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At the end of the day a lot of these individuals applying to competitive specialties are none different than others applying to less competitive specialties. This uniquely holds true for Canada. In the US, it's a different ball game with their obsession with standardized test scores.

In Canada, it's all about who you know, not what you know. Interested in derm? Hopefully you have a home derm institution. Reach out to them starting in first year, say hello, work on projects with them, shadow, and don't be an awkward freak. They will remember you and you will match over the all-star applicant who has an MD/PhD, is interested in academics, and has a genuine interest in advancing the field of dermatology. I'll repeat, it's who you know, not what you know. This probably explains why there aren't many academic dermatologists in Canada. Many of them are just doing general or cosmetic derm.

When you go to the US, it's a different world - there you see true academic dermatologists advancing the field. Dermatology in Canada is in a sad sad state.

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11 minutes ago, F508 said:

Sorry response unclear. I meant that it isn't necessarily just less-competitive programs that are worried about commitment to the specialty. For example if you split your electives between obs-gyn and gen surg, I would assume both specialties may be worried about your commitment. However, I think in all cases, you just need to be prepared during interviews to reassure the program that you're committed to them. I think if you're convincing, it won't necessarily put you at a significant disadvantage.

Ok, understood. When I wrote less competitive, I was trying to specify that it was in relation to a more competitive specialty. In the example you provided, in which there is no obvious gradient in competitiveness between two specialties, it would likely come across as an interest in both areas, rather than an obvious backup strategy.

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1 hour ago, DermJuly2018PGY1 said:

 

When you go to the US, it's a different world - there you see true academic dermatologists advancing the field. Dermatology in Canada is in a sad sad state.

This is not unique to derm. The US simply has more research opportunities, pharmaceutical companies and A LOT more residency opportunities compared to Canada. On top of that, heavy emphasis in basic science research and a basic science heavy curriculum/board exam in the US made sure to select more research heavy candidates into top programs and specialities to advance the field. It is not about who you know in the US to get into competitive programs, in fact, you don't even have to do an onsite elective to be competitive for the top US programs.

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36 minutes ago, peace2014 said:

This is not unique to derm. The US simply has more research opportunities, pharmaceutical companies and A LOT more residency opportunities compared to Canada. On top of that, heavy emphasis in basic science research and a basic science heavy curriculum/board exam in the US made sure to select more research heavy candidates into top programs and specialities to advance the field. It is not about who you know in the US to get into competitive programs, in fact, you don't even have to do an onsite elective to be competitive for the top US programs.

Derm in the US is definitely who you know. It is dominated from people from top 20 programs or people who have done research fellowships with big name faculty.

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On March 1, 2018 at 5:24 PM, humhum said:

Chances are most people interviewing had other but related first choices, such as gen surg, ENT, uro, etc... personally I'm more shocked about the open anesthesia spot. At our school it seemed like every third person wanted to go into that.

It's because Calgary is super stingy about giving out interviews (24 for 5 spots or something) because they expect people will rank Calgary first. 

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11 hours ago, DermDermDermDerm said:

Derm in the US is definitely who you know. It is dominated from people from top 20 programs or people who have done research fellowships with big name faculty.

Top 40 programs only account for 40% of derm residents (ie 60% come from schools you've probably never heard of), and 80% of derm residents have no graduate degree of any kind. So yes, connections certainly help, but the NRMP statistics do not fit the picture you paint.

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14 hours ago, hopeful_med said:

It's because Calgary is super stingy about giving out interviews (24 for 5 spots or something) because they expect people will rank Calgary first. 

Interviewing less people in 1st iteration is less work, and as you said, they were probably confident everyone will be begging for a spot with them.

It is major backfire in their face, because by all accounts, going into the second round is shit-ton more work. They will be flooded with applications to review. 

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After reviewing DermJuly2108PGY comments above..........it makes me wonder...

With so many unmatched this year, will home schools favour their own applying to their local home programs who were not matched so that their stats after second round are favourable or will they truly chose the best person for the position?..will they chose unmatched cmgs over imgs where the img may be a stronger candidate for a program?  So much beyond an application to consider. Hopefully the system will become more fair in the future. 

