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

[ralk]

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

 

Dentistry is fairly similar to physicians. They live more in a market economy, but it's a rather inflexible one with high barriers to entry domestically and a large pool of foreign-trained dentists in Canada not practicing, so much the same logic that applies for physicians applies to dentists. There's more than enough Canadians who want to be dentists, so I don't see much purpose in opening up the floodgates to foreign-trained dentists. However, since dentistry is largely not paid for by governments and they do ultimately live in a market economy, I don't think we can justify constraints on the number of foreign-trained dentists to the same degree we can for physicians. I think maintaining high standards for foreign-trained dentists is enough (passing the boards, etc.), rather than strict numerical controls. I have no idea if that's currently the case though. From what I understand most foreign-trained dentists still fail to gain a right to practice here, but many individual dentists and dentistry associations feel the requirements are too lax. I'll take their word on it, I don't know enough about dentistry to make any judgment on that front. There's also some concern about a rising CSA cohort in dentistry which, if true, would provide more justification for clamping down on foreign-trained dentist numbers.

 

I really can't speak to pharmacy at all. I know their job market has gotten tighter recently (along with most medical professions), though I wonder how much that has to do with expanded domestic training. No idea how many foreign-trained pharmacists there are. It's a competitive program to get into, once again with no shortage of Canadian aspirants, so I see no reason to encourage foreign-trained pharmacists to come here, but I don't know enough about their job market to argue for actively keeping them out either.

[tiger]

In my opinion what makes the Canadian and possibly the US physicians "superior" is the residency training, access to more resources, better facilities and more incentives for life long learning, as they call it.

 

As I said, a lot of students I met in Eastern and Central Europe were strong in sciences and some were exceptionally smart people, who, given the appropriate training would make great physicians here or there. The way I saw it, the problem with their system was that most of them were not given the training and opportunities to develop.

 

 

When discussing how to solve problems within the current Canadian healthcare system, most people on here ignore external factors. Namely, the growing number of Immigrants and citizens of third world countries, obtaining OHIP in Canada, and ways in which this provincial government fails to fund healthcare.

Low number of CMGs, coupled with low number of residency spots simply does not meet the demand for services.

Thus, I believe both could be increased without any effect on physician's compensation or work loads.

I do believe that it might be fair for only CMGs to play in the first round match. But there is enough space in the system for IMGs or CSAs, who could be selected in second round.

 

Otherwise, even a government regulated market would find ways to equalize itself, and they might be less than ideal ways.

 

At the end people wait for operable cancer surgery for months until they get mets and become inoperable.

 

There must be a solution to this somewhere.

Just my sole option.

[NLengr]

At the end people wait for operable cancer surgery for months until they get mets and become inoperable.

 

Any evidence of this? Our system is actually pretty good at getting you treated if you have a serious life/limb threatening illness. It's elective stuff that you wait months-years for.

 

Getting operations completed isn't constrained by number of physicians. It's constrained by limited hospital budgets who can't afford to give enough OR time to the surgeons who are on staff. We have recent grads in Canada who struggle to find work, and long waiting lists for many elective surgeries. The crunch is in OR time.

[older]

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.

 

So what that UK is not in Schengen? You can still get in without visa, study and work there if you have EU passport.

 

If you want to make a point that UK keeps its distance, you are right, but more meaningful and consequential indication is opting out from Economic and Monetary Union, and Charter of Fundamental Rights of European Union.

[older]

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.

 

 

If you read my post you'd notice that I never said Karolinska and Oxbridge produce superior graduates.  I questioned whether they produce inferior graduates, as those who like generalizations seem to imply. I find North American "superiority" complex quite annoying. Developing coutries aside, the Old World and Canada/US have excellent med schools, some maybe better and more prestigious than others, but generally they are all regulated and must keep high educational standards.

 

But education of doctors is one thing, whilst quality of national health systems is another. You may have excellent doctors but less than excellent healthcare for the population if the system sucs.  US comes to mind as the worst example. Think of people who have no access to those excellent doctors and hospitals. Other countries may have  excellent doctors and universal health care, but limited resources (e.g. former Eastern Bloc).

 

Withe regards to McGill probation, you are correct - I miswrote - they did not fail 160+, they failed 24 criteria out of 160+. The  point I was making is that standards may not be  effectively enforced - compliance asssessment by regulatory bodies in 8-year interval is not sufficient if schools lack internal controls. McGill probation shows it clearly. You'd think that they do self-assesments and correct problems before the external regulator puts them on probation. One more point to question "superiority".

[oshaku]

So what that UK is not in Schengen? You can still get in without visa, study and work there if you have EU passport.

 

If you want to make a point that UK keeps its distance, you are right, but more meaningful and consequential indication is opting out from Economic and Monetary Union, and Charter of Fundamental Rights of European Union.

