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Current CaRMS Competitiveness - Schools and Specialties


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7 minutes ago, shikimate said:

 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)

That sounds pretty bad and ineffective. Sounds like just bunch of government officials doing what's the easiest for them (not a fan of politicians in general). It sucks to know that there might be "no road" for med school graduates after completing an extra 4 years of schooling and sacrifice etc. Seems like a broken system to me. Wish I can do something about it.

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20 hours 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.

To clarify, they practice in Urban centres alongside 5 years after doing the +1 (Rural/semi-rural FM was more so to get a stronger foundation in their perspective).  Irony of the +1 is that it ends up creating urban ED docs mostly.

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1 hour ago, Idontknowanymore said:

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.

It's not like people passionate about X specialty will get it in America. In both systems it's a numbers games in terms of number of spots available to number of applicants.

The main difference is that in America you have your USMLE score that will seal your fate earlier if you do badly on it.

The match system is in most ways fundamentally not very different from other careers except you are more 'locked in' after the match whereas most other careers will have some opportunities for lateral switches.  

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9 hours ago, MSWschnoodle said:

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. 

I disagree with your notion that the NRMP match is worse than CaRMS.

The American system is infinitely better than the Canadian one. It does not penalize failure the same way CaRMS does, in that if you fail to match one year, or match to a field you later want to leave, you are not prohibited from taking part in the first round again. It also does not offer spots that are exclusively for FMGs, which many Canadian programs, through political pressure from well-connected families with children in foreign schools, have been pressured to do, which smacks of corruption. There is far more choice in terms of numbers of programs, and although their quality can be variable, any person of the caliber of a Canadian medical graduate should be able to match to at least a mid-tier program. If you do match to a program of poor caliber, the odds are that it isn't in a place with minus fifty winters. And finally, the USMLE exams act as the 'great equalizer', making applications more objective.

As a footnote, I think it is foolish to assume that the government is acting in your best interests in any situation as a doctor. As a practicing physician, I can say that the government is more of an adversary than an ally.

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2 hours ago, Findanus said:

I disagree with your notion that the NRMP match is worse than CaRMS.

The American system is infinitely better than the Canadian one. It does not penalize failure the same way CaRMS does, in that if you fail to match one year, or match to a field you later want to leave, you are not prohibited from taking part in the first round again. It also does not offer spots that are exclusively for FMGs, which many Canadian programs, through political pressure from well-connected families with children in foreign schools, have been pressured to do, which smacks of corruption. There is far more choice in terms of numbers of programs, and although their quality can be variable, any person of the caliber of a Canadian medical graduate should be able to match to at least a mid-tier program. If you do match to a program of poor caliber, the odds are that it isn't in a place with minus fifty winters. And finally, the USMLE exams act as the 'great equalizer', making applications more objective.

As a footnote, I think it is foolish to assume that the government is acting in your best interests in any situation as a doctor. As a practicing physician, I can say that the government is more of an adversary than an ally.

What can the current Canadian med students do though, given the situation? I know there are advocacy by the CFMS going on, but it seems like it's not getting anywhere.

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On 1/20/2021 at 3:25 PM, Idontknowanymore said:

That sounds pretty bad and ineffective. Sounds like just bunch of government officials doing what's the easiest for them (not a fan of politicians in general). It sucks to know that there might be "no road" for med school graduates after completing an extra 4 years of schooling and sacrifice etc. Seems like a broken system to me. Wish I can do something about it.

Its not broken, it works exactly as it was designed to. Why would they give more options to people and risk an even greater shortage in some fields then they already have. if by limiting spots and funding, they can shunt people towards a certain path or field, then its working great from the government's perspective.

 

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On 1/21/2021 at 3:53 AM, Idontknowanymore said:

What can the current Canadian med students do though, given the situation? I know there are advocacy by the CFMS going on, but it seems like it's not getting anywhere.

You gotta fend for yourself.