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9 hours ago, Coby said:

After reviewing DermJuly2108PGY comments above..........it makes me wonder...

With so many unmatched this year, will home schools favour their own applying to their local home programs who were not matched so that their stats after second round are favourable or will they truly chose the best person for the position?..will they chose unmatched cmgs over imgs where the img may be a stronger candidate for a program?  So much beyond an application to consider. Hopefully the system will become more fair in the future. 

Fairness is a tough question - fairness for the CMG who might have have had bad luck of trying to match into a system that's stretched beyond capacity and couldn't afford to go abroad?  Fairness for the taxpayer who subsidizes the medical training and faculties for CMGs?  Fairness to the faculties that maintain their LCME credentials?  Fairness for the IMG (likely CSA) who might have been unlucky on CMG admission but did well in some foreign med school?  Every stakeholder has their own viewpoint.  

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46 minutes ago, Coby said:

1) The "intimidation and harassment" piece was always somewhat questionable and involved only a few people that are either gone now or dealt with. So no issue at all there and I don't think there ever really was. 

2) The supervision issue again was something of a non-issue, but call has been completely revamped. This has been fully addressed. 

3) Teams are bigger now so there is more of a hierarchical senior-junior structure on CTU and medicine call. That's what the RC wanted. 

4) The "intent to withdraw" decision vs just an "external review" was driven partly by a previous chair who wasn't from here and who has now gone. 

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I'm actually really glad that the schools are scared of our accreditation body. The reason Canadian residency programs are so successful is because of this. In the States, the program to program variation is much greater, such that some programs are considered malignant and still run. 

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~220 unmatched current year CMGs, ~110 unmatched prior year CMGs (RIP Dr. Robert Chu) plus an unknown number of residency transfer attempts. IMGs traditionally taking 40-50% of second round spots.

228 spots in second round. 1 openly set aside for IMGs, then an unknown number "set aside" for a transfer or IMGs (Ottawa dermatology?). 114 Anglophone seats available in second round.

Assuming one doesn't speak French that leaves best case ~116 seats for ~330 CMG applicants. Assuming Quebec seats do not fill with CMGs or IMGs as they did last year, and IMGs take 45% of the seats on average that is ~63 Anglophone seats for ~330 CMG applicants.

Second round CMGs could be looking at a <20% chance of matching this year.

Potential caveats: I do not know how various schools factor in unmatched prior year grads. Potentially some could be included the ~220 unmatched CMG stat. There may also be attrition in the form of people not entering second round to try and match next year which given the marked lack of surgical spots is a possibility however I expect max 10% of people do things along that line.

How did we let things get this bad?

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6 minutes ago, 2018hopeful said:

~220 unmatched current year CMGs, ~110 unmatched prior year CMGs (RIP Dr. Robert Chu) plus an unknown number of residency transfer attempts. IMGs traditionally taking 40-50% of second round spots.

228 spots in second round. 1 openly set aside for IMGs, then an unknown number "set aside" for a transfer or IMGs (Ottawa dermatology?). 114 Anglophone seats available in second round.

Assuming one doesn't speak French that leaves best case ~113 seats for ~330 CMG applicants. Assuming Quebec seats do not fill with CMGs or IMGs as they did last year, and IMGs take 45% of the seats on average that is ~63 Anglophone seats for ~330 CMG applicants.

Second round CMGs could be looking at a <20% chance of matching this year.

Potential caveats: I do not know how various schools factor in unmatched prior year grads. Potentially some could be included the ~220 unmatched CMG stat. There may also be attrition in the form of people not entering second round to try and match next year which given the marked lack of surgical spots is a possibility however I expect max 10% of people do things along that line.

How did we let things get this bad?

Where did you get the breakout of 220 current year vs 110 prior year CMG? Last year after 1st iteration there were a total 189 unmatched CMGs from 2017 and previous years combined. I suspect the 220 figure being thrown around is the combined current and previous year unmatched CMGs, not just current year, otherwise we're talking a near doubling of the unmatched numbers. Also last year IMGs got 34% of the 2nd round spots (53/155), and their proportion has trended downwards for the last few years as the number of unmatched CMGs has grown. This makes sense, since IMGs as a group face increased competition from the growing ranks of unmatched CMGs. It's going to be a tough year but not as bad as you make it out to be.

