Arztin Posted August 15, 2015 Report Share Posted August 15, 2015 I'm surprised that they did not adjust medical school enrolment before reducing residency positions. Yeah, I think this is the main problem. It would make more sense to cut med school spots first.... (at least for the med students) Link to comment Share on other sites More sharing options...
med_rollerpgy Posted August 19, 2015 Report Share Posted August 19, 2015 Carms will be so much more competitive for the next years. At some point there will be more medical students than residency spots if they don't cut med school enrollment. Link to comment Share on other sites More sharing options...
Bambi Posted August 19, 2015 Report Share Posted August 19, 2015 ^unimportant to the policy makers Link to comment Share on other sites More sharing options...
GrouchoMarx Posted August 19, 2015 Report Share Posted August 19, 2015 USA! USA! Link to comment Share on other sites More sharing options...
LittleDaisy Posted August 19, 2015 Report Share Posted August 19, 2015 I would like to remain in Canada, I like the public health system My med studies is entirely funded by the government, so I would like to give back as well I think that there are still some specialties that have good job prospects, I do admit that the job market is tight for surgical specialties in Canada Still not wise to cut CMG residency spots without cutting med school spots prior to this decision. USA! USA! Link to comment Share on other sites More sharing options...
rmorelan Posted August 19, 2015 Report Share Posted August 19, 2015 Yeah, I think this is the main problem. It would make more sense to cut med school spots first.... (at least for the med students) the only way that they current plan makes sense is if the ont government wants say more family doctors but DOESN'T want to pay for them. Cuts a bunch of spots - doesn't even matter if they are in family - knowing that the next result is that other very likely family positions in other provinces will now be filled. All this relies on them think those people will likely come back to Ontario to actually practise. The government saves say 300K or so per residency done elsewhere, and doesn't really have too much of a downside if they come back. Plus they get to avoid delaying with political fall out of cutting medical school seats in the short term. even if true still seems a bit silly to say the least Link to comment Share on other sites More sharing options...
ralk Posted August 19, 2015 Report Share Posted August 19, 2015 the only way that they current plan makes sense is if the ont government wants say more family doctors but DOESN'T want to pay for them. Cuts a bunch of spots - doesn't even matter if they are in family - knowing that the next result is that other very likely family positions in other provinces will now be filled. All this relies on them think those people will likely come back to Ontario to actually practise. The government saves say 300K or so per residency done elsewhere, and doesn't really have too much of a downside if they come back. Plus they get to avoid delaying with political fall out of cutting medical school seats in the short term. even if true still seems a bit silly to say the least Considering there were only 9 positions left unfilled in the rest of the country (outside of Quebec), there's not a lot of wiggle room in the rest of Canada. At best, Ontarians might fill some more spots in the first round outside of Ontario. That would keep some spots in those provinces from hitting the second round that might go to IMGs (who would then be bound to an ROS in that province) so it might lead to a slight uptick in residents trained in other provinces returning to Ontario, but the numbers would probably be very small. It'd also be completely overwhelmed by the 50 fewer residents trained in Ontario, at least half of whom would be tied to an ROS in Ontario. There'll be a bit of cost-shifting to other jurisdictions, but I can't see the main effect of this as anything but a cut, both to the number of residents trained in Ontario and the number of physicians eventually practicing in Ontario. Link to comment Share on other sites More sharing options...
JohnGrisham Posted August 19, 2015 Report Share Posted August 19, 2015 Politicians, who don't know much about actual healthcare economics, making the decisions. Always great. Link to comment Share on other sites More sharing options...
3change Posted August 19, 2015 Report Share Posted August 19, 2015 ... Link to comment Share on other sites More sharing options...
Edict Posted August 19, 2015 Report Share Posted August 19, 2015 Do you think they might implement regional policies for residency training? Similar to med school admissions. I don't think so, or else how could doctors ever move? As it is, medical students/doctors are pigeonholed into places throughout their entire 20s pretty much. Link to comment Share on other sites More sharing options...
JohnGrisham Posted August 19, 2015 Report Share Posted August 19, 2015 I don't think so, or else how could doctors ever move? As it is, medical students/doctors are pigeonholed into places throughout their entire 20s pretty much. Well, I mean technically they could then just move after training. But yeah, don't think it would happen. Link to comment Share on other sites More sharing options...
