Applying to Second Iteration of CaRMS

[PlasticSurgery]

Hi Everyone, 

I had a question regarding the second iteration of CaRMS. I applied for a competitive surgical speciality but unfortunately, did not receive any interviews for said specialty. I did however receive interviews for every single parallel plan program I applied to (all non-surgical). However, I have found that I am not very passionate about these programs, given that they are non-surgical.

My question is, if I end up matching to a program in the first iteration, can I still apply to programs in the second iteration, if there are open spots for surgery programs? 

[CaRMS2021]

If you match to a program in the first iteration, it is binding and you cannot apply to a program in the second iteration. You can try to transfer during residency but it may be challenging to go from non-surg to surg or a program with lower years of funding to a program with higher years of funding (e.g. FM to surgery). 

If you do not rank any programs in the first iteration, you can apply to programs in the second iteration or next year. 

[bearded frog]

As carms2021 says your match is binding and you will not be able to attempt the second round. Do not rely on a transfer. (Assuming you applied broadly, if they didn't even want to interview you why would they accept you later?) Look at previous years to see if there are usually open spots in the second round in your desired field. Even if so you should consider it very compeditive vs IMGs and so very likely you will go unmatched.

Consider why you didn't match, unless you applied to only 1 or 2 programs, honestly with not even any interviews it's you're not a good candidate that just got unlucky with the match process, which would have suggested a relatively good chance you would be successful next year. For success you're going to have to change something significantly, and do you have a red flag somewhere that won't be going away or just not enough electives or research which in theory could be fixed in 6m? If you honestly can't see yourself doing any of your back-ups, and would rather risk going unmatched, then do not rank them, see what the second round options are, and likely end up re-applying next year, with the understanding that there is no more guarantee that you will fare any better next year, and it will actually be more difficult because you will be flagged a previous YOG applicant (it doesn't flag between unmatched and un-applied is my understanding), although programs will assume you didn't match and will have to discuss it and overcome that stigma.

Some medical schools will let you defer graduation and do electives, research etc as a 5th year which in theory could improve your matching chances next year but some schools require you to apply broadly in the second round to be eligible from what I've heard.

Still, for a lot of people that risk is worth being miserable for the remainder of your career, but it is a gamble, especially with not even any interviews. I apologize if this sounds harsh but its a huge decision and you need to think rationally.

[PlasticSurgery]

20 hours ago, CaRMS2021 said:

If you match to a program in the first iteration, it is binding and you cannot apply to a program in the second iteration. You can try to transfer during residency but it may be challenging to go from non-surg to surg or a program with lower years of funding to a program with higher years of funding (e.g. FM to surgery). 

If you do not rank any programs in the first iteration, you can apply to programs in the second iteration or next year. 

Thanks for the response!

[PlasticSurgery]

15 hours ago, bearded frog said:

As carms2021 says your match is binding and you will not be able to attempt the second round. Do not rely on a transfer. (Assuming you applied broadly, if they didn't even want to interview you why would they accept you later?) Look at previous years to see if there are usually open spots in the second round in your desired field. Even if so you should consider it very compeditive vs IMGs and so very likely you will go unmatched.

Consider why you didn't match, unless you applied to only 1 or 2 programs, honestly with not even any interviews it's you're not a good candidate that just got unlucky with the match process, which would have suggested a relatively good chance you would be successful next year. For success you're going to have to change something significantly, and do you have a red flag somewhere that won't be going away or just not enough electives or research which in theory could be fixed in 6m? If you honestly can't see yourself doing any of your back-ups, and would rather risk going unmatched, then do not rank them, see what the second round options are, and likely end up re-applying next year, with the understanding that there is no more guarantee that you will fare any better next year, and it will actually be more difficult because you will be flagged a previous YOG applicant (it doesn't flag between unmatched and un-applied is my understanding), although programs will assume you didn't match and will have to discuss it and overcome that stigma.

Some medical schools will let you defer graduation and do electives, research etc as a 5th year which in theory could improve your matching chances next year but some schools require you to apply broadly in the second round to be eligible from what I've heard.

