IM in Ontario

[YoungDumb&Broke]

Hi all, I just got into medical school (UofA and UWO), and I realize this may be a bit premature but in deciding where I want to pursue my medical education, I was considering where my chances to match best would be to Ontario. I’m leaning towards going to UofA but want to settle in Ontario for residency. Specifically, I am interested in IM, and was wondering if it’s more difficult to match to this specifically in a province where you didn’t do your med school?

 

Would thatching to a different province be more difficult if I was to pursue say, vascular surgery or something more competitive?

 

Thank you. 

[zoxy]

UofA doesn't have Vascular surgery and while Vascular surgery may sound fancy, it's not particularly competitive. It has an awful lifestyle and the patients never really get better. There's a joke that it's surgical palliative care. In fact, there was an empty Vascular surgery spot at Calgary in this year's first iteration. It has AAAs though but I'm not sure how many you'd actually see practising. It's all going endovascular as well so where's the fun in that? Cold Leg, Fem-Pop, Fem-Fem, Carotid endarterectomy, and dialysis access are the bread and butter. Another common operation is Chop-Chop (also known as amputations). Not exactly a fun list of procedures.

Additionally there isn't a rule of thumb as to what school is best for a difficult specialty. Each school will favour a particular specialty based on its strengths/quotas offered. However, the two schools you outlined are very similar in the quotas they offer for competitive specialties. You'll definitely have an advantage at your home school, but neither will be better than the other for matching to other schools, including other Ontario schools. As discussed in other threads, its hard to separate applicants desire to stay local from matches in the same province or region. The consensus seems to be that any apparent regionalism is due to applicant preference rather than a large home-region advantage.

Western and UofA are roughly similar for quotas offered for competitive specialties with a couple of exceptions. Western doesn't have Dermatology at all while UofA has 2 spots and the UofA has one more Ophtho spot than Western. On the other hand, Western has a Vascular Surgery spot while UofA doesn't have one. Otherwise they seem identical in quota offered for other competitive specialties and have roughly the same number of students too. For IM, UofA has 27 IM spots while Western has 25, so that is also quite similar.

If you're interested in Derm go to UofA, if you want vascular go to Western. Otherwise don't let residency odds be the deciding factor in picking between the two.

[ihsh]

I can only speak to IM but I agree with Zoxy. It will definitely be easier to match to Western IM if you go to Western for med school, but your chances at other Ontario IM programs would likely be similar. 

[indefatigable]

While I agree the "home school" effect is much stronger, I personally believe that home-region advantage extends beyond applicant preference.  I think, just like med school, Ontario is a "magnet" province where many people are interested in pursuing residency.  Yet, invariably, Ontario matches are overwhelmingly from Ontario med schools.  

In smaller specialties this effect would be more obvious as the letter writers would be more likely to know each other personally.  I know that small programs sometimes even prefer in-province letter writers as they know them.  

Yet, even in a larger specialty, like IM, there are soft factors, like being able to do research more easily at other Ontario universities that could contribute.  Supposing, for instance, full visiting electives come back - again, it would be easier to do such electives when in Ontario.  Easier to go to such an elective when it's an hour or two away rather than having to take a flight from Edmonton (but not impossible).  Having an elective at another Ontario university then makes it easier to match there.  Consider for example two identical candidates - one that has done all their electives in AB and other all in ON (including the program itself).  Likely, familiarity with the candidate and/or letter writer from ON would help.  

There's even another way of looking at Ontario - it's generally thought that Ontario med schools are the most competitive.  Suppose this applies to residency too - then gunner from Ontario might be forcibly more competitive than gunners from other provinces which could also explain that match rate.    

I don't think in a large specialty like IM it's as marked - but for smaller specialties, sure.  

It's not purely "home region" though as often certain schools or program will have "good reputations" or less so.  I know of multiple IM gunners that got no/very few interviews in ON from the school that I went to (despite electives, research..).

