Ontario's 53 extra residency spots

[shematoma]

6 hours ago, JohnGrisham said:

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). 

Catastrophic is a matter of perspective. If you're one of the unlucky 4% that didn't match this year, it's a catastrophe. If you're one of the unlucky x percentage that matched but either to a specialty they didn't want and/or a location they didn't want, it's also a personal catastrophe in many ways. Based on this thread, we know of 2 recent suicides at least partly related to not matching. People have good reason to be spooked.

[JohnGrisham]

10 hours ago, shematoma said:

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.

Did you read my post? I said "somewhere". Not Harvard. But its not sarcasm. If you have a 215+ as a CMG and apply to the US broadly for FM or IM, you will 99% match assuming you're not a huge red flag and interview average. I know 3 people who are US grads with failed step 1s and bare passes on 2nd attempt who matched FM/IM in the Midwest and east coast to just fine programs and are doing just fine clinically.

For non primary care, yes you for sure have to work way harder than above.

As for US electives, you probably would only have to do 1-2, which is still feasible at most schools. Doing OOP electives isnt as big of a thing in the US for matching, scores are generally still good enough to get you into doors. From then its your interview.

As for staying in Canada, my perspective is if you arent staying in your home program or province, I personally dont care if I'm across the other side of canada or an adjacent US state instead. Its still not home. At least one would have a job hah. But for sure different perspectives.

If I'm going from Manitoba for example and having to move for residency to Nova Scotia, that's still a far flight away from my support system, it wouldnt make a huge difference to me if I instead did residency in Philadelphia. A lot closer.  But thats personal perspective.

[JohnGrisham]

10 hours ago, shematoma said:

Catastrophic is a matter of perspective. If you're one of the unlucky 4% that didn't match this year, it's a catastrophe. If you're one of the unlucky x percentage that matched but either to a specialty they didn't want and/or a location they didn't want, it's also a personal catastrophe in many ways. Based on this thread, we know of 2 recent suicides at least partly related to not matching. People have good reason to be spooked.

Of course. I'm just providing reasons for why people aren't keeping the US open by doing the exams - they have it fairly good otherwise without exams and you can most often by apart of that 96% that match or that 80% that match to their specialty of choice.

[thestar10]

Canadians are not as preferred due to issues obtaining VISA's, letters of need etc. 

Backing up in the US is not really a viable option for most people. The effort required to do so would almost certainly be better spent going to making one a better candidate for the Canadian application.

Anyway, not sure it was ever answered but the extra Ontario spots were a one-time thing. will not be repeated in the future. (THe government said they were creating the spots but in reality, they told the university to do so and the government did not actually give any additional money to them. 

[peace2014]

3 hours ago, thestar10 said:

Canadians are not as preferred due to issues obtaining VISA's, letters of need etc. 

Backing up in the US is not really a viable option for most people. The effort required to do so would almost certainly be better spent going to making one a better candidate for the Canadian application.

Anyway, not sure it was ever answered but the extra Ontario spots were a one-time thing. will not be repeated in the future. (THe government said they were creating the spots but in reality, they told the university to do so and the government did not actually give any additional money to them. 

So I guess CMGs can't even use US as a viable option then.... So its either match in Canada or bust. The best thing about the US is that after training, you are almost guaranteed a job in at least a fairly reasonable location near a metropolitan centre. I guess the grass is always greener south of the border. 

[JohnGrisham]

3 hours ago, thestar10 said:

Canadians are not as preferred due to issues obtaining VISA's, letters of need etc. 

Backing up in the US is not really a viable option for most people. The effort required to do so would almost certainly be better spent going to making one a better candidate for the Canadian application.

Anyway, not sure it was ever answered but the extra Ontario spots were a one-time thing. will not be repeated in the future. (THe government said they were creating the spots but in reality, they told the university to do so and the government did not actually give any additional money to them. 

Incorrect. Getting J1 visas is not difficult. Especially for primary care it has never been an issue. Recent changes have removed limits for statement of needs all together. So if you match you're set.

[Edict]

15 hours ago, tere said:

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?

I wonder if the reason many left back then was because salaries were lower in Canada. 

[indefatigable]

2 hours ago, Edict said:

I wonder if the reason many left back then was because salaries were lower in Canada. 

Except that it's difficult to stay in the US on a J-1 visa - so moving after Canadian training wouldn't have been any more difficult.  

