2017 Carms Applicants

[LittleDaisy]

2017 CaRMS preliminary stat reports are out: http://www.carms.ca/wp-content/uploads/2017/04/2017-CaRMS-Forum-web-deck-EN.pdf

 

Perhaps I am just denying the fact that my LMCC is coming up soon! ahah 

Good read everyone, and best of luck for MCCQE part 1

[rmorelan]

2017 CaRMS preliminary stat reports are out: http://www.carms.ca/wp-content/uploads/2017/04/2017-CaRMS-Forum-web-deck-EN.pdf

 

Perhaps I am just denying the fact that my LMCC is coming up soon! ahah 

Good read everyone, and best of luck for MCCQE part 1

 

get back to studying  

[rmorelan]

these stats are always interesting - people say you should go to TO if you are hoping to residency there, but only 35% of the TO class actually is staying at here for residency. Not much different than the remaining Ontario schools. 

 

More "brand loyalty" elsewhere though!

[distressedpremed]

these stats are always interesting - people say you should go to TO if you are hoping to residency there, but only 35% of the TO class actually is staying at here for residency. Not much different than the remaining Ontario schools. 

 

More "brand loyalty" elsewhere though!

 

Yeah I don't think that "brand loyalty" exists for U of T (sorry to burst your bubble folks).  A lot of residency spots are filled by people not from U of T, and that amount varies year to year.  

 

Number of unmatched candidates are going up...

[sulfamethoxazole]

these stats are always interesting - people say you should go to TO if you are hoping to residency there, but only 35% of the TO class actually is staying at here for residency. Not much different than the remaining Ontario schools. 

 

More "brand loyalty" elsewhere though!

 

Hmmm, I think it's 50% of the TO class is staying in TO for residency (first graph), but only 35% of TO residents are from TO (second graph).

 

You have to factor in that MD class sizes and residency class sizes aren't 1 to 1. For example, Toronto has far more CMG residency spots (337) than med students (259) but Mac has less spots (187) than students (205). Theoretically, the entire Toronto class could match to TO and the second number would only be 76%. Mac can't accept all its grads even if it wanted to.

 

Brand loyalty plays a part in Toronto, or you wouldn't have half the class staying for residency. I don't think you can say if it's more or less than other schools based on these stats though, since they also have more room to accept its own grads.

[doc_doc_doc]

166 unmatched CMGs after first round --> 68 unmatched after second round in 2017

 

vs.

 

77 unmatched CMGs after first round --> 8 unmatched after second round in 2016

 

WOW. 

[rmorelan]

Hmmm, I think it's 50% of the TO class is staying in TO for residency (first graph), but only 35% of TO residents are from TO (second graph).

 

You have to factor in that MD class sizes and residency class sizes aren't 1 to 1. For example, Toronto has far more CMG residency spots (337) than med students (259) but Mac has less spots (187) than students (205). Theoretically, the entire Toronto class could match to TO and the second number would only be 76%. Mac can't accept all its grads even if it wanted to.

 

Brand loyalty plays a part in Toronto, or you wouldn't have half the class staying for residency. I don't think you can say if it's more or less than other schools based on these stats though, since they also have more room to accept its own grads.

 

hey valid points I think - didn't realize they had that many residency spots proportionally. I will have to check out the break down of what they are in. 

[thestar10]

166 unmatched CMGs after first round --> 68 unmatched after second round in 2017

 

vs.

 

77 unmatched CMGs after first round --> 8 unmatched after second round in 2016

 

WOW. 

 

Your numbers for 2016 are incorrect. Those numbers relate to the c2016 unmatched entering the 2017 match.

[ralk]

Preliminary report so no great opportunities for deeper dives into the data, but this largely fits my expectations. IM was definitely more competitive than last year (by a meaningful but not massive margin), which was compensated by FM being less competitive. The uptick in interest in surgical specialties is interesting; anecdotally that fits with what I saw, but didn't expect that to be a national trend.

 

The lower match rate can be largely explained by those facts alone - more people going for a specialty (IM or surgical specialties) with no room to absorb the extra interest, fewer people going for a specialty with plenty of room to begin with (FM). Also explains why fewer people got their first choice discipline or top-3 programs.

[gsmith]

The CFMS released a statement of concern about the number of unmatched CMGs after round 1 and 2. 

