Current CaRMS Competitiveness - Schools and Specialties

[bearded frog]

There is a stickied post in this forum from 2014 discussing the competitiveness of various specialties. Things have changed a little since then (but not much!) so I thought I would discuss the current field using data from the 2020 match available at https://www.carms.ca/data-reports/r1-data-reports/. I also tried to approach the competitiveness of specific schools as well, as someone just asked about where average applicants end up.

Competitiveness of Specialties

There are two main ways to approach this. The first way, the way that was done in the above mentioned post, is to consider the first choice specialty of applicants, and then consider the number of available spots. A specialty is considered more compeditive if there are less spots per first-choice applicant, and less compeditive if there are more spots per applicant. Traditionally, optho, plastics, and derm have vied for the top spot in being most competitive, trading year by year. In general the pathology specialties usually have more spots than applicants and are seen as least compeditive. The data for 2020 is below, with the caveat that I combined the program variants, ie there was a research anesthesiology track with one applicant and one spot which I combined with anesthesiology, and I combined the pathology subspecialties together. Doing this did not change the order of competitiveness.

To understand this graph, the number is the ratio of spots to applicants. There were 1.68 spots for every pathology applicant, and there were two applicants for every ophthalmology spot. There was just over 1 spot for every internal medicine applicant.

As you can see, the traditionally compeditive specialties are still compeditive, but has been joined by emergency medicine as one of the most compeditive disciplines, with 126 applicants for 73 spots and a ratio of 0.58 spots per applicant. Interestingly, radiology has a fairly compeditive reputation, however it is less competitive using this method than psychiatry and pediatrics, typically seen as low compeditive specialties. Interestingly ortho as seen as relatively noncompetitive using this method as well. Ortho, pathology, family medicine, physical medicine & rehab, and IM are the only specialties with more spots than applicants.

Now I feel that this is the best way to approach the question with the data available, but there are obviously caveats and problems using this method, as applicants potentially apply to multiple fields without a "first" choice, or prioritize location over specialty, etc. Another way to look at this question is to see where applicants actually end up after the first round, or more specifically where they don't end up.

In theory, more compeditive specialties will have less unfilled spots at the end of the first round of the match, and less compeditive specialties will have more. This doesn't really work as it will skew towards specialties with larger quotas. Family and IM are likely to have left over spots just because the number of available spots are so much higher. So to account for this we can rank disciplines by the ratio of unfilled spots to total offered spots. Less compeditive disciplines, in theory, will have a higher proportion of their total quota go unfilled.

This graph shows the ratio of unmatched spots to total offered quota for specialties that had unmatched spots. The total number of unmatched spots are listed next to the bar. For example, over a third of the pathology spots were not filled, and 10% of the vascular surgery spots were still available. Those not shown had no unmatched spots after the first round. You can see that it somewhat correlates with the previous method, with pathology, family, ortho, and PM&R still at the top. However, as you can see with the labels, we are talking about very low numbers for everything other than pathology, IM, ortho, and IM, so it's difficulty to extrapolate using this method, as that one spot in gyne might be due to a program making only limited selection of applicants, for whatever reason, hoping to do better in the second round? We cannot say.

The reason why I bring up this method though, is that based on the data supplied by CaRMS, a similar method is the only way to look at school competitiveness, as while school quotas are published, we do not know the numbers of first-choice applicants for each school.

Competitiveness of Schools

We have the number of spots offered by each school, and we have the number of unmatched spots after the first round so we can get a ratio.

This is a graph of ratio of total unfilled spots to total quota with the number of unfilled spots next to the bar. A third of NOSM's spots went unfilled. Note that the vast majority of these are family medicine spots. The graph with only royal college disciplines (ie. no family med) is below.

As you can see the overall numbers are much lower, but the general order of schools is the same. Without judgment, the trend generally correlates with "desirability" to live in that city, especially in the non-family data. (Calgary certainly is an outlier there)

Summary

These data are not perfect, and there's caveats to every method, but I hope this gives a general idea about where things stand, at least for CMG's in the first round of CaRMS. There might be some interesting trends over time if we compare how this ranking changes going back previous years, which I may do in the future, but for now I'll leave it at this.

[bearded frog]

I took some time and scraped the last 20 years of 1st choice and quota data going back to 2000 to see if there were any interesting trends in competitiveness over time. It turns out things have been relatively stable over the last two decades. I again combined pathology and dropped the 1 applicant a year research tracks, and combined community medicine and public health as the name transitioned. Vascular surgery only became a thing in 2012.

