Is there an in-province advantage to residency matching?

[dynamite17]

I know there's a so-called "home school advantage" when it comes to CARMS matching, but I was wondering if any current med students/residents could speak to whether it's easier to match to a school that's in your home school's province. Although the data shows that most stay in their home province, I know that it can be skewed due to students wanting to be close to home, etc.

I'm currently trying to decide between an in-province medical school (NOSM) that doesn't offer as many specialties, versus a larger OOP school that offers every speciality that I may be interested in. However, NOSM has previously had an 100% match rate, while it looks like the OOP school has an overall lower match rate (but this could be due to more people gunning for more competitive specialties due to NOSM being more focused on primary care). Ultimately, I'd like to come back to live in Ontario, but I'd be very excited to attend either school at the moment!

Any insight on this would be extremely helpful!

Edited May 13, 2021 by dynamite17

[zoxy]

45 minutes ago, dynamite17 said:

I know there's a so-called "home school advantage" when it comes to CARMS matching, but I was wondering if any current med students/residents could speak to whether it's easier to match to a school that's in your home school's province. Although the data shows that most stay in their home province, I know that it can be skewed due to students wanting to be close to home, etc.

I'm currently trying to decide between an in-province medical school that doesn't offer as many specialties, versus a larger OOP school that offers every speciality that I may be interested in. However, it looks like the OOP school has an overall lower match rate (but this could be due to more people gunning for more competitive specialties). Ultimately, I'd like to come back home, but I'd be very excited to attend either school at the moment!

Any insight on this would be extremely helpful!

I don't know of any data that can decouple the desire of applicants to remain in their home province vs in-province preference. NOSM does seem to do exceptionally well in matching to other schools and also matching to other schools as a whole. Even in really rough matches from 2017-19 they did exceptionally well relative to other Ontario and Canadian schools.

I think it would also depend on what specialties you're interested in and also the quota for those specialties offered at the school in question. If it's something like Plastic Surgery then it would probably make a big difference. What would your specialties of interest be and what is the quota offered at the OOP school for those specialties and how many students does the OOP school have? Would you be fine with living away from Ontario for 9 years and potentially putting down roots somewhere else away from your family?

 

[dynamite17]

21 minutes ago, zoxy said:

I don't know of any data that can decouple the desire of applicants to remain in their home province vs in-province preference. NOSM does seem to do exceptionally well in matching to other schools and also matching to other schools as a whole. Even in really rough matches from 2017-19 they did exceptionally well relative to other Ontario and Canadian schools.

I think it would also depend on what specialties you're interested in and also the quota for those specialties offered at the school in question. If it's something like Plastic Surgery then it would probably make a big difference. What would your specialties of interest be and what is the quota offered at the OOP school for those specialties? Would you be fine with living away from Ontario for 9 years and potentially putting down roots somewhere else away from your family?

 

Thank you for your reply!

At the moment, I think I'm leaning more towards OB/GYN and potentially Derm, but I'm very open to exploring other specialties. For all I know, I might even end up enjoying some form of primary care more than I think I will! My OOP school is UofA, which has 6 spots for OB/GYN and 2 for Derm. As you mentioned, it's currently a con for me that I would be potentially living away from Ontario for almost a decade. I think it would be a fun adventure for 4 years, but I'm not sure I'd like to settle there in the long run. Again, maybe that will change once I live there for a few years. I'm on the "normal" waitlist for Western, which I think would be a good balance between being a larger school and close to home, but it's a gamble as to whether I'll receive an acceptance there.

[bearded frog]

9 minutes ago, dynamite17 said:

At the moment, I think I'm leaning more towards OB/GYN and potentially Derm.

obgyn is very compeditive and derm trades with plastics for most compeditive every year. Ie. people who take a year off to do a Masters sometimes don't match (to derm). You're correct that NOSM has had 100% match in the past, however we assume due to their selection process and mission statement that it probably very heavily skews primary care, however CaRMS does not publish match outcomes on a per-school basis, but I would be very interested to see if any NOSM alumni can comment on match distribution. There is 100% a home school advantage, but it's very difficult to see if there is a home province advantage for the reasons you have disclosed above, (people self-select to go to medical school where they are from or where they want to end up and that usually coincides with medical school selection) and that there are only 3 provinces with multiple schools and other than Ottawa, generally the in-province schools are the closest geographically. One might assume that in Alberta say, the Edmonton specialist physicians will know their Calgary counterparts fairly well due to provincial associations/meetings etc, and likely closer than say neighbouring Vancouver or Saskatchewan. Same goes for Ontario/Quebec, but probably to a lesser extent due to sheer numbers.

