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thestar10

50 Cmg Pgy1 Spots Being Slashed Over The Next Two Years.

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Sigh. Once again, you call everyone entitled and naive while you spout your opinions about things you don't understand.

 

Kingston may be 110 thousand, but their catchment is much larger.

Queen's the medical school is amazing...in fact almost chose the school (but because of family reasons opted not to).  But the fact that the cachement area goes to Brockville in the east and as far as Trenton in the West does not change the fact that most KGH based teaching has a much smaller catchment.  Many people from the far reaches of the catchment area choose Ottawa or GTA based specialists.   When it comes to Gen Surg consults or Ortho consults...the true catchment area is only around 150-200 thousand at most.  Napanee and Gananoque are close...Bellville is nearly an hour away, and Brockville is also 45-60 minutes away (and only has 15 thousand or so people). 

 

Queen's probably should have no more than 65-70 medical students per class.  100 is really pushing it.

 

And yes...I do 'understand'.   At least much of the political stuff - as well as some of the stresses educators in medicine have as well.  Nothing like having tons of family in medicine to help with that. Are you denying that the OMA tour meetings aren't as I described (generally whenever an issue of hot importance comes up, the president of the OMA, with an entourage, does a tour of all the major city centers in the province giving town hall meetings and answering questions - they are also catered with gourmet meals). 

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I'm not advocating greater pay cuts necessarily.  But some of the demands by the premeds and med students on this board are ludicrous.  Increase medical spots!  Increase residency spots!  Create more specialist jobs!  The CMAs demand more CMA positions!  For once, I would wish that instead of greed based self interest - some of the people on this board would understand things are more nuanced.  The government doesn't get pleasure from cutting residency spots.  They are doing it because there are WAY too many residency spots. 

 

 

Except there are not "way too many residency spots". The ratio of spots to graduates is not at an all time high. In fact, it's on the low end right now I believe.

 

The government of Ontario is broke. They spent themselves so far into the hole over the past 10-15 years that they are struggling to find ways to make ends meet. To make matters worse, they can't take advantage of low oil prices (and a dropping Canadian dollar) because Ontario manufacturing is a shell of what it once was. They're cutting spots to save money. That's the long and short of it. Unfortunately, a corresponding cut to medical student positions was not carried out, which would have made more sense than an isolated cut of post graduate training positions.

 

I gotta ask: what point are you at in your training? Are you even in medical training?

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Queen's the medical school is amazing...in fact almost chose the school (but because of family reasons opted not to). But the fact that the cachement area goes to Brockville in the east and as far as Trenton in the West does not change the fact that most KGH based teaching has a much smaller catchment. Many people from the far reaches of the catchment area choose Ottawa or GTA based specialists. When it comes to Gen Surg consults or Ortho consults...the true catchment area is only around 150-200 thousand at most. Napanee and Gananoque are close...Bellville is nearly an hour away, and Brockville is also 45-60 minutes away (and only has 15 thousand or so people).

 

Queen's probably should have no more than 65-70 medical students per class. 100 is really pushing it.

 

And yes...I do 'understand'. At least much of the political stuff - as well as some of the stresses educators in medicine have as well. Nothing like having tons of family in medicine to help with that. Are you denying that the OMA tour meetings aren't as I described (generally whenever an issue of hot importance comes up, the president of the OMA, with an entourage, does a tour of all the major city centers in the province giving town hall meetings and answering questions - they are also catered with gourmet meals).

Their catchment is over 600 000 actually. That's for internal but still.

 

http://deptmed.queensu.ca/education/prospective/welcome

 

And I wasn't talking about the OMA tour meetings. Because I have no experience with them. And I don't like to express strong opinions about things I have no knowledge of.

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wow. Meanwhile med school admission applications are so rigorous and they drill you on your dedication to x, y, z, and your research interest in this and that...and at the end of the journey there isn't even money to continue your research interest or pursue your dream of x,y,z....