 

https://www.cfms.org/UnmatchedCMGPressRelease.pdf

[JohnGrisham]

CFMS...always so dramatic. Have to put "advocate for medical students against the injustice of CaRMS" on their CV.

[thestar10]

The ON government did cut 25 residency spots 2 years ago which is likely a large contributing factor. 

[silvantes]

It would be dramatic for you if you had a family to support, no idea of what was to come while you wait for another year after spending thousands on a process that didn't work.

Not all of us are in the same situation.

It is a big problem.

[JohnGrisham]

It would be dramatic for you if you had a family to support, no idea of what was to come while you wait for another year after spending thousands on a process that didn't work.

Not all of us are in the same situation.

It is a big problem.

Of course it is a big issue, my apologies. More so meant to highlight how they describe the issue like its a national tragedy shutting down the healthcare system. It just reminds me so much of politics and political pandering.

 

Also, it would be nice to see the breakdown of the unmatched, because for every person who applied broadly and backed up (for which I am definitely hugely sympathetic for) I would not be surprised if there are those who only applied to competitive specialties without backing, or only applied to geographically constrained areas. These strategies work out for people all the time, but its never gauranteed. As much as I want to have sympathy for the person who didn't match to FM because they only applied to metropolitan Toronto due to family constraints, I just can't. Things get very individual really quickly, and people have to weight the pros and cons for their individual circumstances and hope it works out the best for them.

 

If it hasn't been known, people should come into the expectation of a very real reality of having to move anywhere in the country and perhaps even not their #1 specialty or program. With the understanding that most end up where they want in what they want.

 

Unless I am completely off base and then the above is all to be ignored. I just have a hard time believing the vast majority are just "unlucky" or screwed over "by the algorithm". Many definitely are, but there is room to bring those unmatched numbers down a bit(Or not, some individual contributors to those statistics are likely fine with the risk and will match the following year) if you make it clear to people that not everyone gets to be a dermatopathoopthoneonatalologist.

[silvantes]

Unfortunately there is a lot of politics in this.

 

But as far as specific situations. You can apply as broadly as you think you should without breaking the bank, willing to go almost anywhere, be told you're a great applicant with no red flags, get involved in research early etc., have a back up where you were "wanted", and yet end up without anything. Also a good run at second iteration with high hopes, again nothing.

 

They have been calling it "bad luck" but it's not quite acceptable.

 

There are too many medical school seats with a decrease of residency positions. I also saw a problem with a huge number of French only seats. There is also absolutely no possibility like years gone by of a rotating internship.

 

You are right about some applicants I'm sure. I cannot afford to be *that* picky and I certainly do not feel entitled except to at least a position. I came from nothing and trying to provide a better life for my family and now I do not know how I will provide and carry the debt we have from this endeavor. I have no living parents to help, and they couldn't even if they were here.

[JohnGrisham]

Unfortunately there is a lot of politics in this.

 

But as far as specific situations. You can apply as broadly as you think you should without breaking the bank, willing to go almost anywhere, be told you're a great applicant with no red flags, get involved in research early etc., have a back up where you were "wanted", and yet end up without anything. Also a good run at second iteration with high hopes, again nothing.

 

They have been calling it "bad luck" but it's not quite acceptable.

 

There are too many medical school seats with a decrease of residency positions. I also saw a problem with a huge number of French only seats. There is also absolutely no possibility like years gone by of a rotating internship.

 

You are right about some applicants I'm sure. I cannot afford to be *that* picky and I certainly do not feel entitled except to at least a position. I came from nothing and trying to provide a better life for my family and now I do not know how I will provide and carry the debt we have from this endeavor. I have no living parents to help, and they couldn't even if they were here.

I sincerely hope it all works out for you next cycle, as it seems you are an unfortunate casualty.

[ralk]

The CFMS released a statement of concern about the number of unmatched CMGs after round 1 and 2. 

 

https://www.cfms.org/UnmatchedCMGPressRelease.pdf

 

Hope this goes further than words. The CFMS and other student organizations are fairly quick to release statements like this - which usually get ignored - and concrete results are hard to find. The OFMS' lobbying to delaying the second round of residency spot cuts in Ontario comes to mind, but even that was only temporarily halting what were supposed to be IMG spot cuts, doing very little for CMGs.