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https://www.carms.ca/en/data-and-reports/r-1/r-1-match-reports-2017/

Table 62 shows 114 unmatched CMGs at the end of second round 2017. Minus several cases that are semipublic (suicide, severe injury, or other causes) the net number should be around 110 unmatched CMGs going into the 2018 match.

As I said I don't know how individual schools count their unmatched but given UofT having 26 and the other schools having very high unmatched numbers 220 current year unmatched doesn't seem like a huge jump. 

We don't have a breakdown of previous year CMGs matching first round this year so I assumed worst case scenario for the numbers.

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Barring a huge jump in med school enrollment this year, the number of vacant spots don't bear out an increase from 189 to 330 unmatched total CMGs this year. We don't even have official confirmation of the 220 figure often quoted here.

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Big picture - 220 CMGs going for 228 spots in the second round.  

There are, assuming the accounting above is correct, only 114 English-speaking spots out of the 228.  Now, some of the unmatched CMGs are from QC (~60ish) eyeballing the numbers from last year, who will likely be attempting to match in QC spots, which means there's effectively 160 English-speaking CMGs going for 114 spots.  Next, take 45 of the spots away to account for IMG matching which leaves only ~70 spots (assuming there's no IMGs in QC).

 So we're on track for about very roughly speaking around 90 unmatched CMGs after round two, including prior year.  I think the official prediction  was 82.  I may have missed something.  

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On 3/3/2018 at 9:36 AM, MDLaval said:

I disagree. What programs should evaluate is whether a given applicant would make a good/great Family Physician. I couldn't care less if they're applying to something else or not, and that goes to every single specialty. Of course, I understand it's not what happens (mainly in the ROC and McGill).

People often have interest for more than one specialty. The fact they want something more doesn't automatically means that FM programs should behave like some other programs and cut those applicants off. Also, who can affirm they know 100% that a given candidate is "only" backing up with FM? A lot of things happen between the deadline to send applications and the interview, and also until the final deadline to send ROL. People change their minds. I have friends who applied to IM, Psychiatry, and even General Surgery, got the interviews they wanted and ended up ranking FM as their 1st choice! By the way, I've always heard and thought that the humanistic side of FM is precisely one of the main characteristics and forces of the specialty.

When I was going through CARMS many years ago, a few programs would outright not give you an interview if you didn't do at least a 2 week FM elective. I can't think of anything more indicative of a back-up applicant than that, and it's very reasonable.

I feel very bad for all the applicants going through CARMS right now as it seems to be giant zoo.

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21 hours ago, shematoma said:

Barring a huge jump in med school enrollment this year, the number of vacant spots don't bear out an increase from 189 to 330 unmatched total CMGs this year. We don't even have official confirmation of the 220 figure often quoted here.

Schools tend to brief their students on some rough figures from the match and 220 lines up with what I've heard coming out of several schools - that is, an unmatched rate of about 8% across Canada for first year applicants. Last year there were 166 unmatched current year grad CMGs in the first round, which would mean only about a 32% total jump from last year to get to this year's 220. Every school I've heard about has had more go unmatched this year than last year, some dramatically so. Of course we don't have hard confirmation of that number publicly, and won't until the CaRMS stats come out in a few months, but until that time, this is about as reliable as an unconfirmed number gets.

Now, 220 unmatched doesn't mean 220 in the 2nd iteration. Last year only 138 of the 166 unmatched current year grads ended up applying in the 2nd round. That'd put us at around 180 in the 2nd round this year from current year grads assuming the same proportion of those unmatched from the 1st round enter the 2nd. There were 78 previous year grads in the 2017 2nd round as well, a number which is unlikely to fall this year, even if it doesn't rise much. Even being conservative, we're looking at about 250 CMGs in the 2nd round match this year, going for 228 spots, with IMGs in the mix as well. Add in the fact that Quebec programs often leave about 60 spots unfilled every year regardless of the applicants they get, and we're clearly looking at a situation where some CMGs must go unmatched after the 2nd round. The math for graduating CMGs relative to CaRMS spots just doesn't add up anymore - as this system is set up currently, we are guaranteeing that a small proportion of CMGs will never gain residency spots in Canada every year after successfully graduating medical school.

