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Unfilled positions after R1 match 2021


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11 hours ago, bearded frog said:

First, a word on "streams":

  • Competitive/regular - Open to all non-military comers. For some reason Quebec uses regular vs competitive in rest of Canada.
  • CMG - open to Canadian medical graduates only (ie. not IMG)
  • IMG - open only to international medical graduates

We can see from the above though that "regular" means Quebec. Let's break it down by school. These are unmatched spots by school:

As you can see, the french language programs are over-represented, which is not atypical.

So what are your options if you're an unmatched CMG not interested in FM and does not speak french? Lots of pathology:

 

Quebec does not have a separate IMG stream - so regular implies the default situation i.e. "open at all".  

As English-speaking Canada has separate IMG streams, "competitive" indicates a specific-blending of streams (CMG and IMG) rather than the "default" situation where the streams are separate.  

It's a common misconception that "speaking French" is sufficient to practice medicine optimally or well in French without full fluency - yes, in surgical disciplines, language is less of a barrier, but absolute fluidity is necessary to be an excellent clinician in French when dealing with a wide variety of patients that speak a range of French or charting efficiently, writing consult notes, or reading technical readouts, etc..

 It's odd how this point gets repeated, when so many MD programs put emphasis on English-language communication skills through CASPer, CARS, etc.. before entry.  French-speaking patients deserve the best care possible - and for that, French-language fluency is often important - which is probably partly why the French universities have also now adopted CASPer.  

Language testing is very developed area to assess language fluency objectively.

  •  In English there is the Academic IELTS (out of 9) used for medicine including residency in many provinces.  Surprisingly very few people actually achieve the full 9 (less than 0.5%) - even among native English speakers (native German speaker actually outperform native English-speakers)!  The written component in particular can be challenging.   
  • In French, there is the TFI (which is much simpler than the IELTS academic) but is necessary for many French-language residency programs.  UdeM requires a test of written French on MD entry which makes the test more comparable to the IELTS academic, although probably still easier.  There is also a TEF which apparently gives levels.  
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2 hours ago, indefatigable said:

Quebec does not have a separate IMG stream - so regular implies the default situation i.e. "open at all".  

As English-speaking Canada has separate IMG streams, "competitive" indicates a specific-blending of streams (CMG and IMG) rather than the "default" situation where the streams are separate. 

I'm aware, just wondering why they don't standardize the language - use competitive in Quebec or regular in Canada for second round. 

I also agree that you shouldn't apply for residency in Quebec without speaking french - that's usually responsible for why they have more open spots than the rest of the country - it's less competitive as there are fewer french speaking applicants vying for those spots. In my analysis I later removed them to show the practical options for the non-french-speaking majority of applicants in Canada.

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On 4/20/2021 at 10:43 PM, bearded frog said:

I'm aware, just wondering why they don't standardize the language - use competitive in Quebec or regular in Canada for second round. 

I also agree that you shouldn't apply for residency in Quebec without speaking french - that's usually responsible for why they have more open spots than the rest of the country - it's less competitive as there are fewer french speaking applicants vying for those spots. In my analysis I later removed them to show the practical options for the non-french-speaking majority of applicants in Canada.

Regular could be confusing - it would seem to mean "default" (like I mentioned above) which it isn't.  Having Quebec use "competitive" makes sense to me, however.

I think for me the difficulty in semantics is in the distinction between "speaking French" and a being a "French-speaker" as analogous to "English-speaker".  I'm sure 99% of Canadians can say "Bonjour" - but that doesn't mean they speak French well enough to be a proficient clinician in French.

To put it simply - language skills exist along a continuum- there is not a binary threshold where all of a sudden one is completely fluent vs speaking no  French.  One could count words like bonjour, merci..  and categorize into “basic”, “intermediate” and “advanced” but language tests can be used to objectify skill like I mentioned in the previous post.

To summarize,  "Speaking French" and being fluent enough to excel in medically oriented specialties are two different concepts .  

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43 minutes ago, Haribo7173 said:

Quebec did extremely well with the specialties. 

How can you do well when there are a set number of spots?

Do you mean they were successful in matching to specialties in English Canada in addition to filling their own spots?

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I wonder what the picture is going to look like in a few years with the extra seats that Quebec is adding. Will Quebec add enough residency spots for them or balk at the cost when COVID is in their rear view mirror? If they are to add extra residency spots it, will they announce it in advance or wait until the last minute and give applicants more match anxiety than they currently have? Will those extra spots all be in FM?