The point is I think where you go to med school can matter - not the name itself, but rather the associated opportunities, including the "home programs", as well as the educational focus (e.g. UofA vs NOSM).  To a lesser, but non-negligible extent, the region you're in may also help you with medical career goals.    

That being said, unless you end up in an exceptionally difficult situation (e.g. language barrier), then you should be able generally pursue your career goals wherever you go as the system is designed to train physicians in all parts of the country. 

As you have a defined goal of residency in ON, and both schools are more or less equal (notwithstanding derm and vascular surgery), then I think you would be better going to Western for the reasons that I have mentioned above.

[bearded frog]

2 hours ago, indefatigable said:

Yet, even in a larger specialty, like IM, there are soft factors, like being able to do research more easily at other Ontario universities that could contribute.  Supposing, for instance, full visiting electives come back - again, it would be easier to do such electives when in Ontario.  Easier to go to such an elective when it's an hour or two away rather than having to take a flight from Edmonton (but not impossible).  Having an elective at another Ontario university then makes it easier to match there.  Consider for example two identical candidates - one that has done all their electives in AB and other all in ON (including the program itself).  Likely, familiarity with the candidate and/or letter writer from ON would help.  

Yeah but if this person goes to U of A and knows he wants to match to Ontario, they're going to do all their electives in Ontario schools anyway. I disagree that a flight from Edmonton to Ottawa that is 3.75 hours is significantly different than a 4 hour drive from Toronto to Ottawa for an elective. So the U of A person could have just as many Ontario school letters as someone at Western.

2 hours ago, indefatigable said:

There's even another way of looking at Ontario - it's generally thought that Ontario med schools are the most competitive.  Suppose this applies to residency too - then gunner from Ontario might be forcibly more competitive than gunners from other provinces which could also explain that match rate.    

I don't buy that Ontario medical schools are the most competitive outside of the fact that 40% of Canada lives in Ontario and ~45% of English language medical school spots are in Ontario and you'll see some local preference effect. Certainly some, the most obvious being U of T, are more competitive than others. Same with residency with 41% of English language IM spots in Ontario this year.

[indefatigable]

13 hours ago, bearded frog said:

Yeah but if this person goes to U of A and knows he wants to match to Ontario, they're going to do all their electives in Ontario schools anyway. I disagree that a flight from Edmonton to Ottawa that is 3.75 hours is significantly different than a 4 hour drive from Toronto to Ottawa for an elective. So the U of A person could have just as many Ontario school letters as someone at Western.

The comparator the OP mentioned was Western.  It's not only much easier to drive 1 hour to Hamilton or 2 hours to Toronto for electives, it's also easier to set up research opportunities based on proximity.  They could either take a short flight from TO to Ottawa or a longer drive - I don't think an apples to oranges comparison is fair (of flight vs driving).

They wouldn't be precluded from doing everything from AB, and coming to ON for electives, I just personally think it's easier to set it up when it's right around the corner, do some networking etc..  Plus, the OP would have very signficant in-roads in ON if at Western.  

13 hours ago, bearded frog said:

I don't buy that Ontario medical schools are the most competitive outside of the fact that 40% of Canada lives in Ontario and ~45% of English language medical school spots are in Ontario and you'll see some local preference effect. Certainly some, the most obvious being U of T, are more competitive than others. Same with residency with 41% of English language IM spots in Ontario this year.

The other provinces have mostly in-province quota admits - including McGill (only 10 OOP) and UBC (~25/288 OOP).  Without the IP preference, those medical schools would end up with a much broader mix of across the country applicants, which they are unwilling to accept (often more from ON which as you point out is the largest province).  If UBC admitted applicants purely based on "merit" then its own stats show it would be admitting many more from OOP - but this would go against social accountability.  

https://mdprogram.med.ubc.ca/files/2018/12/Interim-Statistics-2018-19-MED-2023.pdf  (e.g. TFR for interview for OOP is 61.84 vs 51.12 IP at UBC).