 

The ON government did cut 25 residency spots 2 years ago which is likely a large contributing factor. 

 

It certainly doesn't seem to be helping, but there's more at work. The ratio of spots-to-students has been declining since before the Ontario government's actions, mostly due to an increase in medical students in Canada overall. The trend of total unmatched also starts before those 25 spots were lost.

 

I do worry that this might start a snowball effect - not only are the chances for current year grads to match declining, but there are more prior-year grads now fighting for the same spots. In prior years, going unmatched graduating year led to a year or two delay in starting residency much more frequently than those students failing to get a residency position ever. If that changes... well, that's a bigger problem.

[doc_doc_doc]

Hope this goes further than words. The CFMS and other student organizations are fairly quick to release statements like this - which usually get ignored - and concrete results are hard to find. The OFMS' lobbying to delaying the second round of residency spot cuts in Ontario comes to mind, but even that was only temporarily halting what were supposed to be IMG spot cuts, doing very little for CMGs.

 

 

It certainly doesn't seem to be helping, but there's more at work. The ratio of spots-to-students has been declining since before the Ontario government's actions, mostly due to an increase in medical students in Canada overall. The trend of total unmatched also starts before those 25 spots were lost.

 

I do worry that this might start a snowball effect - not only are the chances for current year grads to match declining, but there are more prior-year grads now fighting for the same spots. In prior years, going unmatched graduating year led to a year or two delay in starting residency much more frequently than those students failing to get a residency position ever. If that changes... well, that's a bigger problem.

 

The snowball effect should be relatively small in 2018 and 2019 since I don't think even the extra 20 unmatched is really enough to tilt the odds very much - maybe a few percent. But, I agree: if the trend continues for the next 5 years, it's going to get worst and worst.

 

The people that this most effects is the unmatched. The match rate for first time CaRMS applicants after round 1 and 2 is in the high 90%'s and that has been steady. The match rate for those applying for a second, third, etc time is in the mid-60%'s. The stigma of going unmatched, despite the fact that often those applicants have nothing "wrong" with them, is still very real as this illustrates.

 

In a CaRMS of too many med students vs residency spots, it's pretty easy for schools to screen out the unmatched applicants off the bat, since they already have so many qualified first time applicants. I think this is part of what the CFMS may be hinting at addressing and why their tone is so dire. When the unmatched rate is 0.5% and the ratio of spots/students is reasonable, going unmatched is a hindrance but it's not a massive deficit. As the ratio of spots/students gets more uneven, schools could look to screen with objective, simple criteria - such as a previous unmatched result in CaRMS, no matter what the reasoning - which now stands to affect a lot more people, with the rates of unmatched climbing.

 

This is what the discussion has been amongst my colleagues at least. At the end of the day, it's all highly speculative and we'll only be able to assess the impacts of 2017 once we have several more years of CaRMS to compare to. Hopefully, the CFMS and AFMC look into why this is happening and implement concrete solutions. I'm very happy to see them addressing it and recognizing it, since I think this is the first step to change.

[JohnGrisham]

Lets be clear though - no one should be expecting the match rate to be 100%. I've heard a few upper years say that, but it doesn't make sense.  I think 99% is a reasonable target, since you have a 1% fluctuation buffer of user preference to spots available.   Not everyone is going to want to jump ship from their 1st choice residency or location, in order to match in a different specialty/locale should they go unmatched in round 1(and not have initially backed up). 

[distressedpremed]

I heard some of my classmates discuss bringing back the rotating internship....do you think that would potentially help? 

[JohnGrisham]

I heard some of my classmates discuss bringing back the rotating internship....do you think that would potentially help? 

That wouldn't make sense. FM is a 2 year program now, and rotating internship wouldn't serve a purpose in that sense.  

 

It made sense in the past, when you could just begin working as a GP with just the internship. 

[hero147]

I heard some of my classmates discuss bringing back the rotating internship....do you think that would potentially help? 

 

I think it would help but the CFPC would never allow it to happen.