If you're serious about gunning obgyn or derm I would choose U of A, because even if you would prefer to return to Ontario, you're going to be doing electives in as many programs as you can and will be applying across the country and taking what you can get, and having a home program vs NOSM which has neither an obgyn or derm program will be an advantage in terms of LORs and experience regardless if you end up wanting to stay at U of A.

[zoxy]

I wouldn't solely attribute NOSM's good match rate to everyone wanting primary care. Even in 2018 and 2019 where only 36 and 38 percent ranked FM as their first choice they still did very well relative to other schools. Also the home school advantage is biggest for competitive specialties according to CARMs studies. Additionaly Ontario is really tough for Derm. Six derm spots for all of Ontario while the two Alberta schools have 5 spots between them.

Data:

http://carms.ca/pdfs/CMG-home-and-away.pdf

https://www.carms.ca/wp-content/uploads/2018/06/r1_tbl38e_2018-1.pdf

https://www.carms.ca/wp-content/uploads/2019/05/2019_r1_tbl38e.pdf

https://www.carms.ca/wp-content/uploads/2018/06/r1_tbl15e_2018.pdf

https://www.carms.ca/wp-content/uploads/2018/06/r1_tbl15e_2018.pdf

[dynamite17]

Thank you to both of you for your input, it's really helpful! You both outline why this is a bit complicated. It does seem like having direct access to those specialties will make them easier to reach due to more experience and LORs, but I do wonder what it is about NOSM that allows for them to have such a high match rate. I remember NOSM students being matched to obgyn and derm in the past, but I wonder how they were able to set themselves apart without as much exposure.

[zoxy]

21 minutes ago, dynamite17 said:

I do wonder what it is about NOSM that allows for them to have such a high match rate

Greater degree of clinical exposure and responsibility due to the lack of residents and fellows. For example, students at satellite campuses oftentimes report greater degrees of responsibility relative to those at the main campus of big schools. This in turn allows them to shine in electives and match well. That seems to be the main school of thought for NOSM's high match rate.

Edited May 13, 2021 by zoxy

[indefatigable]

I have seen NOSM grads match to ON derm, but never from BC/AB - probably partly self-selection, but I believe "regionalism" also plays a role (& those provinces have more derm spots).  Derm would be more work for sure - making connections at other schools, but maybe NOSM alumni that are residents/alumni could also help you.

I think OB/GYN is possible too - although NOSM doesn't have a residency program, local attendings might really want to help you get into residency if it means that you would come back and might also have connections in some residency programs.  So, although you might not get the full "home school" advantage, they might still be very supportive if you made a good impression (someone I know was in such a situation but basically didn't want to go away from were they were for residency even with attendings almost begging, etc..).  

I think the possible downside is moving to AB, then maybe not being as happy, less of a support network, changing your mind..  I'm not sure if I'd recommend going to medical school purely for perceived residency matching, if it has other potential significant disadvantages (although it's great to able to think ahead and make choices!!)

I think QC is probably the most heavily-IP due to differences culture/language, except for McGill.  

[bearded frog]

19 minutes ago, zoxy said:

I wouldn't solely attribute NOSM's good match rate to everyone wanting primary care.

Agreed, however the years you chose were outliers. In 2016 and 2017, 58.5% and 58.1% chose family medicine, respectively. And the most current match data in 2020 has 44% for FM. In any case it's consistently the highest proportion in the country. I agree with what you say that sometimes having less residents/fellows allows for more exposure and competency. NOSM applicants can and surely do match to compeditive residencies, however with obgyn and derm I think you would be at a disadvantage relative to UofA.

We can at least see the match location distribution, turns out roughly the same % go to UBC, U of T, Ottawa:

[indefatigable]

21 minutes ago, bearded frog said:

We can at least see the match location distribution, turns out roughly the same % go to UBC, U of T, Ottawa:

 

Interesting graphics for sure.  Some other points

•  UofA has a higher "home school" match rate than NOSM (48% vs 42%)
• UofA "Western provinces" match rate works out to be 75% (BC, AB and SK)
• NOSM ON match rate works out to be 72%.

In other words, there does seem to be"regionalism" when it comes to matching, similar to "home school", probably multi-factorial. 

[dynamite17]

Thank you for all of your help again! I really appreciate it.

If it helps to put things into perspective, some UofA pros for me are that it's in a bigger city with more to do, the class seemed to know each other well during the info session (=perhaps better social life/class cohesiveness), better reputation/academically stronger, large teaching hospital connected to the school. UofA cons are that it's far from home, (potentially) reduced likelihood to match in Ontario, and (potentially) less clinical exposure due to more students/residents, etc.