The OOP applicants are forcibly more competitive than IP, based on Stats/ECs because they are competing against a larger pool.  The stats at programs like Dal, McGill and Manitoba also bear this out and more extremely Sask.  OTOH there is much less "IP" preference in ON (although Mac is an exception), which means that ON applicants are essentially the most competitive in the country, not just the province.

https://www.mcgill.ca/medadmissions/prospective/our-statistics (Interview GPA is 3.95 OOP vs 3.89 IP)

https://umanitoba.ca/faculties/health_sciences/medicine/education/undergraduate/media/CL2023_Statistics.pdf (MCAT average 523 OOP vs 511 IP)

https://medicine.usask.ca/documents/ugme/admission/admissions-statistics-5-year-summary.pdf (MCAT cut-off IP is 24th percentile vs 97th OOP)

I think the exact same pattern plays out for residency.  ON applicants are competing against a large pool that want to match to residency in ON - which forces them to be more competitive.  It's exactly the high number of applicants that creates the "competitiveness".  Many people have less desire to match to some other provinces/programs.  

That being said, McGill and UBC med students do seem to benefit from a strong reputation, good education with many opportunities.  So, regardless of whether they may have benefitted from "IP" status when applying/matriculating, they are able to do generally well when matching including their "home schools" which have a full complement of programs.

[JohnGrisham]

Just do medical school in Ontario. UWO is an excellent school.

[ACHQ]

GIM staff here, recently finished residency (in Ontario).

 

TBH it really doesn't matter that much *where* you go to medical school for residency in IM, other than the "home school advantage". I think with covid this became more pronounced but I can't confirm this directly. However if you are very keen on going to an ON school for IM residency than your lack of home school advantage can be overcome if you are a strong candidate (done electives with good reference letters at your site, aren't an A-hole, etc...), especially if you aren't picky about which ON school you want to go to. *Generally* strong IM candidates will match in one of their top 3 choices (at least that was the stats back 4-5 years ago).

[indefatigable]

3 hours ago, ACHQ said:

GIM staff here, recently finished residency (in Ontario).

TBH it really doesn't matter that much *where* you go to medical school for residency in IM, other than the "home school advantage". I think with covid this became more pronounced but I can't confirm this directly. However if you are very keen on going to an ON school for IM residency than your lack of home school advantage can be overcome if you are a strong candidate (done electives with good reference letters at your site, aren't an A-hole, etc...), especially if you aren't picky about which ON school you want to go to. *Generally* strong IM candidates will match in one of their top 3 choices (at least that was the stats back 4-5 years ago).

Thanks for weighing in.  

Would you say then that the proportion of strong candidates falls proportionally along school/province size (notwithstanding the "home school" effect)?  

A related question would be is if someone didn't do electives at your school, would it then make any difference if they did other in-province electives? Or would there be no difference of all ON vs AB at that point (including med school and electives)?

I think my issue with the "Top 3" is that candidates may not rank programs they didn't receive interviews at and so it only gives limited insight of where true preferences may lie.  Speaking with some IM gunners, I learned that quite a few didn't get interviews at programs they were hoping for. (could be my school/province specific)    

[ACHQ]

2 hours ago, indefatigable said:

Thanks for weighing in.  

Would you say then that the proportion of strong candidates falls proportionally along school/province size (neglecting the "home school" effect)?  

A related question would be is if someone didn't do electives at your school, would it then make any difference if they did other in-province electives? Or would there be no difference of all ON vs AB at that point (including med school and electives)?

I think my issue with the "Top 3" is that candidates may not rank programs they didn't receive interviews at and so it only gives limited insight of where true preferences may lie.  Speaking with some IM gunners, I learned that quite a few didn't get interviews at programs they were hoping for. (could be my school/province specific)    

I would say so, I don't think ON has many more stronger IM candidates vs Manitoba lets say, proportionally that is.