[promethease]

Something I've been mulling over since the match... how do we reconcile personal entitlement vs. societal need in CaRMS? On the one hand, everyone in med school has worked hard to get where they are, so I understand why people feel cheated when they don't land their chosen specialty. But on the other, the government is funding all of us to provide a service for society, so I think societal need should dictate people's career choices more than it does right now honestly. Too many people want to be specialists when what our healthcare system desperately needs is good primary care. Sure, some people find their passion in super specialized areas, but most people's interests could probably be satisfied through a tailored family practice (OB, peds, IM, psych, derm, etc.) The only things you really can't do through FM are the specialties with no patient contact and to a certain extent surgery (but even then... you can be as procedural as you want to be). 

 

The increasing number of unmatched students this year has a direct relationship to the decreased interest in family medicine so maybe that's the problem we need to address, instead of focusing on the total number of residency positions. It seems kind of overkill to me for the CFMS to declare a crisis when there are still positions in family medicine leftover after the 2nd round. Primary care, for various reasons, is unattractive to the majority of medical students right now. Not sure what needs to change... reducing the difference in compensation between specialists and GPs? Having more topics taught by GPs in medical school or at least from a primary care perspective (to minimize the hidden curriculum)? Somehow selecting for candidates in the admissions process who are adaptable to society's needs and maybe more collectivistic rather than individualistic? Having different medical school streams entirely with their own application processes for people who want to go into primary care vs. specialized training? Some of those are probably outright unfeasible, but just throwing out some ideas.

 

Personally, I think going back to the rotating internship model would solve a lot of problems. I really think a lot of people would be surprisingly happy as GPs and at least some would no longer desire to go back for further training after working for a while. And if they still do, then at least they've tried it out and realized it's not for them. I think an ideal model would have some direct-entry specialty positions as well as rotating internships with the option to go back and specialize at a later time (without any discrimination between these candidates and direct-entry candidates). I agree that it doesn't make sense to come out of the internship without any credentials, so I would advocate going back to a one-year training model to be a general practitioner. For those who wanted to be leaders in the field of primary care or do academic FM, there could also be an option to go back and "specialize" in FM by doing an extra year in it. As an added bonus, 4th year would be less of a prolonged audition process and more of a chance to explore different areas of medicine.

 

Anyway, interested to hear others' thoughts on that. I'm admittedly pretty biased as someone who felt drawn to a lot of different areas and ultimately ended up in FM. I know many people who ended up matching to their desired specialties do feel really passionate about that field and couldn't see themselves doing anything else.

[ralk]

The snowball effect should be relatively small in 2018 and 2019 since I don't think even the extra 20 unmatched is really enough to tilt the odds very much - maybe a few percent. But, I agree: if the trend continues for the next 5 years, it's going to get worst and worst.

 

The people that this most effects is the unmatched. The match rate for first time CaRMS applicants after round 1 and 2 is in the high 90%'s and that has been steady. The match rate for those applying for a second, third, etc time is in the mid-60%'s. The stigma of going unmatched, despite the fact that often those applicants have nothing "wrong" with them, is still very real as this illustrates.

 

In a CaRMS of too many med students vs residency spots, it's pretty easy for schools to screen out the unmatched applicants off the bat, since they already have so many qualified first time applicants. I think this is part of what the CFMS may be hinting at addressing and why their tone is so dire. When the unmatched rate is 0.5% and the ratio of spots/students is reasonable, going unmatched is a hindrance but it's not a massive deficit. As the ratio of spots/students gets more uneven, schools could look to screen with objective, simple criteria - such as a previous unmatched result in CaRMS, no matter what the reasoning - which now stands to affect a lot more people, with the rates of unmatched climbing.

 

This is what the discussion has been amongst my colleagues at least. At the end of the day, it's all highly speculative and we'll only be able to assess the impacts of 2017 once we have several more years of CaRMS to compare to. Hopefully, the CFMS and AFMC look into why this is happening and implement concrete solutions. I'm very happy to see them addressing it and recognizing it, since I think this is the first step to change.

 

I'd disagree that the match rate for first round, first time applicants has been steady. It is still very high overall, but there's a clear downward trend. There's cause for concern there.

 

I fully agree, however, that the ratio of spots to students is a major concern, and that the effect of that lowered ratio disproportionately falls on unmatched students. That's part of the snowballing effect of the razor-thin margin between spots and CMGs in the match - even if the carryover of prior year graduates is small, it either progressively adds to the problem by causing either more graduating-year CMGs to go unmatched, or as you say, forces prior-year CMGs out of medicine entirely (at least in Canada). I suspect the results will involve a bit of both, though I agree we won't know for a few years, assuming no intervening policy changes to relieve the situation.

