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Ontario's 53 extra residency spots


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32 minutes ago, blah1234 said:

I think NLengr's experiences are not that far off from what a lot of my surgeon friends experience. I think that's why I'm more pessimistic about the overall situation than you. Even if I'm content, I'm afraid for the thousands of students that go through the system with the possible risk of being rewarded with these outcomes despite their years of hard work and perseverance. 

Yeah surgery in particular has gotten a raw deal for quite some time. I do understand the perspective, and even surgeons are ~10% of all doctors that is still a lot of people (and there are other fields that haven't exactly been having a great time either. 

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45 minutes ago, ninja7292 said:

As a medical student "gunning" for an extremely competitive surgical subspecialty, this thread is extremely sobering and has me hesitating going all in for the speciality. I would be happy to match wherever and practice wherever (would OK with community in Southern Ontario but prefer academic centre anywhere). Now, I am thinking of going something ,more realistic to match in, but something I would enjoy less. Any thoughts to my struggling decision making process?

I would make sure I was happy with community ANYWHERE in the country. If you aren't, pick something that will let you stay in your preferred location. A job is a job. Friends and family are really what makes your life happy. 

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On 1/31/2019 at 11:13 PM, NLengr said:

I agree. It's not worth it. Sure some people get lucky, match to what they want and then land a job they like in a location they are happy in. But for every story like that, there is a person who didn't match, scrambled into a specialty they hate or ended up with a job or location they hate (I'm in the last category). 

It's not worth the risk. Get out while/if you can. You can be happy with another career and have way more flexibility and way better co-workers. I wish I had known enough to quit early.

I am not a staff yet but a current resident over halfway through who matched well objectively to a medical specialty. However,  the specialty is a poor fit for me and I have tried to transfer out twice but unfortunately lack of funding in general and speculatively the unmatched initiative and the funding it used last year have prevented that/university politics.  Nothing amiss on my record and the PD locally just is not able to accommodate applications due to funding allocations.

Medicine and residency matching and staff work may work for many people but it’s an inherently inflexible field. The lack of flexibility is something I find quite challenging because I initially went into medicine because I thought it would offer that. Maybe it still does in family medicine, but it seems to not be in most specialties.

Generally the transfer process available is disheartening. Now I feel stuck in a field that will require me to do the never ending slog of fellowship, masters, perpetual education likely with a job in a location I don’t want to live in with poor job propspects for my partner along with the possibility I need to move to the States.  Maybe I was naive when I matched but staff in the specialty had not endorsed that as the future in their program, perhaps because it was not Ike that for them. 

Truly the process has been really disheartening. I have had medical students on the carms tour ask us about how residency transfers work, and though I (and likely many other current residents) cannot be public about how I have tried to transfer, I feel like we should be very clear about how most transfers do not succeed. We only hear the success stories. Honestly, this whole situation has been very discouraging for me and sometimes it’s  hard to continue on, knowing how badly I don’t want to be there and don’t want to be in this path. 

The system is so inflexible with our tuition debt, the match, with transfers, and unfortunately with job availability after residency and fellowships and whatnot. People need to be aware of these issues before they commit themselves for a lifetime. 

Ps: if any residents read this who are interested in transfers, I’m happy to chat about my experience as well as some of my friends’ experiences over PM. 

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11 hours ago, NLengr said:

Fingers crossed. Nowhere to go but up. 

I hope things work out for you. You worked way too hard to tolerate your situation.

Have you considered the USA?  I am all for Canadian doctors leaving for our southern neighbors as a method of protest.

 

To the new medical students and the unhappy residents:

Medical students and residents, and doctors, are being used as political pawns. Maintain your sovereignty: take the USMLEs and apply to the USA.

 

 

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On 1/31/2019 at 9:43 PM, ontariocarmsthrowaway said:

Spots at my school were offered in internal med (2) and family med (3). I believe 2 spots in each were filled.

Other programs like ER and psych that were included in the press release were not possible due to lack of training space.