Doing electives does matter for sure. For IM usually what matters is if you did an elective at that specific school and in an IM specialty (GIM or subspecialty). That being said the programs know that not everyone can do electives everywhere. Some schools are more picky about doing electives at their school and will rarely offer anyone who didn't do any elective there an interview (UofT, McMaster, Ottawa for example). Does doing an elective at another school in the province matter to some degree? Maybe, but its really hard to know unless you are directly on those committees. I'm sure some schools will look at an application with some skepticism if someone did only electives in Western Canada (UBC, UofA and UofC) and applied to schools on the other side of the country (Dal, MUN). Interestingly I only did electives as a medical student in Ontario and still got some Non-Ontario interviews (3/6).

 

The "top 3" was based off of numbers from CARMS presented to us by our school. It showed for those who ranked IM #1 as a specialty the vast majority (>85-90%, I believe but I could be off it was a while ago). Things of course can change and I would go by recent trends, seeing is how IM filled up all its 1st round spots (which would be unheard of a few years back). Most IM gunners at my school (again back when I was applying 5 years ago) got 5+ IM interviews, as long as they were broad in their application and elective choices.

Using myself as an example, I was broad in my application (applied to 11 schools across the country) but pretty narrow in terms of where I did electives (only did electives at 2 away schools and my home school for a total of 3 different schools). I still managed to get 7/11 interviews, all 4 places I didn't get interviews were places I didn't go to for electives.

[indefatigable]

5 hours ago, ACHQ said:

I would say so, I don't think ON has many more stronger IM candidates vs Manitoba lets say, proportionally that is.

Doing electives does matter for sure. For IM usually what matters is if you did an elective at that specific school and in an IM specialty (GIM or subspecialty). That being said the programs know that not everyone can do electives everywhere. Some schools are more picky about doing electives at their school and will rarely offer anyone who didn't do any elective there an interview (UofT, McMaster, Ottawa for example). Does doing an elective at another school in the province matter to some degree? Maybe, but its really hard to know unless you are directly on those committees. I'm sure some schools will look at an application with some skepticism if someone did only electives in Western Canada (UBC, UofA and UofC) and applied to schools on the other side of the country (Dal, MUN). Interestingly I only did electives as a medical student in Ontario and still got some Non-Ontario interviews (3/6).

The "top 3" was based off of numbers from CARMS presented to us by our school. It showed for those who ranked IM #1 as a specialty the vast majority (>85-90%, I believe but I could be off it was a while ago). Things of course can change and I would go by recent trends, seeing is how IM filled up all its 1st round spots (which would be unheard of a few years back). Most IM gunners at my school (again back when I was applying 5 years ago) got 5+ IM interviews, as long as they were broad in their application and elective choices.

Using myself as an example, I was broad in my application (applied to 11 schools across the country) but pretty narrow in terms of where I did electives (only did electives at 2 away schools and my home school for a total of 3 different schools). I still managed to get 7/11 interviews, all 4 places I didn't get interviews were places I didn't go to for electives.

Thanks again for offering some insight.  I agree that lack of electives at Program X may have been part of it given the pickiness of some programs with respect to on-site electives - although this past year was obviously very different  with COVID-19.  

Yeah - the stats are overall very good for IM in terms of matching (slide 29-31 of link below) and in-line with what you are saying.  But, I agree it's much more competitive than in the past as corroborated by lack of second iteration spots.  

The top three is based on the final submitted rank order list - so it's generally safe to assume that these are programs which interviewed the applicant.  I'm not sure how many apply to IM, but aren't interviewed; nor how many apply to a program with an a priori strong interest, but don't get an interview offer either (with or without an elective).  

But, regardless, the top three could both underestimate the full interest in IM and the interest in particular programs - i.e. top three is more of a post-hoc figure.  

https://www.carms.ca/pdfs/2020-carms-forum.pdf

Still, your experience is also interesting to note given your alma mater; it also appears there's some sort of decreased matching effect for matching from Quebec which may contribute (slide 28) .

For completeness, I'll simply state that a PD in a much smaller program suggested they consider IP letters more heavily, but that could also be a smaller program +/- Quebec effect.   

