Residency backlog could triple for medical school grads, report warns

[la marzocco]

No news here. 

Immediate attention is required to address the growing number of Canadian medical students who are unable to match to a residency and then practice medicine. In 2009 the number of unmatched was 11, in 2017 it was 68. By 2021 the number of current year unmatched students is projected to exceed 140 while prior year unmatched will exceed 190.

• https://afmc.ca/news/2018-02-13
• https://afmc.ca/sites/default/files/documents/en/Publications/AFMC_reportreducingunmatchedcdnmg_en.pdf
• https://www.thestar.com/news/canada/2018/02/13/residency-backlog-could-triple-for-medical-school-grads-report-warns.html

[rmorelan]

Recent cuts to provincial funding have resulted in that ration dropping to 102 spots for every 100 students in 2017

This is why the first round is just a blood bath right now in a nut shell. 

Either they fund more spots (which clearly they don't want to do) or there is going to have to be some additional IMG restriction introduced as a stop gap. Not surprisingly people are talking about removing IMG from the second round or moving them to yet another round with the CMGs having two rounds first. 

well or of course dropping the number of medical students - not sure any of those choices are going to be popular. 

[la marzocco]

Just now, rmorelan said:

Recent cuts to provincial funding have resulted in that ration dropping to 102 spots for every 100 students in 2017

This is why the first round is just a blood bath right now in a nut shell. 

Either they fund more spots (which clearly they don't want to do) or there is going to have to be some additional IMG restriction introduced as a stop gap. Not surprisingly people are talking about removing IMG from the second round or moving them to yet another round with the CMGs having two rounds first. 

well or of course dropping the number of medical students - not sure any of those choices are going to be popular. 

• Will Quebec be willing to loosen it's foothold on language requirements so that the 50-odd FM spots can be up for grabs? Unlikely?
• Streamline the timing of the Canadian and US matches to level the playing field? Since CaRMS happen before the NRMP, this is to the disadvantage of CMGs and to the advantage of USMGs. 
• Keep steaming for 2nd match - separate IMGs and CMGs?

[rmorelan]

Just now, la marzocco said:

• Will Quebec be willing to loosen it's foothold on language requirements so that the 50-odd FM spots can be up for grabs? Unlikely?
• Streamline the timing of the Canadian and US matches to level the playing field? Since CaRMS happen before the NRMP, this is to the disadvantage of CMGs and to the advantage of USMGs. 
• Keep steaming for 2nd match - separate IMGs and CMGs?

There isn't much even left in the second round to so streaming I don't think will help much(?) 

I like the NRMP move but Canada has little interest in letting our graduate go to the US in case they don't come back so I suspect there is resistance there.

Part of the problem is exactly what you mention - there may be mathematically 102 spots per 100 but not everyone obviously can do all the spots. Quebec has little interest in paying for spots that they won't benefit from.  

This has been not so subtly creeping up for years now and annoys me greatly. Cutting residency spots probably implies reduced need for doctors - particularly when you are done to the level we are at now, or that the residency spots are being used a management level tool to force people to go into particular things. It makes for a lot of desperate people.

[goleafsgochris]

Carms was scary enough when I finished in 2012.  I cant imagine the stress of how it is now.  Going unmatched is pretty career-destroying for a lot of people--this stigma makes it so much harder to get into anything, and youre basically knocked out of anything even slightly competitive.  

I truly think the best solution is to force home schools to accept unmatched students into their family med programs.  This could easily be done.  The match could work such that a family med program would take matched students to the program, then unmatched students from that home school, THEN IMGs if there is space remaining.  I get that family programs would resist (because clearly its unfair to them), but it would be my best case suggestion for fixing the issue fast

[la marzocco]

I think part of the issue is also the cascading effect right.. the prior year unmatched will take a bite into the current year. Some immediate measures are needed to block this cascade before it spirals outta control:

• Identify one-time funding to add supernumerary PGY1 positions in disciplines aligned with population health needs and allocated to schools pro rata.
• On a time-limited basis, provincial governments shift some portion of their IMG allocation over to their CMG allocation <-- THIS!

[insomnias]

1 hour ago, la marzocco said:

• Will Quebec be willing to loosen it's foothold on language requirements so that the 50-odd FM spots can be up for grabs? Unlikely?