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I don't think it's necessarily "entitlement" when you expect to have some kind of residency position available to you after your medical school training when you were basically told that from your first day in medicine. I have talked to innumerable physicians who say "Do what you love" etc with seemingly little incorporation of the economic situation and the tightening crunch on residency spots. While I agree that much of the uproar is from people wanting to match to very specific specialties and specific locations, it is still unreasonable for a med student to not have to go to the other side of the country to train in a specialty that is not what they're interested in. The mentality that has been reinforced for years is that if you make it into a Canadian med school, you are likely to do well after in terms of being able to pick a speciality that interests you and practice somewhere you like. To be suddenly denied that can be disconcerting. This impacts the current clerks much more than the incoming clerks- they have to submit their CaRMS apps in a few months and official numbers for which specialties are affected have not even been announced. Worse, this trend could continue in the coming years- what about 100 cuts in 4 years? Until the govt explains its rationale for what it is doing, there is going to be a lot of upset people.

 

I agree with schmitty- we may be reacting too aggressively when there is still limited info- at the end of the day, the cuts could, perhaps, relate to positions that actually do go routinely unfilled. In which case, this may not be so dramatic as it presently appears. 

 

More info is needed before we started jumping to conclusions.

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I don't think it's necessarily "entitlement" when you expect to have some kind of residency position available to you after your medical school training when you were basically told that from your first day in medicine. I have talked to innumerable physicians who say "Do what you love" etc with seemingly little incorporation of the economic situation and the tightening crunch on residency spots. While I agree that much of the uproar is from people wanting to match to very specific specialties and specific locations, it is still unreasonable for a med student to not have to go to the other side of the country to train in a specialty that is not what they're interested in. The mentality that has been reinforced for years is that if you make it into a Canadian med school, you are likely to do well after in terms of being able to pick a speciality that interests you and practice somewhere you like. To be suddenly denied that can be disconcerting. This impacts the current clerks much more than the incoming clerks- they have to submit their CaRMS apps in a few months and official numbers for which specialties are affected have not even been announced. Worse, this trend could continue in the coming years- what about 100 cuts in 4 years? Until the govt explains its rationale for what it is doing, there is going to be a lot of upset people.

 

I agree with schmitty- we may be reacting too aggressively when there is still limited info- at the end of the day, the cuts could, perhaps, relate to positions that actually do go routinely unfilled. In which case, this may not be so dramatic as it presently appears. 

 

More info is needed before we started jumping to conclusions.

 

To play devil's advocate...how could it be done better? Yes, it would be be 'better' for new MDs to be able to go to any specialty, wherever they want, but this is taxpayer money that is funding us and MDs provide a necessity of life. If the system was open, the huge inequalities and inequities in access to primary care MDs and specialists that already exists would be even greater than they are now. Of course it sucks think about moving to a place you don't want to live, possibly even for a specialty that is not your first choice (the last bit is not THAT common), believe me, I am stressing over it (and so is my spouse who has built a career in our current city), but I can't think of a way that would make all MDs happy AND suit the needs of healthcare longterm. 

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Queen's the medical school is amazing...in fact almost chose the school (but because of family reasons opted not to).  But the fact that the cachement area goes to Brockville in the east and as far as Trenton in the West does not change the fact that most KGH based teaching has a much smaller catchment.  Many people from the far reaches of the catchment area choose Ottawa or GTA based specialists.   When it comes to Gen Surg consults or Ortho consults...the true catchment area is only around 150-200 thousand at most.  Napanee and Gananoque are close...Bellville is nearly an hour away, and Brockville is also 45-60 minutes away (and only has 15 thousand or so people). 

 

Queen's probably should have no more than 65-70 medical students per class.  100 is really pushing it.

 

And yes...I do 'understand'.   At least much of the political stuff - as well as some of the stresses educators in medicine have as well.  Nothing like having tons of family in medicine to help with that. Are you denying that the OMA tour meetings aren't as I described (generally whenever an issue of hot importance comes up, the president of the OMA, with an entourage, does a tour of all the major city centers in the province giving town hall meetings and answering questions - they are also catered with gourmet meals). 

 

I don't think you understand that just because X number of students are training in a certain school, that does not mean the same number of students will be practicing in that area...

 

UBC accepts approx. 300 medical students a year, with 200 in Vancouver alone. That does not necessitate that there is actually an annual need for 200 new physicians in Vancouver. Many of them will go on to practice in other hospitals in other areas around the country. The medical school just train a group of students in a specific location, it does not mandate that students will definitely pratice there.

