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

[Bambi]

In politics, perception is reality.

[NLengr]

In politics, perception is reality.

True.

 

To answer the question about potential savings of NP's vs. Family Docs given all the extra expenses and less hours worked by NPs:

 

The government (as in the politicians) don't really care if they save money. To a politician, the important thing is that the public thinks the government is saving money. You get additional points if you act like you are sticking it to an enemy of the average joe (bankers, doctors, other politicians, dentists etc). What the government care about is the public thinking they are saving money. That's what gets you re-elected.

 

So the strategy is demonize physicians as overpaid, uncaring and out of touch. People who the average person is getting screwed by. Really whip up some general anger towards them. Then you try to replace them with NPs, who you portray as caring, down to earth practitioners, who are the ones who really care about the patient. You promote them as cheaper but do not provide any context as to costs of physicians vs. NP's (hours worked, pensions, office expenses, patients seen, use of tests, referrals to specialists etc). The public isn't going to take the time to learn about actual real world costs, or look at the actual government budgets. It's too boring and complex. The majority will believe the 10 second sound bite supplied by the government.

 

So now you have framed yourself as fighting the big bad overpaid out of touch MD lobby while saving the government money AND bringing in a group who really care about people. It doesn't matter if its true or not as long as most voters buy the story you are selling them. Then, you just sit back and watch the votes roll in.

 

This is the strategy you use for ANYTHING in politica. Look at the Conservative playbook from the last 10 years. It's not just limited to healthcare.

[ralk]

Western was kindly willing to share some further information on these cuts with current students that might be of interest to the wider community.

 

1) It's not just CMG positions as was initially reported, but 25 CMG positions and 25 IMG positions, with the 25 CMG position cuts coming in 2016.

2) The cuts are being spread across Ontario proportionally, with each school losing a proportion of their residency spots.

 

Still no information on the disciplines of the positions being cut - it sounds like that is still under negotiation and may be up to the individual schools in Ontario.

 

As a reminder, all the information coming out is not from the Ministry, which is the only official source on all of this, so the current information may be subject to change. To their complete credit, our student organizations and schools have been providing this information as they get it in order to keep Ontario medical students as up-to-date as possible, but they only know what the Ministry tells them.

[rmorelan]

Western was kindly willing to share some further information on these cuts with current students that might be of interest to the wider community.

 

1) It's not just CMG positions as was initially reported, but 25 CMG positions and 25 IMG positions, with the 25 CMG position cuts coming in 2016.

2) The cuts are being spread across Ontario proportionally, with each school losing a proportion of their residency spots.

 

Still no information on the disciplines of the positions being cut - it sounds like that is still under negotiation and may be up to the individual schools in Ontario.

 

As a reminder, all the information coming out is not from the Ministry, which is the only official source on all of this, so the current information may be subject to change. To their complete credit, our student organizations and schools have been providing this information as they get it in order to keep Ontario medical students as up-to-date as possible, but they only know what the Ministry tells them.

 

there are debates in the schools themselves to where the spots will be. Those discussions have been going on for a bit. Internally the cut were known way back in Dec of 2014 at least.

[ralk]

there are debates in the schools themselves to where the spots will be. Those discussions have been going on for a bit. Internally the cut were known way back in Dec of 2014 at least.

 

That lines up with what I've been hearing. It's a bit disappointing to know that schools have been aware of the cuts for that long, but I don't get the sense they have many firm details, even now.

 

Either way, the Ministry is the one making the change and should be the ones providing information to students, not pawning that responsibility off on schools or student groups. If this change has been in the works for this long, the fact that they still haven't officially informed us of the policy change is almost spiteful. My cohort now has some advance notice, but the 2016s have virtually no chance to respond if the changes affect their plans. The absolute number of lost CMG spots is low enough that most people shouldn't be impacted, but there will be a few casualties from this and fair warning seems like the least the Ministry could do.

