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Residency backlog could triple for medical school grads, report warns


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36 minutes ago, MDLaval said:

If you consider only Laval, there were 10 FM available in Quebec City after round 2. Not to mention the rural/remote ones that almost nobody wants. By doing that (taking the funding to an English speaking program), the problem would be too easily solved/reduced. That's why they won't/can't do it. Bureaucrats don't think like normal people (if at all :lol:).

One possibility would be for other provinces to sign up some sort of agreement with QC regarding a certain number of positions becoming available to CMG from other provinces, just like some Maritimes provinces have regarding positions in Med school in QC. But I think that would probably be too complicated to sort out and someone would end up challenging it in the Courts. 

Don't know if / how McGill could play a role in offering those unfilled positions to CMGs whose French isn't that good / virtually inexistent.

Indeed, the provincially fragmented system doesn't favour CMGs at all. 

Well the issue is, even if QC agreed to sign an agreement..would be kind of pointless as you say, if your french isnt good. I dont want people who know very little french going to quebec and offering substandard care, and likely receiving substandard training(hard to get nuances if you dont know the language)

Another solution would be for people to learn french, but easier said then done. At this point in your life.

Really, moving funding from Quebec to other provinces is a great solution, but wont happen.

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3 hours ago, bloh said:

Sorry to burst your bubble but the gap is in the process of being remedied. 80% of the working MDs (across all fields) voted in favour of doing something about it and the initiative was began last year. This gap is enormous and has wide-reaching implications in our healthcare system from the early stages of medical school training, to relationships between healthcare professionals and to our system overall. You can actually see a tiny glimpse of the problem just in your comment alone (highlighted in quotes :)).


For comparison, this gap was only 50% 30-40 years ago and it's gotten truly out of hand.

There have been plenty of votes and petitions for the last 2 decades haha...times are slow to change.

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1 hour ago, JohnGrisham said:

Well the issue is, even if QC agreed to sign an agreement..would be kind of pointless as you say, if your french isnt good. I dont want people who know very little french going to quebec and offering substandard care, and likely receiving substandard training(hard to get nuances if you dont know the language)

Another solution would be for people to learn french, but easier said then done. At this point in your life.
 

"The journey of 1000 miles begins with one step".

The issues regarding care and training in a second language aren't ones that I haven't considered in my own journey.

 I believe the IELTS (for non-anglophones) academic (that is used in the Western provinces) rather than general, which is like the TFI (Test de Français International) for non-francophones (used in QC), is more representative of the linguistic competence needed to excel in med school.  

Nonetheless, I recognize that regional and demographic factors, coupled with the provincial nature of med school admissions means that compromises are made.  As people will generally try to seek out opportunities available to them, I believe the linguistic criteria for French residency program that are clearly stated in CaRMS program description by PDs necessitate a minimally sufficient level to successfully complete training.         

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7 hours ago, bloh said:

Here's how you fix it.

 

1. Cut medical student spots by 5%

2. Reduce income equality between family medicine/pediatrics/psychiatry AND everything else. Alberta medical association has done a study and found that the gap between highest paid and lowest paid specialty is different by a factor of 3.3 EVEN AFTER ACCOUNTING FOR TRAINING TIME AND OVERHEAD COSTS. This means that the lowest paid specialist has to work a full work week to match 3 half days that a highest paid specialist works. That is the crux of the problem. I'm glad people brought up dermatology as an example. You can actually appreciate how this gap result in wider problems in our healthcare system as well. If a dermatologist can make as much as a full-time pediatrician in 1.5 days, they will. Guess what happens to the wait times? :)

Except this doesn’t apply to derm. 

If derm fees are cut, then guess what the average dermatologist does? First, they increase the relative proportion of cosmetic patients they see. They already get 10-15% of their practice as cosmetic by doing zero advertising. Increase that cash business to 30% and you’ve made up for government cuts. Next, they tighten up on what they consider medical vs cosmetic. Every SK spray will turn to cash, further increasing cash earnings and reducing need for medical billing. As a consequence, the dermatologist works the exact same hours at the same overall income, and their wait time gets longer. 