[ACHQ]

56 minutes ago, indefatigable said:

Thanks again for offering some insight.  I agree that lack of electives at Program X may have been part of it given the pickiness of some programs with respect to on-site electives - although this past year was obviously very different  with COVID-19.  

Yeah - the stats are overall very good for IM in terms of matching (slide 29-31 of link below) and in-line with what you are saying.  But, I agree it's much more competitive than in the past as corroborated by lack of second iteration spots.  

The top three is based on the final submitted rank order list - so it's generally safe to assume that these are programs which interviewed the applicant.  I'm not sure how many apply to IM, but aren't interviewed; nor how many apply to a program with an a priori strong interest, but don't get an interview offer either (with or without an elective).  

But, regardless, the top three could both underestimate the full interest in IM and the interest in particular programs - i.e. top three is more of a post-hoc figure.  

https://www.carms.ca/pdfs/2020-carms-forum.pdf

Still, your experience is also interesting to note given your alma mater; it also appears there's some sort of decreased matching effect for matching from Quebec which may contribute (slide 28) .

For completeness, I'll simply state that a PD in a much smaller program suggested they consider IP letters much more heavily, but that could also be a smaller program +/- Quebec effect.   

I can only comment on the IM program. Also quebec is a different beast when it comes to CARMS, and wouldn’t use them as a model for the rest of Canada, let alone Ontario

[YoungDumb&Broke]

That is a lot of helpful information! Thank you all for commenting. I'm still weighing all the pros and cons. To give more information, I'm from Ontario but settled in AB, 8 years ago as a HCP. Being in Edmonton would be an easier move, financially safer, and with family around there as well.

However, long term, I have always wanted to go back to Ontario. Getting a Western invite allows me to do that, but it presents a more difficult move, more cost (tuition wise and cost of living, as far as I know vs. Edmonton). Family exists in that area of the country as well though. Keeping my long term goals in mind, I suppose Western would make more sense. Although, by the time clerkship rolls around, I would suspect (or HOPE, rather) that we're past this COVID ordeal and visiting electives are once again back.

 

Overall a tough decision!

[ACHQ]

15 hours ago, YoungDumb&Broke said:

That is a lot of helpful information! Thank you all for commenting. I'm still weighing all the pros and cons. To give more information, I'm from Ontario but settled in AB, 8 years ago as a HCP. Being in Edmonton would be an easier move, financially safer, and with family around there as well.

However, long term, I have always wanted to go back to Ontario. Getting a Western invite allows me to do that, but it presents a more difficult move, more cost (tuition wise and cost of living, as far as I know vs. Edmonton). Family exists in that area of the country as well though. Keeping my long term goals in mind, I suppose Western would make more sense. Although, by the time clerkship rolls around, I would suspect (or HOPE, rather) that we're past this COVID ordeal and visiting electives are once again back.

 

Overall a tough decision!

You are wise to consider the financial aspect of this. Many med students just have the mindset of "I can just get a LOC to pay for everything".  Well being in debt with anywhere from 80-200k while starting out your career in medicine (i.e. staff life) sucks royally... can't truly enjoy staff life (or at least the perks of being paid appropriately) if you continually have to pay off debt.

[YoungDumb&Broke]

7 hours ago, ACHQ said:

You are wise to consider the financial aspect of this. Many med students just have the mindset of "I can just get a LOC to pay for everything".  Well being in debt with anywhere from 80-200k while starting out your career in medicine (i.e. staff life) sucks royally... can't truly enjoy staff life (or at least the perks of being paid appropriately) if you continually have to pay off debt.

Thanks. I've been working as a HCP for almost 8 years now, and I really planned for medicine when I started to apply. I wanted to go into this with the lowest amount of debt possible, which is also why UofA is so appealing (almost 14k-15k tuition vs. 25k-26k for Western). In the grand scheme of things though it might not matter, but I also have a family so it makes it hard. 

 

I'm still thinking about this so hope to make a decision in a next coming days, as the UofA deadline approaches! Thanks again.