Still, for a lot of people that risk is worth being miserable for the remainder of your career, but it is a gamble, especially with not even any interviews. I apologize if this sounds harsh but its a huge decision and you need to think rationally.

Thanks for the advice! I honestly thought I had a strong application because I had publications in the the double digits in reputable peer-reviewed journals in this field and many presentations, as well as numerous leadership and mentorship activities throughout medical school. After reviewing my application, the only thing I can think of being a red flag possibly are my reference letters, as 2 of my letter writers hadn't submitted their letters until the morning of the CaRMS deadline, after I had to remind them daily leading up to that point including an email the day of. However, I definitly understand that it is incredibly risky to apply to this surgical specialty in the second round and even as a re-applicant the next year, where I would likely end up applying to similar backup programs as I did this year, which is why I was just considering putting up with my backup programs for the duration of my career. I just keep thinking of what a waste it was to do all that research and not even get an interview  

[indefatigable]

1 minute ago, PlasticSurgery said:

, the only thing I can think of being a red flag possibly are my reference letters, as 2 of my letter writers hadn't submitted their letters until the morning of the CaRMS deadline, after I had to remind them daily leading up to that point including an email the day of. However, I definitly understand that it is incredibly risky to apply to plastic surgery in the second round and even as a re-applicant the next year, where I would likely end up applying to similar backup programs as I did this year, which is why I was just considering putting up with my backup programs for the duration of my career. I just keep thinking of what a waste it was to do all that research and not even get an interview  

It's probably a reference - unfortunately reminding them daily may not have helped

It is highly unlikely that there would be an open plastic surgery spot in the second round and re-applying if you already have a lot of research may not change much.

If you really, really want plastics you could consider trying the US route which really values research.  Problem is Step 1 is really a difficult test especially as a CMG and it's turning P/F next year.  So if you're really determined for Plastics, you could try a very long game of reapplying with more research and strong Step 2CK in 2022 (you could reapply to Canada this year, but not sure the outcome would be much different).  

[PlasticSurgery]

Sorry, I should have clarified, I only reminded them daily for the last 3 days before the deadline haha. 

Thanks for the advice, I'll look into the US route as well!!

[dooogs]

4 minutes ago, PlasticSurgery said:

Sorry, I should have clarified, I only reminded them daily for the last 3 days before the deadline haha. 

Thanks for the advice, I'll look into the US route as well!!

Somebody mentioned that it's possible to get access to the letters (sorry I dont remember the process but you can probably search it in the forum). But if you decide to go unmatched and apply again  it's probably a good idea to see if they actually wrote you good letters.  Did you have a longitudinal relationship with them?

[PlasticSurgery]

1 minute ago, dooogs said:

Somebody mentioned that it's possible to get access to the letters (sorry I dont remember the process but you can probably search it in the forum). But if you decide to go unmatched and apply again  it's probably a good idea to see if they actually wrote you good letters.  Did you have a longitudinal relationship with them?

Thanks for your reply! I messaged CaRMS so I would be able to get a copy of my letters  I had a longitudinal relationship with one of my letter writers, and the other 2 letter writers we physicians I worked with during my electives. But I had assumed they would be strong letters because they seemed very happy to write me a letter when I asked at the end of my elective.

[bread]

I don't have any advice to offer, but wanted to say you're not alone Unfortunately I think this year has been harder to predict than others - multiple of my classmates either got no or very few interviews for their desired specialty, despite having seemingly strong applications for those specialties.  I actually have a friend who didn't match to plastics several years ago and ended up matching to family med.  He found a niche within family med that he ended up loving and pursued extra training in it, while still doing some cosmetics on the side.  He's thankfully really happy with how things turned out.  Best of luck in whatever you end up deciding to do - my fingers are crossed tight for you.

[PlasticSurgery]

13 minutes ago, bread said:

I don't have any advice to offer, but wanted to say you're not alone Unfortunately I think this year has been harder to predict than others - multiple of my classmates either got no or very few interviews for their desired specialty, despite having seemingly strong applications for those specialties.  I actually have a friend who didn't match to plastics several years ago and ended up matching to family med.  He found a niche within family med that he ended up loving and pursued extra training in it, while still doing some cosmetics on the side.  He's thankfully really happy with how things turned out.  Best of luck in whatever you end up deciding to do - my fingers are crossed tight for you.

