Residency backlog could triple for medical school grads, report warns

[insomnias]

In the US, the biggest things you need for management consulting are pedigree and the ability to interview well -- so an IMG wouldn't get into one of these positions, and they generally recruit from the top 10. In Canada, we're pretty much all on a level playing field, and I think every university (except NOSM?) that grants an MD is considered a "target school" by the consulting firms. So you have the pedigree--now you need to spend three weeks teaching yourself how to a) justify the move to consulting and b ) solve cases in a high-stakes interview. After 2-3 years with one of the main firms, most people leave consulting to get jobs that are either more lucrative, have better hours, or both. Or you can stay and work your way up -- if you make partner, you're looking at $1M+ per year. This is the pathway for people who actually want money, and it's what I'd suggest to any premed who's capable of getting into medicine but only wants to do it for the money.

[la marzocco]

Just now, insomnias said:

In the US, the biggest things you need for management consulting are pedigree and the ability to interview well -- so an IMG wouldn't get into one of these positions, and they generally recruit from the top 10. In Canada, we're pretty much all on a level playing field, and I think every university (except NOSM?) that grants an MD is considered a "target school" by the consulting firms. So you have the pedigree--now you need to spend three weeks teaching yourself how to a) justify the move to consulting and b ) solve cases in a high-stakes interview. After 2-3 years with one of the main firms, most people leave consulting to get jobs that are either more lucrative, have better hours, or both. Or you can stay and work your way up -- if you make partner, you're looking at $1M+ per year. This is the pathway for people who actually want money, and it's what I'd suggest to any premed who's capable of getting into medicine but only wants to do it for the money.

this.

[rmorelan]

4 minutes ago, marrakech said:

I'm not convinced that 120K/year is at all achievable without further qualifications, like a MBA.  The additional degree would definitely add to the debt load, if it weren't covered by an employer.  

I can understand your skepticism - I only have two examples of it happening that I am personally aware of. The sample size is small - but then again so is the number of people this would apply to. One went the law route (consultant on all of those insurance claims). One went into a large health care firm and helped them figure out all the request for proposals. Both probably down stream would benefit from an MBA but to be clear it is not their management skills that was the driving force for them being hired. 

[JohnGrisham]

1 hour ago, la marzocco said:

You will be very surprised. A few friends of mine realized medicine was not really for them at the end of 4th year, and steered into consulting and were able to command that starting salary. Not much business background in their CV (if at all), and the consulting firm was also very willing to send them to the US for their MBA.

I was recruited by a few consulting firms right after law school and the salary was handsome, but a JD is nothing without articling, which is why I passed on that opportunity in order for me to pass the bar. One could argue JD is more "translatable" than an MD into consulting, but I don't see it that way, either way consulting firms are trying hard to get their hands on niche areas.

Maybe Quebec's different, but a good chunk of my social group is in consulting across the spectrum...and it just doesn't add up. But that is great for them!  I just don't see it as the norm hah. 

Would love to know which company that was(if you'd be willing to share, via PM, if not that's fine too!), having done some summer work with one of the big consulting firms before medicine, its never off the table. Especially at 175k.

[la marzocco]

I know there are are about ~300 odd spots in the IMG-designated path for the first iteration of the R-1 match, but what is preventing the provinces to just move 1/2 of those spots to CMG-designated for let’s say a few years? Can they realistically do that to temporary stopgap the problem of unmatched or would that cause even more uproar by IMGs?

[rmorelan]

On 2/13/2018 at 7:59 PM, 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. 

They cannot do the first point - that has been attempted but it is illegal. They cannot discriminate on the country of origin - ha even if the country of origin is Canada. 

Not to mention we start closing that door they will do the same - and I like the fact there is at least that safety valve there in place. 

[rmorelan]

57 minutes ago, la marzocco said:

I know there are are about ~300 odd spots in the IMG-designated path for the first iteration of the R-1 match, but what is preventing the provinces to just move 1/2 of those spots to CMG-designated for let’s say a few years? Can they realistically do that to temporary stopgap the problem of unmatched or would that cause even more uproar by IMGs?