I believe US residency was more of a low hanging-fruit at that point, so CMGs wrote the boards and matched. Now I think that route is more challenging even though there's more pressure than ever to match (record unmatched grads & tight matching ratios).  

[Hyped_4_Med]

Hey guys forgive me as I'm not too knowledgable on the carms process! However, isn't it possible to just apply to residency again the next year? Or does that somehow reduce your chances of matching to the residency you want? It seems like if you're already in med it's a 10-15 year process so an extra year wouldn't hurt too much. I think that's better than going into a residency you don't want. Right? 

[rmorelan]

27 minutes ago, Hyped_4_Med said:

Hey guys forgive me as I'm not too knowledgable on the carms process! However, isn't it possible to just apply to residency again the next year? Or does that somehow reduce your chances of matching to the residency you want? It seems like if you're already in med it's a 10-15 year process so an extra year wouldn't hurt too much. I think that's better than going into a residency you don't want. Right? 

You are absolutely correct - you can. But of course there is a catch - your odds of getting something the following year statistically speaking are relatively low. For a variety of reasons that may vary depending on the field you are hoping to get into it generally becomes less and less possible the longer you go on (and some people have stretched this out for more than one extra year I might add). Some reasons would be they think your clinical skills may be stale, your networking prospects dim if you are not actually in the hospital, and maybe some will think even though match is hard and unpredictable at times that there might be an issue with you in particular - even if they cannot seem to figure out what it is. That last point is often unfair but I still think it goes one from time to time. 

There is also the general issue of having a large amount of debit most likely, and if you graduate then you are not in the school anymore as a student. Not easy to find something to do with the year. If the school allows you to extent your graduation - often at the cost of more tuition - and you are in the system still but they may be directing you towards fields with higher match rates - which you might not be all that interested in. For instance they won't let you just go and do 20 weeks of electives in plastic surgery if that is what you want. They may force you to be more diversified - basically hoping you will match by going into anything that you can get into. Doesn't look good on the school to have someone unmatched. 

In short - it is messy.

[rmorelan]

On 2/2/2019 at 11:18 AM, 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.

I am not even sure that has that big an impact with wealth. I mean if your family (far more likely than you) is well off you can endure going unmatched, or worst case ignore the loans and do something else with their support. What you cannot do is just use that to get what you want in the system. The government control is still there - in fact I think that is a large part of why the number of spots is so low. They tried all kinds of ways to get people to go into family medicine, go to unpopular locations etc - bonuses, recruiting med schools with geographic biases, advertising, loan forgiveness......not really all that effective. What is effective? having 1000 medical students and only 990 spots. You see people fighting for things they never would have applied for previously. They have power basically - not something they are easily going to give up. Even their current fixes - all temporary, all after the fact, and if they open any new spots they are in exactly what and where they want those spots to be. 

Since sitting back and going it again the following year is at best of limited effectiveness it is only of limited use. You are are right that having less debit makes you better able to level the playing field but if you want to be doctor you are still stuck playing the game regardless. 

[JohnGrisham]

2 hours ago, tere said:

Except that it's difficult to stay in the US on a J-1 visa - so moving after Canadian training wouldn't have been any more difficult.  

I believe US residency was more of a low hanging-fruit at that point, so CMGs wrote the boards and matched. Now I think that route is more challenging even though there's more pressure than ever to match (record unmatched grads & tight matching ratios).  

? I'm not sure what evidence of US matching being more challenging there is. If anything its the same relative difficulty. It's just that as CMGs weve been accustomed to pass/fail, no board exams, such that why would you go through the extra work(which is doable) to write US board exams, when 96% of the time you'll match, and at least >80% of the time(not sure on the exact number) you'll match to the specialty of your choice.  

Look at fields like Ortho and Radiation oncology - they are extremely competitive in the US. Radiation Onc for example on top of requiring high scores and research, a large % of the applicants have PhDs.  It is competitive in Canada for Radiation oncology sure, but no where near as competitive as the US, not even close. Do electives, be relatively well read, and you have a good shot somewhere in Canada if youre not picky. Ortho - lack of jobs in Canada at least anecdotally has pushed a fair number of applicants away from the field,  whereas in the US its still extremely competitive.   For those fields - theres less incentive to write the board exams up front, since you'll probably have a easier path of least resistance into residency in canada. Then you can write the boards for just a pass for licensing purposes should you want to make the move for Jobs in the US after residency in Canada. 