 

Something I've been mulling over since the match... how do we reconcile personal entitlement vs. societal need in CaRMS? On the one hand, everyone in med school has worked hard to get where they are, so I understand why people feel cheated when they don't land their chosen specialty. But on the other, the government is funding all of us to provide a service for society, so I think societal need should dictate people's career choices more than it does right now honestly. Too many people want to be specialists when what our healthcare system desperately needs is good primary care. Sure, some people find their passion in super specialized areas, but most people's interests could probably be satisfied through a tailored family practice (OB, peds, IM, psych, derm, etc.) The only things you really can't do through FM are the specialties with no patient contact and to a certain extent surgery (but even then... you can be as procedural as you want to be). 

 

The increasing number of unmatched students this year has a direct relationship to the decreased interest in family medicine so maybe that's the problem we need to address, instead of focusing on the total number of residency positions. It seems kind of overkill to me for the CFMS to declare a crisis when there are still positions in family medicine leftover after the 2nd round. Primary care, for various reasons, is unattractive to the majority of medical students right now. Not sure what needs to change... reducing the difference in compensation between specialists and GPs? Having more topics taught by GPs in medical school or at least from a primary care perspective (to minimize the hidden curriculum)? Somehow selecting for candidates in the admissions process who are adaptable to society's needs and maybe more collectivistic rather than individualistic? Having different medical school streams entirely with their own application processes for people who want to go into primary care vs. specialized training? Some of those are probably outright unfeasible, but just throwing out some ideas.

 

Personally, I think going back to the rotating internship model would solve a lot of problems. I really think a lot of people would be surprisingly happy as GPs and at least some would no longer desire to go back for further training after working for a while. And if they still do, then at least they've tried it out and realized it's not for them. I think an ideal model would have some direct-entry specialty positions as well as rotating internships with the option to go back and specialize at a later time (without any discrimination between these candidates and direct-entry candidates). I agree that it doesn't make sense to come out of the internship without any credentials, so I would advocate going back to a one-year training model to be a general practitioner. For those who wanted to be leaders in the field of primary care or do academic FM, there could also be an option to go back and "specialize" in FM by doing an extra year in it. As an added bonus, 4th year would be less of a prolonged audition process and more of a chance to explore different areas of medicine.

 

Anyway, interested to hear others' thoughts on that. I'm admittedly pretty biased as someone who felt drawn to a lot of different areas and ultimately ended up in FM. I know many people who ended up matching to their desired specialties do feel really passionate about that field and couldn't see themselves doing anything else.

 

I think it's very important to note that the leftover FM spots after the second round are entirely in Quebec and exclusive to candidates who speak French. Those spots aren't open to most candidates unmatched after the first or second rounds - this year there were only 6 current year grads left unmatched after the second round across all of Canada who would be qualified for those spots. I'll also point out that interest in FM, while down from a high two years ago, is still near all-time highs and well above where it was at its lowest nearly 15 years ago. The current situation isn't an entitlement problem.

 

I strongly disagree with bringing back the rotating internship. Medical school is far from sufficient to allow for independent practice, and an unfocused, rotating internship is not enough to bridge that gap towards capable primary care. FM training in Canada is already shorter than it is in many comparable countries. This seems like it'll just weaken and devalue primary care, exacerbating whatever negative perceptions of primary care people have that drive them away from the field. FM has spent a lot of time trying to build up its respectability and garner interest from competitive candidates - that's not something to risk lightly. In any case, rotating internship still requires training spots which are currently in short supply and the reason (in addition to more medical students) that there's a problem with more unmatched CMGs in the first place.

[doc_doc_doc]

I'd disagree that the match rate for first round, first time applicants has been steady. It is still very high overall, but there's a clear downward trend. There's cause for concern there.

 

The 2017 combined round 1 and 2 match rate was 96.5% (slide 9). The 2016/15/14/13 rates were 97.2%/97.7%/97.4%/97.5% (slide 47) respectively. There was a slight dip in 2017, but I wouldn't call that a "clear downward trend." It's actually been VERY steady since 2013 with max variability being only 1.2%!

 

Source: http://www.carms.ca/wp-content/uploads/2017/04/2017-CaRMS-Forum-web-deck-EN.pdf