3change Posted August 19, 2015 Report Share Posted August 19, 2015 ... Link to comment Share on other sites More sharing options...
JohnGrisham Posted August 19, 2015 Report Share Posted August 19, 2015 Based on the same reasoning for medical school admissions: people who are from a geographical location tend to stay there after training. That is, authorities don't want doctors to move. I mean, if Ontario cuts residency spots some more, wouldn't other provinces enact protectionist policies to protect their own grads? I can imagine that is already in play in an indirect sense - graduates of a given school are probably more likely to match at their school because they spend a lot more time with them. Definitely not an absolute, but i'd be surprised if there wasn't even a slight indirect bias. Link to comment Share on other sites More sharing options...
Edict Posted August 19, 2015 Report Share Posted August 19, 2015 As doctors though its pretty difficult to move, how many doctors can honestly choose where they live. Most people don't get the choice during medical school, and with the job market today the same post-residency. Residency is one of the few times when people can move without it being too difficult. Link to comment Share on other sites More sharing options...
JohnGrisham Posted August 19, 2015 Report Share Posted August 19, 2015 As doctors though its pretty difficult to move, how many doctors can honestly choose where they live. Most people don't get the choice during medical school, and with the job market today the same post-residency. Residency is one of the few times when people can move without it being too difficult. Unless you do FM or some other outpatient clinic work Link to comment Share on other sites More sharing options...
Laika Posted August 20, 2015 Report Share Posted August 20, 2015 USA! USA! Be very careful and look into the recent J1 statement of need changes instituted by Health Canada. They are effectively trying to limit the number of physicians trained outside the country and are making it increasingly difficult to do residency in the US. There are a couple of threads over at SDN about the changes where people are (understandably) freaking out. Link to comment Share on other sites More sharing options...
JohnGrisham Posted August 20, 2015 Report Share Posted August 20, 2015 Be very careful and look into the recent J1 statement of need changes instituted by Health Canada. They are effectively trying to limit the number of physicians trained outside the country and are making it increasingly difficult to do residency in the US. There are a couple of threads over at SDN about the changes where people are (understandably) freaking out. It isn't that bad for all specialties, but yes there are some changes that are very detrimental for those who are currently pursuing IM subspecialization etc. One thing i want to add as i've seen it said a lot, they are not limiting US trained physicians from practicing in Canada. They are trying to limit the number of Canadian only citizens specifically, from doing US residency training. Recent updates from those involved in lobbying have seem to indicate Health Canada is aware of the rammifications towards current US IM students, that they were unaware of. Perhaps it may come to a good solution of grandfathering. Time will tell. Link to comment Share on other sites More sharing options...
3change Posted August 20, 2015 Report Share Posted August 20, 2015 ... Link to comment Share on other sites More sharing options...
JohnGrisham Posted August 20, 2015 Report Share Posted August 20, 2015 I just read they're discontinuing all sub specialty training in the US under J1 in 2017 for physicians not licensed to practice in Canada. This is ridiculous. Yeah, you have to first come back to Canada and get licensed, and then you can go subspecialize through category C. Definitely adds hiccups and some logistical issues that's for sure. Link to comment Share on other sites More sharing options...
Edict Posted August 20, 2015 Report Share Posted August 20, 2015 Wait so if you lets say did residency in Canada and wanted to subspecialize in the US would that still be allowed? Can you just get an H1B instead? It seems ridiculous that our countries supposedly have free trade, we have the NEXUS cross border pass and yet getting a visa to work in the other country is more difficult than for 3rd world countries. Link to comment Share on other sites More sharing options...
ralk Posted August 20, 2015 Report Share Posted August 20, 2015 Wait so if you lets say did residency in Canada and wanted to subspecialize in the US would that still be allowed? Can you just get an H1B instead? It seems ridiculous that our countries supposedly have free trade, we have the NEXUS cross border pass and yet getting a visa to work in the other country is more difficult than for 3rd world countries. If you completed residency in Canada, yes you could subspecialize in the US. However, under the rules being put in place, you couldn't do three years of IM in Canada and then go to the US for your subspecialty training because three years isn't a complete residency in IM. H1B visas are not affected by these changes, Canada has no say in those. Some programs do sponsor H1B visas, but it sounds like you'd have to be worth the extra effort they'd need to put in to complete that for you and I've heard there are other hurdles to overcome on the H1B route (I think you have to complete Step 3 before getting it). Getting a visa to work in the US isn't really the issue, the J1 visa is an "exchange" visa, not a work visa. The idea is that the US provides training or experiences that have value to Canada and so the US asks Canada to endorse that training as being necessary through a Statement of Need (SON). Canadian authorities have decided - with some validity - that we don't need an unlimited number of US-trained physicians in Canada, so they've put a cap on the numbers they're willing to endorse. While they Canadian government is not taking the most well-tailored approach to changing the number of SONs issued, their overarching decision fits exactly with how the J1 system is supposed to function. Link to comment Share on other sites More sharing options...