[indefatigable]

1 hour ago, JohnGrisham said:

? I'm not sure what evidence of US matching being more challenging there is. If anything its the same relative difficulty. It's just that as CMGs weve been accustomed to pass/fail, no board exams, such that why would you go through the extra work(which is doable) to write US board exams, when 96% of the time you'll match, and at least >80% of the time(not sure on the exact number) you'll match to the specialty of your choice.  

It seems we're looking at things different ways.  From what I understand of your viewpoint, somehow today Canadian med students are intrinsically less motivated for the US and happy with the status quo (with the match rate, etc..).  In the past, Canadian med students were possibly more motivated and thus would write and do well on the boards and match to the US.  

But to me, today, Canadian med students have even more reasons to be considering all options, including the US, and seem to even be applying to more programs in the past.  The unmatched rate has reached unsustainable levels with a backlogs of med students.  So I think med students are more motivated than ever.    

So why aren't more med students matching to the US?  I think it's that all aspects of matching, including the boards have gotten more challenging.  It's now a harder reach for the US for residency so less people are trying and succeeding.   

 I know you see curriculum as being irrelevant, but when I look through a US med school block description and I see pretty much all the topics that are covered in Step 1 then I realize there is in fact a difference.  Back in 2003, FA was 425 pages - today it's over 800.  Despite the fact schools are now P/F, which should logically give more time to study for things like the boards, I think it's become a more challenging path to the US so less people are trying.  

McGill, which seems to have been the school which has had the most students match to the US, recently changed it's curriculum and dropped a lot of the basic sciences.  At the same time, the number of matching US students has decreased greatly from its peak.  This is consistent with my viewpoint.   

Canadian schools have no reason to teach to the boards and sometimes I wonder if some stakeholders would prefer to have unmatched students rather than an exodus of students to the US.  

 I realize you'll disagree, but this my view of the whole picture.  

[blah1234]

Is it even possible to fit in all those IM/FM interviews in the US with a Canadian Clerkship schedule? I know we get time off for CaRMS interviews but how does the American timeline fit in with that? I can't imagine the school would just let students off for additional weeks for "back up" interviews. And if there is an overlap with the Canadian interview schedule can people even fit all these IM/FM interviews in?

I know my friends and I had enough schedule conflicts with just Canadian residency programs back in the day.

[hopeful_med]

Getting a visa to work in the states is getting harder and harder and thus US programs are less willing to accept CMGs because there is no guarantee that the CMGs are able to get the visa, etc in time for July 1 when accepted. 

Grain of salt - I personally never applied to the states. This is of course, from my conversatiom with multiple interviewees  (CSA) when I was going through carms 

[shematoma]

2 hours ago, JohnGrisham said:

? I'm not sure what evidence of US matching being more challenging there is. If anything its the same relative difficulty. It's just that as CMGs weve been accustomed to pass/fail, no board exams, such that why would you go through the extra work(which is doable) to write US board exams, when 96% of the time you'll match, and at least >80% of the time(not sure on the exact number) you'll match to the specialty of your choice.  

Look at fields like Ortho and Radiation oncology - they are extremely competitive in the US. Radiation Onc for example on top of requiring high scores and research, a large % of the applicants have PhDs.  It is competitive in Canada for Radiation oncology sure, but no where near as competitive as the US, not even close. Do electives, be relatively well read, and you have a good shot somewhere in Canada if youre not picky. Ortho - lack of jobs in Canada at least anecdotally has pushed a fair number of applicants away from the field,  whereas in the US its still extremely competitive.   For those fields - theres less incentive to write the board exams up front, since you'll probably have a easier path of least resistance into residency in canada. Then you can write the boards for just a pass for licensing purposes should you want to make the move for Jobs in the US after residency in Canada. 

I think the problem is that the advantage in applying to the US is specialty specific. For instance, if you're going to FM/IM there's no point in going through all the extra effort because the ratio of spots:applicants is 1:1 or higher. On top of that, there's no advantage to going to the US at all for FM since it's a 3 year residency there and that extra year gets you nowhere in Canada.

