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

[older]

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.

 

 

 I am surprised about India numbers. 60 arriving each year to Canada is a small number comparing to about 35,000 graduating doctors in India annually. Besides,  India problem appears to be not with practicing doctors who leave, but rather with doctors training in US and not coming back (about 1000/year). But this is apparently due to lack of training spots for MDs in India.  

 

From your numbers, it looks like rural areas in Canada truly benefit from IMGs; particularly Saskatchewan (54%) and Newfoundland (41%). Quite a good reason to accommodate IMGs. Even if they move away after few years, other IMGs will fill their places.

 

I am not denying your point about ethical aspect of poaching doctors from poorer countries.  But  Canada is not actively recruiting those doctors; they come like thousands of other immigrants for their own reasons, and as the example above shows, not in staggering numbers. What we are discussing here is the practical matter what to do with IMGs who decided to immigrate to Canada. Is it better to let them practice in rural Saskatchewan, where very few of Canadian grads want to go, or shut-down doors to residency and have them drive a taxi..  

[NLengr]

 I am surprised about India numbers. 60 arriving each year to Canada is a small number comparing to about 35,000 graduating doctors in India annually. Besides,  India problem appears to be not with practicing doctors who leave, but rather with doctors training in US and not coming back (about 1000/year). But this is apparently due to lack of training spots for MDs in India.  

 

From your numbers, it looks like rural areas in Canada truly benefit from IMGs; particularly Saskatchewan (54%) and Newfoundland (41%). Quite a good reason to accommodate IMGs. Even if they move away after few years, other IMGs will fill their places.

 

I am not denying your point about ethical aspect of poaching doctors from poorer countries.  But  Canada is not actively recruiting those doctors; they come like thousands of other immigrants for their own reasons, and as the example above shows, not in staggering numbers. What we are discussing here is the practical matter what to do with IMGs who decided to immigrate to Canada. Is it better to let them practice in rural Saskatchewan, where very few of Canadian grads want to go, or shut-down doors to residency and have them drive a taxi..  

 

Most of the IMGs practicing in rural NL did not do residency in Canada. They were trained overseas and immigrated after they were fully trained. In NL for many years, they could get a provisional license to work at least temporarily (sometimes long term) without having done the LMCC/CCFP/Royal college. That was the draw of working in NL. Now, they still can get a provisional license, but now will need to get the LMCC within 3 years of starting if the are primary care.

 

Cutting IMG residency spots will not necessarily mean less IMGs for rural NL, since I don't believe the majority of those physicians had completed a Canadian residency anyway. 

[ralk]

 I am surprised about India numbers. 60 arriving each year to Canada is a small number comparing to about 35,000 graduating doctors in India annually. Besides,  India problem appears to be not with practicing doctors who leave, but rather with doctors training in US and not coming back (about 1000/year). But this is apparently due to lack of training spots for MDs in India.  

 

From your numbers, it looks like rural areas in Canada truly benefit from IMGs; particularly Saskatchewan (54%) and Newfoundland (41%). Quite a good reason to accommodate IMGs. Even if they move away after few years, other IMGs will fill their places.

 

I am not denying your point about ethical aspect of poaching doctors from poorer countries.  But  Canada is not actively recruiting those doctors; they come like thousands of other immigrants for their own reasons, and as the example above shows, not in staggering numbers. What we are discussing here is the practical matter what to do with IMGs who decided to immigrate to Canada. Is it better to let them practice in rural Saskatchewan, where very few of Canadian grads want to go, or shut-down doors to residency and have them drive a taxi..  

 

For India, many of those physicians would be MDs training in Canada and (likely) not returning home, same as the US. And 60 a year is nothing to scoff at - if our population was the size of the US, that'd be about 550. Proportionally, our impact on IMG poaching isn't much better than it is in the US when it comes to India (not to mention all the other countries we draw physicians from).

 

Canada was actively recruiting those physicians. Those numbers you see in Saskatchewan and Newfoundland are a direct result of that recruitment. South Africa had to chastise Canada for actively recruiting its physicians, predominantly to work in Saskatchewan or Newfoundland.

 

Keep in mind that those numbers are only from active physicians, not the foreign-trained physicians sitting around in Canada not practicing. There are still thousands of foreign-trained physicians in Canada unable to practice. In no small part because of crowding out by CSAs, only a small number of true IMGs gain residency here in Canada (180 last year). Cutting back residency positions for IMGs wouldn't affect the majority of foreign-trained physicians immigrating the Canada. I agree that it's pointless to have foreign-trained physicians driving taxis, but that's what we do anyway.