Process was by internal match (independently within each school). One could rank all or some of the available programs/locations. Submission involved all the typical documents, CV, letters, personal statement for generalist medicine. No interview. Admission and spots were determined a few days before grad. This was very fluid with meetings between schools and govt taking place well into May to decide on a process.

In order to participate one must have entered the 2nd iteration by agreeing to the contract. I believe actually applying and ranking programs was not a requirement.

Some decided to continue pursuing a specialty. Most here took the deal.  We lost one student to suicide. I am not sure if all the unmatched people at my school were eligible due to the 2nd round requirement.

2 yr return of service, the same contract as for IMG residents. Some limitations on +1 and fellowships that are permitted. Internal med was required to be GIM or geriatrics. Family allowed rural +1 ER, northern anesthesia +1, and care of the elderly. These have to be approved by MOH in advance.

Overall it worked out but was a miserable experience. The admin freely admitted they did not foresee how tight the match would be, with fewer spots than applicants.

Backup plans were year 5 (risking an even worse match year and roughly another 18k tuition + 7 months of electives fees, travel and accommodation) or the armed forces recruitment surge. I wonder how many the army signed on.

Considered leaving medicine, but this comes with approximately 200k of debt that would have been converted to a 10 year term loan, approx 2k/month in payments, with another 50k in OSAP loans. I was more on the frugal side, and self-funded both undergrad and medical studies. My peers from undergrad have been earning at 70-95k/year salary and graduated with low 5 figure debts.

For any premeds reading this, avoid medicine as it is now a high risk game. If I had worked after undergrad and gambled all my earnings away on bitcoin and weed stocks I still would be ahead, while having flexibility where and what field I work in. Having to seriously consider the rural spots (La Ronge, Fort Mac, Grande Prairie, Nunavut, etc) in the 2nd iteration made me realize how much I had taken job portability for granted.

Closely following the match this year. I fear it will be the same or worse, with no rescue from the govt this time.

Medical school is for the well-off.

 

If you're from middle class means or below, the debt forces you to do whatever the government wants you to do. This means doing family medicine in remote places, being paid less than your nurse administrator or middle-manager government stooge.

 

All this talk of socioeconomic diversity in medicine is bullshit. It only serves the government to admit more po' folk. They can't just back away or take more time to work on applications, re-applications etc. Take it or leave it are their only options.

 

that's why every medical student has to strongly entertain the USA option. At this point I would say it is mandatory. Triply so if you're not from a rich family.

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1 hour ago, GrouchoMarx said:

Medical school is for the well-off.

 

If you're from middle class means or below, the debt forces you to do whatever the government wants you to do. This means doing family medicine in remote places, being paid less than your nurse administrator or middle-manager government stooge.

 

All this talk of socioeconomic diversity in medicine is bullshit. It only serves the government to admit more po' folk. They can't just back away or take more time to work on applications, re-applications etc. Take it or leave it are their only options.

 

that's why every medical student has to strongly entertain the USA option. At this point I would say it is mandatory. Triply so if you're not from a rich family.

Concerning US, I have a few questions:

1) is it hard for current canadian med student to land a "decent" but not top tier residency in IM in USA with good UISMLE scores?

2) Is US a better place for physicians to work? Such as more desirable locations, better treatment and higher compensation?

3) Are residency programs and later employers willing to sponsor H1B visas? 

4) Are the conditions for physician employment much better in US compared to Canada?

 

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59 minutes ago, peace2014 said:

Concerning US, I have a few questions:

1) is it hard for current canadian med student to land a "decent" but not top tier residency in IM in USA with good UISMLE scores?

2) Is US a better place for physicians to work? Such as more desirable locations, better treatment and higher compensation?

3) Are residency programs and later employers willing to sponsor H1B visas? 

4) Are the conditions for physician employment much better in US compared to Canada?

 

Not hard at all for IM.

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3 hours ago, GrouchoMarx said:

To the new medical students and the unhappy residents:

Medical students and residents, and doctors, are being used as political pawns. Maintain your sovereignty: take the USMLEs and apply to the USA.