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1 hour ago, ZBL said:

Except this doesn’t apply to derm. 

If derm fees are cut, then guess what the average dermatologist does? First, they increase the relative proportion of cosmetic patients they see. They already get 10-15% of their practice as cosmetic by doing zero advertising. Increase that cash business to 30% and you’ve made up for government cuts. Next, they tighten up on what they consider medical vs cosmetic. Every SK spray will turn to cash, further increasing cash earnings and reducing need for medical billing. As a consequence, the dermatologist works the exact same hours at the same overall income, and their wait time gets longer. 

Except people that are willing to pay for cosmetics don't grow on trees. They already will bump every medical patient for a cosmetic so it doesn't matter.

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49 minutes ago, bloh said:

Except people that are willing to pay for cosmetics don't grow on trees. They already will bump every medical patient for a cosmetic so it doesn't matter.

True, they don't, but there's enough of them that any fee cuts to derm probably wont have an effect on their total income, but come at the expense of medical patients 

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17 hours ago, JohnGrisham said:

Well the issue is, even if QC agreed to sign an agreement..would be kind of pointless as you say, if your french isnt good. I dont want people who know very little french going to quebec and offering substandard care, and likely receiving substandard training(hard to get nuances if you dont know the language)

Another solution would be for people to learn french, but easier said then done. At this point in your life.

Really, moving funding from Quebec to other provinces is a great solution, but wont happen.

Yeah, I thought about the French "detail" while I was writing. However, I was also trying to imagine what kind of a role McGill and its affiliate sites could play in trying to help those CMGs whose French skills aren't that good (or no French at all). Besides, we know that there are Fellows and even residents from abroad at McGill who don't speak French. How do they deal with the language requirement for those cases? :confused:  I don't know, maybe it's just me, but if they apply whatever rule they do for those cases, why not do the same for CMGs?

I understand that the unfilled spots are in French speaking programs, and that it would require some restructuring at some McGill's sites so that they could receive a few more residents. But at least that kind of funding reassignment is, in theory, possible, since the funding would remain in the province of Quebec.

I agree that moving funding would be the easiest solution, but then again, it won't happen with our provincially funded system. But, let's go crazy for a second: what about a federally funded system where all residents would be paid the same and the national interest would come 1st, with some input from provinces of course, and with the ability to move the funding from spots that remain repeatedly unfilled (like the tens os FM positions in QC) towards funding a few more FM positions spread through the ROC?? yeah, forget that I said that. :lol:

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55 minutes ago, MDLaval said:

Yeah, I thought about the French "detail" while I was writing. However, I was also trying to imagine what kind of a role McGill and its affiliate sites could play in trying to help those CMGs whose French skills aren't that good (or no French at all). Besides, we know that there are Fellows and even residents from abroad at McGill who don't speak French. How do they deal with the language requirement for those cases? :confused:  I don't know, maybe it's just me, but if they apply whatever rule they do for those cases, why not do the same for CMGs?

I understand that the unfilled spots are in French speaking programs, and that it would require some restructuring at some McGill's sites so that they could receive a few more residents. But at least that kind of funding reassignment is, in theory, possible, since the funding would remain in the province of Quebec.

I agree that moving funding would be the easiest solution, but then again, it won't happen with our provincially funded system. But, let's go crazy for a second: what about a federally funded system where all residents would be paid the same and the national interest would come 1st, with some input from provinces of course, and with the ability to move the funding from spots that remain repeatedly unfilled (like the tens os FM positions in QC) towards funding a few more FM positions spread through the ROC?? yeah, forget that I said that. :lol:

Practicing in Montreal without sufficient french proficiency is one thing. Doing so in the rest of Quebec is a completely different beast. After round 2, McGill only had 2 spots left last year and those were probably the 2 FM spots in Val-d'Or. You need perfect french for those so there isn't much McGill can do.