 

As mentioned, IMGs generally only practice in those locations because it's do that, or don't practice at all. Many leave those areas after their contractual obligations are up. Other IMGs may come in, but that rotating door of physicians is costly and has negative consequences for patients. If using IMGs in rural areas were the only option to get physicians to those areas, it might be worthwhile, but it's not. Recruiting physicians from those areas, or training physicians in them, increases the likelihood of Canadian-trained physicians to practice there and stay long-term. That's why we have regional requirements at most schools - heck, it's the major reason NOSM exists. It's also why relying on IMGs - whether CSAs or not - to staff rural communities is problematic, since CSAs are rarely from underserved communities and IMGs understandably tend to prefer larger metropolitan areas which have higher immigrant populations. IMGs are not the answer to inadequate staffing in rural areas - decades of trying that approach demonstrate as much.

[JohnGrisham]

For India, many of those physicians would be MDs training in Canada and (likely) not returning home, same as the US. And 60 a year is nothing to scoff at - if our population was the size of the US, that'd be about 550. Proportionally, our impact on IMG poaching isn't much better than it is in the US when it comes to India (not to mention all the other countries we draw physicians from).

 

Canada was actively recruiting those physicians. Those numbers you see in Saskatchewan and Newfoundland are a direct result of that recruitment. South Africa had to chastise Canada for actively recruiting its physicians, predominantly to work in Saskatchewan or Newfoundland.

 

Keep in mind that those numbers are only from active physicians, not the foreign-trained physicians sitting around in Canada not practicing. There are still thousands of foreign-trained physicians in Canada unable to practice. In no small part because of crowding out by CSAs, only a small number of true IMGs gain residency here in Canada (180 last year). Cutting back residency positions for IMGs wouldn't affect the majority of foreign-trained physicians immigrating the Canada. I agree that it's pointless to have foreign-trained physicians driving taxis, but that's what we do anyway.

 

As mentioned, IMGs generally only practice in those locations because it's do that, or don't practice at all. Many leave those areas after their contractual obligations are up. Other IMGs may come in, but that rotating door of physicians is costly and has negative consequences for patients. If using IMGs in rural areas were the only option to get physicians to those areas, it might be worthwhile, but it's not. Recruiting physicians from those areas, or training physicians in them, increases the likelihood of Canadian-trained physicians to practice there and stay long-term. That's why we have regional requirements at most schools - heck, it's the major reason NOSM exists. It's also why relying on IMGs - whether CSAs or not - to staff rural communities is problematic, since CSAs are rarely from underserved communities and IMGs understandably tend to prefer larger metropolitan areas which have higher immigrant populations. IMGs are not the answer to inadequate staffing in rural areas - decades of trying that approach demonstrate as much.

Ralk on the money, don't forget all the minimum wage workers with MDs, MBBS etc, who came here due to Canadas flawed immigration process only to be left in the dust after paying thousands of $$ to take all the qualifying exams (which btw, is a major cash cow).

[ralk]

Ralk on the money, don't forget all the minimum wage workers with MDs, MBBS etc, who came here due to Canadas flawed immigration process only to be left in the dust after paying thousands of $$ to take all the qualifying exams (which btw, is a major cash cow).

 

That's unfortunately the common denominator here - the immigration system. Whatever someone might think about how the medical system should treat foreign-trained physicians, it has to be congruent with our immigration system to work. That's not the case right now.

[older]

Most of the IMGs practicing in rural NL did not do residency in Canada. They were trained overseas and immigrated after they were fully trained. In NL for many years, they could get a provisional license to work at least temporarily (sometimes long term) without having done the LMCC/CCFP/Royal college. That was the draw of working in NL. Now, they still can get a provisional license, but now will need to get the LMCC within 3 years of starting if the are primary care.

 

Cutting IMG residency spots will not necessarily mean less IMGs for rural NL, since I don't believe the majority of those physicians had completed a Canadian residency anyway. 

 

NL was an exception. Everywhere else IMGs had to go through internship and residency, even if they were higly qualified specialists in their countries.  So residency spots for IMGs was not a moot question. Not sure how it works now, are you saying that after passing qualifying exams, they can get provisional license and practice?

[NLengr]

NL was an exception. Everywhere else IMGs had to go through internship and residency, even if they were higly qualified specialists in their countries.  So residency spots for IMGs was not a moot question. Not sure how it works now, are you saying that after passing qualifying exams, they can get provisional license and practice?

You don't need to have done a Canadian residency program, or even necessarily have passed CCFP or RCPSC exams to get a provisional license to work in a sponsored position. Hence, NL was often a destination for completely foreign trained IMGs to enter practice in Canada.

 

Post-Graduate Basic Clinical Training

To be eligible for a provisional license to enter general practice (family practice), international medical graduates must, amongst other requirements, have completed at least one year of postgraduate basic clinical training satisfactory to the College.