Back in 2003, a whopping 46 graduating students matched into the NRMP (with over half from McGill link).  Last year there was one current year graduate  (from UBC link) that matched [a second visa student matched from McGill], despite a record number of unmatched CMGs.  I don't think it's because people are unwilling to consider the US route, I think it's more of a case of divergence of the Canadian from the US curriculum making it more challenging to ace the boards and increased residency competition on both sides of the border, including the IMG factor which has grown sharply over the past decades.  Both US and some IMG schools prep their students to take their boards to get US residency positions.  Canadian schools generally speaking don't.  Even as a pathology resident, you've mentioned the long study you had before taking Step 1 - some Canadian schools don't cover almost any pathology which is a key component of that test.  

Of course most things can be overcome with time and effort, but then there's a tradeoff in terms of choices - after all Canadian programs generally don't use Step 1 as a criterion to be accepted to residency.  People may disagree, but I think the broader trend in the numbers is more reflective of educational systemic & curriculum changes rather than individuals becoming more averse to the US route or being less capable. 

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10 minutes ago, tere said:

Back in 2003, a whopping 46 graduating students matched into the NRMP (with over half from McGill link).  Last year there was one current year graduate (from UBC link) that matched, despite a record number of unmatched CMGs.  I don't think it's because people are unwilling to consider the US route, I think it's more of a case of divergence of the Canadian from the US curriculum making it more challenging to ace the boards and increased residency competition on both sides of the border, including the IMG factor which has grown sharply over the past decades.  Both US and some IMG schools prep their students to take their boards to get US residency positions.  Canadian schools generally speaking don't.  Even as a pathology resident, you've mentioned the long study you had before taking Step 1 - some Canadian schools don't cover almost any pathology which is a key component of that test.  

Of course most things can be overcome with time and effort, but then there's a tradeoff in terms of choices - after all Canadian programs generally don't use Step 1 as a criterion to be accepted to residency.  People may disagree, but I think the broader trend in the numbers is more reflective of educational systemic & curriculum changes rather than individuals becoming more averse to the US route or being less capable. 

Its not hard at all to self prep for USMLEs to get an slightly above average score.  No different. Canadian curriculums do well for step 2 ck material. 

Canadians just dont see the need or urge to go through the process, because the vast majority match just fine.

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3 minutes ago, JohnGrisham said:

Its not hard at all to self prep for USMLEs to get an slightly above average score.  No different. Canadian curriculums do well for step 2 ck material. 

Canadians just dont see the need or urge to go through the process, because the vast majority match just fine.

But from this thread, it appears that CMGs do not match fine and are unsatisfied with their career choices after residency as well. Wouldn't applying to US residencies help guarantee you get a position (or a speciality you want) and a job south of the border after training?

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30 minutes ago, tere said:

Back in 2003, a whopping 46 graduating students matched into the NRMP (with over half from McGill link).  Last year there was one current year graduate (from UBC link) that matched, despite a record number of unmatched CMGs.  I don't think it's because people are unwilling to consider the US route, I think it's more of a case of divergence of the Canadian from the US curriculum making it more challenging to ace the boards and increased residency competition on both sides of the border, including the IMG factor which has grown sharply over the past decades.  Both US and some IMG schools prep their students to take their boards to get US residency positions.  Canadian schools generally speaking don't.  Even as a pathology resident, you've mentioned the long study you had before taking Step 1 - some Canadian schools don't cover almost any pathology which is a key component of that test.  

Of course most things can be overcome with time and effort, but then there's a tradeoff in terms of choices - after all Canadian programs generally don't use Step 1 as a criterion to be accepted to residency.  People may disagree, but I think the broader trend in the numbers is more reflective of educational systemic & curriculum changes rather than individuals becoming more averse to the US route or being less capable. 

At my school, we spend a great deal of time doing path for each block. But I do agree with the divergence. I feel like US med students are just boards boards boards. Some even completely ignore lecture material and study boards material only. 

McGill also has quite a few international students (mostly American) so the high match back to US is not unexpected.

