. It's good to hear conflicting, controversial opinions.

[Username92]

OK there uwopremed, thanks for your most excellent of contributions you're a beacon of hope for those struggling to become a cmg

 

Crying out that the guy is arrogant while responding in a sarcastic/arrogant manner himself. Suuuure

[bruhh]

Let's not gang up on uwopremed. It's good to hear conflicting, controversial opinions.

Naw, some opinions are really not worth listening to - especially uwopremed's. I mean, the guy couldn't even get an interview invite the first time around with near 40 MCAT, 4.0GPA, and multiple publications because his annoying personality reflected on his LOR's and got red flagged.

[Edict]

Are you kidding me??  Almost all the Irish schools let in Canadians, with pretty low standards, in an effort to make money.  That is totally obvious.  The Irish kids themselves are very competitive for the Irish stream.  I'm talking about the foreigners that they let in. 

 

Most UK schools are the same as the Irish schools; I'm talking about the few exceptions (Imperial, Cambridge, Oxford) that are super competitive for anyone.  They do not have low standards for foreigners (ie - they don't let in a bunch of Canadians that have the money to buy a medical degree).

 

Actually most UK schools are not the same as Irish schools because the government has a 7.5% quota on international students. Yes, a few schools have circumvented these quotas but as a whole most schools stick to them. 

[Edict]

Naw, some opinions are really not worth listening to - especially uwopremed's. I mean, the guy couldn't even get an interview invite the first time around with near 40 MCAT, 4.0GPA, and multiple publications because his annoying personality reflected on his LOR's and got red flagged.

 

There is always one person on the forum like this. Amazing stats, incredibly arrogant, can't get in first time around. Their arrogance probably shows at interview. 

[Edict]

It is you that exudes arrogance and elitism.  Let me explain.

 

Going to Ireland, or Autralia, or the Caribean (because one could not get into Canada), skirts the basic system of fairness.  Most middle class or poor Canadians, if they did not make the cutoffs to get into a Canadian school, cannot afford to go overseas to buy themselves a degree that will eventually earn them a lot of money.  These Canadians that go abroad defeat the very system of fairness we have in medical admissions.  They usually belong to well off families.  And then these kids, who could not get into a Canadian school, feel entitled to work in Canada and make huge money of our taxpayer funded system.

 

IT is VILE and appalling.  And people like you, in support of these IMGS, help prop up the major social imbalances we have in our society.  Your support of these purchased degrees allows the upper middle class and upper class to allow their children access to high paying secure jobs with a backdoor access. 

 

And that appalls me.

 

You use the word "buy" when it so clearly is not like that. They have to study medicine, be competitive and at the end of the day apply back to a very competitive system. 

[JohnGrisham]

Crying out that the guy is arrogant while responding in a sarcastic/arrogant manner himself. Suuuure

Well responding maturely didn't do much. Trolls be trolling.

[MathToMed]

These Canadians that go abroad defeat the very system of fairness we have in medical admissions.  They usually belong to well off families.  And then these kids, who could not get into a Canadian school, feel entitled to work in Canada and make huge money of our taxpayer funded system.

Statistically speaking, people who get into Canadian Med Schools belong to well off families as well. It's easier to focus on maintaining a stellar GPA and acing your MCAT when you have courses and tutors at your disposal because money is no option. For this reason, many people who get in everywhere are from well off families and even our system can hardly be called fair.

 

Also you speak of foreign educated doctors as some drain on our financial system. In fact, the government pays a lot of money to train Canadians which students who study abroad pay for themselves. The rest, such as a GP's annual income, whether being paid to a foreign GP (who has become accredited, hence displays the appropriate competencies) or a local GP, makes no financial difference.

[amichel]

Statistically speaking, people who get into Canadian Med Schools belong to well off families as well. It's easier to focus on maintaining a stellar GPA and acing your MCAT when you have courses and tutors at your disposal because money is no option. For this reason, many people who get in everywhere are from well off families and even our system can hardly be called fair.