Thanks for the reply and I appreciate the support! I agree, this year was definitly a unique year to be applying to competitive specialties. Many of my colleagues who were very competitive (many publications/presentations with leadership experiences and great networking) for specialities such as emerg, ophtho and urology unfortunately received only 1 or even zero interviews. 

The story about your friend is very inspiring! Hopefully I can find a niche I am happy with if I decide to not reapply to a surgical specialty!

[bearded frog]

47 minutes ago, PlasticSurgery said:

Thanks for your reply! I messaged CaRMS so I would be able to get a copy of my letters  I had a longitudinal relationship with one of my letter writers, and the other 2 letter writers we physicians I worked with during my electives. But I had assumed they would be strong letters because they seemed very happy to write me a letter when I asked at the end of my elective.

You know, when I first replied I completely missed your username. There is basically 0 chance of second-round plastics or transfer options. Plastics and derm trade the spot for most compeditive specialty in terms of number of applicants for spots each year, with around 2 applicants for every spot. Derm/optho/plastics are just at a level where even excellent applicants have a high risk of not matching, even when applicants would be very competitive for other specialties (as demonstrated by your interviews for your back-ups). If you were gunning psych/ortho/obgyn/peds/gas then I think I would more strongly advocate for you to try again next year but honestly for the derm/plastics/optho people they generally have to realize they try their best but it might not be in the cards, and there are other avenues to pursue their interests.

The question then becomes should you take what you can get now, or see if there are any alternative specialties/programs you would prefer more. I honestly don't know what I would do in your situation, but if you are quite rick-tolerant then maybe only rank the few back-ups you would be actually happy doing, see what the second round options are, then if unmatched look into working your application for something else you would be content doing, because "I really wanted plastics but unfortunately I was not successful and in the intervening time I explored other options and found that gen surg/FM/rheumatology whatever was the calling for me" is not the worst excuse for not matching.

1 hour ago, indefatigable said:

If you really, really want plastics you could consider trying the US route which really values research.  Problem is Step 1 is really a difficult test especially as a CMG and it's turning P/F next year.  So if you're really determined for Plastics, you could try a very long game of reapplying with more research and strong Step 2CK in 2022 (you could reapply to Canada this year, but not sure the outcome would be much different).  

Plastics is also compeditive in the US, but less so (roughly 1.5 applicants per spot). The US publishes a lot more detailed statistics about their match, and we can see what the stats of the matched and unmatched derm applicants are. Keep in mind CMGs are equivalent to USMDs technically and not IMGs but not all schools will accept students who need a visa and you will have gone unmatched once which Is already a red flag. The USMLE scores are not actually that crazy in terms of percentile but you'd have to write them both from scracth in less than a year while USMDs are taught to the test for two years.

	Matched	Unmatched
Step1	~80th %ile	~70th %ile
Step 2	~70th %ile	~60th %ile
Abstcs/posters/pubs	19	11
Top 40 med school	34%	29%
Graduate degree	24%	33%

[bread]

3 hours ago, PlasticSurgery said:

Thanks for the reply and I appreciate the support! I agree, this year was definitly a unique year to be applying to competitive specialties. Many of my colleagues who were very competitive (many publications/presentations with leadership experiences and great networking) for specialities such as emerg, ophtho and urology unfortunately received only 1 or even zero interviews. 

The story about your friend is very inspiring! Hopefully I can find a niche I am happy with if I decide to not reapply to a surgical specialty!

Any time! It sure has been a unique year - I didn’t realize how common it is to not get any, or just very few, interviews for some specialties. To go off of what @bearded frog said, I have next to no knowledge about transfers, but a PGY1 in plastics here mentioned there being surprisingly a few transfers into her program. I have no idea of the details of that as I didn’t ask - so I don’t know what year they were in, what they transferred from, etc. But maybe it would be worth chatting with some plastics residents just to see what all the options are. 