3change Posted August 20, 2015 Report Share Posted August 20, 2015 ... Link to comment Share on other sites More sharing options...
Edict Posted August 20, 2015 Report Share Posted August 20, 2015 If you completed residency in Canada, yes you could subspecialize in the US. However, under the rules being put in place, you couldn't do three years of IM in Canada and then go to the US for your subspecialty training because three years isn't a complete residency in IM. H1B visas are not affected by these changes, Canada has no say in those. Some programs do sponsor H1B visas, but it sounds like you'd have to be worth the extra effort they'd need to put in to complete that for you and I've heard there are other hurdles to overcome on the H1B route (I think you have to complete Step 3 before getting it). Getting a visa to work in the US isn't really the issue, the J1 visa is an "exchange" visa, not a work visa. The idea is that the US provides training or experiences that have value to Canada and so the US asks Canada to endorse that training as being necessary through a Statement of Need (SON). Canadian authorities have decided - with some validity - that we don't need an unlimited number of US-trained physicians in Canada, so they've put a cap on the numbers they're willing to endorse. While they Canadian government is not taking the most well-tailored approach to changing the number of SONs issued, their overarching decision fits exactly with how the J1 system is supposed to function. So the only way you can go to the US is if you did 3 years in IM lets say 3 years in Cardiology, get your certification in that and then apply for lets say EP in the US? It just seems as if they don't want proper exchange of ideas, so much bureaucracy... Thanks for the info anyways Link to comment Share on other sites More sharing options...
ralk Posted August 20, 2015 Report Share Posted August 20, 2015 Wait if you match to a US residency in IM or anesthesiology under J1 and you can't complete training in the US to satisfy Canadian standards because of the new rules, would Canada guarantee you a position to complete training in Canada? What if you did your training in the US but need extra years and Canada doesn't offer you any positions?!?!?! Are you pretty much screwed? There are options for IM and anesthesiology residents, namely to complete an additional year of training as a fellow or as a Chief Resident to get their training up to Royal College standards. They just couldn't do a multi-year fellowship to subspecialize. The complaint seems to be that those options are too difficult to reliably pursue, in which case the SON policy should be changed to provide some additional flexibility, but I have no idea whether that's a valid complaint or not. Link to comment Share on other sites More sharing options...
ralk Posted August 20, 2015 Report Share Posted August 20, 2015 So the only way you can go to the US is if you did 3 years in IM lets say 3 years in Cardiology, get your certification in that and then apply for lets say EP in the US? It just seems as if they don't want proper exchange of ideas, so much bureaucracy... Thanks for the info anyways More like you'd do 4 years in general IM, get certified, and then apply to the US for your subspecialty training. Category A applications also seem to imply that if you started your IM training here and wanted to do your subspecialty training in the US after three years of IM, that would not be subject to the restrictions, but the wording is not entirely clear to me. Edit - They're carving out a lot of exceptions for Canadians who want to get expert training in the US, to have that exchange of ideas you mention. Canadian physicians and residents can still do fellowships and subspecialty training in the US, without much difficulty. The goal seems to be to halt what looked to be a growing back-door to practicing medicine in Canada through US residencies. One poster on SDN reported that the number of Canadians doing IM on J1 visas in Canada shot up dramatically in the last 5 years or so. From the NRMP match stats, this isn't due to a rush of CMGs to the US and from CaRMs stats probably isn't due to an increase in Canadian USMDs either. It's CSAs (and maybe some Canadian USDOs) driving those numbers. If Canadian governments are worried about physician over-supply, as the Ontario government claims they are, cutting residency positions in Canada while leaving the J1 visa route as it was would have been like bandaging a paper cut on a gunshot victim. Link to comment Share on other sites More sharing options...
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