 

Also you speak of foreign educated doctors as some drain on our financial system. In fact, the government pays a lot of money to train Canadians which students who study abroad pay for themselves. The rest, such as a GP's annual income, whether being paid to a foreign GP (who has become accredited, hence displays the appropriate competencies) or a local GP, makes no financial difference.

Your right, our system isn't fair but you have to admit that most CSA are (quite) wealthy and that having more of them would increase the socioeconomic disparity in medicine?

[JohnGrisham]

To be fair though, you dont exactly have to be super wealthy to go abroad. 250-275k bank loan and 40-50k student loans covers 80%+ total COA in some cases. I'd argue that it wouldn't be significantly different than the average cmg cohort when it comes to parental wealth and contributions. Yes you will need to have family money, but not necessarily to the tune of the total COA, but rather the difference in the unmet funds, which would still be a whole lot, but not necessarily something special that differentiates from CMG students. Talk about a run on sentence. Is it expensive? Yes. Is it something that would necessarily make a CSA significantly more wealthy then the average CMG? I'm not so sure. Just because many CMGs dont need to fund the huge costs a CSA would(specifically the ability to cosign a large loan and have extra money to cover the remaining costs), doesn't necessarily mean they couldn't. Talking to a few incoming classmates, who's parents are talking about buying them apartments at UBC and the likes..

 

I can definitely see the point though that it would be more likely that a CSA would be better off than a CMG, I'm just not so sure its founded on actual statistical data. I mean, what's to say most people whom become CMGs aren't also from the same backgrounds as CSAs, but just actually had even better resources that helped them be better applicants etc?

 

Random musings.

[older]

Actually most UK schools are not the same as Irish schools because the government has a 7.5% quota on international students. Yes, a few schools have circumvented these quotas but as a whole most schools stick to them. 

 

True but so what. Quotas or not, international  applicants still have to compete with other qualified applicants, whether local or other internationals.

 

The only med  schools within EU relatively "easy" to get in are those in Eastern Europe. This is because, in addition to forking out international tuition, med students have to learn local language at some point. Try to learn Czech, Polish or Romanian, good luck. Those schools are popular with Canadians of Easter European origin who know the language.

 

Getting to med school in  Ireland or  UK is tough, and criteria are similar to those in Canada and US. The good thing there is that different schools use criteria in different way - most have academic cutoffs and entrance test cutoffs (not the same for every school) and once you pass that, ECs and interview performance get you in even if your GPA is lower than what would be a minimum in Canada. Is this admission system inferior? Personally I don't think so, people can apply to their strengths.  I think there is something wrong with admission system that forces applicants to fight about fractions of GPA and tailor ECs to the "right" scheme. In addition, this sytem creates truly arogant "winners" that feel superior to "lesser" doctors educated elsewhere, even if they attend med schools and programs older and better than those in Canada.

 

That being said, Canada is pretty bad in terms of  number of applicants per place. But only in Ontario - not  where there are quotas for out of province applicants. Getting a place at, let's say, UofS, is not any harder than getting a place in any of UK med schools - and I mean any, not Oxbridge or Imperial  (which tend to have less applications per place, not more).

[older]

There is always one person on the forum like this. Amazing stats, incredibly arrogant, can't get in first time around. Their arrogance probably shows at interview. 

 

And it shows on this Forum. I daresay those persons don't show promise as future doctors if they cannot argue their case on merits and in polite way. The uwopremed has a lot to learn, mostly in the areas of maturity and manners.

 

Difference in opinion is fine, it is about whether you argue on merit and also how do you make your point. There will be a lot of professional disagreements in the future, anonymous forums are good way to practice.  

[amichel]

To be fair though, you dont exactly have to be super wealthy to go abroad. 250-275k bank loan and 40-50k student loans covers 80%+ total COA in some cases. I'd argue that it wouldn't be significantly different than the average cmg cohort when it comes to parental wealth and contributions. Yes you will need to have family money, but not necessarily to the tune of the total COA, but rather the difference in the unmet funds, which would still be a whole lot, but not necessarily something special that differentiates from CMG students. Talk about a run on sentence. Is it expensive? Yes. Is it something that would necessarily make a CSA significantly more wealthy then the average CMG? I'm not so sure. Just because many CMGs dont need to fund the huge costs a CSA would(specifically the ability to cosign a large loan and have extra money to cover the remaining costs), doesn't necessarily mean they couldn't. Talking to a few incoming classmates, who's parents are talking about buying them apartments at UBC and the likes..