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24 minutes ago, Snowmen said:

Practicing in Montreal without sufficient french proficiency is one thing. Doing so in the rest of Quebec is a completely different beast. After round 2, McGill only had 2 spots left last year and those were probably the 2 FM spots in Val-d'Or. You need perfect french for those so there isn't much McGill can do.

That's why I talked about the need of probably restructuring some McGill's sites so that they could receive a few more residents where French isn't that much needed. Then again, I don't see why the province would willingly fund those residents knowing they'll probable leave the province after their training due to their lack of French language skills.

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5 hours ago, Snowmen said:

Practicing in Montreal without sufficient french proficiency is one thing. Doing so in the rest of Quebec is a completely different beast. After round 2, McGill only had 2 spots left last year and those were probably the 2 FM spots in Val-d'Or. You need perfect french for those so there isn't much McGill can do.

T'as raison de dire que dans les régions les gens ne vont pas nécessairement parler d'anglais et il faut visionner une plus haute capacité en français.  Mais c'est un point discutable, car même à Montréal, les personnes qui veulent rester et pratiquer doivent réussir un test de français exigeant.

You're correct in stating that in the regional areas, people won't necessarily speak English, and residents would have to be able to speak better French.  But it's a slightly moot point, since even in Montreal, people who want to stay and to practice will need to pass a difficult French language test.

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On 2/13/2018 at 11:33 AM, la marzocco said:

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.

Do we know how many CMG residency spots go unfilled each year in total?

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29 minutes ago, W0lfgang said:

Do we know how many CMG residency spots go unfilled each year in total?

2017: There are 64 unfilled positions after the second iteration of the 2017 R-1 Main Residency Match: 4 in Alberta, 2 in Ontario and 58 in Quebec. Hard to map exactly the original designation of these spots since they end up getting blended in the 2nd round. But I did read somewhere noting that IMGs are more successful at getting the 1st-round-CMG-designated spots in the 2nd round than CMGs are. Interestingly, one of the proposals from the AFMC is to maintain streaming in the 2nd match to prevent this from happening.

2016: There are 51 unfilled positions after the second iteration of the 2016 R-1 Main Residency Match. Again most in Quebec.

2015: 73

...

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5 hours ago, la marzocco said:

But I did read somewhere noting that IMGs are more successful at getting the 1st-round-CMG-designated spots in the 2nd round than CMGs are. Interestingly, one of the proposals from the AFMC is to maintain streaming in the 2nd match to prevent this from happening.

 

Wouldn't it be in the best interest of everyone to rather identify what the reasons are that make these CMGs less competitive / less qualified than IMGs, so that the weaknesses could be solved and, therefore, preventing other future CMGs from having the same issues (whatever they are)??

By simply protecting people by maintaining streaming in the 2nd round doesn't solve any problem except for the number of unmatched CMGs in the final report. It doesn't do any good towards actually helping them and the future CMGs who could be developing the same weaknesses/issues during med school.

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9 minutes ago, MDLaval said:

Wouldn't it be in the best interest of everyone to rather identify what the reasons are that make these CMGs less competitive / less qualified than IMGs, so that the weaknesses could be solved and, therefore, preventing other future CMGs to have the same issues (whatever they are)??

By simply protecting people by maintaining streaming in the 2nd round doesn't solve any problem except for the number of unmatched CMGs in the final report. It doesn't do any good towards actually helping them and the future CMGs who could be developing the same weaknesses/issues during med school.

I agree with doing a root cause analysis. Also, I mean.. unmatched 1st round CMGs also benefit from unfilled previously designated IMG spots - so I think the net benefit of maintaining streaming in 2nd round from CMG perspective if anything may be smaller than they anticipate.

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If a CMG didn't match in the first round, they didn't get their preferred specialty (ies).  The supply of IMGs who are "gunning" for a given specialty is so much higher, that likely, they could look more competitive than the CMG in terms of electives, etc... and thus may be chosen over a CMG with possibly no elective experience in a given specialty in the second round.