To be satisfactory to the College, postgraduate basic clinical training must meet all of the following core criteria:

1) The postgraduate basic clinical training must have been obtained in an established postgraduate training program accredited in the country of training as the standard for entry into general practice in that country (an “accredited postgraduate training program for entry into general practice”).

2) The accredited postgraduate training program for entry into general practice must be comprised of a minimum of a twelve (12) month rotating internship, which includes a minimum of eight (8) weeks’ rotation in each of Medicine, Surgery, Paediatrics, Obstetrics/Gynaecology and Psychiatry. The rotations must be completed as part of a continuous, uninterrupted program.

3) A rotating internship postgraduate training program completed other than as part of an accredited rotating internship postgraduate training program for entry into general practice is not accepted by the College as meeting the requirements of criteria 2) above.

4)   International medical graduates whose postgraduate basic clinical training does not meet the requirements of criteria 2) above may be eligible for entry to the Clinical Skills Assessment and Training Program (the “CSAT”), provided they meet the requirements for registration on the educational register of the College.

 

Post-Graduate Specialist Clinical Training

Medical practitioners are eligible to apply for a provisional license for entry into sponsored practice in a specialty of medicine if they meet the following criteria:

(i) Applicants who have graduated in medicine from an approved faculty or school of medicine and who have completed a minimum of four years of postgraduate training in the speciality in Canada, the United States of America, the United Kingdom, the Republic of Ireland, Australia, New Zealand or the Republic of South Africa. Such applicants may be required to have passed a specialist higher qualification examination administered by a medical authority responsible for specialist training in the country where the applicant completed postgraduate training.

(ii) Applicants who have completed three years of postgraduate training in internal medicine, pediatrics or emergency medicine in the United States of America in a program accredited by the Accreditation Council on Graduate Medical Education and who acquired by examination board certification in one of these specialties from the appropriate American Board.

 

https://www.cpsnl.ca/default.asp?com=Pages&id=164&m=382

[NLengr]

In contrast, here is the CPSO guidelines for Ontario.

 

To practise medicine independently in Ontario, whether as a family practitioner or specialist, International Medical Graduates (IMGs) must hold an Independent Practice certificate of registration issued by the CPSO. To qualify for an Independent Practice certificate, IMGs must have all the required Canadian postgraduate qualifications. The following are the core requirements for an Independent Practice certificate:

1. Degree in medicine from an acceptable medical school.
2. Part 1 and Part 2 of the Medical Council of Canada Qualifying Examination (MCCQE) or one of the acceptable alternative examinations.
3. Certification, by examination, by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).
4. Completion in Canada of one year of postgraduate training or active medical practice with pertinent clinical experience.
5. Canadian citizenship or permanent resident status.

[tiger]

I don't understand why Canadian schools place so much weight on ECs. You would have a hard time convincing me that a professional athlete would make a better doctor than someone who is research-oriented or has higher MCAT/GPA than the athlete.

 

And sometimes we are not even talking professional, but just mediocre provincial level. I don't see how this is related to studying Medicine. I love sports, but most "big" athletes or even artists I have met win their grades based on athletic, not on academic performance.

Personally, I had a school mate who got admitted based on being a professional dancer to NOSM. NOSM doesn't even require MCAT. The girl totally sucked on science, had a 3.7 GPA and got in based on geographical location and being a dancer. How is that fair?

 

What if one realizes one wants to study Medicine at let's say 25 or 30 years of age and has the stellar GPA and test scores, but no extracurriculars? They can't go back to 16 and become a pianist or an athlete? Does this mean that this person could not be the researcher that would benefit millions of cancer patients?

 

To me, the local system doesn't make much sense. And NOSM does not interview people who did not attend Highschool in the area, however a high % of their graduates go to Toronto and Southern Ontario for residency and even a higher number goes to practice elsewhere. Thus, the school discriminates admission based on geographic location and place of origin, but at the same time does not bind their graduates to Northern Ontario in any way. How is this fair?

I think we should stop talking about fairness in the Canadian medical system altogether.

 

I don't mean to offend students with strong athletic or artistic background, and certainly in some cases they could coexist with strong academic background, however, Canada, and to lesser extent the US are the only countries in the world that prioritize ECs over academic achievements.

 

I want my Doctor to be smart, intelligent, educated and skilled. I don't care if they play the piano or dance at national competitions.

 

Also, admitting people with strong ECs discriminate based on income. It is expensive to have your kid in hockey, tennis or another sport, to pay coaches in order to reach a high level of performance. It is expensive to volunteer in another country, or even in your country, when you have to work in order to pay your bills. It takes more than good intentions.

[oshaku]

I don't understand why Canadian schools place so much weight on ECs. You would have a hard time convincing me that a professional athlete would make a better doctor than someone who is research-oriented or has higher MCAT/GPA than the athlete.