Is the language requirement just "you must be fluent in French?" That seems pretty reasonable for Quebec. Is it possible for a non-QC francophone, or a non-QC bilingual person to match to QC? Perhaps the best solution for those of us who are okay at French would then be to take medical French courses while in med school so that we have a shot at that spot. I hear derm is less competitive in Quebec, too...

[la marzocco]

Just now, insomnias said:

Is the language requirement just "you must be fluent in French?" That seems pretty reasonable for Quebec. Is it possible for a non-QC francophone, or a non-QC bilingual person to match to QC? Perhaps the best solution for those of us who are okay at French would then be to take medical French courses while in med school so that we have a shot at that spot. I hear derm is less competitive in Quebec, too...

It is perfectly possible for non-QC francophones/bilingual candidates to match into Qc, but the issue is more desirability. Prospects in Qc are less attractive (in general) because of recent health reforms mandated by the Qc health minister. 

But I think it has been stated in this forum multiple times, Qc graduates are generally much more bilingual than ROC graduates. The Qc spots are open to everyone as long as you can demonstrate a working knowledge of the French language. So yea.. another advantage of being bilingual I guess  

[indefatigable]

1 hour ago, rmorelan said:

There isn't much even left in the second round to so streaming I don't think will help much(?) 

I like the NRMP move but Canada has little interest in letting our graduate go to the US in case they don't come back so I suspect there is resistance there.

Part of the problem is exactly what you mention - there may be mathematically 102 spots per 100 but not everyone obviously can do all the spots. Quebec has little interest in paying for spots that they won't benefit from.  

This has been not so subtly creeping up for years now and annoys me greatly. Cutting residency spots probably implies reduced need for doctors - particularly when you are done to the level we are at now, or that the residency spots are being used a management level tool to force people to go into particular things. It makes for a lot of desperate people.

Yeah - as you've mentioned before, I think the management aspect is important.  Looking at the match outcomes, it's basically surgery with non-lab specialties (anesthesia, derm, pediatrics..) that have much greater demand than supply (p32-3).  IM (and psych) are close (at) to the 1:1 demand/supply ratio.  These are probably Canada wide stats.

  It'd be great if they would break it down by province - Québec's situation is clear, but what about Ontario or the Western provinces - where's the biggest deficit?  With ratios this close, even the matching USMGs could tilt the balance a little, not to mention accommodating IMG matches which could be a factor in 2nd round decision.  Effectively what is the Ontario balance considering IMGs, USMGs, OOP, etc.. (maybe it's available somewhere?)

[rmorelan]

52 minutes ago, la marzocco said:

I think part of the issue is also the cascading effect right.. the prior year unmatched will take a bite into the current year. Some immediate measures are needed to block this cascade before it spirals outta control:

• Identify one-time funding to add supernumerary PGY1 positions in disciplines aligned with population health needs and allocated to schools pro rata.
• On a time-limited basis, provincial governments shift some portion of their IMG allocation over to their CMG allocation <-- THIS!

They already have been doing the latter point quite a bit already - not much slack left in many areas. 

[indefatigable]

8 hours ago, la marzocco said:

It is perfectly possible for non-QC francophones/bilingual candidates to match into Qc, but the issue is more desirability. Prospects in Qc are less attractive (in general) because of recent health reforms mandated by the Qc health minister. 

But I think it has been stated in this forum multiple times, Qc graduates are generally much more bilingual than ROC graduates. The Qc spots are open to everyone as long as you can demonstrate a working knowledge of the French language. So yea.. another advantage of being bilingual I guess  

Yeah - there's typically a criterion, like 860/990 on the TFI for eligibility as a non-francophone to be considered.  In perspective - Montreal anglos aren't always at ease achieving this, but it's actually less strict than the IELTS academic for non-anglophones used in the Western provinces.  It's more like the IELTS general test.

 it's a little odd, though: the CanMEDS role of communicator is crucial.  But, unless one is exceptionally bilingually fluent communication is going to really decrease in a second language environment.  So I understand the motivation for people to consider francophone positions, but at the same time I hesitate to recommend that route since clinical effectiveness will probably reduced for quite some time and will clearly impact patient care.  

In a separate thread, there was a final discussion of US residency (Health Canada will sponsor FM positions) vs Québec.  Probably, for most people, writing the MLEs over the summer and during clerkship is much easier than becoming fluent in French (which necessarily should include written fluency in a clinical environment).
 

 

[la marzocco]

2 hours ago, rmorelan said:

I like the NRMP move but Canada has little interest in letting our graduate go to the US in case they don't come back so I suspect there is resistance there.