 

Which might yet happen.... If there is a point (which there wasn't supposed to be), I suppose it'd be as much as each country differs in the EU, UK is even more so. Being Schengen matters a lot for people who live and travel there. 

 

If you read my post you'd notice that I never said Karolinska and Oxbridge produce superior graduates.  I questioned whether they produce inferior graduates, as those who like generalizations seem to imply. I find North American "superiority" complex quite annoying. Developing coutries aside, the Old World and Canada/US have excellent med schools, some maybe better and more prestigious than others, but generally they are all regulated and must keep high educational standards.

 

But education of doctors is one thing, whilst quality of national health systems is another. You may have excellent doctors but less than excellent healthcare for the population if the system sucs.  US comes to mind as the worst example. Think of people who have no access to those excellent doctors and hospitals. Other countries may have  excellent doctors and universal health care, but limited resources (e.g. former Eastern Bloc).

 

Withe regards to McGill probation, you are correct - I miswrote - they did not fail 160+, they failed 24 criteria out of 160+. The  point I was making is that standars may not be  effectively enforced - compliance asssessment by regulatory bodies in 8-year interval is not sufficient if schools lack internal controls. McGill probation shows it clearly. You'd think that they do self-assesments and correct problems before the external regulator puts them on probation. One more point to question "superiority".

 

I'm really curious as to why you feel the need to be so aggressive.  The definition of inferior is superior, which is what I thought you meant when you think they are not inferior.  Honestly I think neither of us know enough about what McGill does and doesn't do and doesn't do to comment much about it much.  

[older]

 

I'm really curious as to why you feel the need to be so aggressive.  The definition of inferior is superior, which is what I thought you meant when you think they are not inferior.  Honestly I think neither of us know enough about what McGill does and doesn't do and doesn't do to comment much about it much.  

 

I re-read my post, where is it agressive? My apologies if it came out that way. Actually I decry using highly subjective and possibly offensive terms as   "superior" or "inferior", especially when generalizing (hence quotation marks).

 

About McGill, details are in the report for everybody to see, While it is disappointing that such a reputable med school was put on probation, the regulatory process that ensures consistency and quality of medical education is highly commendable.

[ralk]

I know this thread has been dormant for a little while - but I recently checked the Ross website and saw three matches into UofT family and internal (6 total to uoft). now I don't know how many mcgill grads matched into uoft, but there is at least one who couldn't match into FM (lurie). And I realize, that this was possibly a dedicated stream, etc... Nonetheless, one is forced into a couple of conclusions based on the outcome of the general policy: a) admission based on high gpa and mcat scores doesn't really matter for clinical performance; or b] the training at Ross is much better than the training at McGill in terms of clinical readiness despite the possible lesser caliber of student based traditional admission metrics. Now I realize that this is a sample size of one, and that many people felt he (lurie) have tried to really back-up toronto - but why is that? I mean a Ross graduate by that reasoning should never try Toronto, but many do and are successful... A great deal of interesting discussion resolved around ethics of studying abroad etc,, but I'd like to understand this case a bit better and appreciate any thoughts. Just for reference stats at Ross - avg gpa on admission is 3.2 and mcat 24. When Mcgill had the mcat it was avg 32 and gpa my guess about 3.8.

 

You answered your own problem - dedicated streams.

 

U of T fills all its programs for both CMGs and IMGs in the first round and virtually every program is quite competitive. A McGill student is competing against all the CMGs. A Ross student is competing against all the IMGs. Saying some students from Ross are better than other IMGs and some students from McGill are worse than other CMGs tells you absolutely nothing about the relative strengths of the individual students in question. Those students are never compared. It tells you even less about the relative education students get at McGill and Ross because you don't have the numbers of students from McGill who were successful, or the numbers from Ross who weren't.

[indefatigable]

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[xkittens]

I know this thread has been dormant for a little while - but I recently checked the Ross website and saw three matches into UofT family and internal (6 total to uoft). now I don't know how many mcgill grads matched into uoft, but there is at least one who couldn't match into FM (lurie). And I realize, that this was possibly a dedicated stream, etc... Nonetheless, one is forced into a couple of conclusions based on the outcome of the general policy: a) admission based on high gpa and mcat scores doesn't really matter for clinical performance; or b] the training at Ross is much better than the training at McGill in terms of clinical readiness despite the possible lesser caliber of student based traditional admission metrics. Now I realize that this is a sample size of one, and that many people felt he (lurie) have tried to really back-up toronto - but why is that? I mean a Ross graduate by that reasoning should never try Toronto, but many do and are successful... A great deal of interesting discussion resolved around ethics of studying abroad etc,, but I'd like to understand this case a bit better and appreciate any thoughts. Just for reference stats at Ross - avg gpa on admission is 3.2 and mcat 24. When Mcgill had the mcat it was avg 32 and gpa my guess about 3.8.