And sometimes we are not even talking professional, but just mediocre provincial level. I don't see how this is related to studying Medicine. I love sports, but most "big" athletes or even artists I have met win their grades based on athletic, not on academic performance.

Personally, I had a school mate who got admitted based on being a professional dancer to NOSM. NOSM doesn't even require MCAT. The girl totally sucked on science, had a 3.7 GPA and got in based on geographical location and being a dancer. How is that fair?

What if one realizes one wants to study Medicine at let's say 25 or 30 yes of age and has the stellar GPA and test scores, but no extracurriculars? They can't go back to 16 and become a pianist or an athlete? Does this mean that this person could not be the researcher that would benefit millions of cancer patients?

To me, the local system doesn't make much sense. And NOSM does not interview people who did not attend High school in the area, however a high % of their graduates go to Toronto and Southern Ontario for residency and even a higher number goes to practice elsewhere. Thus, the school discriminates admission based on geographic location and place of origin, but at the same time does not bind their graduates to Northern Ontario in any way. How is this fair?

I think we should stop talking about fairness in the Canadian medical system altogether.

 

 

I think this board overblows the amount of ECs people need.  The problem with only looking at grades and MCAT is that study upon study have reported that grades and MCAT don't correlate with job performance.  Not med or any other profession.  Being a doctor is about more than knowing the sciences, it's also about understanding people.  Some examples of situations that a OB/GYN friend comes across in his practice include women after sexual assault, which sometimes the doctor recognizing the signs and tease it out of the patient, and dealing with obesity issues in his patients, convincing them that their weight is unhealthy and getting them to follow a weight-loss regiment.  Both situation require knowing how quickly assess a person and communicating in ways they are most receptive to.  Unfortunately, many people with perfect GPAs don't have that sort of people skill simply because it is not a skill that can be developed by studying.  Certainly not every specialty require these types of patient interaction, but when the goal of 50% of med graduate to enter family med (which isn't being met), it might feel like soft skills are overly emphasized by adcom.  ECs are ways the admission committee can use to look for soft skills.   Something I feel is very important to have as a primary care physician is the ability to establish a rapport with your patient very quickly, and that's something that you can't learn to do well without talking to or interacting with a lot of people.  Things like sports, clubs, art all involve interacting/working with other people, learning about them.

 

About the local system.  I agree it's not perfect.  Though looking at the CaRMS results, more NOSM student actually stay at their home institution than Mac, Queens and Ottawa, but less than Western and Toronto.  You're pointing out the problem, but f the class was mostly students from Toronto or god forbid southwestern Ontario, an even higher proportion of them would move back to the big cities.   As for not binding their graduates to Norther Ontario, it's legally sticky to be binding anyone to an area since mobility is pretty enshrined in the Charter of Rights and Freedoms.  They can only do that through soft factors like family and a history of connection.  I would not be so quick to discount the role of family and community connection in determining where NOSM graduates go.  Having gone to school in the southwestern Ontario area (not Toronto or London), I was surprised at how many people I know end up spending their lives in the same city or only moved within a few hours away.  I would also treat the talk about moving "south" with a grain of salt.  Northern indigenous communities (in Quebec) complain about how their youths are all moving south for work and opportunities.  A big draw in the "south" they were talking about turned out to be Val D'Or.  Are you kidding me? Val D'Or?? It's 4 hours straight north from Ottawa.  I'm also sure that place like Lanark county is considered "south" by people from Thunder Bay even though it's still technically Northern Ontario. 

[oshaku]

What if one realizes one wants to study Medicine at let's say 25 or 30 years of age and has the stellar GPA and test scores, but no extracurriculars? They can't go back to 16 and become a pianist or an athlete? Does this mean that this person could not be the researcher that would benefit millions of cancer patients?

 

 

I think again this board overblows what having (or not having) ECs mean.  Having no ECs means you've done absolutely nothing in you life except taking the core curriculum in school and did absolutely nothing else in your spare time.  Nobody I know is like that.  If you're 25 or 30, I would assume that you're working or have worked for a some time.  That's an EC.  If you went to grad school then there's loads of "ECs" that come part and parcel. For example: any conferences, posters, departmental talks count.  If things go well, you might get a publication or an award, which are ECs.  Most grad school require TAing as part of your funding, which counts as another EC.  

 

You don't have to be a pianist or athlete, you don't have to have volunteered for x-amount of years at a clinic or hospital or VP of some club/society.  I didn't decide I want to do med till last year when I was 23.  I did things with my time that reflected what I cared about (research and education) but they were none of the things that were particularly directed at med (no clinical/hospital volunteering, no sports, no music, no club activities) and things worked out fine for me. (Granted, most people in my life including me thought I'd take at least 2 cycles to be accepted) I though I was one of those people that have no ECs since I didn't prepare my life for med, but when app time came and I sat down to list everything I've done in the past 7 years, it turned out to be quite a lot (mostly little things though).  I think the only people who have absolutely no ECs are those who did absolutely nothing with their time (except sleep?) and care about nothing.