[JohnGrisham]

"It's okay guys, lets cut the spots, they'll just match in a different province that has a few extra seats- and then it will be on their budget! At least we save some $$$"

[Laika]

What's the rationale for cutting CMG instead of IMG spots?  Aren't unfilled CMG spots available to IMGs if they go unfilled?  Doesn't this just create the possibility of Ontario paying to train a medical student who then goes unmatched?

[ArchEnemy]

What's the rationale for cutting CMG instead of IMG spots?  Aren't unfilled CMG spots available to IMGs if they go unfilled?  Doesn't this just create the possibility of Ontario paying to train a medical student who then goes unmatched?

I'm surprised that they did not adjust medical school enrolment before reducing residency positions. 

[JohnGrisham]

I'm surprised that they did not adjust medical school enrolment before reducing residency positions. 

I guess they figure those students will get picked up by a different province for residency tsk tsk

[rmorelan]

That lines up with what I've been hearing. It's a bit disappointing to know that schools have been aware of the cuts for that long, but I don't get the sense they have many firm details, even now.

 

Either way, the Ministry is the one making the change and should be the ones providing information to students, not pawning that responsibility off on schools or student groups. If this change has been in the works for this long, the fact that they still haven't officially informed us of the policy change is almost spiteful. My cohort now has some advance notice, but the 2016s have virtually no chance to respond if the changes affect their plans. The absolute number of lost CMG spots is low enough that most people shouldn't be impacted, but there will be a few casualties from this and fair warning seems like the least the Ministry could do.

 

well not to defend it too much but they wasn't much to announce as even now they aren't completely sure exact WHERE the cuts will lie.

 

Annoyingly the government often takes this approach in MANY areas of health care - oh figuring out how much each specialty should make is too complex, we will just cut them ALL by a fixed amount. Oh figuring out how to cut costs is too hard, we will just close entire systems down to make our quota. Oh family doc offices are cost too much, let's just stop all new grads from joining a team. Oh the costs of residency are too high.............. There isn't always a lot of planning.

 

changing the spots in theory and in particular the composition is the best tool they have for getting the types of doctors they want. Something they haven't play with too much (for instance if they really wanted to hit their 50% family doctor number, that is probably done easiest by controlled the make up for the residency spots). I have found it strange they haven't adjusted it more previously. They still aren't doing it here (another way to cut costs would be to simply convert those 50 spots into family medicine positions - in the end costs would drop by 60%.

[ralk]

well not to defend it too much but they wasn't much to announce as even now they aren't completely sure exact WHERE the cuts will lie.

 

Annoyingly the government often takes this approach in MANY areas of health care - oh figuring out how much each specialty should make is too complex, we will just cut them ALL by a fixed amount. Oh figuring out how to cut costs is too hard, we will just close entire systems down to make our quota. Oh family doc offices are cost too much, let's just stop all new grads from joining a team. Oh the costs of residency are too high.............. There isn't always a lot of planning.

 

changing the spots in theory and in particular the composition is the best tool they have for getting the types of doctors they want. Something they haven't play with too much (for instance if they really wanted to hit their 50% family doctor number, that is probably done easiest by controlled the make up for the residency spots). I have found it strange they haven't adjusted it more previously. They still aren't doing it hear (another way to cut costs would be to simply convert those 50 spots into family medicine positions - in the end costs would drop by 60%.

 

Good point - this change is more symptomatic of the broader trend of rather reactionary or rushed health policy.

 

There does appear to be a slow, ongoing transition in residency spots to meet public needs (surgical spots declined while psych went up last year, for example), but that seems to be almost entirely between Royal College residencies. No real incentive for schools to switch a 5-year residency for a 2-year FM residency voluntarily.

[Edict]

What's the rationale for cutting CMG instead of IMG spots?  Aren't unfilled CMG spots available to IMGs if they go unfilled?  Doesn't this just create the possibility of Ontario paying to train a medical student who then goes unmatched?