Up roar yes for sure - and once you drop the levels good luck turning it back politically. Any temporary anything will just delay the issue (which sometimes is not a bad thing to say the least particularly if you are unmatched). You would just eventually have the same problem - too many people applying to too many spots with a government that wants to use the limited spots to force people to do things they may not otherwise want to do. 

[indefatigable]

18 hours ago, la marzocco said:

I know there are are about ~300 odd spots in the IMG-designated path for the first iteration of the R-1 match, but what is preventing the provinces to just move 1/2 of those spots to CMG-designated for let’s say a few years? Can they realistically do that to temporary stopgap the problem of unmatched or would that cause even more uproar by IMGs?

17 hours ago, rmorelan said:

Up roar yes for sure - and once you drop the levels good luck turning it back politically. Any temporary anything will just delay the issue (which sometimes is not a bad thing to say the least particularly if you are unmatched). You would just eventually have the same problem - too many people applying to too many spots with a government that wants to use the limited spots to force people to do things they may not otherwise want to do. 

Agree - there's no legal reason why it couldn't happen (i.e. no mandated minimum number of quota positions), but issues like losing the RoS (even though essentially meaningless in ON) and not filling priority positions for the provincial governments mean it may not happen.  UBC I believe converted a 1st round derm IMG-RoS into a CMG-RoS position - could be a template for competitive residencies, but might be harder to sell for other residencies.  

 

[GrouchoMarx]

1 hour ago, tere said:

Agree - there's no legal reason why it couldn't happen (i.e. no mandated minimum number of quota positions), but issues like losing the RoS (even though essentially meaningless in ON) and not filling priority positions for the provincial governments mean it may not happen.  UBC I believe converted a 1st round derm IMG-RoS into a CMG-RoS position - could be a template for competitive residencies, but might be harder to sell for other residencies.  

 

USMLE is the best backup option.

Things wont change for the better unless canadian medical students utilize superior alternate options in the USA. When a bunch of CMGs start matching to the states, you can be assured that it will have political effects up here.

[Blasé]

30 minutes ago, GrouchoMarx said:

USMLE is the best backup option.

Things wont change for the better unless canadian medical students utilize superior alternate options in the USA. When a bunch of CMGs start matching to the states, you can be assured that it will have political effects up here.

I'm not familiar with the space, but wouldn't CMGs have to do away electives in the US to have a chance at matching into a decently competitive speciality (in addition to good USMLE scores) in the States. Wouldn't that come at the expense of matching in Canada because it would take away from away electives in Canada? In addition, since the CARMS match occurs first, that makes it even difficult for CMGs to match in the States.

[GrouchoMarx]

1 hour ago, Blasé said:

I'm not familiar with the space, but wouldn't CMGs have to do away electives in the US to have a chance at matching into a decently competitive speciality (in addition to good USMLE scores) in the States. Wouldn't that come at the expense of matching in Canada because it would take away from away electives in Canada? In addition, since the CARMS match occurs first, that makes it even difficult for CMGs to match in the States.

They would not.

Besides something like derm which is super competitive on both sides of the border, away rotations are seldom done in the USA as they place more emphasis on step scores, letters, and research.

The US match would be the backup option in my suggestion, instead of the anemic second round of carms where CMGs are competing with FMGs from everywhere on earth for undesirable spots that they might not even get.

[indefatigable]

2 hours ago, GrouchoMarx said:

USMLE is the best backup option.

Things wont change for the better unless canadian medical students utilize superior alternate options in the USA. When a bunch of CMGs start matching to the states, you can be assured that it will have political effects up here.

I agree that numerous CMGs matching to the US would have significant political repercussions.  

But, as Canadian schools have moved away from emphasizing the basic sciences needed in Step 1 (which itself has increased in complexity) and CaRMS has become more competitive (i.e. more time on research, etc..), I think this is less likely to occur.  To me, it's not a question of CMGs refusing to consider the US - just an increasingly disadvantageous position for the US match.  There will always be exceptions, but overall it's becoming more difficult - not easier.  