[older]

I don't understand why Canadian schools place so much weight on ECs. You would have a hard time convincing me that a professional athlete would make a better doctor than someone who is research-oriented or has higher MCAT/GPA than the athlete.

 

And sometimes we are not even talking professional, but just mediocre provincial level. I don't see how this is related to studying Medicine. I love sports, but most "big" athletes or even artists I have met win their grades based on athletic, not on academic performance.

Personally, I had a school mate who got admitted based on being a professional dancer to NOSM. NOSM doesn't even require MCAT. The girl totally sucked on science, had a 3.7 GPA and got in based on geographical location and being a dancer. How is that fair?

 

What if one realizes one wants to study Medicine at let's say 25 or 30 years of age and has the stellar GPA and test scores, but no extracurriculars? They can't go back to 16 and become a pianist or an athlete? Does this mean that this person could not be the researcher that would benefit millions of cancer patients?

 

To me, the local system doesn't make much sense. And NOSM does not interview people who did not attend Highschool in the area, however a high % of their graduates go to Toronto and Southern Ontario for residency and even a higher number goes to practice elsewhere. Thus, the school discriminates admission based on geographic location and place of origin, but at the same time does not bind their graduates to Northern Ontario in any way. How is this fair?

I think we should stop talking about fairness in the Canadian medical system altogether.

 

I don't mean to offend students with strong athletic or artistic background, and certainly in some cases they could coexist with strong academic background, however, Canada, and to lesser extent the US are the only countries in the world that prioritize ECs over academic achievements.

 

I want my Doctor to be smart, intelligent, educated and skilled. I don't care if they play the piano or dance at national competitions.

 

Also, admitting people with strong ECs discriminate based on income. It is expensive to have your kid in hockey, tennis or another sport, to pay coaches in order to reach a high level of performance. It is expensive to volunteer in another country, or even in your country, when you have to work in order to pay your bills. It takes more than good intentions.

 

 

You are missing the point why and how Admissions are looking at ECs. They don't want gold medals, they want all-rounded applicants -  a total bookworm who maxed out GPA/MCAT but never lifted his head from a textbook  is equally undesirable as a star athlete with not much in his head. Admission committees are trying hard to balance the criteria to ensure that they get  people who have not only academic ability but also exist as community members, teammmates, family members and generally human beings.

 

However, the fierce competition for places in our system warpes it all.  On academic side, it is not about academic ability anymore - perfectly capable people will not get in, people who are fractionally "better"  in MCAT or GPA feel disgustingly superior to those who also have excellent academic results but did not make it to the 10th percentile necessary to secure a place. The med schools who have reasonable cutoffs rather than ranking applicants in accordance to numbers are likely doing much better selection job, including NOSM (does 3.7 GPA really sucks? I would think this girl shows quite an academic ability if she balanced academia with professional dancing). The pressure on applicants to get better numbers is enormous, hence the moves that look stupid anywhere but here: taking second degrees or masters or fifth and sixth years, solely for the purpose  of "improving"  academics.  

 

On the EC side, people also feel that they have to outdo the others.  You should read posts on the applicants thread, full of questions such as what is a "right" or "best" or "best looking on the application" combinations on ECs. It is not about their interests or engagement anymore. And look how people whine about income discrimination, since money is supposed to buy "better" ECs.

 

But with this respect, I would trust Admission committees. The same people who once decided that MCAT/GPA genius with no people skills and no engagement of any kind would not make the best doctor, have enough intelligence and judgement not to seek professional athletes or music virtuosos. How much it costs you to volunteer in old people's home or doing things for your community? You may be surprised that this can count more on your application than somebody's athletic awards. I know of  a person who didn't have any time for ECs because she was taking care of her handicapped brother for years. Guess what? She got 3 offers.

 

Not taking away from athletes or artists - it's just that people contribute to the society in so many different ways.  People who make sincere contribution and show who they really are, on the application and at interviews, should be fine without an olympic medal.   The poster above is a very good example.

[tiger]

Thank you all for commenting on my post. Your perspectives are valuable and interesting. I come from a very unique background (in fact I went to high school in Europe, due to my father's work obligations), and was highly discouraged by some of the EC requirements. It is not that I am a bookworm. I have work experience, as well as volunteer experience in Canadian teaching hospitals + publications. I think I might have been over estimating the importance of athletic/artistic achievements. Moreover, I never fully understood the logic behind these requirements. So, thanks for the replies.