The values are ratios of first choice applicants to spots, ie number of applicants per spot. Numbers above 1 mean more applicants than spots and blow 1 are more spots than applicants. To account for outliers I used a 3 year rolling average to smooth the data somewhat. The data is presented below in 4 separate graphs for ease of visualization. Also note the scales for each graph are not the same!

Stable

The following specialties have been generally stable in competitiveness in the last 20 years:

Otolaryngology and Urology had a bump in ~2002 and ~2018 but otherwise reverted to mean. Pediatrics had a small valley with a nadir at 2010. Otherwise these ones have been pretty solid at their respective competitiveness levels.

Declined then Recovered

The following specialties had a significant decline from 2000 with a nadir around 2010 and recovered to current levels:

ER had a bump around 2005 but otherwise slumped somewhat before peaking again in 2017. Nuclear medicine had a little peak in the middle of their nadir for some reason. Generally if we only looked back 10 years we would consider these specialties on the rise.

Increasing

The following specialties have generally increased in competitiveness over the last 20 years:

The caveat here is radiation oncology which peaked in 2004 then had a big slump before a meteoric rise in the last 3 years. PM&R, while still increased form 2000, is also down from its peak in 2015. Anesthesiology had a small nadir in 2005. Interesting to see how much neurosurgery has grown, even with its terrible reputation.

Decreasing

The following specialties have been *relatively* decreasing in competitiveness in the last 20 years:

This basically goes to show that while still the most compeditive, plastics and derm are not as crazy competitive as they once were, now with only ~2 applicants for every spot as opposed to 3-4 in 2000. Vascular started off strong in 2012 and then has come down. Rads has seen a steady decline.

[LostLamb]

GO PSYCH!

[Haribo7173]

On 1/10/2021 at 4:05 AM, LostLamb said:

GO PSYCH!

Chill, psych

[Findanus]

It saddens me that pathology is so unpopular.

 

Would you consider separating out the pathology disciplines? They are extremely different and attract people with different interests and skill sets (e.g. med micro is nothing like anatomical pathology and has no overlap whatsoever)

[blah1234]

@bearded frog were there any substantial changes in spots and thus associated competitiveness impact (e.g. 30 applicants constant but spots went from 35 -> 30)? I'm curious if you looked at that as I thought there were some redistribution of residency spots between programs a while back.

[ChemPetE]

On 1/10/2021 at 2:05 AM, LostLamb said:

GO PSYCH!

GO RAD ONC!

[1D7]

51 minutes ago, Findanus said:

It saddens me that pathology is so unpopular.

 

Would you consider separating out the pathology disciplines? They are extremely different and attract people with different interests and skill sets (e.g. med micro is nothing like anatomical pathology and has no overlap whatsoever)

Many of us entered medicine to get away from H&E staining that we encountered in the labs. Not entirely surprising.

[Findanus]

1 hour ago, 1D7 said:

Many of us entered medicine to get away from H&E staining that we encountered in the labs. Not entirely surprising.

That may be the case. As a pathologist I can safely say that the field of pathology is absolutely nothing like the stuff you see in boring academic labs, but I also think that medical school curricula does nothing to express this truth. The only exposure students get to pathologists are when pathologists are recruited to teach basic science, which I think any doctor should be able to do. I think more people would want to become pathologists if we were diagnosing on screens instead of microscopes, and if there was more prestige.

[shikimate]

Academic pathologists aren't good representatives for the field. They are probably overloaded with cases, overworked and many aren't any good at teaching. I would shadow a community pathologist if I was  interested.

[bearded frog]

6 hours ago, Findanus said:

It saddens me that pathology is so unpopular.

 

Would you consider separating out the pathology disciplines? They are extremely different and attract people with different interests and skill sets (e.g. med micro is nothing like anatomical pathology and has no overlap whatsoever)

I personally think that pathology as a discipline is somewhat divergent from other disciplines from medicine. Someone who isn't exactly a "people person" might make an excellent pathologist but might make it through the grinder of medical school applications that are looking for something entirely different.

Here's the path sub specialties for 2020 (spots per applicant) with FM thrown in for comparison, they all have more spots than applicants:

Here's the ratio applicants to spots over time (ie briefly around 2010 medical microbio had more applicants than spots:

[bearded frog]

6 hours ago, blah1234 said:

@bearded frog were there any substantial changes in spots and thus associated competitiveness impact (e.g. 30 applicants constant but spots went from 35 -> 30)? I'm curious if you looked at that as I thought there were some redistribution of residency spots between programs a while back.

There are obviously changes in 1st choice applicants every year, but there are also changes in quota every year as provinces change their numbers and funding. Basically numbers of spots and applicants have all been going up, at different rates.