[deathvvv]

unfortunately the number of spots is way too tight to allow for any room for error , especially with cmg applying to competitive specialties or having a change of heart in fourth year and applying to a different specialty that they had not done electives in. sure, the long term solution is to a) decrease medical school spots to ratio the 1.01 to 1 cmg to residency spot ratio or b) increase funding for more residency spots. both of which needs to occur at the administrative level and may take years if it happens at all. the only thing med students can do is to maximize their options. I agree that preclerkship does not prepare students well for USMLE 1. However, the first two years in Canadian med schools are pretty "chill" and there is summer breaks as well. There is no reason why Canadian students cannot study in their own time to do well on step 1 (pathoma, uworld). At worse they become more proficient in the basic sciences, at best they open up a fallback option in the states. If they aim for family medicine or psych in the US, they don't necessarily have to aim for the moon, anything around average or even below average in step one would land them a residency in the us

[quibble]

.

[indefatigable]

5 hours ago, deathvvv said:

unfortunately the number of spots is way too tight to allow for any room for error , especially with cmg applying to competitive specialties or having a change of heart in fourth year and applying to a different specialty that they had not done electives in. sure, the long term solution is to a) decrease medical school spots to ratio the 1.01 to 1 cmg to residency spot ratio or b) increase funding for more residency spots. both of which needs to occur at the administrative level and may take years if it happens at all. the only thing med students can do is to maximize their options. I agree that preclerkship does not prepare students well for USMLE 1. However, the first two years in Canadian med schools are pretty "chill" and there is summer breaks as well. There is no reason why Canadian students cannot study in their own time to do well on step 1 (pathoma, uworld). At worse they become more proficient in the basic sciences, at best they open up a fallback option in the states. If they aim for family medicine or psych in the US, they don't necessarily have to aim for the moon, anything around average or even below average in step one would land them a residency in the us

This could make sense for someone aiming for a competitive specialty with no viable Canadian alternative.  But a lot of specialty gunners do activities during the summer and people aiming for FM, with flexible matching locations, generally have less problems with CaRMS.  Whether gunners would accept US FM or Psych is another question.  Experiences may vary, but from mine, I'd say preclinical in QC isn't too "chill" (people commonly study weekends, nights, etc..).  

5 hours ago, lmck said:

Out of curiosity, how do US schools look at CMGs matching into the states? Are CMGs viewed more favourably than other IMGs then b/c of the CACMS/LCME accreditation? Realistically if one does want a competitive speciality, you can ROL only that specialty in CaRMS and back-up with the same specialty in LCME? As @tere mentioned, do we then need to spend at least a bit of our elective time down south? I have heard some say that if you do this, you may stretch yourself too thin to be competitive in both matches.

To be fair, the credit goes to @Blasé for that point.  There's very little matching for CMGs in the NRMP - always some, often either non-Canadians or prior-year grads.  Graduates from well-known Canadian schools with strong step scores can match well and in theory may be able to apply your backup suggestion.

[jfdes]

On 11/3/2018 at 7:02 AM, tere said:

Agree - there's no legal reason why it couldn't happen (i.e. no mandated minimum number of quota positions), but issues like losing the RoS (even though essentially meaningless in ON) and not filling priority positions for the provincial governments mean it may not happen.  UBC I believe converted a 1st round derm IMG-RoS into a CMG-RoS position - could be a template for competitive residencies, but might be harder to sell for other residencies.  

 

Ok, I'm having a hard time seeing why this is a bad thing... maybe someone can comment? This actually seems like a great solution, an incredibly competitive residency that was previously locked to IMG is now available to CMGs. Sure, there's an ROS attached, but the BC government already funds 288 residencies, which is the same number as the graduating class (usually). After 288, it seems more then fair for the government to have a bit more say in where people practice. What am I missing?