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I find this situation of reducing CMG spots while keeping IMG spots and welcoming Saudi residents ironic and horrible. I know CMGs unmatched for urology and dermatology, it is not rare.

The taxpayers and the government invest a lot of money in every CMG medical student while we cannot guarantee a residency spot for everyone, and we are reducing primary care residency spots while the population is aging and needs more complex care :(

The Saudi spots have nothing to do with us. They're not CaRMS spots and they're not taking away funded positions from CMGs. They come here, train and leave. Those spots are paid for by the Saudi government. i just wanted to clarify that. 

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If 54 spots went unmatched last year then the overall savings of cutting 50 spots is zero. All they are doing is taking the slack out of the system. This is a political stunt to show taxpayers they are cutting money for rich doctors. Your average person doesn't understand what this all means. They just like the cuts. But they can be informed. Gently.

 

If a tree falls and no one is there does it make a sound?

If a residency spot goes unfilled does it cost any money?

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If 54 spots went unmatched last year then the overall savings of cutting 50 spots is zero. All they are doing is taking the slack out of the system. This is a political stunt to show taxpayers they are cutting money for rich doctors. Your average person doesn't understand what this all means. They just like the cuts. But they can be informed. Gently.

 

If a tree falls and no one is there does it make a sound?

If a residency spot goes unfilled does it cost any money?

 

Not exactly. Many of those 54 spots were IMG positions which, as far as we know, aren't getting touched. In addition, all those unfilled spots went to the 2nd round, where all but 1 filled.

 

This isn't just taking away empty spots. In 2017, there will be approximately 50 fewer PGY-1s in Ontario. Not all of this reduction fall on Ontario MD grads - non-Ontario CMGs and IMGs will eat some of this loss too - but there will be fewer physicians able to practice as a result of this action by the Ministry.

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Not exactly. Many of those 54 spots were IMG positions which, as far as we know, aren't getting touched. In addition, all those unfilled spots went to the 2nd round, where all but 1 filled.

 

This isn't just taking away empty spots. In 2017, there will be approximately 50 fewer PGY-1s in Ontario. Not all of this reduction fall on Ontario MD grads - non-Ontario CMGs and IMGs will eat some of this loss too - but there will be fewer physicians able to practice as a result of this action by the Ministry.

 

This is not true...you are assuming that all 50 spots cut would have been filled, which is not true. Likely will push a few more outside of Ontario, but overall, the reduction in working PGY1's in Ontario will NOT be 50 in 2017.

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This is not true...you are assuming that all 50 spots cut would have been filled, which is not true. Likely will push a few more outside of Ontario, but overall, the reduction in working PGY1's in Ontario will NOT be 50 in 2017.

 

I'm not assuming they would have been filled, it's what happened. There was a single spot left unfilled in Ontario this year after the second round. So 49 fewer PGY-1's in Ontario, minimum.

 

It's true that there could be a redistribution to other provinces, which could mean the total number of PGY-1's across Canada won't fall by quite that many. However, excluding Quebec French-language programs that are not an option for the large majority of Ontario CMGs, there were only 10 unfilled spots in the second round across Canada, so that still means 40 fewer PGY-1's across Canada (barring an unexpected shift to Quebec). In addition, offsetting increases in the rest of Canada still means 50 (ok, 49) fewer PGY-1's in Ontario.

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I'm not assuming they would have been filled, it's what happened. There was a single spot left unfilled in Ontario this year after the second round. So 49 fewer PGY-1's in Ontario, minimum.

 

It's true that there could be a redistribution to other provinces, which could mean the total number of PGY-1's across Canada won't fall by quite that many. However, excluding Quebec French-language programs that are not an option for the large majority of Ontario CMGs, there were only 10 unfilled spots in the second round across Canada, so that still means 40 fewer PGY-1's across Canada (barring an unexpected shift to Quebec). In addition, offsetting increases in the rest of Canada still means 50 (ok, 49) fewer PGY-1's in Ontario.

 

Curious where you are getting your numbers? Using CARMS reports, these are the numbers for CMGs for 2015:

 

Total CMG Applicants: 912

Total CMG Spots: 1007

 

That means they can cut 50 from Ontario and still have the same number of Ontario PGY1s. Of course, it likley will go down a BIT since this may push a few more people to go out of province rather than take a less desirable position, but it doesn't doesn't mean a cut of 50 PGY1 working in Ontario based on the CARMS numbers.