 

As to IMGs: I think medical education in Canada and the US is superior to the education in some other parts of the world. There is a reason why double lung transplant is done in Canada, but not in India, China, East Europe and so on. Better facilities as well, but also higher requirements are enforced for the medical students here. Hint: One of my parents worked as a professor in Central Europe and in the US. His impression was that the US system was superior, although some European graduates could eventually possess deeper knowledge in core medical sciences, but I doubt this is always of high importance in practice.

[GH0ST]

You are missing the point why and how Admissions are looking at ECs. They don't want gold medals, they want all-rounded applicants -  a total bookworm who maxed out GPA/MCAT but never lifted his head from a textbook  is equally undesirable as a star athlete with not much in his head. Admission committees are trying hard to balance the criteria to ensure that they get  people who have not only academic ability but also exist as community members, teammmates, family members and generally human beings.

 

However, the fierce competition for places in our system warpes it all.  On academic side, it is not about academic ability anymore - perfectly capable people will not get in, people who are fractionally "better"  in MCAT or GPA feel disgustingly superior to those who also have excellent academic results but did not make it to the 10th percentile necessary to secure a place. The med schools who have reasonable cutoffs rather than ranking applicants in accordance to numbers are likely doing much better selection job, including NOSM (does 3.7 GPA really sucks? I would think this girl shows quite an academic ability if she balanced academia with professional dancing). The pressure on applicants to get better numbers is enormous, hence the moves that look stupid anywhere but here: taking second degrees or masters or fifth and sixth years, solely for the purpose  of "improving"  academics.  

 

On the EC side, people also feel that they have to outdo the others.  You should read posts on the applicants thread, full of questions such as what is a "right" or "best" or "best looking on the application" combinations on ECs. It is not about their interests or engagement anymore. And look how people whine about income discrimination, since money is supposed to buy "better" ECs.

 

But with this respect, I would trust Admission committees. The same people who once decided that MCAT/GPA genius with no people skills and no engagement of any kind would not make the best doctor, have enough intelligence and judgement not to seek professional athletes or music virtuosos. How much it costs you to volunteer in old people's home or doing things for your community? You may be surprised that this can count more on your application than somebody's athletic awards. I know of  a person who didn't have any time for ECs because she was taking care of her handicapped brother for years. Guess what? She got 3 offers.

 

Not taking away from athletes or artists - it's just that people contribute to the society in so many different ways.  People who make sincere contribution and show who they really are, on the application and at interviews, should be fine without an olympic medal.   The poster above is a very good example.

 

Totally agree with this... it's sad that our warped perceptions of a decent GPA, MCAT, and/or ECs that 3.7 is looked at as "low." I mean to most people they would be satisfied with that. There are also so many cases of people near that range that had one bad year or had slips in their academic performance spread out based on when they took their classes, different commitments etc....

 

I think the other thing just from a grades point of view is ... do we really need to smartest people to be in medicine? If we don't get the top 5% ... would the top 15% do worse? It's all a matter of perspectives too... do we really need geniuses (which arguably isn't even reflected purely by GPA and MCAT) to be in medicine? Sure we need bright people... but there's so much more to it than that.

[medhope15]

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[medhope15]

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[older]

Thank you all for commenting on my post. Your perspectives are valuable and interesting. I come from a very unique background (in fact I went to high school in Europe, due to my father's work obligations), and was highly discouraged by some of the EC requirements. It is not that I am a bookworm. I have work experience, as well as volunteer experience in Canadian teaching hospitals + publications. I think I might have been over estimating the importance of athletic/artistic achievements. Moreover, I never fully understood the logic behind these requirements. So, thanks for the replies.

 

As to IMGs: I think medical education in Canada and the US is superior to the education in some other parts of the world. There is a reason why double lung transplant is done in Canada, but not in India, China, East Europe and so on. Better facilities as well, but also higher requirements are enforced for the medical students here. Hint: One of my parents worked as a professor in Central Europe and in the US. His impression was that the US system was superior, although some European graduates could eventually possess deeper knowledge in core medical sciences, but I doubt this is always of high importance in practice.

 

 

You don't say where in Europe you studied, but I can assure you that UK med schools look at Personal Statement & ECs even more than those in Canada (that's on average - some care more than others). However, they are far form encouraging applicants to assemble a collection of "right"  ECs. To the contrary,  schools emphasise again and again that it is not important what kind of experience you had, but what you learnt from it. You are supposed to reflect on your experiences in your PS, which is an important component of the application.  Grades and UKCAT/BMAT are just that - grades -  you are supposed to  pass cutoffs, but few points better than other applicants will not necessarily get you a spot.

 

You must  also be aware that admission systems differ significantly accross Europe (e.g. in France they admit everybody  to the 1st year of med school and brutal 1st year exams are the selector), but the aim is the same: select the best and most suited for the profession.