We have so many people who are not matching at all. Surely converting 50 IMG-ROS residencies to CMG-ROS could only be a good thing?

[NLengr]

4 hours ago, jfdes said:

Ok, I'm having a hard time seeing why this is a bad thing... maybe someone can comment? This actually seems like a great solution, an incredibly competitive residency that was previously locked to IMG is now available to CMGs. Sure, there's an ROS attached, but the BC government already funds 288 residencies, which is the same number as the graduating class (usually). After 288, it seems more then fair for the government to have a bit more say in where people practice. What am I missing?

We have so many people who are not matching at all. Surely converting 50 IMG-ROS residencies to CMG-ROS could only be a good thing?

If you open the door to making standard cmg's do ROS for a residency spot, the government will push for all CMGs to do an ROS eventually. It gives them more power to force people to work where the government thinks they should (think crappy undesirable locations) and it will reduce physicians ability to negotiate fee schedules (yay pay cuts!) etc. 

Once you get into practice, you realize the government rarely has any idea what the hell it is doing in the healthcare system. The last thing you want it to hand more control of your life and career over to them. 

[ArchEnemy]

On 11/3/2018 at 10:02 AM, tere said:

Agree - there's no legal reason why it couldn't happen (i.e. no mandated minimum number of quota positions), but issues like losing the RoS (even though essentially meaningless in ON) and not filling priority positions for the provincial governments mean it may not happen.  UBC I believe converted a 1st round derm IMG-RoS into a CMG-RoS position - could be a template for competitive residencies, but might be harder to sell for other residencies.  

 

I went back to previous year's program description to verify.

UBC Derm never had any IMG spots to begin with. UBC Derm converted a CMG spot to a CMG-ROS spot. 

[la marzocco]

7 hours ago, NLengr said:

If you open the door to making standard cmg's do ROS for a residency spot, the government will push for all CMGs to do an ROS eventually. It gives them more power to force people to work where the government thinks they should (think crappy undesirable locations) and it will reduce physicians ability to negotiate fee schedules (yay pay cuts!) etc. 

Once you get into practice, you realize the government rarely has any idea what the hell it is doing in the healthcare system. The last thing you want it to hand more control of your life and career over to them. 

When things got desperate this spring.. the Liberals in Ontario created ~58 spots for unmatched CMGs - all those spots were 2-yr ROS. The thing is the government knows that the situation is dire and using it to their advantage.. it is totally foreseeable that they make all additional spots for CMGs in the future ROS.

[la marzocco]

7 hours ago, NLengr said:

If you open the door to making standard cmg's do ROS for a residency spot, the government will push for all CMGs to do an ROS eventually. It gives them more power to force people to work where the government thinks they should (think crappy undesirable locations) and it will reduce physicians ability to negotiate fee schedules (yay pay cuts!) etc. 

Once you get into practice, you realize the government rarely has any idea what the hell it is doing in the healthcare system. The last thing you want it to hand more control of your life and career over to them. 

And they got some nice PR out of it. They cut 50 spots a few years prior (2015?) and then "re-created" 50-ish new ones.. and OMSA and all the Ontario med schools were praising the government for intervening.. but the deal is sour. These "re-created" 50-spots are all ROS. Their positioning was to increase rural medicine support for counties and towns.. "seemed" like a win-win for all, but we actually had the short end of the stick

 

[Edict]

8 hours ago, la marzocco said:

And they got some nice PR out of it. They cut 50 spots a few years prior (2015?) and then "re-created" 50-ish new ones.. and OMSA and all the Ontario med schools were praising the government for intervening.. but the deal is sour. These "re-created" 50-spots are all ROS. Their positioning was to increase rural medicine support for counties and towns.. "seemed" like a win-win for all, but we actually had the short end of the stick

 

Nvm re-read it. 

[jfdes]

19 hours ago, NLengr said:

If you open the door to making standard cmg's do ROS for a residency spot, the government will push for all CMGs to do an ROS eventually. It gives them more power to force people to work where the government thinks they should (think crappy undesirable locations) and it will reduce physicians ability to negotiate fee schedules (yay pay cuts!) etc. 