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12 minutes ago, peace2014 said:

But from this thread, it appears that CMGs do not match fine and are unsatisfied with their career choices after residency as well. Wouldn't applying to US residencies help guarantee you get a position (or a speciality you want) and a job south of the border after training?

It was pretty much a non-issue until 2015 I'd say. Things really spiralled out of control in the last few years. 

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21 minutes ago, peace2014 said:

But from this thread, it appears that CMGs do not match fine and are unsatisfied with their career choices after residency as well. Wouldn't applying to US residencies help guarantee you get a position (or a speciality you want) and a job south of the border after training?

I think the issue for people is that the ones who don't match are often not the type that is considering writing the USMLE, doing US electives and interviews in order to match... 

 

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4 hours ago, peace2014 said:

But from this thread, it appears that CMGs do not match fine and are unsatisfied with their career choices after residency as well. Wouldn't applying to US residencies help guarantee you get a position (or a speciality you want) and a job south of the border after training?

There are individuals yes, but the stats show that >90% of people match, and still at least  80% match to a specialty they are happy with.  Rough numbers, but unless you want to dig through the publically available data from CaRMS to show otherwise(i'm too tired post call). 

People are more so talking about job prospects POST-residency.  

Yes getting a residency is getting harder than before, but the vast majority are still matching.  Its definitely less than ideal, but its not catastrophically terrible (Yet, it definitely may move that direction without interventions). 

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4 hours ago, la marzocco said:

At my school, we spend a great deal of time doing path for each block. But I do agree with the divergence. I feel like US med students are just boards boards boards. Some even completely ignore lecture material and study boards material only. 

McGill also has quite a few international students (mostly American) so the high match back to US is not unexpected.

Sure, but with a bit of self-prep, its not unfathomable to review Pathoma on top of canadian curriculum and self teach. The majority of people are still self-teaching with their own board material.

That said plenty of people are doing just fine with board prep on top of just focusing on classes.  Given most Canadian curriculums are more clinically relevant, you can easily make the argument that by supplementing with board prep material, you have the best of both worlds - relevant lecture material, and fill in minutae details on top of it if you want to score well on the US board exams. 

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8 hours ago, la marzocco said:

McGill also has quite a few international students (mostly American) so the high match back to US is not unexpected.

Back in the day - sure.  In 2003, McGill had 27 graduating students matching into NRMP.  Last year, there was only a single  current year graduate (visa) from McGill that matched there (i.e. non-Canadian).    At the moment, McGill seems to admit only 2 internationals per year.  

McGill graduates leaving the province (and country) with subsidized education was a source of tension though, including from the current premier.  

Perhaps the divergence has helped keep graduates in the country.         

 

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27 minutes ago, tere said:

Back in the day - sure.  In 2003, McGill had 27 graduating students matching into NRMP.  Last year, there was only a single visa current year graduate from McGill that matched there (i.e. non-Canadian).    At the moment, McGill seems to admit only 2 internationals per year.  

McGill graduates leaving the province (and country) with subsidized education was a source of tension though, including from the current premier.  

Perhaps the divergence has helped keep graduates in the country.         

 

Fair, if you look at strictly visa graduates. From what I have seen, many McGill med students actually grew up in the US/have significant ties to the US so they are IP Quebec on paper (maybe b/c of birth), but have no intention to stay in Quebec. They really see McGill as a school with super low IP tuition before they bounce back to the US - which is the tension you described.

https://www.carms.ca/wp-content/uploads/2018/05/table_41_cmgs_matched_in_the_us_match_nrmp_english_2017.pdf

I know you looked at the last cycle (2018), but if you look even at 2017, 7 of the 8 people who matched to the US were from McGill. True, 3 of the 7 were visa students. And this is undoubtedly still much less than 27 back in 2003. 