[PlasticSurgery]

On 3/16/2021 at 1:03 PM, bearded frog said:

You know, when I first replied I completely missed your username. There is basically 0 chance of second-round plastics or transfer options. Plastics and derm trade the spot for most compeditive specialty in terms of number of applicants for spots each year, with around 2 applicants for every spot. Derm/optho/plastics are just at a level where even excellent applicants have a high risk of not matching, even when applicants would be very competitive for other specialties (as demonstrated by your interviews for your back-ups). If you were gunning psych/ortho/obgyn/peds/gas then I think I would more strongly advocate for you to try again next year but honestly for the derm/plastics/optho people they generally have to realize they try their best but it might not be in the cards, and there are other avenues to pursue their interests.

The question then becomes should you take what you can get now, or see if there are any alternative specialties/programs you would prefer more. I honestly don't know what I would do in your situation, but if you are quite rick-tolerant then maybe only rank the few back-ups you would be actually happy doing, see what the second round options are, then if unmatched look into working your application for something else you would be content doing, because "I really wanted plastics but unfortunately I was not successful and in the intervening time I explored other options and found that gen surg/FM/rheumatology whatever was the calling for me" is not the worst excuse for not matching.

Plastics is also compeditive in the US, but less so (roughly 1.5 applicants per spot). The US publishes a lot more detailed statistics about their match, and we can see what the stats of the matched and unmatched derm applicants are. Keep in mind CMGs are equivalent to USMDs technically and not IMGs but not all schools will accept students who need a visa and you will have gone unmatched once which Is already a red flag. The USMLE scores are not actually that crazy in terms of percentile but you'd have to write them both from scracth in less than a year while USMDs are taught to the test for two years.

	Matched	Unmatched
Step1	~80th %ile	~70th %ile
Step 2	~70th %ile	~60th %ile
Abstcs/posters/pubs	19	11
Top 40 med school	34%	29%
Graduate degree	24%	33%

Thanks for those stats!

[PlasticSurgery]

On 3/16/2021 at 4:46 PM, bread said:

Any time! It sure has been a unique year - I didn’t realize how common it is to not get any, or just very few, interviews for some specialties. To go off of what @bearded frog said, I have next to no knowledge about transfers, but a PGY1 in plastics here mentioned there being surprisingly a few transfers into her program. I have no idea of the details of that as I didn’t ask - so I don’t know what year they were in, what they transferred from, etc. But maybe it would be worth chatting with some plastics residents just to see what all the options are. 

Thanks for the advice! I'll definitly get in touch with some of the plastics residents!

[whatisgoingon]

On 3/16/2021 at 11:15 AM, PlasticSurgery said:

Thanks for the advice! I honestly thought I had a strong application because I had publications in the the double digits in reputable peer-reviewed journals in this field and many presentations, as well as numerous leadership and mentorship activities throughout medical school. After reviewing my application, the only thing I can think of being a red flag possibly are my reference letters, as 2 of my letter writers hadn't submitted their letters until the morning of the CaRMS deadline, after I had to remind them daily leading up to that point including an email the day of. However, I definitly understand that it is incredibly risky to apply to this surgical specialty in the second round and even as a re-applicant the next year, where I would likely end up applying to similar backup programs as I did this year, which is why I was just considering putting up with my backup programs for the duration of my career. I just keep thinking of what a waste it was to do all that research and not even get an interview  

The deadline for letters was the 11:59PM the day prior to the CaRMS deadline ... 

[frenchpress]

1 hour ago, whatisgoingon said:

The deadline for letters was the 11:59PM the day prior to the CaRMS deadline ... 

That was the requested deadline so that applicants have time to assign letters and submit applications by the hard application deadline - because no one wants to assign a letter that hasn’t arrived yet and risk it not being uploaded in time. But the letters didn’t technically need to be uploaded until the actual application deadline. 

[PlasticSurgery]

10 hours ago, whatisgoingon said:

The deadline for letters was the 11:59PM the day prior to the CaRMS deadline ... 