Once you get into practice, you realize the government rarely has any idea what the hell it is doing in the healthcare system. The last thing you want it to hand more control of your life and career over to them. 

I've worked for government for several years, I definitely agree that they rarely have an idea of what the hell is going on in any sector. That being said, this feels like a slippery slope argument. I don't see why CMG ROS spots on top of the current allocation (which, in BC, is 1:1) would lead to all CMG spots turning to ROS. This seems like a huge jump from adding spots that weren't even there in the first place. Also not following how it would reduce physician's ability to negotiate fee schedules.

12 hours ago, ArchEnemy said:

I went back to previous year's program description to verify.

UBC Derm never had any IMG spots to begin with. UBC Derm converted a CMG spot to a CMG-ROS spot. 

It does look like the residencies were changed up a bit, but last year there were 288 CMG residencies and 58 IMG residencies, and this year there are 288 CMG residencies and 58 IMG residencies, with an additional CMG-ROS for Derm. So it looks like it wasn't a conversion, it was a brand new spot.

I've heard there's a committee from the Faculty of Medicine that determines the residency allocation for a given year, so that might explain the change in spots... but it does look like it was new funding for the Derm ROS.

11 hours ago, la marzocco said:

When things got desperate this spring.. the Liberals in Ontario created ~58 spots for unmatched CMGs - all those spots were 2-yr ROS. The thing is the government knows that the situation is dire and using it to their advantage.. it is totally foreseeable that they make all additional spots for CMGs in the future ROS.

I guess I'm still struggling to understand why this is a bad thing. I mean, I get that we need enough residencies for graduating students, and those residencies shouldn't have an ROS attached. That goes without saying. But residencies above and beyond that? I can see why government may want to put some strings to those, there are shortages in certain regions and the government's job is to address those shortages. I know ROS isn't the best way of addressing it, but at least it's something.

[NLengr]

You need to have more than a 1:1 ratio of students to residency spots. If you don't than a whole lot of people would be forced to do things they hate, are ill suited for or both. You need some flexibility in the system. The flexibility should not come at the cost of ROS's for CMGs. 

Being forced to work in an undesirable location doesnt sound that bad as a med student because you honestly have no idea what it will be like. I am speaking from personal experience here.

Most of the locations are rural, so right away, forget most of the things you enjoy about being in an even medium sized city (restaraunts that are decent, shopping, nightlife, cultural activities etc). You will probably be away from all family support and I can tell you first hand that makes your life very difficult, especially if you have children. You also will be away from your entire social base and it may be hard to build a new one in a smaller center.

Smaller centers mean a lot more call for you. Even if you aren't getting called in all night, just being on call limits your life. Also, don't expect to have all the services you are used to at an academic center. This increases your workload and limits the type of practice you have or procedures you may perform. 

Once you are done your ROS and want to leave, it is still difficult. You'll realize that after a few years in practice it's hard to find new job opportunities in many specialties. Canada doesn't have great mobility for physicians to change jobs. So maybe your 3 year ROS is now a 6 year stay because there is nothing avaliable anywhere else you would be willing to work. Expect the administration of the hospital and the local government to not give a shit about your concerns because you are on ROS so it's not like you can easily threaten to leave. If you do leave at the end of your ROS, who cares, the government will force another ROS new grad in the position. That removes the motivation for anyone to address problems or concerns you have. 

 

CMG ROS contracts will reduce our ability to negotiate contracts because it will force people to stay and work in a province. If you can't leave, why would the government care about trying to pay you well and keep you? Even if you do leave at the end of your ROS, they have more ROS's to replace you. Make no mistake, the government sees physicians as an expense before anything else. They would like nothing more than to pay you 60k a year like a standard government without providing you with any of the benefits government workers are given.

