Unmatched Help

[liammo29]

Hi all,

 

So with about 2 weeks left until CaRMS applications were due I fell in love with diagnostic medicine during a radiology elective. I had essentially hated everything I did previously so I decided to go all in on radiology and try for that.  Unfortunately I went un matched after the first round and was told by the program director that he wished that he could have taken me and that had he had more funding he would have. 

 

In the second round there wasn't much that I liked at all so I just applied to a local pathology program. This spot was filled by an IMG (I think it may have been reserved for an IMG) but I was told that had I had more experience in paht they woud have took me. Obviously I am completely devastated and am now wondering what to do. In hindsight my matching strategy was pretty awful but I just refuse to get matched to a program that I hate.

 

Plan for this year:

I have already started research with the rads department and am due to go to a conference in the fall. I plan to keep researching with them and also take on a research project or two in pathology to show my interest there. I am also going to start a masters in clinical education (by distance) which is required if I one day want to teach. How does this plan sound? I want to do some shadowing aswell, is this possible? Seeing as rads and path don't have a ton of patient work I am hoping it is! Basically I hope to get a bunch of research work, make more contacts, and start a masters. Then apply to every rads and path program and back up with family. Do you think I will match next year? Path is not very competitive so I really hope so. I can barely sleep I am so scared about not matching again. How much of a red flag will this be? I think path and rads value research a lot so hoping not too much.

 

Thanks so much!

 

Note: I was told by my program I had absolutely zero red flags and that it was just a late choice and that I had a good application. 

[LittleDaisy]

Hey hang in there.

Your plans of doing a master and shadowing are great. I would suggest that you try to convince your med school to allow you to be enrolled as a ''5th year medical student''. That way, you are still covered under malpractice insurance, and you could apply for radiology electives through the AFMC Portal across the country.

 

I am from a Quebec medical school, and my school allows the unmatched students to be continuously enrolled in the following year. I think that the unmatched students with an extra year choose not to write their LMCC, and have 1 extra year of doing any electives they want, while covered by the insurance.

 

Research always helps, regardless of which specialty you are applying to.

 

I do not think pathology is very competitive for CMGs.

 

Shadowing is a great idea. For radiology rotations, most of the med students end up shadowing anyway. 

 

I had a friend in the same situation as you, but end up matching to radiology in the second round without any elective experience. The spot was French-speaking, so that might explain he&she got lucky.

 

For next year's match, if you apply broadly to radiology & pathology, while backing up with family medicine, your chance of matching is very high (I want to say 100%, but nothing is certain with CaRMS). As you said, the PD told you that you are a great candidate, the only downside of your application is lack of exposure. You could certainly work on this through shadowing and research.

 

Your chance of matching to radiology is the highest at your home school, since you already know some of the staff.

 

Best of luck for the next year's match!

Anyone else with more experience wants to chime in?

[liammo29]

Thanks very much. Really appreciate it! If I took the fifth year option would I still be able to attend graduation etc? It would all be so so so much harder to have to explain why I didn't attend my own graduation.

 

Thanks again

[LittleDaisy]

Humm...you should talk to the dean of medicine, vice-dean, or student affair office asap, to figure out if your faculty allows being enrolled as a 5th-year med student.

 

Try to sell your case, and explain why this is important to you. Also, you won't be in the student pool for doing mandatory core rotations, so it will be less problematic for the administration to find you clinical placements. Explain that you will mostly be doing radiology electives in other schools, so fewer logistics for your faculty.

 

For graduation, I have no clue, sorry...People who had done this, were happy to be considered as a '''med student''. You still have the student status, so no interest for the governmental loans, LOC is still fine, all the student discounts still work, and 1 more year to do clinical electives.

 

If your faculty does not allow this option, I think that your current plans are ideal and increase your chance of matching next year!!

 

Hang in there! 

 

 

 

 

 

Thanks very much. Really appreciate it! If I took the fifth year option would I still be able to attend graduation etc? It would all be so so so much harder to have to explain why I didn't attend my own graduation.

 

Thanks again

[hamham]

Agree with Little Daisy.

 

Not sure about rads but path had a very competitive year, even in round 1. And I got the impression that path programs would rather leave their spots unfilled than fill them with candidates whom they think are not strong enough for the specialty (i.e. due to lack of elective).

[liammo29]

I think you are right. I got the feeling that had I had some shadowing or research in path that I would have gotten the spot. If my school won't let me do the fifth year, do you think I could still shadow in rads and path. When I did my rads elective it was a lot of watching people do things, so hoping I could still do the shadowing.