 

To be fair the news before was 50 CMG spots being slashed, if its true that its 25 split then IMGs proportionally are hurt more since they have fewer spots in the first place and it makes a competitive route of entry that much more competitive. If 25 spots are slashed for CMGs it hurts but I don't think it will increase the number unmatched dramatically, a few more people might not end up getting their first choice though.

 

To be fair though I do think there needs to be some sort of competition, if literally every CMG got a guaranteed spot there wouldn't be enough incentives to work hard anymore. Admissions may be right 95% of the time but is admissions right 100% of the time? That remains to be seen.

[ralk]

To be fair the news before was 50 CMG spots being slashed, if its true that its 25 split then IMGs proportionally are hurt more since they have fewer spots in the first place and it makes a competitive route of entry that much more competitive. If 25 spots are slashed for CMGs it hurts but I don't think it will increase the number unmatched dramatically, a few more people might not end up getting their first choice though.

 

To be fair though I do think there needs to be some sort of competition, if literally every CMG got a guaranteed spot there wouldn't be enough incentives to work hard anymore. Admissions may be right 95% of the time but is admissions right 100% of the time? That remains to be seen.

 

The change to 25 CMG spots only does make the situation dramatically better, though still undesirable. We at least retain a small buffer of positions (about 3%). Devil's in the details though, which still aren't known/available.

 

In terms of competition for residency, please recognize that there is already a pretty powerful incentive to work hard in medical school. Getting a residency position may not be that hard, but getting a preferred position is still a challenge, particularly for Royal College specialties. I more than double my workload by doing optional activities, mostly because I enjoy those activities, but improving my CV is definitely a consideration. Besides, if you think there are holes in the Med School selection process (and I would agree that there are), the residency selection process will make your head spin. While a few people go unmatched because of legitimate issues with their performance, most just have a poor match strategy or simply fall victim to luck. About 90% of CMGs unmatched in the 1st iteration get a residency program within a year - if anything, a greater cohort of unmatched students would be of higher quality than the current group, yet even the current group has a good proportion of students considered residency-worthy.

 

Edit - Correcting my math fails...

[LittleDaisy]

I think that the admission standards to medical schools are so high, that every medical student is hard working and does his or her best. We all kind of have type A personality, striving for the best and want to perform well compared to our colleagues. 

Even if there is one spot for all the CMGS, getting into your dream specialty and at your preferred location is not guaranteed. There is always competition even if there are 2300 spots for 2200 CMGs (I made those numbers xD) 

To be fair the news before was 50 CMG spots being slashed, if its true that its 25 split then IMGs proportionally are hurt more since they have fewer spots in the first place and it makes a competitive route of entry that much more competitive. If 25 spots are slashed for CMGs it hurts but I don't think it will increase the number unmatched dramatically, a few more people might not end up getting their first choice though.

 

To be fair though I do think there needs to be some sort of competition, if literally every CMG got a guaranteed spot there wouldn't be enough incentives to work hard anymore. Admissions may be right 95% of the time but is admissions right 100% of the time? That remains to be seen.

[NLengr]

I'm surprised that they did not adjust medical school enrolment before reducing residency positions. 

Cutting medical school spots is bad politics. Voters very easily understand what medical school is. If you are cutting med school spots, then voters look at the long wait times to get service (even though it's generally not due to lack of qualified physicians), look at your cuts and then vote for the other dude.

 

Cutting residency spots is easy. The general public doesn't understand post graduate training, and frankly, doesn't really have the time or desire to learn about it. Hence, cutting residency spots without cutting med school spots is much politically safer, even though from a financial point of view, it's a terrible idea.

[uwopremed]

I think that the admission standards to medical schools are so high, that every medical student is hard working and does his or her best. We all kind of have type A personality, striving for the best and want to perform well compared to our colleagues. 