 

EDIT: Whoops, noticed your link...that's weird, the numbers I read elsewhere must have been after round 1 only.

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I hope they cut pathology. THere are too many spots, not enough jobs, and too many IMG residents who shouldn't have matched to anything in it. Pathology is a dumping ground.

 

Cutting FM is unexpected. I wonder if they're going to cut the spots that have little interest, since that would make the most sense from a cost-cutting perspective. Cutting highly desirable urban spots will probably just push students into doing specialties. Lots of interest in urban FM comes from people with urban ties, not a love for FM.

 

They really should cut the number of IMG and CSA matches, and they should cut medical school admissions. Medical schools if acting in the best faith of their students should advise them to write American board exams and provide funding and courses to help them excel. Nothing ruins a career in medicine like going unmatched.

 

Ok thats like cutting the bridge you just crossed. I'm sure you wouldn't be saying that if you were a premed a CSA or an IMG.

 

Sure theres a lot of medical school spots in Canada now, but its not ridiculous. I'm not happy about 50 residency spots being cut in Ontario, but its just part of life and something you have to accept.

 

The amount of bias and self interest in a medical student saying we should cut medical school spots and not residency spots is massive.

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I'm not assuming they would have been filled, it's what happened. There was a single spot left unfilled in Ontario this year after the second round. So 49 fewer PGY-1's in Ontario, minimum.

 

It's true that there could be a redistribution to other provinces, which could mean the total number of PGY-1's across Canada won't fall by quite that many. However, excluding Quebec French-language programs that are not an option for the large majority of Ontario CMGs, there were only 10 unfilled spots in the second round across Canada, so that still means 40 fewer PGY-1's across Canada (barring an unexpected shift to Quebec). In addition, offsetting increases in the rest of Canada still means 50 (ok, 49) fewer PGY-1's in Ontario.

Has there been increases in the rest of Canada? I know NS cut some spots in some specialities. I don't know if they added spots to other specialties to make up the difference.

 

This will be a bigger problem if more provinces start cutting spots to save money too.

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Curious where you are getting your numbers? Using CARMS reports, these are the numbers for CMGs for 2015:

 

Total CMG Applicants: 912

Total CMG Spots: 1007

 

That means they can cut 50 from Ontario and still have the same number of Ontario PGY1s. Of course, it likley will go down a BIT since this may push a few more people to go out of province rather than take a less desirable position, but it doesn't doesn't mean a cut of 50 PGY1 working in Ontario based on the CARMS numbers.

 

I'm looking at the CaRMS report - I linked one of the tables in my previous post. What table are you looking at?

 

Spots don't just disappear after the first round, they get put into the second round, where they fill. There were 1192 PGY-1's this year in Ontario with only 1193 spots (this includes IMG and CMG spots) ultimately available (initially there were 1211 spots, but the quota appeared to be revised down). Take away 50 spots from 1193 and there's only 1143 to go around - hence, 49 fewer PGY-1's, minimum. If we go by the original quota before revisions, that's still only 1161 spots available, leaving 31 fewer PGY-1's, minimum.

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Has there been increases in the rest of Canada? I know NS cut some spots in some specialities. I don't know if they added spots to other specialties to make up the difference.

 

This will be a bigger problem if more provinces start cutting spots to save money too.

 

Not to my knowledge. From what I can tell, Ontario had a higher applicant-to-residency ratio than the rest of Canada last year, so it's not like there was a ton of flexibility in other provinces that could absorb this loss. From what I've been told, no changes to CMG spots are being announced in other provinces, in either direction, but that doesn't mean it couldn't happen.

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Ok thats like cutting the bridge you just crossed. I'm sure you wouldn't be saying that if you were a premed a CSA or an IMG.

 

Sure theres a lot of medical school spots in Canada now, but its not ridiculous. I'm not happy about 50 residency spots being cut in Ontario, but its just part of life and something you have to accept.

 

The amount of bias and self interest in a medical student saying we should cut medical school spots and not residency spots is massive.