For some of the more competitive specialties, let's say EM, Derm, etc., there is a discrepancy in training length (3 and 4 years respectively), whereas in Canada almost every specialty is 5 years. So you end up having to do extra fellowships in order to be able to take the Canadian boards, and that adds on extra stress. And on top of that, unless you're a green card holder or US Citizen, once you do training in the US on a J1 visa, you MUST return to Canada for at least 2 years after training unless you can get a waiver of that. In theory if you couldn't get a suitable fellowship but need one to work in Canada, you could be screwed. I think there was an article a while back about EM docs who did med school and residency in the US who couldn't return to Canada because they couldn't find 2 extra years of fellowship to get the same length of training as Canada. But at least doing med school in the US, you can get an H-1B visa which would allow you to stay and work after residency.

So I would say the case for going to the US is strongest in certain specialties that are otherwise quite competitive and only if the training length matches up (e.g. radiology) and much lower for the most commonly picked specialties like FM/IM.

[thestar10]

8 hours ago, JohnGrisham said:

Incorrect. Getting J1 visas is not difficult. Especially for primary care it has never been an issue. Recent changes have removed limits for statement of needs all together. So if you match you're set.

J1 is really far from an ideal visa. It is quite difficult to get an HB-1 nowadays, which frankly is the only visa applicants should really consider. 

[JohnGrisham]

10 hours ago, thestar10 said:

J1 is really far from an ideal visa. It is quite difficult to get an HB-1 nowadays, which frankly is the only visa applicants should really consider. 

J1 also isn't as bad as many people make it out to seem. Thousands have used it just fine.

In fact, this cycle they removed all limits for SON for getting a J1. So as long as you could match, you could do any residency you wanted under a J1 this year.  Yes, all the above restrictions already mentioned about the j1 stand. But if its that, versus not doing residency, its relatively not that bad. Especially if you're flexible and don't mind coming back to Canada for the 2 yr return period and doing locums(or doing a fellowship). 

As for H1b being more difficult - i think sure it is maybe a bit harder to get as a IMG from the carribs as a fresh grad, but I havent seen any objective evidence to show that it is non-subjectively more difficult. Anecdotally, Canadians who are studying at US med schools are still getting H1B visas. If you have your ducks in a row and are a strong applicant, and flexible with location, you can still snag H1bs in theory as a CMG. This is just reasonable conjecture, given the fact that very few CMGs apply to the US anyways for residency. Hence why i dont understand how people can make broad negative claims to the effect, given the almost negligible sample data. 

[JohnGrisham]

13 hours ago, hopeful_med said:

Getting a visa to work in the states is getting harder and harder and thus US programs are less willing to accept CMGs because there is no guarantee that the CMGs are able to get the visa, etc in time for July 1 when accepted. 

Grain of salt - I personally never applied to the states. This is of course, from my conversatiom with multiple interviewees  (CSA) when I was going through carms 

Again, there is no basis for your claim in the first paragraph. There are so few CMGs actively applying to make such a claim. Canadians students abroad(IMGs) are not the same. Neither are CMGs necessarily as good as USMGs in the US match, they are probably somewhere in between. 

Specifically for your claim of "not getting the visa in time for july 1" - this is based on zero facts. Up until now getting a J1 visa for the US match for IMGs has generally been an all or nothing - you either got the SON or you didnt. So there wouldn't be much in the way of "limbo" in making the july 1st start date. It's if you're applying H1b that there could be some issues in this regard, but at least you could back up with a J1. 

Instead of relying on anecdotal information and then continuing to propagate falsely, please spend a few minutes reading up on the topic This year the J1 program for example removed all limits on SON, so if you were able to match you were gauranteed a visa pretty much. A huge change.  

[rmorelan]

19 hours ago, JohnGrisham said:

Incorrect. Getting J1 visas is not difficult. Especially for primary care it has never been an issue. Recent changes have removed limits for statement of needs all together. So if you match you're set.

True - although with the time different to complete primary care in the US that is a big price to pay I would think. Almost worth it to set out a year here(?) than take a 4 year program down there if you want to come back to Canada. If you happened to go unmatched in Canada and you haven't already I would definitely consider writing the US USMLEs to expand the chances for the following year. There is a price to pay for doing them automatically - might a price worth paying - but a price no the less. If I chose to do a summer to rapidly prep for the USMLE I would have lost a year of research, or being unable to do a large number of student council ECs. I would have weakened parts of my app that I know got me into the residency program I got to prepare for a backup. 

There isn't a perfect answer I guess to any of this as all the various parties have competing goals - you, your school, the various governments.....everyone doesn't want the same thing. 