 

I can definitely see the point though that it would be more likely that a CSA would be better off than a CMG, I'm just not so sure its founded on actual statistical data. I mean, what's to say most people whom become CMGs aren't also from the same backgrounds as CSAs, but just actually had even better resources that helped them be better applicants etc?

 

Random musings.

Hmm you're forgetting the fact that you'd have to have someone to consign that bank loan. I also think there is a psychological aspect involved. Someone who comes from money is way more likely to gamble 300+ k than someone who doesn't. This mindset has definitely been discussed on this forum before.

 

Plus, just from my personal anecdotal experience, CSAs are mostly the family money type.

 

Obviously that's just my experience but...

 

On a personal level, the whole thing just bugs me. I feel like lots of these people (people who go to the states excluded) don't want to put in the work to get in here. Maybe that's unfair but it's been my personal experience.

[older]

 Even if IMGs/CSAs were equal to CMGs in all academic and clinical metrics, I would still prefer to see the system fundamentally altered.

 

Altered? Which way?  The current system does not in any way favor IMGs/CSAs - it actually protects the Canadian market from too many of them.

[JohnGrisham]

Hmm you're forgetting the fact that you'd have to have someone to consign that bank loan. I also think there is a psychological aspect involved. Someone who comes from money is way more likely to gamble 300+ k than someone who doesn't. This mindset has definitely been discussed on this forum before.

 

Plus, just from my personal anecdotal experience, CSAs are mostly the family money type.

 

Obviously that's just my experience but...

 

On a personal level, the whole thing just bugs me. I feel like lots of these people (people who go to the states excluded) don't want to put in the work to get in here. Maybe that's unfair but it's been my personal experience.

Fair enough, I can agree with that - i think it has to do with personal experiences as well. For me, getting a LOC to go to the US(DO schools which would have made me an IMG in most Canadian provinces, except BC ironically) cosigned, wasn't too hard. And my family is definitely middle class at best - more likely lower middle class.  But I do agree, that i'm probably an exception to the average potential CSA/active CSA's, and i'm sure there are other exceptions as well - I believe Leviathan had commented before about his experiences.

 

Its too bad there isn't more robust data about the CSA population, as I would love to see what proportions are those who just missed the mark due to supply/demand in Canada, or those who skipped out on undergrad and went to 6 year programs, and those who were really off the mark in Canada etc.     The CSA survey that CaRMS does is okay, but far from what I would want to see to be able to talk more intelligently on this topic. That said, we all have our anecdotes and personal experiences which frame our discussions, which helps add some diversity to prevailing opinions

[ralk]

Altered? Which way?  The current system does not in any way favor IMGs/CSAs - it actually protects the Canadian market from too many of them.

 

The way I'd like to see the system altered is to shift away from foreign-trained physicians to Canadian-trained physicians, with the secondary goal of eliminating any major incentive for Canadians to leave the country to study medicine (unless their intent is also to leave the country to practice medicine).

 

My preferred method would be to increase Canadian medical school enrollment and shift IMG residency positions to CMG residency positions. That requires a fair bit of coordination between the various stakeholders in Canadian medical education to accomplish, but we may already be on that path. There was a huge increase in CMGs over the last decade, and with some signs that there may be too many physicians, especially in a few notable specialties, there's certainly pressure to reduce the number of IMG residency spots to make room for all the new CMGs. That appears to be happening somewhat, though not nearly as quickly or transparently as I'd prefer.

 

Another, perhaps easier option, would be to simply revert to the old rules for IMGs matching through CaRMS. Namely, no IMGs in the first round at all. No dedicated spots, not even shared spots. CMGs only until the second round. That wouldn't reduce the overall number of IMGs/CSAs getting Canadian residencies, but it would reduce the desirability of those residencies. Right now there are dedicated IMG spots in fields or locations that CMGs would gladly take. Last year there were 20 IMG-dedicated Family Medicine spots in Toronto. That's the most sought-after Family Medicine site in the country and one of the few locations where there isn't a shortage of Family Medicine physicians. Canadian patients gain virtually nothing by having those spots available to IMGs.