 

We may not agree on much - but this I agree with.  You can's support one (cutting medical school spots) without support the other (residency spots) without being a self interested hippocrite.  I personally think both should be cut heavily.  I already have a medical school spot - and I suspect I'll be competitive for a residency spot in 4 years time.  And if I'm not - I probably didn't deserve that residency spot (even though I'd be whining at that time I'm sure - we all can be self interested at times).

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Sorry to be off topic, which med school are you going to in the fall? If it is not too indiscreet :P

We may not agree on much - but this I agree with.  You can's support one (cutting medical school spots) without support the other (residency spots) without being a self interested hippocrite.  I personally think both should be cut heavily.  I already have a medical school spot - and I suspect I'll be competitive for a residency spot in 4 years time.  And if I'm not - I probably didn't deserve that residency spot (even though I'd be whining at that time I'm sure - we all can be self interested at times).

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I ultimately chose western, after wracking my head between Queen's and Western.  In the end, London is home, and the larger city may allow for more unique clinical encounters than Queen's.  That being said - curriculum and infrastructure wise - Queen's impressed me the most of all the Canadian medical schools I interviewed at.

 

I did hold onto a couple of Western Canadian school acceptances for a while - in case something made me decide to move to Edmonton or Vancouver - but ultimately I gave up those spots.  A few lucky people a month ago got into both schools. 

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Ok thats like cutting the bridge you just crossed. I'm sure you wouldn't be saying that if you were a premed a CSA or an IMG.

 

Sure theres a lot of medical school spots in Canada now, but its not ridiculous. I'm not happy about 50 residency spots being cut in Ontario, but its just part of life and something you have to accept.

 

The amount of bias and self interest in a medical student saying we should cut medical school spots and not residency spots is massive.

 

The likely effect on the average medical student from this will be fairly minor. The large majority of us will match, most to a specialty/location that we're happy with, even after this change.

 

However, the objection most people have made is not that it'll be bad for us, but that it's poor policy. Cutting CMG residencies without cutting medical student spots just means more unmatched CMGs that the Ontario government paid to train. If they wanted to save money by cutting the number of CMGs trained, they should have cut both med student spots and residencies. If they just wanted to reduce the costs of residencies, cutting IMG spots would be a more efficient way to do so.

 

It is expensive to train physicians (and then to pay them once they're trained) and so cutting down the number of physicians trained could be a way to save on educational and health care costs. I may not agree that cutting those costs is a necessity or beneficial, but at I least understand how that could be a valid goal for the Ontario government to pursue. But paying for half of a physicians' training and not the rest means you leave a good portion of those savings on the table. That makes no sense to me.

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Those Western Canadian school's spots made some others very happy.

I ultimately chose western, after wracking my head between Queen's and Western.  In the end, London is home, and the larger city may allow for more unique clinical encounters than Queen's.  That being said - curriculum and infrastructure wise - Queen's impressed me the most of all the Canadian medical schools I interviewed at.

 

I did hold onto a couple of Western Canadian school acceptances for a while - in case something made me decide to move to Edmonton or Vancouver - but ultimately I gave up those spots.  A few lucky people a month ago got into both schools. 

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Since I'm a cynic, I suggest keeping your eyes open in the next couple of years (especially in the run-up to the next provincial election) for ads touting a corresponding increase in NP training*

 

"Your Ontario government is committed to providing quality health care to all Ontarians. That's why we're investing in training more nurse practitioners to provide primary care in Ontario."

 

"Nurse practitioners are health professionals who will take the time to listen to your health concerns...to give you the attention that you deserve...who will be there when you need them..."

 

etc etc etc

 

 

 

*Yes, I know the money for training comes from different pots, and it's not as simple as I'm making it out to be. But if I were Minister of Health, facing a huge deficit, and believed that NPs cost the system less than FMDs it's what I'd do.

 

I expect this to occur more aggressively in the near future. I'm not sure how the government expects to save money by employing nurse practitioners with 6 figure salaries, pensions, benefits, fixed work hours, and vacation. They also take more time with patients and as a result see fewer in a day. On top of that, receptionists and office staff/supplies would have to be paid for by he government.

 

I also wouldn't expect specialties beyond primary care to enjoy immunity against mid level creep. We already have nurse practitioners specializing in things like neurology.

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