Keeping the streaming would give a greater chance to those CMGs to still match, even after not matching the first round.  

But I agree, more data could be useful as well.  

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The most concerning aspect of this report is the new "philosophy" of the government. In their eyes, going "unmatched" is not a concern. They don't seem to mind the training costs of the unmatched. I spoke to a counselor at my school, and this reflects the new reality. I think CMGs have to accept that matching will no longer be a guarantee .  I only hope programs and program directors will recognize this fact and don't stigmatize the unmatched.

 

I hope Canadian medical students vote with political pressure and do their preferred residencies in the US. I think it's the only way there will be any political volition to change things.

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36 minutes ago, snapmoster82 said:

The most concerning aspect of this report is the new "philosophy" of the government. In their eyes, going "unmatched" is not a concern. They don't seem to mind the training costs of the unmatched. I spoke to a counselor at my school, and this reflects the new reality. I think CMGs have to accept that matching will no longer be a guarantee .  I only hope programs and program directors will recognize this fact and don't stigmatize the unmatched.

I hope Canadian medical students vote with political pressure and doing their preferred residencies in the US. I think it's the only way there will be any political volition to change things.

Isn't a quick fix to link # of medical seats with # of residency positions? If provincial fundings does not permit the creation of new spots, isn't the next best measure to curb medical enrolment as a stopgap?

What boggles my mind was back in 2015/2016 when Ontario reduced 70 spots, none of Ontario's 6 medical schools enacted an in-step/commensurate reduction in its intake. 

I am not sure, but do the faculties of medicine in Ontario have a say in its enrolment or is that also dictated by the government? If the latter, then it even makes less sense.

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37 minutes ago, snapmoster82 said:

The most concerning aspect of this report is the new "philosophy" of the government. In their eyes, going "unmatched" is not a concern. They don't seem to mind the training costs of the unmatched. I spoke to a counselor at my school, and this reflects the new reality. I think CMGs have to accept that matching will no longer be a guarantee .  I only hope programs and program directors will recognize this fact and don't stigmatize the unmatched.

 

I hope Canadian medical students vote with political pressure and doing their preferred residencies in the US. I think it's the only way there will be any political volition to change things.

You can't effectively "vote with political pressure and doing preferred residencies in the US" because Canada also restricts what you can and can't do in the US for the most part.

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1 hour ago, la marzocco said:

Isn't a quick fix to link # of medical seats with # of residency positions? If provincial fundings does not permit the creation of new spots, isn't the next best measure to curb medical enrolment as a stopgap?

What boggles my mind was back in 2015/2016 when Ontario reduced 70 spots, none of Ontario's 6 medical schools enacted an in-step/commensurate reduction in its intake. 

I am not sure, but do the faculties of medicine in Ontario have a say in its enrolment or is that also dictated by the government? If the latter, then it even makes less sense.

To be fair, medical schools should have reduced spots  and the process likely takes time. I am not sure how it works. I do know that universities and med schools alike, justify their presence in part due to their enrollment and expansion.  In almost all health care fields, universities address gaps and shortages by increasing satellite campuses, and adding more students. Asking the medical school to reduce spots is not likely to be their first reaction. 

It is always good to keep in mind that any changes take three/four years to take effect. As such, the immediate solution to avoid the crisis is not likely to be a reduction in enrollment. 

 

 

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1 hour ago, snapmoster82 said:

To be fair, medical schools should have reduced spots  and the process likely takes time. I am not sure how it works. I do know that universities and med schools alike, justify their presence in part due to their enrollment and expansion.  In almost all health care fields, universities address gaps and shortages by increasing satellite campuses, and adding more students. Asking the medical school to reduce spots is not likely to be their first reaction. 

It is always good to keep in mind that any changes take three/four years to take effect. As such, the immediate solution to avoid the crisis is not likely to be a reduction in enrollment. 