Even if there is one spot for all the CMGS, getting into your dream specialty and at your preferred location is not guaranteed. There is always competition even if there are 2300 spots for 2200 CMGs (I made those numbers xD) 

 

Hi LittleDaisy.  I do want to comment on this aspect that all medical students are hard working, or that they are all type A.  While the considerable majority do fit into both categories - it is not true that all students are good and capable.

 

Many get into medical school on the merit of good marks and good ECs - it does not always translate into being a good physician or dealing with complex physical/emotional problems.  Not everyone is cut out to be a good doctor; even those that are hard working and have good marks.  These people abound in all medical classes - talk to anyone here privately in medical school and they will all have 5-10 people in their class that they would never have a relative ever see due to incompetence. 

 

Not everyone in medical school had a hard road either.  IF you went to an easy university AND are in province in a small place or less competitive province (Newfoundland, Manitoba, Quebec) - getting into medical school in infinitely easier AND very mediocre people get in.  When in medical school - they will do enough to pass - but are hardly stellar.

 

I like how you are optimistic.  But be honest to yourself when you evaluate some of you classmates - some are definitely complete dummies.

[uwopremed]

The change to 25 CMG spots only does make the situation dramatically better, though still undesirable. We at least retain a small buffer of positions (about 3%). Devil's in the details though, which still aren't known/available.

 

In terms of competition for residency, please recognize that there is already a pretty powerful incentive to work hard in medical school. Getting a residency position may not be that hard, but getting a preferred position is still a challenge, particularly for Royal College specialties. I more than double my workload by doing optional activities, mostly because I enjoy those activities, but improving my CV is definitely a consideration. Besides, if you think there are holes in the Med School selection process (and I would agree that there are), the residency selection process will make your head spin. While a few people go unmatched because of legitimate issues with their performance, most just have a poor match strategy or simply fall victim to luck. About 90% of CMGs unmatched in the 1st iteration get a residency program within a year - if anything, a greater cohort of unmatched students would be of higher quality than the current group, yet even the current group has a good proportion of students considered residency-worthy.

 

Edit - Correcting my math fails...

 

I do agree with this.  Residency selection is even more subjective than medical school admissions.  Sometimes average students match in to Plastics and Ophthalmology - while quality students don't match to somewhat easier specialties like Anesthesia or General Surgery.  I've already mentioned a case of an Ophthalmology resident that managed to fail step 1, step 2 and the royal college exam on their first tries - but still manages to work as a specialist now.  This person probably should never have been admitted into medicine in the first place - but ended up into the highest paying hardest to get specialty.  To be fair - an exception - but not as rare as one would think.

[amichel]

Hi LittleDaisy. I do want to comment on this aspect that all medical students are hard working, or that they are all type A. While the considerable majority do fit into both categories - it is not true that all students are good and capable.

 

Many get into medical school on the merit of good marks and good ECs - it does not always translate into being a good physician or dealing with complex physical/emotional problems. Not everyone is cut out to be a good doctor; even those that are hard working and have good marks. These people abound in all medical classes - talk to anyone here privately in medical school and they will all have 5-10 people in their class that they would never have a relative ever see due to incompetence.

 

Not everyone in medical school had a hard road either. IF you went to an easy university AND are in province in a small place or less competitive province (Newfoundland, Manitoba, Quebec) - getting into medical school in infinitely easier AND very mediocre people get in. When in medical school - they will do enough to pass - but are hardly stellar.

 

I like how you are optimistic. But be honest to yourself when you evaluate some of you classmates - some are definitely complete dummies.

You're not even in med school.

[NLengr]

Not everyone in medical school had a hard road either.  IF you went to an easy university AND are in province in a small place or less competitive province (Newfoundland, Manitoba, Quebec) - getting into medical school in infinitely easier AND very mediocre people get in.  When in medical school - they will do enough to pass - but are hardly stellar.

You my friend are an idiot. You really should keep your mouth shut until you at least get into med school (if you get in) and have some experience in the system. You know very little to nothing about medicine or medical training, yet you continue to present yourself as having knowledge of the subject. You are frequently a detriment to productive discussion. 