[JohnGrisham]

1 hour ago, rmorelan said:

True - although with the time different to complete primary care in the US that is a big price to pay I would think. Almost worth it to set out a year here(?) than take a 4 year program down there if you want to come back to Canada. If you happened to go unmatched in Canada and you haven't already I would definitely consider writing the US USMLEs to expand the chances for the following year. There is a price to pay for doing them automatically - might a price worth paying - but a price no the less. If I chose to do a summer to rapidly prep for the USMLE I would have lost a year of research, or being unable to do a large number of student council ECs. I would have weakened parts of my app that I know got me into the residency program I got to prepare for a backup. 

There isn't a perfect answer I guess to any of this as all the various parties have competing goals - you, your school, the various governments.....everyone doesn't want the same thing. 

Aside from FM being 1 year longer in the US, the time difference is such that most Canadian programs are longer than the US and you need a top up. 

Given the rising number of people doing formal or informal +1s after FM these days in canada it wouldnt be a huge deal. Especially catering your pgy3US to your interest.

That said, I dont think there are CMGs taking usmles to do FM in the US unless for a very specific personal indication. And I've sidetracked ha.

[ChemPetE]

I’m going to take a few minutes here to weigh in on a few issues, and what should be a very germaine topic for a lot of potential medical students that are considering career options. 

For context, I’m a very sparse and occasional poster here and get a lot of messages with questions about radiation oncology, the field I am specializing in.

First, with regards to radiation oncology specifically:

I do wish to correct one statement prior which identified rad onc as a very copetitive specialty within the US. That was once the case, but the field is crashing. This is the first year where there were more residency spots than applicants in the US, which is multifactorial. Residency spots have more than doubled in the past several years down south, and with the pattern of hypofractionation and decreased utilization of RT in some bread and butter sites, has left a lack of jobs for many graduates. Within the next few years US rad onc is set for probably worse what happened to the Canadian RO field 10 yrs ago, where US grads will be pushed into locums, unaccredited fellowships, and extremely low ball and borderline abusive employment. Basically its set up to become the next pathology with no incentive from leadership to turn off the taps so to speak. 

This is in contrast to the Candian market which closed residency spots, hunkered down, and only in the past few years has there been more signs of recovery with increased employment opportunities. But for the past 3 years it’s still stayed ~2 years from finishing residency to full time employment (and RO has a severe greographic limitation). So Canada is getting better, US is preparing for a shitstorm. For reference, this is only one of many recent topics (and acknoledged controversial thread) on the matter but I will link it here because I do think it represents closer to the truth than not: https://forums.studentdoctor.net/threads/future-resident-do-not-become-a-radiation-oncologist.1294979/ . Oh, did I mention approximately half of the American RO residents failed their physics and radiobiology boards this year out of the blue? It was much worse for the Canadians that wrote. You can’t count on practicing in the US if you can’t pass the boards, and even if you’re in a specialty that has the option to practice in the US, until you’re boarded there’s nothing to say they can’t change the board requirements out of the blue, or in the current political climate, visa eligibility as well. So my advice: don’t count on the US. (Rebuttal: at least one of my colleagues has had employment interviews in the US, and there are a few doing fellowship there as well).

Second, with regards to finding employment:

I will first comment on my own personal experience, and then comment on some of my other colleagues outside of the ‘RO microcosm’ experiences. I matched into RO knowing full well what the market was like, and knowing that I had a good chance of having to move around (with a semi-serious notion of having to go to US for work - very unlikely given the US market right now with limited US connections). In residency I matured some more, settled down a bit more, and I emphasize to rotating med students with me each time that what you value now is certinaly not going to be your needs and priorities when you graduate. Employment opportunities matter huge, and after a 5 year (or more) residency, people get tired of bouncing around for fellowships and academic jobs. The job market in Canada is crap right now for much of academia, but that extends to tertiary surgery jobs, tertiary medical jobs, and diagnostic jobs. Yes there remain a lot of opportunities still but you can’t predict how things will change in 5 years (for better or worse), but if there is a reasonable chance you have to hustle, you are not going to like it. It will cause undue personal and professional stress. Rad onc may be better in outlook than it once was, but is no means guaranteed. And you have to hustle to get your pubs, fellowship with the right people for the hiring committees to take your spot seriously, lest you be religated to the bottom of the resume pile when it comes for hiring. Basically, hindsight is 20/20 but I’ll play the game while there is still ‘hope’ at the end for stable employment. But my immediate friends and family know how much personal sacrifice it’s taken to get here. It’s accepted that R5 is hell in RO with studying for boards, fellowship/job applications, and lack of control of life. Think CaRMS is bad? Fail your boards in a specialty and it’s a ‘black mark’ on you, and then good luck competing for the job you want at the center you want. Not saying one’s worse than the other but it’s a comparable looming black cloud that’s not fun to live with, and makes its impact in how you conduct your life.