 

It is a slippery slope because, again, the politicians you as the enemy. You are an expense item, nothing more. They don't care about you. They care about getting re-elected and getting that pension. They will do whatever it takes to do that. Once they realize they can force.CMGs into ROS's, it's very easy to whip up public support for this. Then they can claim they are using the ROS to:

1. improve staffing (even if it doesn't)

2. reduce costs (no need to pay incentives if you are locked into working for them)

3. Stick it to those fat cat doctors (make no mistake, this plays really well with a segment if the electorate).

All three of those help them get re-elected. 

[indefatigable]

19 hours ago, ArchEnemy said:

I went back to previous year's program description to verify.

UBC Derm never had any IMG spots to begin with. UBC Derm converted a CMG spot to a CMG-ROS spot. 

Thanks for correcting the record.  Apologies for not double checking.

Yes - it looks UBC derm went from 4 -> 3 (including 1 CMG-ROS).

6 hours ago, jfdes said:

IIt does look like the residencies were changed up a bit, but last year there were 288 CMG residencies and 58 IMG residencies, and this year there are 288 CMG residencies and 58 IMG residencies, with an additional CMG-ROS for Derm. So it looks like it wasn't a conversion, it was a brand new spot.

UBC did some shuffling - took away 1 from derm and converted another.  Added a couple to anesthesia, emerg.. didn't go through it all.  But, I suppose that they've effectively increased their CMG quota by 1 by the conversion.

There's a second derm CMG-ROS spot at Saskatchewan in 2019 (although not marked as such).  That is a brand new spot.

[GrouchoMarx]

20 hours ago, NLengr said:

You need to have more than a 1:1 ratio of students to residency spots. If you don't than a whole lot of people would be forced to do things they hate, are ill suited for or both. You need some flexibility in the system. The flexibility should not come at the cost of ROS's for CMGs. 

Being forced to work in an undesirable location doesnt sound that bad as a med student because you honestly have no idea what it will be like. I am speaking from personal experience here.

Most of the locations are rural, so right away, forget most of the things you enjoy about being in an even medium sized city (restaraunts that are decent, shopping, nightlife, cultural activities etc). You will probably be away from all family support and I can tell you first hand that makes your life very difficult, especially if you have children. You also will be away from your entire social base and it may be hard to build a new one in a smaller center.

Smaller centers mean a lot more call for you. Even if you aren't getting called in all night, just being on call limits your life. Also, don't expect to have all the services you are used to at an academic center. This increases your workload and limits the type of practice you have or procedures you may perform. 

Once you are done your ROS and want to leave, it is still difficult. You'll realize that after a few years in practice it's hard to find new job opportunities in many specialties. Canada doesn't have great mobility for physicians to change jobs. So maybe your 3 year ROS is now a 6 year stay because there is nothing avaliable anywhere else you would be willing to work. Expect the administration of the hospital and the local government to not give a shit about your concerns because you are on ROS so it's not like you can easily threaten to leave. If you do leave at the end of your ROS, who cares, the government will force another ROS new grad in the position. That removes the motivation for anyone to address problems or concerns you have. 

 

CMG ROS contracts will reduce our ability to negotiate contracts because it will force people to stay and work in a province. If you can't leave, why would the government care about trying to pay you well and keep you? Even if you do leave at the end of your ROS, they have more ROS's to replace you. Make no mistake, the government sees physicians as an expense before anything else. They would like nothing more than to pay you 60k a year like a standard government without providing you with any of the benefits government workers are given.

 

It is a slippery slope because, again, the politicians you as the enemy. You are an expense item, nothing more. They don't care about you. They care about getting re-elected and getting that pension. They will do whatever it takes to do that. Once they realize they can force.CMGs into ROS's, it's very easy to whip up public support for this. Then they can claim they are using the ROS to:

1. improve staffing (even if it doesn't)

2. reduce costs (no need to pay incentives if you are locked into working for them)

3. Stick it to those fat cat doctors (make no mistake, this plays really well with a segment if the electorate).

All three of those help them get re-elected. 

Based af