 

For anyone who did a fifth year, did you still graduate? Did you write your licensing exam?

[LittleDaisy]

To OP, I think that it is the best that you speak to your vice-dean, student affairs office, clerkship director ASAP. I am not sure all the Canadian medical faculties are flexible and allow the unmatched students to prolong their medical training.

 

If you can't do the extra year, go for shadowing and a master in research. For shadowing, your chances are higher at your home school. I think that the staff physician gets remunerated if you are considered a clinical clerk for teaching, well, at least one small incentive for them to show an interest and actually teach you. You could even dictate or type your preliminary impressions for simple X-Rays for radiology if you were considered a clinical clerk, same goes for pathology. 

 

Arranging to shadow in radiology & pathology might be more difficult outside your homeschool, but once again, try nevertheless, write to all the radiology PDs or preceptors, and administrators!

 

For pathology, I know people who were invited for interviews for 1st round;  but went unmatched despite spots left for the second iteration, because the PDs prefer to take interested candidates, or candidates they found compatible, rather than just filling up the spots.

[liammo29]

Also, to confirm, I am eligible to apply for the 1st round next year right?

[LittleDaisy]

Yeah you are!! You are qualified for CaRMS next year!

Have you met with your school's vice-dean or student affairs right after the match?? They are the best to give advice and help to prepare for next year's match. They want their students to match!

Also, to confirm, I am eligible to apply for the 1st round next year right?

[Lactic Folly]

Hi liammo29,

Sounds like you have an advocate in your program director. This is very encouraging. Take whatever advice they have for strengthening your application. Presumably this is your home school - so work hard on your research and do your best to make a good impression/not annoy anyone. Your goal is to have people in the department go to bat for you come CaRMS next year, citing what a great person you are and how committed you are to the program.

 

If you've already had enough clinical exposure to radiology to make an informed career decision, and the PD doesn't feel more shadowing is important, I wouldn't necessarily push it. Maybe things are different in Quebec, but I haven't encountered an institution where staff rads are compensated for having students shadow, or where students would be able to dictate on the system. If you can set up electives or even informal visits at other schools (for programs who are receptive to such things), this would be useful for you to become known elsewhere, same as the 3rd/4th years on elective.

 

You will probably need some shadowing in pathology as it sounds like you haven't had much exposure, and it would be difficult to demonstrate a sincere interest in / understanding of the field otherwise. Similar to rads, teaching and thinking through cases at the same time is distracting and increases risk of errors, but don't let that stop you from trying to set something up as it is in a program's best interest to meet and assess prospective candidates.  

 

A project is again a great idea - more to demonstrate your interest/commitment and get to know people in the department better. I'm not sure how much the majority of programs emphasize research for its own sake (unless they are very focused on producing academically-oriented graduates)  - it just happens to be the most common way for students to demonstrate their productivity/personal qualities/talents. It will be better if you can frame this as a year of career exploration, as no program would like to feel they are a backup choice.

 

Good luck!

 

Hi all,

 

So with about 2 weeks left until CaRMS applications were due I fell in love with diagnostic medicine during a radiology elective. I had essentially hated everything I did previously so I decided to go all in on radiology and try for that.  Unfortunately I went un matched after the first round and was told by the program director that he wished that he could have taken me and that had he had more funding he would have. 

 

In the second round there wasn't much that I liked at all so I just applied to a local pathology program. This spot was filled by an IMG (I think it may have been reserved for an IMG) but I was told that had I had more experience in paht they woud have took me. Obviously I am completely devastated and am now wondering what to do. In hindsight my matching strategy was pretty awful but I just refuse to get matched to a program that I hate.

 

Plan for this year:

I have already started research with the rads department and am due to go to a conference in the fall. I plan to keep researching with them and also take on a research project or two in pathology to show my interest there. I am also going to start a masters in clinical education (by distance) which is required if I one day want to teach. How does this plan sound? I want to do some shadowing aswell, is this possible? Seeing as rads and path don't have a ton of patient work I am hoping it is! Basically I hope to get a bunch of research work, make more contacts, and start a masters. Then apply to every rads and path program and back up with family. Do you think I will match next year? Path is not very competitive so I really hope so. I can barely sleep I am so scared about not matching again. How much of a red flag will this be? I think path and rads value research a lot so hoping not too much.

 

Thanks so much!

 

Note: I was told by my program I had absolutely zero red flags and that it was just a late choice and that I had a good application. 