Non-RO experiences:

Those that went into primary care, while there may not have the clinics specifically open that they want to practice in, have been generally able to locum, get hospitalist privaledges, etc etc. They’re making it work and some are really hustling doing incredible hours of walk in shifts to pay down debt. Some are more relaxed. But my facebook feed for those in family tells a general trend of happiness, minus provincial/local shenanigans. My colleagues in other specialties are a mix. Those with sparse employment opportunities are either stressed to hell with the same sort of thing as above, or have accepted offers to work in more rural centers, for better or worse. Some are happy with that, some are less so. But it represents a lack of control with how you wish to conduct your life and should be acknoledged up front that that’s very likely to be the outcome for the current crop as they graduate, as when they want to compete for the academic jobs, my cohort will be that much more experienced and ‘eligible’ for them, once the retirements happen. If the university/gov’t chooses to keep the position/ARP funded. I can’t begin to say how many texts from friends that have wanted to quit or have come close to but keep push on. That’s not a healthy system. Deeman in his posts I would agree with and I think portrays a very apt description of the system for what its worth.

On a more personal note, another thing people need to consider: for unattached students that don’t have a romantic partner, it’s difficult to develop a relationship with someone amongst clerkship hours, as well as convince someone you’re worth it depsite the fact you may be across the country at the whims of the CaRMS blackbox. As a resident if you’re doing IM, same thing except hours are worse. Surgical resident? Worse hours yet. No middle CaRMS to fight through, but you’re put right in the middle of the fight for jobs and who knows where you will end up. Specialty with humane hours, no jobs? Prepare to sacrifice employment opportunity if you pursue a social life as your peers are publishing and networking. Or prepare to sacrifice your personal life even more as you work on your database, abstracts, and hustling for good references all throughout your 5y. Balance is rarely ‘attained’ here. Specialty with humane hours, good job prospects? Overloaded with students at the CaRMS cycle, and those good job prospects are only acknoledged now, and not guaranteed to be there 5 years from now. And guess what? If there is a shortage, you are then competing with the same type-A students that landed the residency spots after CaRMS and have that much more of a competitive field (read: endless research in your already valuable and extremely limited personal time) to hustle against if you want your desired employment.

Add in the CaRMS shitshow, the long term view of gov’t health economics (incredibly aging demographic with huge increase in care needs - where are the funds coming from? They’re certainly not increasing residency funding proportional to med students, nor hiring decisions proprortional to residencies) is that across the board, I think it can be anticipated that the average physician will be working harder for less compared with historical records for the gov’t to stay solvent and provide even comparable care to what is offered now. Within cancer land, impossibly expensive drugs are increasingly approved for new indications, people are living longer with incredibly expensive therapy, and that’s just within one field where costs are expected to skyrocket. Synthesizing all of this, I really do not recommend medicine as a career for people. Premeds in general tend to be oblivious to the above, and if they do, they don’t care. The residents now (including me) either weren’t aware, or didn’t care, but they do now as it directly impacts them. There are some perks to the field for sure, but it does come at tremendous personal cost, to which many students lack the foresight to see that it does stand a chance to conflict with their future values as they move throughout the training system.

So this is a very pessimistic post in general, but I think it’s approropriate to highlight more of the struggles that come later on too. CaRMS sucks, but it doesn’t end there. Sorry students. Others please feel free to weigh in, agree or disagree as you like, but that is my 2c. 

 

 

[medlotteryticketholder]

Hello all and thank you for your thoughts to us aspiring med hopefuls- your comments add a needed dose of reality. Having said that, I have an interview upcoming and obviously want to do well. I am a fourth year Nursing student and over the weekend, I received a copy of a letter of reference one of of my clinical profs has sent on my behalf for a research position I have applied for. It is very flattering and highly relevant to what the MMIs claim to be assessing- namely our potential skills as clinicians. The letter describes my manner with my patients and the application of my scientific knowledge in micro, anatomy, pharm and patho as being in the top 1% of my class in quite glowing terms.  Do I try to work this letter into my interview somehow? I certainly don't want to come off as bragging- which I am not- but it is an objective but informed view of my skills and highly relevant. Thanks in advance for your thoughts:) 