NOSM pros are that it's close to home, (potentially) greater likelihood to match in Ontario, and I already have established relationships with many students and professors that are part of the school and who are wonderful people. NOSM cons are that it has a reputation here to be academically a bit weaker, there's few specialities (less home school advantage). There's also a large focus on rural/remote health exposure, which I'm not particularly interested in (but again, could allow for a lot of unique clinical exposure opportunities).

I think I'd be happy to spend 4 years at either school for different reasons, which is why I'm a little more focused on what comes after!

[indefatigable]

I think as long you have no issue moving to a different province, then UofA sounds like it suits your overall career goals a bit better.  I agree that UofA has a reputation as a more traditional medical school with more research and other opportunities aligned with surgical and specialty goals.

Although you seem to appreciate NOSM, and of course it's "home", you also don't seem to have any other major ties and seem happy to integrate somewhere new.

I do think different med schools have different focuses/strengths and it's great you've recognized where your interests lie and will be able to make an informed choice.  I think you could match to those specialties from NOSM, but it would probably be harder.  On the other hand, you would probably be able to come back to NOSM eventually or even for primary care residency earlier if you changed your mind.  

[bearded frog]

33 minutes ago, dynamite17 said:

There's also a large focus on rural/remote health exposure, which I'm not particularly interested in (but again, could allow for a lot of unique clinical exposure opportunities).

Personally, if I was not interested in rural or remote medicine, I would choose an alternative school. It's true you may have more obs opportunity in your family medicine experience, and all centres get rare conditions, but I think if you are not interested you might get frustrated at a centre which seems to have that focus front and centre, and allow a fellow applicant who would be interested in the rural aspect the opportunity to come off the wait-list. (And if you did want some rural/remote experience, Edmonton is the referral centre for remote northern AB communities and much of the NWT and there would probably opportunities in that regard)

[GH0ST]

I will say as the only person here that's been to UofA and NOSM on this site that if you wanted OBGYN exposure and to pour your electives there you definitely can. I wouldn't underestimate what the rural GPs are capable of here either. I get more hands on and one-on-one exposure to everything since day 1 and I have had a good experience in Sudbury. I know that NOSM also tries to leverage relationships with other schools to help establish elective opportunities in peds and OBGYN (CHEO, Mississauga high volume OB, etc). 

That said I echo the sentiment that if you only are interested in NOSM because it's close to home that's an insufficient reason to stay as opposed to going to UofA. Both schools will make you a good doctor. 

As a side note... unless you plan to be a high level research academic, academic prestige in these institutions are overrated. It's like saying there's an amazing library at school X but you don't use the library for anything... what's the point of academic prestige then? 

- G 

[dynamite17]

52 minutes ago, GH0ST said:

I will say as the only person here that's been to UofA and NOSM on this site that if you wanted OBGYN exposure and to pour your electives there you definitely can. I wouldn't underestimate what the rural GPs are capable of here either. I get more hands on and one-on-one exposure to everything since day 1 and I have had a good experience in Sudbury. I know that NOSM also tries to leverage relationships with other schools to help establish elective opportunities in peds and OBGYN (CHEO, Mississauga high volume OB, etc). 

That said I echo the sentiment that if you only are interested in NOSM because it's close to home that's an insufficient reason to stay as opposed to going to UofA. Both schools will make you a good doctor. 

As a side note... unless you plan to be a high level research academic, academic prestige in these institutions are overrated. It's like saying there's an amazing library at school X but you don't use the library for anything... what's the point of academic prestige then? 

- G 

Thank you for your unique perspective! I had no idea that NOSM has those types relationships with other schools to help with elective opportunities, which I think is important to know. If you don't mind me asking, if you completed your undergraduate medical education at UofA, did you feel that you significantly lacked the hands-on/one-on-one exposure? Or would it have simply been an added benefit of going to NOSM?

[GH0ST]

2 hours ago, dynamite17 said:

Thank you for your unique perspective! I had no idea that NOSM has those types relationships with other schools to help with elective opportunities, which I think is important to know. If you don't mind me asking, if you completed your undergraduate medical education at UofA, did you feel that you significantly lacked the hands-on/one-on-one exposure? Or would it have simply been an added benefit of going to NOSM?

I don't think it was a lack of exposure as you will get that as well but it is always harder in a larger medical school as there's the hierarchy and when there's a lot of students that day competing for OR time or face time it can be hard. That said I think my lower exposure was more my fault than that of the school (for example... I don't want to do OB at all). 

At NOSM I would say that it is an added benefit for sure, but if you are more interested in subspecialty type training or academia then there are better options out there. If you're looking for more of a homey feel NOSM really is good for that. 

- G