 

If IMGs/CSAs could not match until the second round, CMGs would eat up those desirable residencies in the first round. CSAs are more likely than CMGs to be from major metropolitan centres and state a reasonably strong preference to return there, so eliminating those cities as potential match locations would dissuade at least a few of them from going overseas. It would also better align the system with the purported reasons for including IMGs at all - to fill in the gaps in the Canadian medical system that CMGs are unable or largely unwilling to fill themselves. If we truly have such a great need for additional physicians beyond what we can train domestically, we might as well have them training and working in the places we need the extra physician manpower the most.

 

You're right that the current system does not favour IMGs or CSAs - and I'm advocating for changes that would make things even tougher for them. This discussion often tends to focus narrowly on fairness at the point of residency applications, while neglecting fairness in the bigger picture. Fairness for the worldwide medical system that Canada takes advantage of by willfully taking other countries' physicians or taking advantage of their training systems (we have been labelled a poacher of medical professionals). Fairness for Canadians of all backgrounds who want to be physicians - whether they can afford to go overseas to study or not. Fairness for Canadian patients, who rightly want the highest quality, most accessible care. If there was a way to provide a higher level of fairness on these other metrics without making the situation even more difficult for IMGs/CSAs, I'd be all for it. However, I've yet to see any proposed system that can accomplish that, which is why I would prefer to make things worse for IMGs/CSAs in order to make things better for the Canadian (and worldwide) medical system as a whole.

[older]

Withe regards to the " fairness for the worldwide medical system" I don't think Canada does so badly. The number of doctors poached from Africa or Afganistan to practice in Canada cannot be that large. And if doctors move here from South Africa or Australia or Europe, it hardly leaves tose countries with shortage of doctors. India is the only example that comes to mind mind as a country that could be suffering  as a result of doctors moving abroad. But I don't have numbers to make a judgment whether it is really a problem or not.

 

Canada is an immigrant's country, encouraging people from all over the world to live and work here. Is it "fair" to effectively ban just one profession from ever practicing in Canada?  We may have too many engineers also, yet we let them take qualifying exams and practice here. True, they don't take training spaces from Canadians, but certainly take spots in job market. That's the way immigration works, and we actually encourage people and help them to establish themselves in their profession. Because at the end, everybody here benefits. Why should it be any different with doctors?

 

CSAs are different matter because the impression is, rightly or wrongly, that they circumvent the system. But if we accept that  IMGs should be able to practice here, then singling out CSAs is illogical. "Fairness" is not an absolute term.  

 

Your idea with matching IMGs/CSAs only in the 2nd round is not a bad one - let them go where the need is, and where insiders don't want to go. I believe this is the intent of the current system.

[GrouchoMarx]

Withe regards to the " fairness for the worldwide medical system" I don't think Canada does so badly. The number of doctors poached from Africa or Afganistan to practice in Canada cannot be that large. And if doctors move here from South Africa or Australia or Europe, it hardly leaves tose countries with shortage of doctors. India is the only example that comes to mind mind as a country that could be suffering  as a result of doctors moving abroad. But I don't have numbers to make a judgment whether it is really a problem or not.

 

Canada is an immigrant's country, encouraging people from all over the world to live and work here. Is it "fair" to effectively ban just one profession from ever practicing in Canada?  We may have too many engineers also, yet we let them take qualifying exams and practice here. True, they don't take training spaces from Canadians, but certainly take spots in job market. That's the way immigration works, and we actually encourage people and help them to establish themselves in their profession. Because at the end, everybody here benefits. Why should it be any different with doctors?

 

CSAs are different matter because the impression is, rightly or wrongly, that they circumvent the system. But if we accept that  IMGs should be able to practice here, then singling out CSAs is illogical. "Fairness" is not an absolute term.  