 

With regards to the "superiority" of US and Canadia medical  education, it is somewhat pointless to compare it with developing countries or even with Eastern Europe (where, by the way, education is quite good and well established - e.g Jagiellonian Unversity in Poland was teachig medicine since 1364, whilst buffalos were grazing at the future  UofT grounds).  If you think Canada and US are "the best"  why don't you compare them with the best? You really think that schools like Karolinska or Oxbridge produce doctors in a system inferior to UofS or UofFlorida? And you don't need a school with a  "name" to get good ediucation. European standards are the same for all med schools and are strictly enforced - much better enforced than in US and Canada where accrediting organization inspects med schools every 8 years or so, to find 160+ non-conformancies - see McGill probation thread.

 

I don't like using rankings as an argument because they reflect other factors than quality of education, but still in the 2014 med schools world ranking, there were 6 US schools, 3 UK schools and one Swedish (none Canadian) . Considering population of these countries and the number of med schools, the superiority claims are at least open to querry.

 

The impression that "some European graduates could eventually possess deeper knowledge in core medical sciences" is probably true but it does not contradict the fact that practical  training is very strong in Europe - in UK students have OSCE starting in the 2nd or 3rd year of the 6th year program. If you need to disparage IMGs, spare those educated in European system please. In any case, generalization you present here have little facts to support it .

[tiger]

older, I agree with most of what you said in the above post about European schools. I have a lot of respect for the school system there and I do believe it is a more traditional and established system than the one in developing countries. After all, I love Europe as a continent, their cultural and scientfic contributions built the roots of civilized society and if you wanna know one of my parents was born in a Central European country, so the continent is dear to my heart. After finishing highschool in Poland, I did stellar in all subjects in my undergrad, without even putting much effort into it. I thought  scientific courses at university here were thought in a more simple way than the same courses were in the EU. Take Chemistry, for example. A lot of the material I took in undergrad, was already thought in my highschool classes, and it was presented in a more complicated way in highshcool.

I think, you entirely missed my point. I gave China and India as an example as well.

And ulimately, you can not put all IMGs or all Canadian graduates under the same umbrella. There are a lot of individual factors that determine one's ability to practice a certain profession.

You are right I do not have a lot of facts to support my "generalizations" at this time, as there is not that much research on objectively comparing foreign medical schools with North American schools, or at least not a lot that I have access to. However, I am not quite sure you properly read my "generalizations".

I am well aware, that US schools are ranked better than Canadian schools, but I never said anything about comparing US and Canadian schools. I would gladly go to most US schools, especially those, that care more about test scores and academic ability versus references for example.

 

medhope 15 I think made one of the best posts on this forum! Especially in regards to hospitals politics, which make no sense to me at the present.

 

I personally had a very bad experience with doctors in Poland and this makes me quite biased. To be honest, I have seen similar medical cases in Canadian hospitals managed much better, but this is just a personal opinion. There is no need to personally attack me for my post, it expresses my sole opinion. I have lost a young relative in the european medical system due to medical mistakes/malpractice. I firmly decided that I do not want to study Medicine there. I work in healthcare in Canada and I like the local system better. Of course, mistakes do happen everywhere, but one should learn from experience as well. As I said, I do have some "unique" life experiences, that take more than one sentence to relay.

I have had a lot of serious family and community commitments throughout my undergraduate and graduate studies, so again, I do not speak from the viewpoint of a "bookworm".

 

And, no, you do not need the smartest people in Medicine. People's skills are important as well. However, these skills are much more difficult to evaluate for admission purposes, and make the whole process very subjective. If everyone considers communication skills and character very important, why do not you use some kind of a psychological testing to weed out applicants. The police has psych testing, why not use it for med school admissions?

 

My "dancer" friend for example,  liked to lie to professors and other people and slept with half of the graduating class prior to admission, asking them to recite their interviews over and over again. Knowing her intellectual potential and character, I would rather die, than go to her for any kind of medical advice. I guess, her ECs looked good on paper though.

 

My point is, nooone would say in an interview that they want to pursue Medicine for the wrong reasons or reveal any kind of defamatory information.

[oshaku]

With regards to the "superiority" of US and Canadia medical  education, it is somewhat pointless to compare it with developing countries or even with Eastern Europe (where, by the way, education is quite good and well established - e.g Jagiellonian Unversity in Poland was teachig medicine since 1364, whilst buffalos were grazing at the future  UofT grounds).  If you think Canada and US are "the best"  why don't you compare them with the best? You really think that schools like Karolinska or Oxbridge produce doctors in a system inferior to UofS or UofFlorida? And you don't need a school with a  "name" to get good ediucation. European standards are the same for all med schools and are strictly enforced - much better enforced than in US and Canada where accrediting organization inspects med schools every 8 years or so, to find 160+ non-conformancies - see McGill probation thread.