[LittleDaisy]

Hum...not really relevant..I thought that the staff physicians get paid for teaching clinical clerks and residents in academic hospitals, across Canada???

For shadowing, the staff physician doesn't get paid, it is really for gaining exposure for preclinical medical students, or transition to clerkship.

When we have shadowing preclinical students, the staff or senior resident would prefer that I teach them, and show them around (I guess that is the hierarchy of medicine lol)

 

For radiology electives, in Quebec, the clerks can't dictate, but they can briefly type their preliminary findings in the software, and go over with the staff or senior residents...Then the senior or junior residents dictate, my point is as a clerk, you have electronic access to CT scans, Chest X-Ray, and could read them on your own, and compare your findings with the residents & staff, for an LOR in the end!

[rmorelan]

Hum...not really relevant..I thought that the staff physicians get paid for teaching clinical clerks and residents in academic hospitals, across Canada???

For shadowing, the staff physician doesn't get paid, it is really for gaining exposure for preclinical medical students, or transition to clerkship.

When we have shadowing preclinical students, the staff or senior resident would prefer that I teach them, and show them around (I guess that is the hierarchy of medicine lol)

 

For radiology electives, in Quebec, the clerks can't dictate, but they can briefly type their preliminary findings in the software, and go over with the staff or senior residents...Then the senior or junior residents dictate, my point is as a clerk, you have electronic access to CT scans, Chest X-Ray, and could read them on your own, and compare your findings with the residents & staff, for an LOR in the end!

 

actually they really don't get paid to do that at most places. It is simply a requirement for them to work at the academic centre and they work out some fair distribution for how it is done. 

 

in radiology in particular clerks and junior residents do nothing except slow the process down, and cannot in any real way help the radiologist in some other way to speed things up. When you get to be a senior resident there are things you can do - independently do procedures, your reports are more accurate and properly formed, you can protocol cases, talk over things with other services etc. Probably can help things come out a bit more even but still. It isn't like other services where the resident can go off and do a full long consult and just present the material quickly to the staff. In rads they have to go over the entire image set to make sure nothing is missed (you don't know what you don't know, and you only get one chance to look at an image and get it right).

[Lactic Folly]

Hum...not really relevant..I thought that the staff physicians get paid for teaching clinical clerks and residents in academic hospitals, across Canada???

For shadowing, the staff physician doesn't get paid, it is really for gaining exposure for preclinical medical students, or transition to clerkship.

When we have shadowing preclinical students, the staff or senior resident would prefer that I teach them, and show them around (I guess that is the hierarchy of medicine lol)

 

For radiology electives, in Quebec, the clerks can't dictate, but they can briefly type their preliminary findings in the software, and go over with the staff or senior residents...Then the senior or junior residents dictate, my point is as a clerk, you have electronic access to CT scans, Chest X-Ray, and could read them on your own, and compare your findings with the residents & staff, for an LOR in the end!

There are academic funding plans, but they act more as a general supplement, and not all places have them. I'm sure it varies by setting, but in most cases teaching can be thought of like writing a LOR.. implicit expectation, rewarding to help others, responsibility to 'pay it forward'..

 

Well, interpreting images I'm sure makes a more rewarding experience for clerks than simply observing! Having learners teach more junior learners is not just hierarchy, but more rewarding for all (the preclinical student gets more time and attention than otherwise would be possible, the senior student gets more teaching experience and feels more valuable as a mentor, patients get taken care of more efficiently as staff can focus on the portion of the work that only they can do i.e. overseeing everything

[ellorie]

Our staff can bill OHIP for dedicated time spent supervising residents, but I think it's the same as you'd bill for spending that time with a patient, so you don't really come out ahead.  And you can't bill for clerks.

[LittleDaisy]

In Quebec, the staff physician gets paid for supervising one clerk and one resident. They get paid more by supervising clerk than the resident (well it makes sense).

I guess it's the government's incentive for staff to spend some quality time teaching med students lol

Our staff can bill OHIP for dedicated time spent supervising residents, but I think it's the same as you'd bill for spending that time with a patient, so you don't really come out ahead.  And you can't bill for clerks.

[Andrew]

I am going to give you my take on this as a 2010 umatched grad and now working 4 years as a GP. The reality, is that you are in a brutal situation. There is probably no deficiency in your application or interview, but simply that there are too many candidates and not enough residency spots. Next year, you will be seen as "damaged goods", you can try to candy coat this all you want with a positive attitude, but you need to be realistic, the interview panel will not view you the same way as the other fresh candidates. Here is my advice based on my experience:

1. Get your school to enroll you for 1 more year, as mentioned before by many other people, this gives you access to in-province electives, out of province electives, and most importantly gives you insurance while you are doing clinical electives. Actually do some electives, do family  medicine electives, do rural family medicine electives, do laboratory medicine or unpopular electives. The "student status" shouldn't be that hard - there might be a very small nominal tuition fee, but basically they are just giving you an extra year of student status.