Reasonable that there would be push-back. But, if CMGs are going to be unmatched at these rates, the government can only hope to release some steam by streamlining the match timelines with that of the NRMP, handing out more SoN letters and *hope* that they return to Canada to settle.

[indefatigable]

3 hours ago, la marzocco said:

Reasonable that there would be push-back. But, if CMGs are going to be unmatched at these rates, the government can only hope to release some steam by streamlining the match timelines with that of the NRMP, handing out more SoN letters and *hope* that they return to Canada to settle.

If anything the push-back would be on the American side with the current US administration.  Residency on a J-1 visa in the US is not permission to permanently practice there: a few loopholes like working at a VA hospital exist, but otherwise there's no loss from the Canadian point of view.  Any coordination would probably mean following American timelines.

Edit: It also seems to me that looking at the number of CMG underestimates the number of trained docs, because of the Visa issue.  Any CSA doesn't have an automatic right to stay in the US, and after American especially FM residency would likely come back to work.  

[shikimate]

I tell EVERYONE they should write Step 1, even if they don't think they'll ever go unmatch, or they don't want to go to US, or they don't like their president etc etc.

People just don't get it until they become a martyr of the CaRMS process. I know CMG who went unmatched for 2 years and still haven't wrote Step 1. I wish that person luck this cycle. 

If you don't open more doors, nobody is going to hire a valet to open doors for you, especially NOT politicians. Waiting for the government to solve your problems? Good luck. I'd bet 10 years from now the government would still be trying to form a committee to study this issue without taking any action.

[indefatigable]

1 hour ago, shikimate said:

I tell EVERYONE they should write Step 1, even if they don't think they'll ever go unmatch, or they don't want to go to US, or they don't like their president etc etc.

People just don't get it until they become a martyr of the CaRMS process. I know CMG who went unmatched for 2 years and still haven't wrote Step 1. I wish that person luck this cycle. 

If you don't open more doors, nobody is going to hire a valet to open doors for you, especially NOT politicians. Waiting for the government to solve your problems? Good luck. I'd bet 10 years from now the government would still be trying to form a committee to study this issue without taking any action.

Still - Step 1 is probably most useful for primary care since it's the easiest to get a visa for the US and also to match to.  It's also the specialty that probably has stronger matching prospects in Canada.  For your acquaintance it could make sense though, supposing it's a specialty that's sponsored by Health Canada.  But I kind of wonder whether it's more rational for people to have solid parallel plans for competitive specialties.  

The CaRMS matching issue also kind of slips between the cracks - it's both provincial responsibility on some level, but Canada wide problem.

[JohnGrisham]

6 hours ago, la marzocco said:

• Will Quebec be willing to loosen it's foothold on language requirements so that the 50-odd FM spots can be up for grabs? Unlikely?
• Streamline the timing of the Canadian and US matches to level the playing field? Since CaRMS happen before the NRMP, this is to the disadvantage of CMGs and to the advantage of USMGs. 
• Keep steaming for 2nd match - separate IMGs and CMGs?

Why do you think US match After canada match is bad? I think its actually good that way. With US match first, you'd essentially preclude matching to Canada. 

 

From my perspective, matching in the US is a backup. So it makes perfect sense to have CaRMS before NRMP. It would be nice if CaRMS round 2 was also before NRMP, but can't be too picky.

[JohnGrisham]

3 hours ago, la marzocco said:

Reasonable that there would be push-back. But, if CMGs are going to be unmatched at these rates, the government can only hope to release some steam by streamlining the match timelines with that of the NRMP, handing out more SoN letters and *hope* that they return to Canada to settle.

Canada doesn't care if they return..the whole issue at hand is capping the provision of care. Doctors are expensive. Training costs are peanuts to the actual ongoing costs of a physician who is billing MSP.

[JohnGrisham]

5 hours ago, goleafsgochris said:

Carms was scary enough when I finished in 2012.  I cant imagine the stress of how it is now.  Going unmatched is pretty career-destroying for a lot of people--this stigma makes it so much harder to get into anything, and youre basically knocked out of anything even slightly competitive.  

I truly think the best solution is to force home schools to accept unmatched students into their family med programs.  This could easily be done.  The match could work such that a family med program would take matched students to the program, then unmatched students from that home school, THEN IMGs if there is space remaining.  I get that family programs would resist (because clearly its unfair to them), but it would be my best case suggestion for fixing the issue fast

Most FM programs in English canada dont really have any spots left after round 1 though.