 

Older doesn't necessarily mean better and I rather don't think education in europe is better than canada and the states.  Having went to at institutes on the level of Karolinska and Oxford, I don't think they produce superior graduates.  What they have is access to more resources, maybe that's your definition of "superior" then.  It seems rather pointless to talk about europe in general since, as you said, it varies so much country to country. I lived in the germanic part of europe, so I have a good grasp of Austria, Germany and Switzerland, but I wouldn't dare to generalize those experiences to all of europe.

 

If you've been on the McGill probation thread, you'd know it's 24 non-compliances, not 160+, and in the 8 years since the last review, review committee examined everything for the past 5 years.

[tiger]

I agree, there is a lot of differences between medical schools in West, East and Central Europe, even in between the countries within the different parts of Europe. I have travelled a lot within the EU. And, it seems the UK is a different world as well.

[medhope15]

I agree 1000% with Tiger.

Medicine requires skill. When you have a patient in the ER with chest pain or an open tibial fracture, you better know how to analyze EKGs or perform a reduction/fixation surgery. I don't see where having a 4.0 in organic chemistry assists with any of this. Docs look drugs up on their phones all the time, they ask the pharmacist to verify drugs... What I'm trying to say is marks and gpa and mcat scores are just an indication that you can take material, memorize it, spit it out, maybe hey get lucky on the mcat (1-2 lucky guesses can bump you up a score). There is no real assessment of the ability for hands-on skill, thinking on your feet, making critical decisions etc. I already stated above how undergrad marks have a massive pre-planned strategy to them. If you can get yourself a nice network and basically harass your TAs at every office hour, you can get tips/clues for exams etc. It's not really an indicator of "intelligence" to me anyway.

 

If the health care system were perfect we wouldn't have all these problems today. But we have lots of problems, MDs mispronouncing an infant to be dead, lack of top notch drugs and people begging / petitioning to have special drugs delivered, wait times of months to years to see specialists, if I start to get eye symptoms I'm waiting months to see someone?? so I can finally see a doctor when I'm blind?? I have relatives all over the world and noone has ever waited "months" to see a surgeon or other specialist.

 

I hope we can fix this system, as the population ages we are going to be in deep trouble.

[older]

Tiger, you brought many points in you previous post, some of them were discussed before.  Nothing personal,  we might have different opinions - that's what the Forum is for. 

 

Anyway, I am sorry to hear that you lost a relative due to medical mistakes/malpractice somewhere in Europe. Unfortunately this happens, whether there or here. Even the renowned, first-class institutions like Sick Kids are not immune.

 

Withe regards to your experience in Poland  and similar medical cases in Canadian managed  better, I can't comment specifically - but you have to take into  consideration that the former Eastern Bloc countries, while having academic traditions and schools not worse than Western Europe, may simply lack resources . These are relatively young economies that are still trying to shake off the impacts of WWII that were tragically compounded  by 50 years of communist regime.

[older]

I agree 1000% with Tiger.

Medicine requires skill. When you have a patient in the ER with chest pain or an open tibial fracture, you better know how to analyze EKGs or perform a reduction/fixation surgery. I don't see where having a 4.0 in organic chemistry assists with any of this. Docs look drugs up on their phones all the time, they ask the pharmacist to verify drugs...unless you are some kind of MD / PhD developing a new medication, you are not going to need to know the steps of organic chemistry. Nor will you need to know how to analyze a comparative literature theory passage in 8 minutes. It sucks because lots of us want to be MDs, but we have to put up with this process.

 

If the health care system were perfect we wouldn't have all these problems today. But we have lots of problems, MDs mispronouncing an infant to be dead, lack of top notch drugs and people begging / petitioning to have special drugs delivered, wait times of months to years to see specialists, if I start to get eye symptoms I'm waiting months to see someone?? so I can finally see a doctor when I'm blind?? I have relatives all over the world and noone has ever waited "months" to see a surgeon or other specialist.

 

I hope we can fix this system, as the population ages we are going to be in deep trouble.

 

You agree with Tiger on what?  That medicine requires skills? Nobody in right mind questions that.  And what do you want to fix within the system (here, presumably) that would make doctors more skilled?

[武田信玄]

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.

I'd love to hear your opinions on IMGs in pharmacy and dentistry.

[oshaku]

I agree, there is a lot of differences between medical schools in West, East and Central Europe, even in between the countries within the different parts of Europe. I have travelled a lot within the EU. And, it seems the UK is a different world as well.

 

UK, though still a part of the EU, doesn't consider itself to be european at all.  It's not even in the Schengen area.