2. In my opinion, it is not worth re-applying to a specialty, you already didn't match once, so rather than gamble again, just control the damage and move on. Focus everything you have on matching to Family medicine or (only if you are actually interested in it) some other unpopular specialty e.g. lab medicine, medical genetics etc. Plan on finishing family medicine. (I suppose you could look for opportunities to transfer but this is difficult as Family only gives 2 year of funding).

3. MBA / Masters - these are a waste of time, you went to medical school to be a doctor, focus everything you have to get into Family. Also, I don't really know what having an MBA does for you other than maybe show the interview panel that you lack commitment to their program.

4. Research - this could be ok if you are looking to fill time, especially if you can publish papers to pad your CV. bonus if it is medically related, or related to something you can apply to your interview to demonstrate interest (or at least spin it that way to the interview panel).

5. Learn to overcome anger and depression. In my experience this is THE HARDEST part. Remember the following:

You will be doing electives... as a doctor. You will be introducing yourself to patients as Dr. X, and yet, you will be fulfilling the role of a medical student during electives. You won't be able to write Rx and so on. This is humiliating. The staff and your colleagues around you can try to make it a good experience for you, but in my heart, I still felt that it was shameful to not match. It really sucks to see all your classmates as R1 and you're walking around the hospital doing f*cking electives.

There were days and even complete months where I didn't even leave my apartment, where I felt that I didn't want to do any electives, I would lie in bed, or play video games all day. On my electives, it took everything I had just to put a smile on my face and not be angry. I remember doing a pathology elective just because pathology wasn't a popular elective and to leave that as a possibility for an application. I remember being completely disinterested, and yet having to play medical student game of being completely interested. I think part of overcoming this is just to take some time off to blow off steam, maybe travel a bit. The interviews/applications never asked for an exact breakdown of my electives, so as long as you do some, you don't have to go balls to the wall to fill your schedule.

6. Family medicine is the jumping point to things outside medicine. So now I work as a GP, it's certainly not the most challenging job, but I do a 9-5, I don't do call, I don't do OBS, I have completely predictable and regular hours, I have weekends off, I get to spend time with friends and family whenever I want. I still make way more money than the average person, more money than I feel that I need. I have some minor involvement with teaching/preceptorship which could become greater if I wanted to spend more time/effort on it. I spend less time on medicine, more time on hobbies. A solid base in Family could be the springboard to whatever you want, in teaching, in politics, to apply to the board of directors of medically related companies, you could go work in the insurance business if you wanted etc. My overall experience, is that I used to see Medicine as the endpoint, and not matching to the specialty I wanted, forced me to take Family, which I use as a means to my new endpoints which are mostly non-medical.

[liammo29]

Just to provide an update, I had some great conversations with my home university pathology PD. He agreed to let me do a 3 week elective before I graduated and was impressed with my work (having a legit elective done in my fourth year will be good for my next application). He even told me if I could even find one year of funding that he would take me on as a resident this year and fund the rest. Unfortunately this wasn't possible due to budget cuts but he agreed to set me up with observerships here and with some contacts he has in ontario. He said pathology doesn't judge it against you and that I largely went unmatched due to a fear that maybe I wasn't committed. I am also starting a research project in path and doing some path skills courses. I am going with path and will back up with rads and family. Hope this maybe helps someone else. After not matching I realized you home university is far and away your best chance as (normally) they want wants best for you and they don't want you unmatched on their records.

[Andrew]

Pathology is a solid strategical choice, do family/rural family as a backup.

Also the hours, lifestyle and pay of pathology are quite good. If I didn't hate looking through microscopes and just the examination of slides in general I might have applied to it too.

[liammo29]

Thanks! I have started my pathology observership at my home university and its been going well. I was even given a desk space and a computer and told I was welcome to come in every day until the match. So I am certainly going to make us of that. I've just been shadowing staff/residents, attending teaching, and working on a research project. I am also travelling to another province to complete a month observership there with a contact from the pathology department here.

One piece of advice I have is that observerships seem to work for pathology as they aren't much different than an elective. But, I know in some specialities and elective student would have much more responsibilities (like internal) than an observer, making the observership less valuable.