 

9 hours ago, frenchpress said:

That was the requested deadline so that applicants have time to assign letters and submit applications by the hard application deadline - because no one wants to assign a letter that hasn’t arrived yet and risk it not being uploaded in time. But the letters didn’t technically need to be uploaded until the actual application deadline. 

Exactly what frenchpress said! Definitly incredibly stressful though, haha. I ended up submitting my application a day before the deadline, and my plan was to switch the letter for generic letters I had if my letter writers hadn't ended up submitting the letters on time.

[Davinci]

13 hours ago, PlasticSurgery said:

 

Exactly what frenchpress said! Definitly incredibly stressful though, haha. I ended up submitting my application a day before the deadline, and my plan was to switch the letter for generic letters I had if my letter writers hadn't ended up submitting the letters on time.

Ideally you should have asked for 4-5 plastic surgery letters to make sure that you have 3 letters well before the deadline but not sure how difficult it is to ask for this many letters in plastic surgery. All the best to you man!

[PlasticSurgery]

9 hours ago, Davinci said:

Ideally you should have asked for 4-5 plastic surgery letters to make sure that you have 3 letters well before the deadline but not sure how difficult it is to ask for this many letters in plastic surgery. All the best to you man!

Having 5 letters is a good rule of thumb! I had 4 in the end, but the letter I was waiting on was a preceptor I really connected with/thought would be a strong letter. Thanks for the well wishes!

[tempposter]

On 3/15/2021 at 2:54 PM, CaRMS2021 said:

If you match to a program in the first iteration, it is binding and you cannot apply to a program in the second iteration. You can try to transfer during residency but it may be challenging to go from non-surg to surg or a program with lower years of funding to a program with higher years of funding (e.g. FM to surgery). 

 

I spoke with my residency program about this and I need to say this is false. You do not "carry" your funding years with you. In principle this means switching a 2-year program into a 5 year program is equally as difficult and going 5 years to 5 years, all other things equal.

Big eye opener for me.

[bearded frog]

On 3/22/2021 at 7:43 PM, tempposter said:

I spoke with my residency program about this and I need to say this is false. You do not "carry" your funding years with you. In principle this means switching a 2-year program into a 5 year program is equally as difficult and going 5 years to 5 years, all other things equal.

Big eye opener for me.

You are correct the funding stays with the school, but I think what CaRMS2021 says is correct for transfers within the same school, as the funding is per school (I have heard conflicting reports about funding moving between schools in the same province, have heard both that since its provincial funding it can stay with you and that it stays with the school. Anecdotally, when I was in ON, it seemed within-province transfers were more common but that just may be that there are more schools there and people didn't want to go too far afield.)

That means that generally spots stay where they are, like if you want to transfer to a different school in X program they need to have funding/availability in X program and you can't just show up, which means that unless someone has resigned or transferred out (or they have leftover spots after matching) transferring is very difficult.

[tempposter]

My understanding from talking to my school's PGME is that the funding stays at the same school and at the same program. You take nothing with you no matter where you go.

 

I have no idea how anybody successfully transfers! It seems statistically impossible to me.

[bearded frog]

19 hours ago, tempposter said:

My understanding from talking to my school's PGME is that the funding stays at the same school and at the same program. You take nothing with you no matter where you go.

 

I have no idea how anybody successfully transfers! It seems statistically impossible to me.

If that's true then it occurs if someone leaves the program which opens up the funding, or if there is a mutual exchange between programs. In theory if funding doesn't go with you it actually makes it logistically easier because then a family med resident is on equal footing trying to transfer into a 5 year program vs a gen surg resident trying to go family. Its not terribly rare for a resident to transfer out of a royal college specialty into family after first year if they find they do not enjoy the discipline as much as they thought they would, there are a few family med programs that have empty spots left over and flexible funding, leaving openings in royal college specialties for people to transfer into.

You're right that it's not common though. Around 150 residents per year do transfer though which is about 1.2% of all residents as per the AFMC. It's not clear what proportion of residents who desire to transfer are actually successful though, and would absolutely not rely on it for someone who matched to their back up thinking they can get around CaRMS.