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58 minutes ago, ralk said:

Schools tend to brief their students on some rough figures from the match and 220 lines up with what I've heard coming out of several schools - that is, an unmatched rate of about 8% across Canada for first year applicants. Last year there were 166 unmatched current year grad CMGs in the first round, which would mean only about a 32% total jump from last year to get to this year's 220. Every school I've heard about has had more go unmatched this year than last year, some dramatically so. Of course we don't have hard confirmation of that number publicly, and won't until the CaRMS stats come out in a few months, but until that time, this is about as reliable as an unconfirmed number gets.

Now, 220 unmatched doesn't mean 220 in the 2nd iteration. Last year only 138 of the 166 unmatched current year grads ended up applying in the 2nd round. That'd put us at around 180 in the 2nd round this year from current year grads assuming the same proportion of those unmatched from the 1st round enter the 2nd. There were 78 previous year grads in the 2017 2nd round as well, a number which is unlikely to fall this year, even if it doesn't rise much. Even being conservative, we're looking at about 250 CMGs in the 2nd round match this year, going for 228 spots, with IMGs in the mix as well. Add in the fact that Quebec programs often leave about 60 spots unfilled every year regardless of the applicants they get, and we're clearly looking at a situation where some CMGs must go unmatched after the 2nd round. The math for graduating CMGs relative to CaRMS spots just doesn't add up anymore - as this system is set up currently, we are guaranteeing that a small proportion of CMGs will never gain residency spots in Canada every year after successfully graduating medical school.

Thanks for clearing this up.  It gets very confusing whether "unmatched" refers to current or current+prior year.  I had assumed the poster above was correct regarding 220.

It's also interesting to note so many CMGs decide to forego the 2nd round.  

I'm pretty sure if more English-speaking CMGs were able to apply to the French-speaking positions, more spots would be filled.  QC has a lower number of unmatched students compared to Ontario.  THe language difference was also noted in the AFMC document.

By your math, that means there are 250 CMGS going for 228 spots.  Take away 50 matches for IMGs (reasonable based on previous years), that leaves effectively 250 CMGs going for 180 spots.  But as you point out, about 60 of the spots will be effectively empty (despite the 10 unmatched QC students able to apply based on last year's numbers that are either French-speaking or bilingual).  So that means there are only 120 available spots with 250 CMGs.  

I think it's quite a large number of guaranteed unmatched CMGs.  
 

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7 hours ago, marrakech said:

Thanks for clearing this up.  It gets very confusing whether "unmatched" refers to current or current+prior year.  I had assumed the poster above was correct regarding 220.

It's also interesting to note so many CMGs decide to forego the 2nd round.  

I'm pretty sure if more English-speaking CMGs were able to apply to the French-speaking positions, more spots would be filled.  QC has a lower number of unmatched students compared to Ontario.  THe language difference was also noted in the AFMC document.

By your math, that means there are 250 CMGS going for 228 spots.  Take away 50 matches for IMGs (reasonable based on previous years), that leaves effectively 250 CMGs going for 180 spots.  But as you point out, about 60 of the spots will be effectively empty (despite the 10 unmatched QC students able to apply based on last year's numbers that are either French-speaking or bilingual).  So that means there are only 120 available spots with 250 CMGs.  

I think it's quite a large number of guaranteed unmatched CMGs.  
 

Of the many CMGs that forgo second round, are their chances higher to get into their number one choice specialty (ROAD)the following year in light of the number unmatched .?

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I heard through the grapevine that they are planning to transfer over 1/2 of the IMG-designated spots in the 1st round to CMG-designated for the 2019 CaRMS cycle. That would equate to ~160 spots opening up to CMGs in the first round. I heard that this is a temporary measure and might not be recurring. Might be hearsay, but thought I would share what I have been hearing.

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