 

Honestly, you are making yourself look stupid, not to mention insulting whole regions of the country. It's not helping anyone here.

[ralk]

Let's try to keep this thread on track if we can, these changes and the purpose behind them have a real impact on current and future medical students.

 

Flame wars based on uwopremed's penchant to advance his positions in an inflammatory or arrogant manner are common enough, we don't need another one. As I understand it, uwopremed is entering the MD program at Western this year, where I can only hope he'll put his viewpoints to the test against those of his peers (and maybe find out whether or not he's one of those 5-10 people who apparently exist in every class who we "would never have a relative ever see due to incompetence").

[3change]

...

[GrouchoMarx]

You my friend are an idiot. You really should keep your mouth shut until you at least get into med school (if you get in) and have some experience in the system. You know very little to nothing about medicine or medical training, yet you continue to present yourself as having knowledge of the subject. You are frequently a detriment to productive discussion. 

 

Honestly, you are making yourself look stupid, not to mention insulting whole regions of the country. It's not helping anyone here.

 

[ArchEnemy]

Cutting medical school spots is bad politics. Voters very easily understand what medical school is. If you are cutting med school spots, then voters look at the long wait times to get service (even though it's generally not due to lack of qualified physicians), look at your cuts and then vote for the other dude.

 

Cutting residency spots is easy. The general public doesn't understand post graduate training, and frankly, doesn't really have the time or desire to learn about it. Hence, cutting residency spots without cutting med school spots is much politically safer, even though from a financial point of view, it's a terrible idea.

 

Interesting point. Although looks like the message is nonetheless out there with the help of the TheStar and TorontoSun - "800,000 Ontarians lack a family doctor - yet the ON Govt is cutting residency positions".

 

Good job on our student representatives on getting the message out to the public!

[A-Stark]

Many get into medical school on the merit of good marks and good ECs - it does not always translate into being a good physician or dealing with complex physical/emotional problems.  Not everyone is cut out to be a good doctor; even those that are hard working and have good marks.  These people abound in all medical classes - talk to anyone here privately in medical school and they will all have 5-10 people in their class that they would never have a relative ever see due to incompetence. 

 

This is certainly true. Though I gather - at the very least - that you have not actually started medical school yet. Good luck with that attitude going in. 

 

 

 

Not everyone in medical school had a hard road either.  IF you went to an easy university AND are in province in a small place or less competitive province (Newfoundland, Manitoba, Quebec) - getting into medical school in infinitely easier AND very mediocre people get in.  When in medical school - they will do enough to pass - but are hardly stellar.

 

As NLengr said... well, no need to repeat it. 

 

 

 

I like how you are optimistic.  But be honest to yourself when you evaluate some of you classmates - some are definitely complete dummies.

 

One of the more important characteristics a physician should have is good insight into her or her abilities and limitations. It is not enough to be knowledgeable - it is crucial to be aware of just how much you don't know. Arguably, it's a lot easier to gauge this once you're (at least) a resident and you start having to make some real decisions. 

 

But plenty of med students don't have this sense. At least, they don't have the experience yet to see their limitations - which is why that first clerkship rotation can often be such a shock. In short, your evaluation of your classmates is hardly relevant - and you aren't in any position to do so as a starting first year med student. 

 

It suffices only to be honest in your evaluation of yourself. 

[rmorelan]

Interesting point. Although looks like the message is nonetheless out there with the help of the TheStar and TorontoSun - "800,000 Ontarians lack a family doctor - yet the ON Govt is cutting residency positions".

 

Good job on our student representatives on getting the message out to the public!

 

we have to be so careful with those statistics - 800K may not have a family doctor but that doesn't mean those 800K even want one. I don't have a family doctor for instance There are a lot of people that for large parts of their lives float outside of the system.

 

so much statistics thrown around as bullet points - from BOTH sides - all which hides the truth because the truth is more complex than a few simple talking points.