[ChemPetE]

16 minutes ago, medlotteryticketholder said:

Hello all and thank you for your thoughts to us aspiring med hopefuls- your comments add a needed dose of reality. Having said that, I have an interview upcoming and obviously want to do well. I am a fourth year Nursing student and over the weekend, I received a copy of a letter of reference one of of my clinical profs has sent on my behalf for a research position I have applied for. It is very flattering and highly relevant to what the MMIs claim to be assessing- namely our potential skills as clinicians. The letter describes my manner with my patients and the application of my scientific knowledge in micro, anatomy, pharm and patho as being in the top 1% of my class in quite glowing terms.  Do I try to work this letter into my interview somehow? I certainly don't want to come off as bragging- which I am not- but it is an objective but informed view of my skills and highly relevant. Thanks in advance for your thoughts:) 

No. Just focus on answering the prompts. Doing what you describe has a good chance of even penalizing you points.

[JohnGrisham]

56 minutes ago, ChemPetE said:

I’m going to take a few minutes here to weigh in on a few issues, and what should be a very germaine topic for a lot of potential medical students that are considering career options. 

For context, I’m a very sparse and occasional poster here and get a lot of messages with questions about radiation oncology, the field I am specializing in.

First, with regards to radiation oncology specifically:

I do wish to correct one statement prior which identified rad onc as a very copetitive specialty within the US. That was once the case, but the field is crashing. This is the first year where there were more residency spots than applicants in the US, which is multifactorial. Residency spots have more than doubled in the past several years down south, and with the pattern of hypofractionation and decreased utilization of RT in some bread and butter sites, has left a lack of jobs for many graduates. Within the next few years US rad onc is set for probably worse what happened to the Canadian RO field 10 yrs ago, where US grads will be pushed into locums, unaccredited fellowships, and extremely low ball and borderline abusive employment. Basically its set up to become the next pathology with no incentive from leadership to turn off the taps so to speak. 

This is in contrast to the Candian market which closed residency spots, hunkered down, and only in the past few years has there been more signs of recovery with increased employment opportunities. But for the past 3 years it’s still stayed ~2 years from finishing residency to full time employment (and RO has a severe greographic limitation). So Canada is getting better, US is preparing for a shitstorm. For reference, this is only one of many recent topics (and acknoledged controversial thread) on the matter but I will link it here because I do think it represents closer to the truth than not: https://forums.studentdoctor.net/threads/future-resident-do-not-become-a-radiation-oncologist.1294979/ . Oh, did I mention approximately half of the American RO residents failed their physics and radiobiology boards this year out of the blue? It was much worse for the Canadians that wrote. You can’t count on practicing in the US if you can’t pass the boards, and even if you’re in a specialty that has the option to practice in the US, until you’re boarded there’s nothing to say they can’t change the board requirements out of the blue, or in the current political climate, visa eligibility as well. So my advice: don’t count on the US. (Rebuttal: at least one of my colleagues has had employment interviews in the US, and there are a few doing fellowship there as well).

Second, with regards to finding employment:

I will first comment on my own personal experience, and then comment on some of my other colleagues outside of the ‘RO microcosm’ experiences. I matched into RO knowing full well what the market was like, and knowing that I had a good chance of having to move around (with a semi-serious notion of having to go to US for work - very unlikely given the US market right now with limited US connections). In residency I matured some more, settled down a bit more, and I emphasize to rotating med students with me each time that what you value now is certinaly not going to be your needs and priorities when you graduate. Employment opportunities matter huge, and after a 5 year (or more) residency, people get tired of bouncing around for fellowships and academic jobs. The job market in Canada is crap right now for much of academia, but that extends to tertiary surgery jobs, tertiary medical jobs, and diagnostic jobs. Yes there remain a lot of opportunities still but you can’t predict how things will change in 5 years (for better or worse), but if there is a reasonable chance you have to hustle, you are not going to like it. It will cause undue personal and professional stress. Rad onc may be better in outlook than it once was, but is no means guaranteed. And you have to hustle to get your pubs, fellowship with the right people for the hiring committees to take your spot seriously, lest you be religated to the bottom of the resume pile when it comes for hiring. Basically, hindsight is 20/20 but I’ll play the game while there is still ‘hope’ at the end for stable employment. But my immediate friends and family know how much personal sacrifice it’s taken to get here. It’s accepted that R5 is hell in RO with studying for boards, fellowship/job applications, and lack of control of life. Think CaRMS is bad? Fail your boards in a specialty and it’s a ‘black mark’ on you, and then good luck competing for the job you want at the center you want. Not saying one’s worse than the other but it’s a comparable looming black cloud that’s not fun to live with, and makes its impact in how you conduct your life.