 

Your idea with matching IMGs/CSAs only in the 2nd round is not a bad one - let them go where the need is, and where insiders don't want to go. I believe this is the intent of the current system.

 

i am concerned about the competence of immigrating doctors. in pathology, a none too small number of residents are foreign trained doctors, mostly from the middle east russia or china, who have skill levels far below their canadian trained peers. i wonder if they are even really doctors sometimes.

 

using foreign trained doctors to fill gaps in canadian medical student interest assumes that foreign training is as good as canadian training, and from what i have seen this year that is a false assumption. this does not serve the public interest.

 

there should be no positions delegated to imgs only in the first round. especially not in desirable centers like toronto. i am suspicious that such an arrangement is borne from corruption so that big campaign donors or other urban VIPs can have their kids who trained in ireland or the caribbean come back to live at home in toronto. the conduct of the ubc cardiac surgery program illustrates systemic corruption. i assume that with img only first round positions in toronto, such corruption extends to carms itself.

 

to me there should be no difference between csas and imgs. to separate out the term is prejudiced and may violate the new hate speech law that prohibits discrimination by country of origin.

[ralk]

Withe regards to the " fairness for the worldwide medical system" I don't think Canada does so badly. The number of doctors poached from Africa or Afganistan to practice in Canada cannot be that large. And if doctors move here from South Africa or Australia or Europe, it hardly leaves tose countries with shortage of doctors. India is the only example that comes to mind mind as a country that could be suffering  as a result of doctors moving abroad. But I don't have numbers to make a judgment whether it is really a problem or not.

 

Canada is an immigrant's country, encouraging people from all over the world to live and work here. Is it "fair" to effectively ban just one profession from ever practicing in Canada?  We may have too many engineers also, yet we let them take qualifying exams and practice here. True, they don't take training spaces from Canadians, but certainly take spots in job market. That's the way immigration works, and we actually encourage people and help them to establish themselves in their profession. Because at the end, everybody here benefits. Why should it be any different with doctors?

 

CSAs are different matter because the impression is, rightly or wrongly, that they circumvent the system. But if we accept that  IMGs should be able to practice here, then singling out CSAs is illogical. "Fairness" is not an absolute term.  

 

Your idea with matching IMGs/CSAs only in the 2nd round is not a bad one - let them go where the need is, and where insiders don't want to go. I believe this is the intent of the current system.

 

For the first point, there's quite a bit of evidence that we do take professionals from underserved countries that could really use those professionals. A quick Google search will bring up more than a few reports (such as this one). If the argument is that we save money by accepting IMGs - and in the case of non-CSAs, I would argue that we do - then the flip side is that other countries are losing money. The countries we draw from in significant numbers include Libya, Pakistan, and India (see this CMA report) - not exactly rich countries with strong medical systems.

 

The physician workforce is fundamentally different from the engineer workforce for the simple reason that physician employment is largely centrally planned, while engineers work mostly in a free marketplace. Physician salaries are almost entirely from the government and salaries are inflexible. Flooding the market with physicians either means substantially higher healthcare costs or a lot of unemployed physicians. We're starting to see signs of that. In the latter case, we have surgeons unemployed or heavily underemployed because provincial governments are unwilling to pay their salaries or provide the supports needed for them to practice. It's a bit harder to find conclusive examples of the former case, but they exist - for example, Toronto has become a bit oversaturated with psychiatrists, who consequently see fewer patients (and fewer new patients) than other psychiatrists in areas with fewer psychiatrists. Toronto psychiatrists are less efficient and therefore more expensive than other psychiatrists (that expense may be worthwhile if there are meaningful gains in mental health by seeing fewer patients, but that's beside the point). By contrast, flooding the market with engineers would likely drive down the cost of engineers. As newly introduced engineers compete for limited jobs, they will start accepting increasingly lower salaries. Lower salaries means that some employers who would like to employ engineers but couldn't previously afford to can now do so, provide more jobs for these now-cheaper engineers. Engineers would naturally like to maintain their higher salary, so a huge influx of engineers wouldn't necessarily be a good thing, but there are at least some feedback mechanisms to absorb those new engineers that don't really exist in medicine.