To demonstrate, here are the graphs of all the specialties with more than 100 first choice applicants in 2020 showing 1st choice applicants and quota over time, each normalized to the 2020 quota. As you can see quota generally doesn't change very rapidly, except in 2006 which seemed to get a significant bump across the board.

[1D7]

1 hour ago, bearded frog said:

I personally think that pathology as a discipline is somewhat divergent from other disciplines from medicine. Someone who isn't exactly a "people person" might make an excellent pathologist but might make it through the grinder of medical school applications that are looking for something entirely different.

Here's the path sub specialties for 2020 (spots per applicant) with FM thrown in for comparison, they all have more spots than applicants:

Here's the ratio applicants to spots over time (ie briefly around 2010 medical microbio had more applicants than spots:

What happened to medical biochemistry? Did they get replaced by PhDs or lose all their turf to another lab specialty?

[bearded frog]

6 minutes ago, 1D7 said:

What happened to medical biochemistry? Did they get replaced by PhDs or lose all their turf to another lab specialty?

It seems to have now a subspecialty of internal medicine. https://phx.e-carms.ca/phoenix-web/pd/main?mitid=1420

[Redpill]

I wonder if EM seems more competitive because there are two paths to become a practicing emergency physician, and many are agnostic as to which to take. They may not necessarily be the strongest candidates* but will still rank the 5-year first to try and avoid a second match. Whereas with surgical subspecialties, if you don't have the research early on you're not going to bother to try.

 

*I mean strongest candidate with respect to research and ECs that align with EM. Many will still make great Emerg docs but may be weaker from a CV perspective, so end up matching to FM and taking the +1 route

[JohnGrisham]

9 minutes ago, Redpill said:

I wonder if EM seems more competitive because there are two paths to become a practicing emergency physician, and many are agnostic as to which to take. They may not necessarily be the strongest candidates* but will still rank the 5-year first to try and avoid a second match. Whereas with surgical subspecialties, if you don't have the research early on you're not going to bother to try.

 

*I mean strongest candidate with respect to research and ECs that align with EM. Many will still make great Emerg docs but may be weaker from a CV perspective, so end up matching to FM and taking the +1 route

A few colleagues i know, actually were the "stronger" candidates on paper(and clinically) on their pathways to EM, and chose the rural FM and then +1 EM route.  Two also applied to the 5 year pathway, got many interviews, but ultimately ranked their desired rural FM programs higher. The common thread was that they were older in age, and didn't want to do 5 years as a resident, and we're comfortable with being a bit "greener" in early practice by the FM+1 route.  

[Redpill]

2 minutes ago, JohnGrisham said:

A few colleagues i know, actually were the "stronger" candidates on paper(and clinically) on their pathways to EM, and chose the rural FM and then +1 EM route.  Two also applied to the 5 year pathway, got many interviews, but ultimately ranked their desired rural FM programs higher. The common thread was that they were older in age, and didn't want to do 5 years as a resident, and we're comfortable with being a bit "greener" in early practice by the FM+1 route.  

I think if you're even the least bit interested in rural practice its a no-brainer to do the 2+1 pathway. Shorter training times with equivalent outcomes 5 years into practice, and the option to challenge the exam with enough rural ED experience even if you don't match make that a clear win.

The challenge is if you want to practice in a metro area. You need to match to the +1 otherwise you are stuck. Makes more sense to try for the 5 year even if it is 2 more years of training.

[offmychestplease]

39 minutes ago, Redpill said:

I think if you're even the least bit interested in rural practice its a no-brainer to do the 2+1 pathway. Shorter training times with equivalent outcomes 5 years into practice, and the option to challenge the exam with enough rural ED experience even if you don't match make that a clear win.

The challenge is if you want to practice in a metro area. You need to match to the +1 otherwise you are stuck. Makes more sense to try for the 5 year even if it is 2 more years of training.

you can do FM, work in a rural ER, then challenge the exam after 4 years and with the +1 exam certificate you can work in a metro city just like anyone who did the +1 year

[bearded frog]

5 hours ago, offmychestplease said:

you can do FM, work in a rural ER, then challenge the exam after 4 years and with the +1 exam certificate you can work in a metro city just like anyone who did the +1 year

In that case you should have just done the 5 year pathway in the first place...

[dooogs]

7 hours ago, bearded frog said:

In that case you should have just done the 5 year pathway in the first place...

Im guessing you would make a lot more money by doing less years  Could be why!