What ralk said + you don't know when the people that matched into UofT graduated. They could've been in the same situation as the guy in the article and spent years padding their resumes for all you know. I couldn't find any more information on the Ross website other than a list of the schools and programs anonymous people matched to. For profit institutions have every incentive to spin their products in the best possible way and I wouldn't put it beneath a university that has subway ads to selectively withhold information. 

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[xkittens]

It may be wise to remove any information that could be used to identify individuals. Unless you have their permission of course.

Including the year that each student graduated isn't really identifying information, but it's very telling about the real match rate of a university. Both Ross and St. George don't include this information, although the latter uni throws peoples' names in there haha

https://postgrad.sgu.edu/ResidencyAppointmentDirectory.aspx?year=2014

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[indefatigable]

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[ralk]

Clearly they're going to spin their info. But I highly doubt the ross matches would be sitting around at Ross for a year waiting to match into UofT.

 

I feel that The discussion is kind of turning lurie into a scapegoat - ie he was somehow inferior (older and poor clinical skills maybe)? But I really do wonder how many Cmgs try to match into UofT but are unable to, which brings me back to the original point regarding say mcgill vs ross.

 

Lots of CMGs rank U of T first and match to a different school - the GTA produces huge numbers of medical students who tend to want to stay/return to the GTA. Even if you had that data, it's still comparing apples to oranges, and would tell you nothing about McGill's relative strength to Ross.

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[older]

Including the year that each student graduated isn't really identifying information, but it's very telling about the real match rate of a university. Both Ross and St. George don't include this information, although the latter uni throws peoples' names in there haha

https://postgrad.sgu.edu/ResidencyAppointmentDirectory.aspx?year=2014

 

More interesting than people's  names is the info where they were matched - I am surprised that SGU, not highly regarded by Canadian grads, places so many people in highly desirable places like Boston, New York, and programs like at Mayo, or Yale-New Heaven - or even our McMaster.  If CMGs and IMGs are as under-educated as some suggest, how would they match?  

[indefatigable]

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[JohnGrisham]

More interesting than people's names is the info where they were matched - I am surprised that SGU, not highly regarded by Canadian grads, places so many people in highly desirable places like Boston, New York, and programs like at Mayo, or Yale-New Heaven - or even our McMaster. If CMGs and IMGs are as under-educated as some suggest, how would they match?

There's a lot more to it than that. Many east coast programs in the US are IMG friendly because they need the steady supply to keep their hospitals running. And as well not every brand name program is good, satellite sites and all that.

 

Geographically, NY, NJ etc simply also have a lot of programs. With that comes a lot of variety too.

 

But yes of course, of those that match, many do match at decent and sometimes even strong places-because those people were either strong students in the first place And just were unlucky in Canada OR they turned it around during medical school where it really matters.

[JohnGrisham]

Also, I know for a fact that 1 IMG who matched FM at uoft this year, was a second time applicant to CaRmS(and ignorantly didn't apply nrmp the first time around)

[indefatigable]

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[indefatigable]

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[JohnGrisham]

In economics, there is an assumption that the market is always operating efficiently. Let's assume that those streams are there b/cause decision-makers believe that the Img bring a certain competitiveness that the Cmgs lack.

 

So aside from a bureaucratic convenience, both the cmgs and the imgs are being hired for the same job - which makes them more like than unlike - ie apples and apples. In this case, it's very relevant to compare them. One could argue that it is political pressure etc for the imgs - ie dedicated steams shouldn't exist - but otherwise - supposing a meritocracy then the question arises what is happening here which means that the decision-makers feel they have to look abroad?

Its mostly political pressure, and a means to be able to put some IMGS in underserved areas with ROS. Many IMG positions have ROS tied to it.

[rmorelan]

In economics, there is an assumption that the market is always operating efficiently. Let's assume that those streams are there b/cause decision-makers believe that the Img bring a certain competitiveness that the Cmgs lack.

So aside from a bureaucratic convenience, both the cmgs and the imgs are being hired for the same job - which makes them more like than unlike - ie apples and apples. In this case, it's very relevant to compare them. One could argue that it is political pressure etc for the imgs - ie dedicated steams shouldn't exist - but otherwise - supposing a meritocracy then the question arises what is happening here which means that the decision-makers feel they have to look abroad?

also an assumption the market participants are also 100% rational

 

They aren't Politics often isn't fully rational to say the least. They may not feel they have to look abroad but have to support the immigration policies in order to the federal government and get other things in return (two,levels of government in play here at least).