The Canadian system of P/F grading and no USMLE style exam was not designed for such tight matches. The ratio of spots to applicants has dropped and the current system cannot cope.

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8 hours ago, MaudeB said:

I just saw this on the cma_docs instagram:

That mention at the bottom that the total number of unmatched applicants grows each year is freaking me out! I am starting this fall as a non traditionnal student and this is making me think twice about med school. Honestly, working so hard for 4 years and not matching... I have kids to support, I am already stressing out about carms! :(

There is also more med school position now, which is great, and more opening up in the next years, so with the same residency spots and more applicants, this is going to be terrible in 3-4 years!! 

image.png.606d10909f33401ec5145458d8746e2e.png-

I think being a non-trad student during CaRMs was an advantage. Our diverse life experiences enable us to standout from the crowd. We have interesting stories to tell. Our unique experiences and perspectives are valued by residencies. 
My close friends, all non-trad students, none of us backed up, and we all fortunately matched to our #1 choices this year in various specialties including cardiothoracic surgery, pediatrics, family medicine, and psychiatry.

Please feel free to DM if you need any help!

All the best!!

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19 minutes ago, zoxy said:

I wonder what the picture is going to look like in a few years with the extra seats that Quebec is adding. Will Quebec add enough residency spots for them or balk at the cost when COVID is in their rear view mirror? If they are to add extra spots it, will they announce it in advance or wait until the last minute and give applicants more match anxiety than they currently have? Will all those extra spots all be in FM?

The Canadian system of P/F grading and no USMLE style exam was not designed for such tight matches. The ratio of spots to applicants has dropped and the current system cannot cope.

Good point - nice foresight when long-range planning is almost always lacking.  Quebecers generally do not want to leave Quebec though, but will sometimes apply broadly.  The language barrier is a deterrent for many francophones too - not everyone grows up in Montreal bilingual!

Ultimately, given the parsimony of provincial governments, I suspect there will be added pressure on the dedicated IMG positions, like there was a few years ago.  

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22 minutes ago, indefatigable said:

Good point - nice foresight when long-range planning is almost always lacking.  Quebecers generally do not want to leave Quebec though, but will sometimes apply broadly.  The language barrier is a deterrent for many francophones too - not everyone grows up in Montreal bilingual!

Ultimately, given the parsimony of provincial governments, I suspect there will be added pressure on the dedicated IMG positions, like there was a few years ago.  

I wonder what impact the standardization of electives will have on Quebecers not leaving Quebec. They will now be able to take the same number of electives in a specialty as English Canadians. I think this will make it easier for them to match to English Canada than before.

It's definitely going to be an interesting few year if there is inflation and interest rates rise with it. With the debt burden all levels of government are carrying, even a small increase in interest rates would make servicing this debt very expensive.

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8 hours ago, zoxy said:

I wonder what impact the standardization of electives will have on Quebecers not leaving Quebec. They will now be able to take the same number of electives in a specialty as English Canadians. I think this will make it easier for them to match to English Canada than before.

It's definitely going to be an interesting few year if there is inflation and interest rates rise with it. With the debt burden all levels of government are carrying, even a small increase in interest rates would make servicing this debt very expensive.

Quebec French-speaking school are not always seen to be on the same footing as English-speaking medical schools - partly the age of students, partly less research-culture, partly different admission criteria (e.g. no MCAT)...  That being said, I agree that this, along with the universal P/F, will allow more mobility and I have seen Quebecers establish themselves in some programs.    

Regarding economics, it's a double-edge sword - as inflation can also decrease the real value of debt and possibly even cut costs (e.g. by not raising fees).   However, I agree that rising interest rates could affect many, home-owners, med students and residents especially.  

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22 hours ago, schrodinger's mcat said:

wow, IM this year was a bloodbath just like psych in cycle of 2020.
The theory behind IM popularity is that with pandemic, lots of students didn't get a chance to get a full exposure to IM workload and a lot of them might have idealized perception of the specialty. Maybe we might see lots of transfers out of IM in the upcoming years.


Of note, it's surprising that both combined NucMed programs have spots in 2nd iteration. Both Manitoba and Alberta are very solid options for radiology applicants.

Also, last year was an anomaly with very low numbers of ortho applicants, and lots of ortho spots in 2nd iteration. Seems like it was just a transient trend.

 

 

Or because IM is awesome and people are starting to realize it. I love my job!

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On 4/20/2021 at 6:51 PM, shikimate said:

I didn't know FM are doing less surgery now, I'd think it would be important to have at least surgical exposure.

