Number of Canadian medical graduates denied residency placements declines to four-year low

[la marzocco]

https://www.theglobeandmail.com/canada/article-number-of-canadian-medical-graduates-denied-residency-placements/

A total of 67 students set to graduate from Canadian faculties of medicine this year failed to be matched to a training position, down from 115 last year, 99 the year before and 77 the year before that. The last time the number of unmatched graduates was in this vicinity was in 2015, when 64 graduates did not garner a residency spot, according to the Canadian Resident Matching Service, or CaRMS, which released the 2019 figures on Wednesday.

She pointed out that on top of the 67 current-year graduates of Canadian schools who went unmatched, another 31 from previous years remained unmatched.

[UdeMed]

Interesting! 

Was it a year where people were more backing up or candidates had more diversified interests ... Let's wait for CARMs complete statistics to be launched later in April/May

[1D7]

49 minutes ago, UdeMed said:

Interesting! 

Was it a year where people were more backing up or candidates had more diversified interests ... Let's wait for CARMs complete statistics to be launched later in April/May

Mostly more people backing up and a reduction in back-log of applicants thanks to the "3rd iteration" last year from the military. Increase in tendency to back up is due to the large cohorts of growing unmatched students, plus schools  doing their best to scare students.

[ChemPetE]

I still feel for the students that have not matched, and the dearth of options left for them. This will cool off some incentives to increase the ratio of spots to students somewhat, which is regrettable. I’m happy with some progress, but I think it’s clear that there is still a problem at heart, and the system should still strive to do better for Canadian graduates, both in terms of rates and options. More flexibility in the system also will help facilitate program transfers, which at present had gotten even more difficult.

[blah1234]

I still think there should be a "default" type of doctor. I know that the CCFP doesn't want to be seen as second class citizens but what is the point of the generalist training in medical school if it doesn't necessarily lead to anything. I understand the argument that one internship year isn't enough to learn everything but at least give people the ability to work as associates or something.

Last time I checked there was still stigma towards FM despite the change to make FM its own specialty so perhaps we should move on and give back flexbility to the students so they don't have figure out what kind of doctor they want to be on day 1.

[NLengr]

4 hours ago, blah1234 said:

I understand the argument that one internship year isn't enough to learn everything but at least give people the ability to work as associates or something.

Is that actually based on any research or is it just a random opinion of the CCFP and family med programs?

The only study I have ever seen that looked into 1 year GP vs 2 year family med showed no difference in practice patterns after several years in practice. 

[blah1234]

1 hour ago, NLengr said:

Is that actually based on any research or is it just a random opinion of the CCFP and a family.med programs?

The only study I have ever seen that looked into 1 year GP vs 2 year family med showed no difference in practice patterns after several years in practice. 

I'm not aware of any research to support that statement. I assume it was just built on the notion that medical knowledge has dramatically expanded in the past couple of decades. From what I understand the general licence in the US and Australia is not as flexible as full FM but I mean that's still better than nothing.

Assuming your study is accurate I guess the counter argument the CCFP could put forth is wanting graduates to be skilled within the first few years of practice rather than become competent through "trial by fire" with suboptimal outcomes for patients.

Regardless, I still favour the return of the general licensure. I think it would alleviate a lot of problems with the current system as I don't think it really achieved the goals of the CCFP of getting more respect. 

[NLengr]

54 minutes ago, blah1234 said:

Assuming your study is accurate I guess the counter argument the CCFP could put forth is wanting graduates to be skilled within the first few years of practice rather than become competent through "trial by fire" with suboptimal outcomes for patients. 

Hey! That's how we become competent in surgery!

[GrouchoMarx]

16 hours ago, NLengr said:

Is that actually based on any research or is it just a random opinion of the CCFP and family med programs?

The only study I have ever seen that looked into 1 year GP vs 2 year family med showed no difference in practice patterns after several years in practice. 

Making a residency two years when one was just fine gets the government a year of attending level practice for resident cost. It has nothing to do with practice readiness, or respect, and everything to do with money

 

Ditto for the recent proliferation of rural family med residency programs.