 

Keep in mind that the control on newly practicing physicians doesn't just apply to IMGs - it applies to Canadians too. The number of Canadians entering medical school is heavily restricted and constrained. CMG programs were added or expanded only after significant effort and lobbying, with concerns that this expansion may have gone too far. We don't restrict the number of incoming Canadian-trained engineers like we do physicians either - engineering programs are expanded or opened literally every year. The system is different for foreign-trained engineers than it is for foreign-trained physicians because the system is different for Canadian-trained engineers than it is for Canadian-trained physicians.

 

I think you hit the main reason CSAs get so much attention - they circumvent the system. That circumvention isn't malicious or ill-intentioned, but it is still a circumvention. And that circumvention comes with consequences - to them, to other Canadians wishing to become physicians, to the Canadian economy, and to Canadian patients - that don't necessarily exist when recruiting new immigrant physicians to Canada. It's a bit of a moot point, since virtually any system that distinguishes CSAs from other IMGs in the residency selection process would almost certainly be illegal. I also don't think it's entirely necessary to make such a distinction when formulating residency policies towards IMGs and CSAs - neither of the approaches I mentioned would require separating out CSAs from other IMGs.

[MathToMed]

Your right, our system isn't fair but you have to admit that most CSA are (quite) wealthy and that having more of them would increase the socioeconomic disparity in medicine?

Assuming that's true (I personally know of two people studying medicine abroad, one upper middle and one lower middle class), I think this would increase the socioeconomic disparity between the upper and middle class. That's what this is really, the privileged middle feeling underprivileged/disadvantaged for one of the first times in their lives.

 

Meanwhile, when we say socioeconomic disparity we talk about the entire spectrum of incomes. "This is bad because it affects those who can't afford it. Think of the poor!"

 

And yet, those who are actually under-represented in medicine (the ones who truly have zero chance at procuring a $300K loan) aren't really bothered by the particulars of this because they're well aware of said socio-economic divide. Namely, whether a CMG or IMG gets that coveted residency spot/full time job, it's still someone more privileged than the lower class (statistically, and given the above assumption, I know it's not a hard and fast rule in either case).

[amichel]

Assuming that's true (I personally know of two people studying medicine abroad, one upper middle and one lower middle class), I think this would increase the socioeconomic disparity between the upper and middle class. That's what this is really, the privileged middle feeling underprivileged/disadvantaged for one of the first times in their lives.

 

Meanwhile, when we say socioeconomic disparity we talk about the entire spectrum of incomes. "This is bad because it affects those who can't afford it. Think of the poor!"

 

And yet, those who are actually under-represented in medicine (the ones who truly have zero chance at procuring a $300K loan) aren't really bothered by the particulars of this because they're well aware of said socio-economic divide. Namely, whether a CMG or IMG gets that coveted residency spot/full time job, it's still someone more privileged than the lower class (statistically, and given the above assumption, I know it's not a hard and fast rule in either case).

Hmm. My post test brain is having a hard time understanding what you're getting at, but I think I have it figured out. All good points.

 

However, since even the middle class is underrepresented in medicine, I think my point still stands.

[MathToMed]

Hmm. My post test brain is having a hard time understanding what you're getting at, but I think I have it figured out. All good points.

 

However, since even the middle class is underrepresented in medicine, I think my point still stands.

Yes it does. Well, technically it stands given the assumption that CSAs are statistically more wealthy than CMGs...which I'm not entirely sure I'm willing to contend. But regardless, that was my humble contribution to the discussion.

 

EDIT - changed IMG to CSA as it's more precise.

[amichel]

Yes it does. Well, technically it stands given the assumption that CSAs are statistically more wealthy than CMGs...which I'm not entirely sure I'm willing to contend. But regardless, that was my humble contribution to the discussion.

 

EDIT - changed IMG to CSA as it's more precise.

You're right. No one really knows. You have your personal examples, I have mine. All the CSAs I know come from very wealthy families.

 

I tend to think it's true because I feel like people who didn't grow up with money would balk at the risk:reward ratio. I would. However, that assumes they know their chances to come back to Canada are fairly dismal.