Anecdotally I remember I had a skin neoplasm removed by a FM, it was benign but prone to recurrence. When she reviewed the path report she didn't even think to read about the margin which was very close haha. Obviously I was less than impressed.

Yes, but to be perfectly honest most family med residents who do gen surg rotations probably end up doing mostly scut and very little operating. 

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On 4/20/2021 at 3:42 PM, 1D7 said:

Well in 2019 the military came clutch and took a bunch of unmatched applicants, clearing some of the backlog of unmatched applicants. Prior to that the anxiety surrounding the match probably reached an all time high.

Without a contraction in medical school spots, I would expect the number of unmatched to grow again, sadly.

 

I’m 99% sure this was actually in 2018. I remember my match year (2018) Ontario created new family Med spots as well as a few other positions (ER) after the match. In addition the Armed forces did a recruitment push. Both of these were after the second iteration of the match. None of this was done for the class of 2019 as far as I’m aware.

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7 hours ago, Aetherus said:

I’m 99% sure this was actually in 2018. I remember my match year (2018) Ontario created new family Med spots as well as a few other positions (ER) after the match. In addition the Armed forces did a recruitment push. Both of these were after the second iteration of the match. None of this was done for the class of 2019 as far as I’m aware.

You're probably right on that, my memory of CaRMS is poor from all the stress of it.

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9 hours ago, premed72 said:

So is this most likely because of the covid situation? Surely this is a transient trend, not really likely to occur year after year? Thoughts? 

Maybe it is COVID related, we'll only know in a couple of years if that was indeed the case, but I'm not so sure.

IM has gone from 315 people ranking it as their first choice specialty in 2010 to 460 ranking it as their first choice in 2019, and 453 in 2020. It was 440 in 2016 and 464 in 2016 so you can't say that it's necessarily COVID related since the increase in popularity predates COVID. For perspective, the number of folks graduating from medical school has only increased by 13 percent while IM's popularity has increased by close to 50 percent.I think IM's popularity is on the rise in general and is unrelated to COVID.

If I were a betting person, I'd bet that unless something about IM's working conditions were to change, we're going to see tight IM matches going forward.

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9 hours ago, zoxy said:

IM has gone from 315 people ranking it as their first choice specialty in 2010 to 460 ranking it as their first choice in 2019, and 453 in 2020. It was 440 in 2016 and 464 in 2016 so you can't say that it's necessarily COVID related since the increase in popularity predates COVID. For perspective, the number of folks graduating from medical school has only increased by 13 percent while IM's popularity has increased by close to 50 percent.I think IM's popularity is on the rise in general and is unrelated to COVID.

Also those stats don't take into account the people who apply for IM and then get 0 interviews and can't even rank it as their first choice specialty as well as those who parallel plan with IM as a backup. So the real number is actually much higher than what we see here. 

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1 hour ago, NoMatchNoProblem said:

Also those stats don't take into account the people who apply for IM and then get 0 interviews and can't even rank it as their first choice specialty as well as those who parallel plan with IM as a backup. So the real number is actually much higher than what we see here. 

Anyone can rank any program they apply to however they want.  

Does it make sense to rank a program that doesn't interview you?  Would you like to be a resident there?  Those are different questions and everyone may have their own answer.  

Roughly 1/2 IM apps yield an interview as has been pointed out before: it's safe to assume that IM "gunners" make up the majority of the apps and that they cross-apply across all IM - empirically it seems that some IM "gunners" get almost every interview and some get only a few (but also cross-apply).. which matching and averaging works out to be 1/2.

The numbers are available through the CaRMS website - https://www.carms.ca/data-reports/r1-data-reports/interview-offers/#1602253692894-b7c85e07-4e95

But.. to add to the discussion here are the actual numbers for last year for IM

IV apps | refused apps | total apps

Internal Medicine  | 3,910 | 2,936  | 6,846

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45 minutes ago, NoMatchNoProblem said:

Also those stats don't take into account the people who apply for IM and then get 0 interviews and can't even rank it as their first choice specialty as well as those who parallel plan with IM as a backup. So the real number is actually much higher than what we see here. 

Good point. For 2020, 42 matched to IM  as their second choice specialty and 5 matched to it as their third specialty.

Unrelated but I think with how competitive IM is getting, people should consider the US as well. Only 39 percent of IM residencies were filled by US MDs in the 2021 match. Since the Canadian match usually runs before the American one, it's a no brainer .

I think doing a chief IM year or a year of fellowship would make you eligible for the Royal College boards.

 

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