I think reducing enrolment is probably the most practical thing to do at this point to reduce the number of unmatched CMGs - hence I referred it as a stopgap measure before we can figure out more options from a provincial funding perspective.

Quebec has already phased in a 3-year plan to curtail enrolment - with this year 32 spots reduced across the 4 medical schools. I don't see it as being that difficult to moderate enrolment if funding is constraint at the level of residency. Whereas a province like Ontario which saw a 70-spot reduction in residency positions has not yet pass down this effect to the medical school enrolment level.

In theory, faculties have more say in how many they can accept so if all deans are committed to reducing # of unmatched CMGs, then a stopgap is to reduce enrolment (at least in the medium term until provinces and AFMC and all the stakeholders have a discussion). End of the day the "pan-Canada" physician supply planning is broadly sketched out based on # of residency positions so we shouldn't be graduating more than we can absorb in PGME.

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59 minutes ago, la marzocco said:

I think reducing enrolment is probably the most practical thing to do at this point to reduce the number of unmatched CMGs - hence I referred it as a stopgap measure before we can figure out more options from a provincial funding perspective.

Quebec has already phased in a 3-year plan to curtail enrolment - with this year 32 spots reduced across the 4 medical schools. I don't see it as being that difficult to moderate enrolment if funding is constraint at the level of residency. Whereas a province like Ontario which saw a 70-spot reduction in residency positions has not yet pass down this effect to the medical school enrolment level.

In theory, faculties have more say in how many they can accept so if all deans are committed to reducing # of unmatched CMGs, then a stopgap is to reduce enrolment (at least in the medium term until provinces and AFMC and all the stakeholders have a discussion). End of the day the "pan-Canada" physician supply planning is broadly sketched out based on # of residency positions so we shouldn't be graduating more than we can absorb in PGME.

I agree.  That sounds like roughly a 3% yearly reduction in Québec.  If all other Canadian faculties, especially in Ontario, instituted a 3-4% seat reduction/year for a few years, the whole issue would really improve, if not disappear.  I think it's much easier "sell" to make a case for seat reductions rather than adding residency spots or changing IMG designated positions which are complicated in terms of finances or politically or both.  And it would make a real statement if the Deans took action rather than waiting for provincial or federal resolution - I think it would show strong leadership.

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10 hours ago, snapmoster82 said:

The most concerning aspect of this report is the new "philosophy" of the government. In their eyes, going "unmatched" is not a concern. They don't seem to mind the training costs......

 

It is literally impossible to overestimate the stupidity of the government.

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So I was thinking today, isn't the concept of encouraging people to back up and apply to multiple specialties (as they do at our school), kind of a non-sense tactic for OVERALL match rate improvement, given the current climate?

Heres why im simplistically thinking this:

1. The number of residencies spots is so close to the number of graduating CMGs now, that there really arent that many english speaking CMG spots left after round one.

2. Schools only have so much capacity to interview prospective candidates, and interview X number regardless of the number of applicants. 

3. Given 1 and 2, if suddenly the top 20% of students parralell applied more and more, they are likely to gain more interviews and if they can physically attend more interviews, so instead of going on 10, they go on 20...that just means that they are taking up more interview slots, and someone who is less competitive for specialty B, who would have gone on 10 interviews, is now only going on 5 interviews.  This is under the assumption(which seems very reasonable) that the # of interview slots is finite.

It just seems that while the option of backing up and parralell applying *may* help an individual applicant, it DOESN'T  DO ANYTHING AT ALL to help with the overall match numbers and match rates.  It's not addressing the actual problem, of simply too tight of a residency spot to Graduating CMG ratio. 

So while person 1 who applied to Specialty A and Specialty B, may end up being unsuccessful for choice A and end up in B, that spot at B would likely have been filled regardless.

Just made me think, as one of the M4s who dual applied went on 19 interviews.  

Unless of course, programs actually ARE increasing the number of interviews they offer out..

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