[Idontknowanymore]

I still think that the Canadian government should do something about this whole CaRMS thing because without enough funding whatever issues we currently have persist. It creates so much stress for med students, more so than in any other country I have heard of. I have also heard quite a few sad stories of applicants working so hard just to get matched to a specialty that they are not interested just to avoid being unmatched. CaRMS is just so stupid...

[offmychestplease]

2 hours ago, dooogs said:

Im guessing you would make a lot more money by doing less years  Could be why!

right, 3-4 years of more attending income compared to FRCPC EM and getting out and working much earlier. You would be earning/living as a staff attending for those years....and sure you would not be first choice for metro ER jobs if you are competing with those that did FRCPC or +1 year but there are many benefits of getting out and working years sooner, plus if you are happy with FM it's an awesome choice.

 

[MSWschnoodle]

5 hours ago, Idontknowanymore said:

I still think that the Canadian government should do something about this whole CaRMS thing because without enough funding whatever issues we currently have persist. It creates so much stress for med students, more so than in any other country I have heard of. I have also heard quite a few sad stories of applicants working so hard just to get matched to a specialty that they are not interested just to avoid being unmatched. CaRMS is just so stupid...

The American match system seems much worse from my perspective than CaRMS. The SOAP process is bonkers. 

Unfortunately some of the CaRMS stress comes from the fact that there are way more people who want to do a specific specialty than there is capacity to sustain staff positions in that specialty... It sucks but if 90 people want to do a specialty but there is only capacity to sustain 30 people in the specialty then 60 people will need to wind up doing something else. Because medical school seats and residency positions are funded predominantly by tax dollars in Canada there is a fiduciary duty on the part of the government to ensure that the outcome of those seats/positions is a healthcare system that serves the best interest of the public. The best interest of the public is to ensure the physician workforce is distributed based on what the public needs. While it would be nice if everyone could do whatever they wanted that is not sustainable. The public needs many more family doctors than dermatologists per capita. 

You could argue that medical schools need to do a better job of making sure applicants know that they are not guaranteed to get a residency and/or staff position in the specialty and/or location that they want but it's debatable if that will actually stop people from applying. People need to make their individual decisions about whether going unmatched or matching to an alternate field is a worse fate... but the one thing that remains consistent throughout CaRMS is "Do not rank any site or program that you would not be willing to train at". If a particular training location or program would make you so unhappy that you would regret going in to medicine then do not rank it. That is the control that everyone has in this admittedly very stressful process. 

[shikimate]

I want to express my thoughts on a number of points above:

- the problem sometimes is not capacity, but under and over flows in a particular year. For example maybe this year you apply to derm, and just happens there are 2 other stellar candidates from the same school who wants derm. If you had applied last year, there wouldn't be those 2 black horses. Our system is a one shot system mostly, if you apply to something competitive and go unmatched, you are more or less done (opthho is exception). At least in US there are transition years and abundance of FM/IM that in a pinch you could try to get. I think the UK/Australia model of house officer is much better, at least you can be employed and take your time to keep trying.

- The government has long ago forfeited their riduciary duty, because the current Carms specialty does not correspond to the demand. Why are there so many ortho spots when there aren't ortho jobs? why are there so many cardiac sx spots when there aren't cardiac sx jobs? Why do we train so many anatomical pathologists when the demand is for general pathologists? The government just throws money at universities and surgical programs need warm bodies to cover calls, that's it. The surgical program or whatever other program has no concept of their fiduciary duty when it comes to allocating residency spots. 

- med schools serve their self interest first and foremost. They wanna see people match, doesn't match it's a specialty you have no interest in at Fort Timbuktu. If they truly want to serve their students well in the current environment they would make USMLE prep available to those who want it, and instead of insisting someone rank a specialty they have no interest, they would encourage them to find as many other ways as possible to get into the specialty (not restricted to USA. For example you could do residency in UK or other commonwealth countries and still come back to Canada via alternative pathways afterwards. It's a curved road, but it's better than no road)

Anyways  I disclose the disclaimer that I am bit of a permabear on these issues.

[Idontknowanymore]

13 minutes ago, MSWschnoodle said:

The American match system seems much worse from my perspective than CaRMS. The SOAP process is bonkers. 

Idk, but my friends keep saying that the US match system is way better, at least for competitive specialties (especially if you go to a top 10 med school). It also seems less arbitrary. I feel angry for my friends whenever I hear them talking about not getting into a competitive specialty even though they are very qualified for that specialty (multiple publications, have been smart and diligent students ever since high school for example). It just seems unfair to them to work so hard just to feel bummed due to getting stuck in a specialty they aren't passionate about.