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14 minutes ago, la marzocco said:

Fair, if you look at strictly visa graduates. From what I have seen, many McGill med students actually grew up in the US/have significant ties to the US so they are IP Quebec on paper (maybe b/c of birth), but have no intention to stay in Quebec. They really see McGill as a school with super low IP tuition before they bounce back to the US - which is the tension you described.

https://www.carms.ca/wp-content/uploads/2018/05/table_41_cmgs_matched_in_the_us_match_nrmp_english_2017.pdf

I know you looked at the last cycle (2018), but if you look even at 2017, 7 of the 8 people who matched to the US were from McGill. True, 3 of the 7 were visa students. And this is undoubtedly still much less than 27 back in 2003. 

Thanks for going back another year and adding context.  Nonetheless the 46 graduates matching in 2003 across many schools was surprising to me given the record number of unmatched CMGs and tighter matching ratios that occurred last year (with only 2 NRMP matched  grads).    

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4 minutes ago, tere said:

Thanks for going back another year and adding context.  Nonetheless the 46 graduates matching in 2003 across many schools was surprising to me given the record number of unmatched CMGs and tighter matching ratios that occurred last year (with only 2 NRMP matched  grads).    

Seems very strange I agree.

Do you know if the whole "if you match to CaRMS you are withdrawn from NRMP" was a thing back in 2003? Or maybe if NRMP took place before CaRMS back then? Not really sure, but if the current rules applied back then where you are withdrawn from NRMP if you matched to CaRMS then it would be strange to see that many match to the US.

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38 minutes ago, la marzocco said:

Seems very strange I agree.

Do you know if the whole "if you match to CaRMS you are withdrawn from NRMP" was a thing back in 2003? Or maybe if NRMP took place before CaRMS back then? Not really sure, but if the current rules applied back then where you are withdrawn from NRMP if you matched to CaRMS then it would be strange to see that many match to the US.

A thread from 2003 seems to confirm that was the case back then too - it looks like CaRMS came out a week before the US match.  
https://www.valuemd.com/canadian-img/8476-going-carms-nrmp-match-simultaneously.html

It is odd - perhaps someone who knew the older system would remember what the situation was like back then.  

I do feel there is a divergence though, and Western's apparent deemphasis of the MCAT confirms that at the premed level.  

What provincial government wants its subsidized grads going to the US?

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12 hours ago, cacaonibs said:

If you are CMG and you write USMLEs, are you basically guaranteed a FM/IM match in the US if CaRMS fail? Not really gunning for any competitive specialties, but just wondering what options in the US exist for residencies if you don't do any electives down South during M3/M4.

Yes. You are guaranteed a FM or IM residency somewhere in the US if you get a below average score

 

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23 minutes ago, JohnGrisham said:

Yes. You are guaranteed a FM or IM residency somewhere in the US if you get a below average score

 

Ummm.... I hope that was sarcasm because it's score, interview, and everything else you would normally need to get a residency in Canada.

In all reality, it's not surprising less Canadians are matching to the US these days. It's a risky strategy. Why? Taking the USMLE is a significant time investment especially if your school isn't strong in basic sciences. People spend their entire M2-M3 summer studying for it. And on top of that, your best bets at matching in the US are if you have US elective experience, not just Canadian. So you are really making a big commitment of time and electives - which are both precious resources for matching in Canada.

As the CaRMS match has gotten quite tight these days, people have to commit early to specialties and maximize elective time in their chosen specialty, and in FM if they want to back up with that. Doing electives in the US would work against matching in CaRMS because you don't get face time with Canadian residency programs and you make it look like they're a backup.

Most Canadian medical graduates want to stay in Canada. Most, not all. So it only makes sense that as CaRMS gets tougher, people entrench themselves and maximize elective/research time in Canada, rather than dilute their efforts taking time off to study for the USMLE while missing out on research/summer elective opportunities.

If you get a below average score in the USMLE, on top of being a foreign student who needs a visa, you're probably consigning yourself to third-tier mid-western programs that most American students don't want for a variety of reasons, even in FM/IM. For more competitive specialties, there incompatibilities with length of residency and coming back to practice in Canada.

You need top notch scores and probably local electives if you're going for the Harvards and Mayos, and both of those require lots of time and energy commitment.

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