 

The govt is manipulating us, and we're fool enough to let them do it

[1D7]

Well something that has changed in the recent decade is the reduction of clinical experience students actually get during their M3 and M4. There's more medico-legal and administrative oversight so students for the most part are writing fewer and fewer orders/Rx's. There is a lot less hands-on experience nowadays too—younger attendings routinely mentioned they had completed 20-50 deliveries by the end of their OBGYN rotation, while most of us in M3 had 1-10. And from the student side, there is a lot more anxiety surrounding finding a residency position today, leading to strategies/behaviours from students that maximize matching sometimes at the expense of clinical learning.

I wasn't around back in the day, but my gut feeling is that someone coming out of their rotating internship/R1 back then had a lot more clinical experience than someone finishing R1 now.

[Intrepid86]

20 hours ago, blah1234 said:

I still think there should be a "default" type of doctor. I know that the CCFP doesn't want to be seen as second class citizens but what is the point of the generalist training in medical school if it doesn't necessarily lead to anything.

The reasons for generalist training in medical school should be self evident. Not only can broad exposure promote interest and inform decisions to specialize in a certain area, but specialties themselves don't exist in complete isolation, and it's important to have a sense of what others do, their scope, and how they work together. A single rotation in medical school may be your only meaningful experience with something, and that's actually important, especially if you never see it again. This may sound counter-intuitive, but it's not.

A one year rotating internship may have been enough to start general practice 40 years ago, when even insulin was new, and truly modern medicine was still in its relative infancy, but today one year is insufficient despite what some people may say. The CCFP is two years, and in the U.S Family Medicine residencies are three years, and the extra time does matter.

[blah1234]

2 hours ago, Intrepid86 said:

The reasons for generalist training in medical school should be self evident. Not only can broad exposure promote interest and inform decisions to specialize in a certain area, but specialties themselves don't exist in complete isolation, and it's important to have a sense of what others do, their scope, and how they work together. A single rotation in medical school may be your only meaningful experience with something, and that's actually important, especially if you never see it again. This may sound counter-intuitive, but it's not.

A one year rotating internship may have been enough to start general practice 40 years ago, when even insulin was new, and truly modern medicine was still in its relative infancy, but today one year is insufficient despite what some people may say. The CCFP is two years, and in the U.S Family Medicine residencies are three years, and the extra time does matter.

I agree that the medical specialties don't exist in isolation. However, the way I was taught at least framed all the core rotations in context of how that knowledge is useful for a "general physician". Knowing the red flags of common presentations and knowing what field handles what emergencies. The training I received in medical school was not to prep me to be a future psychiatrist or pathologist but instead how to being a functional general doctor. 

I agree that the broad exposure helps students determine what kind of doctor they want to be but I don't think the curriculum should be structured as one large job fair. We should be producing capable professionals like other professional schools that are capable of independent practice with the option to specialize if needed. Unlike our peers in dentistry, law, etc we are not accomplishing that task because of the split of the CCFP and the Royal College. 

Perhaps one year isn't enough to be a capable family physician (a position I agree with). However, I would find it hard to believe that a one-year internship would not give you the skills needed to do administrative work, or walk-in clinics, or other low-acuity community work that physicians in the US and other Commonwealth countries seem to do fine with just an internship year. At the end of R-1 I knew that I had a lot to learn and I wasn't perfect but I was also capable of doing a lot of things. Right now we have a system where if someone is unhappy with their program and decides to leave as an R4 in whatever they do not have the ability to do anything in medicine which I think is ridiculous. 

[Edict]

I don't believe a 1 year rotating internship is enough to allow you to practice independently as a physician. Not in this era. GP training in the UK is 2 foundation years plus 3 years of training. In the US its 3 years. I would argue that more training as opposed to less would be beneficial in Canada, especially given our 3 year medical schools. 

In fact in the UK they are discussing adding a fellowship to the training pathway for GPs. http://www.pulsetoday.co.uk/news/gp-topics/education/nhs-england-adviser-in-talks-with-hee-about-five-year-gp-training/20036921.article