If you are ok doing something you don't like, then back up for sure. Some people can change specialty and re-train later if they get fed up with whatever they do. Some people work for a bit, gather some capital, and go do other ventures. Once you have an independent license in any specialty what you can do is not restricted to what the textbook says you can do. There is a general surgeon doing hair transplants for men with hair loss. That's not in any gen sx textbook I've read lol. 

If you want something competitive, up your professional networking game. It's not a bad idea to write USMLE. Even if let's say you don't think you'll do well honestly it's like a bonus lotto ticket. If by chance you ace it, you could apply to competitive (or not so competitive) specialties in US. If you don't do well, you can still continue your Carms in Canada.

If you pass all 3 steps, it's permanent so say in the distant future, you want to join some business venture or do some medical related project in USA or elsewhere in the world, you can pull out those scores and easily get a license in a proxy state (for example if you have 2 years of residency and passed all 3 steps, for $35 you can get a Pennsylvania medical license, even if you have never been there or will never actually live or work there). It's like a driver's license, even if you don't own a car, still good to have on hand.

UK has some reciprocity agreement with Canada for family med. I know people who trained in Australia can also get Canadian license to practice under some restrictions, varies by province. So worse case say you can't match to Canda or USA for whatever reason, there are still roads open to you, if you still want to work in medicine.

Don't get stuck in a dead end and end up like the people who can't match, falls in depression and decide to seriously harm themselves. Carms and the bureaucratic apparatus isn't worth shedding your blood for.

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  • 4 weeks later...

After considering IM specifically in another thread, noting that its about equal in terms of first choice applicants to spots, I considered the fact that IM seems to have a reputation as the second most popular "back-up" specialty after FM. In theory say someone who has an excellent IM application was actually gunning dermatology. They have an ok derm app but its not their year and so they easily match IM. This hypothetical person should probably be considered when thinking of IM's competitiveness (as well as FM, etc.). But not all IM back-uppers are going to a) not match to their first choice or b) have a competitive IM application.

Looking at the raw numbers for 2020 as I posted in the other thread, the ratio of first choice applicants to total applicants for IM and family are about one half:

sXS0Xrz.png

Ie half of all IM applicants rank it first, the other half rank it somewhere after another specialty. If we were to then use total applicants per avaliable spots, IM would be something like 2 applicants for every spot, way more compeditive than just looking at first choice applicants. But as I said above the real number of "compeditive" applications lies somewhere between 1 to 2 applicants for every spot. Carms does publish what choice they matched to for each specialty (https://www.carms.ca/wp-content/uploads/2020/05/2020_r1_tbl17e.pdf) showing that of the ~450 that matched, ~40, or about 10%, matched to it as their second choice. (It's ~20% for FM) That also means that of the ~450 people who had IM as a back-up, 10% matched.

Here is a chart showing percentage of non-first-choice applicants who matched to each specialty (that had at least 3 people match outside of first choice) in 2020:

ONTdCoH.png

Surprisingly, IM is in the middle of the pack. I feel like peds neruo probably is a result of people backing up with it after peds, (because as a peds resident I know people who have anecdotally done this) or maybe after IM if their just super into neurology? I'm surprised about rads though. Maybe PM&R are backing up from ortho? No way to know unfortunately. They do publish how many first choice applicants to each specialty match to a back-up though.

There may be a way to do some mathematics to account for this in terms of competitiveness, as if we look back historically and its about ~10% every year that match as a not-first-round, then maybe we should be giving an extra 10% to the first choice applicant number resulting in IM having an adjusted competitiveness of 1.1 applicants per spot. But then almost as many first choice IM applicants match to something else they backed up IM with, so does that cancel this out?

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On 1/20/2021 at 8:21 AM, Idontknowanymore said:

working so hard just to get matched to a specialty that they are not interested just to avoid being unmatched.

Med1 here and count me among this group. Going unmatched after being 100's of thousands of dollars in debt is nothing less than catastrophic imho. And the bandage solutions and preformative "action" of higher ups has done little to mitigate the risk of not matching in recent years. To potentially make matters worse, the ramifications of the pandemic may make life even tougher in the near future. I hate to be all doom and gloom but at the end of the day, negative outcomes in the future may simply be attributed to a worldwide pandemic.

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