[la marzocco]

1 hour ago, JohnGrisham said:

Why do you think US match After canada match is bad? I think its actually good that way. With US match first, you'd essentially preclude matching to Canada. 

 

From my perspective, matching in the US is a backup. So it makes perfect sense to have CaRMS before NRMP. It would be nice if CaRMS round 2 was also before NRMP, but can't be too picky.

Let’s say you backup a competitive specialty with FM and enter into CaRMS. And you end up getting good vibes at competitive specialty programs in the US and feel strongly about US programs. And now imagine the odds fall out of favour for CaRMS and you match to FM and by consequence you are now withdrawn from the NRMP. We can imagine how erratic matching in Canada can be - especially with the absence of a standardized metric like a MLE. Sure, you can participate in the match the following year, but that is not wise.

You not only took a FM position from someone who might actually enjoy FM, you yourself might also not be satisfied. 

This is the big disconnect. I think NRMP should coincide with R1 for CaRMS. So you can have a 2-3 day window to make a decision. If you give up your spot in CaRMS, that can get rolled into R2 match. 

Does that clarify my stance?

[JohnGrisham]

5 minutes ago, la marzocco said:

Let’s say you backup a competitive specialty with FM and enter into CaRMS. And you end up getting good vibes at competitive specialty programs in the US and feel strongly about US programs. And now imagine the odds fall out of favour for CaRMS and you match to FM and by consequence you are now withdrawn from the NRMP. Sure, you can participate in the match the following year, but that is not wise.

You not only took a FM position from someone who might actually enjoy FM, you yourself might also not be satisfied. 

This is the big disconnect. I think NRMP should coincide with R1 for CaRMS. So you can have a 2-3 day window to make a decision. If you give up your spot in CaRMS, that can get rolled into R2 match. 

Does that clarify my stance?

If that was the case, you wouldn't have backed up with FM in CaRMs the first place. Your back up would be the speciality programs in the US match.

You can't have it all ways, if you dont want FM, dont rank it.
 

[indefatigable]

Just now, JohnGrisham said:

If that was the case, you wouldn't have backed up with FM in CaRMs the first place. Your back up would be the speciality in the US match.

 

Plus I don't think the example is realistic for most CMGs.  It's hard to be competitive in both Canada and the US accounting for elective time, MLE scores, etc..  All of a sudden electives are not only getting divided up by specialty, but also by country.  

[la marzocco]

8 minutes ago, JohnGrisham said:

If that was the case, you wouldn't have backed up with FM in CaRMs the first place. Your back up would be the speciality in the US match.

 

I guess FM would be plan C. If you fail to match in NRMP.

What I’m trying to drive home is that I think the timing can be streamlined: R1 = NRMP and R2 = scramble. Maybe it is a moot point.

[JohnGrisham]

2 minutes ago, la marzocco said:

I guess FM would be plan C. If you fail to match in NRMP.

What I’m trying to drive home is that I think the timing can be streamlined: R1 = NRMP and R2 = scramble. 

Im still not sure i follow.

Currently the usual order is this:

1. Round 1 CaRMs

2. Round 1 NRMP 

3. NRMP scramble

4. Round 2 CaRMS 

As long as you don't put programs you wouldn't want to attend on your ROL in Round 1 CaRMs, then the US NRMP match is open to you if you dont match in 1).

 

[la marzocco]

2 minutes ago, JohnGrisham said:

Well, you can also rank US FM in NRMP below your specailties of choice.

It can get quite pedantic and esoteric after a point though. At least for the US match, there is much stronger and predictable patterns: i.e. if you have strong enough scores, you can be fairly sure you'll match if you cast a wide net. 

Also, should a delineation be made regarding CMGs and USMGs who are Canadian citizens? Not sure.

USMGs have a 50% match rate in CaRMS and take 25 spots yearly. 

[JohnGrisham]

3 minutes ago, la marzocco said:

Also, should a delineation be made regarding CMGs and USMGs who are Canadian citizens? Not sure.

USMGs have a 50% match rate in CaRMS and take 25 spots yearly. 

USMDs and Canadian MDs are accredited by the same body. They cannot bump them to Round 2 or the IMG stream, otherwise they would. That was the reason USDOs were bumped to Round 2 the other year, because they realized that there was now a sizeable cohort of Canadians attending USDO programs.