Non-RO experiences:

Those that went into primary care, while there may not have the clinics specifically open that they want to practice in, have been generally able to locum, get hospitalist privaledges, etc etc. They’re making it work and some are really hustling doing incredible hours of walk in shifts to pay down debt. Some are more relaxed. But my facebook feed for those in family tells a general trend of happiness, minus provincial/local shenanigans. My colleagues in other specialties are a mix. Those with sparse employment opportunities are either stressed to hell with the same sort of thing as above, or have accepted offers to work in more rural centers, for better or worse. Some are happy with that, some are less so. But it represents a lack of control with how you wish to conduct your life and should be acknoledged up front that that’s very likely to be the outcome for the current crop as they graduate, as when they want to compete for the academic jobs, my cohort will be that much more experienced and ‘eligible’ for them, once the retirements happen. If the university/gov’t chooses to keep the position/ARP funded. I can’t begin to say how many texts from friends that have wanted to quit or have come close to but keep push on. That’s not a healthy system. Deeman in his posts I would agree with and I think portrays a very apt description of the system for what its worth.

On a more personal note, another thing people need to consider: for unattached students that don’t have a romantic partner, it’s difficult to develop a relationship with someone amongst clerkship hours, as well as convince someone you’re worth it depsite the fact you may be across the country at the whims of the CaRMS blackbox. As a resident if you’re doing IM, same thing except hours are worse. Surgical resident? Worse hours yet. No middle CaRMS to fight through, but you’re put right in the middle of the fight for jobs and who knows where you will end up. Specialty with humane hours, no jobs? Prepare to sacrifice employment opportunity if you pursue a social life as your peers are publishing and networking. Or prepare to sacrifice your personal life even more as you work on your database, abstracts, and hustling for good references all throughout your 5y. Balance is rarely ‘attained’ here. Specialty with humane hours, good job prospects? Overloaded with students at the CaRMS cycle, and those good job prospects are only acknoledged now, and not guaranteed to be there 5 years from now. And guess what? If there is a shortage, you are then competing with the same type-A students that landed the residency spots after CaRMS and have that much more of a competitive field (read: endless research in your already valuable and extremely limited personal time) to hustle against if you want your desired employment.

Add in the CaRMS shitshow, the long term view of gov’t health economics (incredibly aging demographic with huge increase in care needs - where are the funds coming from? They’re certainly not increasing residency funding proportional to med students, nor hiring decisions proprortional to residencies) is that across the board, I think it can be anticipated that the average physician will be working harder for less compared with historical records for the gov’t to stay solvent and provide even comparable care to what is offered now. Within cancer land, impossibly expensive drugs are increasingly approved for new indications, people are living longer with incredibly expensive therapy, and that’s just within one field where costs are expected to skyrocket. Synthesizing all of this, I really do not recommend medicine as a career for people. Premeds in general tend to be oblivious to the above, and if they do, they don’t care. The residents now (including me) either weren’t aware, or didn’t care, but they do now as it directly impacts them. There are some perks to the field for sure, but it does come at tremendous personal cost, to which many students lack the foresight to see that it does stand a chance to conflict with their future values as they move throughout the training system.

So this is a very pessimistic post in general, but I think it’s approropriate to highlight more of the struggles that come later on too. CaRMS sucks, but it doesn’t end there. Sorry students. Others please feel free to weigh in, agree or disagree as you like, but that is my 2c. 

 

 

Thank you for your insight - very valuable.

That said:

2018 NRMP match had a mean Step 1 of 247 for RadONC. With 194 spots, and 165 USMD applicants(total applicants 215). 20% having PhDs, another 20% having a graduate degree.

2011 NRMP shows  171 spots with 181 USMD applicants(total applicants 211).  Same 20%+ had PhDs. 

Hardly "doubling" of spots over 7 years. I don't claim to know as much as you about job market however, from what I know from a colleague with sparse communication, if you don't end up in a "good" brand-name program much like pathology in the US, job prospects are definitely much tougher.   Job prospects from your thread linked definitely seem to be much poorer than before.