CaRMS 2022 - Ophtho

[Med135]

Hi friends,

I wanted to start a conversation on here about the craziness of ophthalmology this year. I've heard from multiple people that they've never seen a year this competitive before - of course it's always competitive but somehow this year it was worse than usual? It's also interesting that the research fellowships are actually more competitive than ophthalmology residency positions (this year anyways). I guess lots of us had the wrong assumption that if we didn't match, we would do a research fellowship and probably match next year.

Anyways, just some of my thoughts. I hope my fellow unmatched ophtho hopefuls are doing okay. I truly believe that we are all incredible, accomplished, kind-hearted people and the future holds great things for us, but the uncertainty of these days is really the worst. Feel free to reply if you're in the same boat and we can have an existential crisis together. If not, I just wanted to post this for next year's unmatched ophthalmology hopefuls to remind them that they are not alone.

Side note: I feel like we only ever hear from unmatched students who did a research fellowship and matched to ophthalmology. What about the inevitably large number of people who don't fit into that group? Do they match second iteration? Do a fifth year? Something else? What specialties do they match to? Have they found happiness outside of ophthalmology?

[CaRMS2021]

Can you elaborate on research fellowships being more competitive than residency programs? I wasn't aware that Canadian university have formal research fellowships in Ophthos for the unmatched

Anecdotally, I know an Ophtho gunner who didnt match the year before me and matched to Family in my year - can't comment on their happiness as I don't know them that well

[Redpill]

It did seem especially insane this year.

I heard there were at least 10+ people at UBC alone going for ophtho, with only 3 spots at home school

I wonder if it is also worth having a broader conversation as a medical community around why ophtho is so competitive year after year...

[McMasterMD]

6 minutes ago, Redpill said:

It did seem especially insane this year.

I heard there were at least 10+ people at UBC alone going for ophtho, with only 3 spots at home school

I wonder if it is also worth having a broader conversation as a medical community around why ophtho is so competitive year after year...

I wonder why it'$ $o competitive year after year. Truly $urpri$ing. 

 

[SML]

Isnt ophtho, with ent, derm and plastics, always this competitive? Was this year really that different?

[Redpill]

1 hour ago, McMasterMD said:

I wonder why it'$ $o competitive year after year. Truly $urpri$ing. 

 

Right, to be clear, I'm not saying it is a big secret, I am saying maybe our medical community should try to address the huge pay discrepancies between specialities that make a growing number of medical students want to grind out multiple extra years in masters programs to win it all, instead of go for other (very high need) specialties with lots of available positions (specifically family medicine)

[McMasterMD]

22 minutes ago, Redpill said:

Right, to be clear, I'm not saying it is a big secret, I am saying maybe our medical community should try to address the huge pay discrepancies between specialities that make a growing number of medical students want to grind out multiple extra years in masters programs to win it all, instead of go for other (very high need) specialties with lots of available positions (specifically family medicine)

Oh absolutely. I couldn't agree more. I'm sure many in the medical community feel the same way. It's hard to understand how ophthalmologists (avg: $702K) get both ridiculous $$$$$ AND a super chill lifestyle. Wasn't realignment of income supposed to happen a while back? 

 

1 hour ago, SML said:

Isnt ophtho, with ent, derm and plastics, always this competitive? Was this year really that different?

ROAD - lifestyle specialties - radiology, ophtho, anesthesia, derm

PEEDO - competitive specialties - plastics, ENT, emerge, derm, ophtho. These have been very competitive for quite a few years now.

[shikimate]

Not quite related, but back in the days the former chief pathologist was an ophtho in India and then became a pathologist. He actually specialized in opthalmic pathology and did a lot of interesting stuff about retinal tumors and tumors of eyelids.

There is actually a dedicated opthalmic pathology fellowship at Boston Eye Infirmary/Harvard. Not many people know about it, but apparently it's an in demand niche area in academic centers because generally neuropathologist are assigned the eye tumor cases but in reality they aren't best trained for that kind of stuff.

[indefatigable]

1 hour ago, McMasterMD said:

Oh absolutely. I couldn't agree more. I'm sure many in the medical community feel the same way. It's hard to understand how ophthalmologists (avg: $702K) get both ridiculous $$$$$ AND a super chill lifestyle. Wasn't realignment of income supposed to happen a while back? 

1 hour ago, Redpill said:

Right, to be clear, I'm not saying it is a big secret, I am saying maybe our medical community should try to address the huge pay discrepancies between specialities that make a growing number of medical students want to grind out multiple extra years in masters programs to win it all, instead of go for other (very high need) specialties with lots of available positions (specifically family medicine)

What I don't understand is why is QC different?

• in QC, Ophtho grosses 691K (highest) with post-overhoed 582K (2nd only to carcio-vascular Sx)
• in QC, Ophtho was 4th LEAST competitive specialty last year (after public health, medical genomics, psych, all other surgical disciplines...)

Is this..

• more financially driven/financially pressured ROC students? (but rads is not that competitive which also has reputation of earnings..)?  higher debt?
• other specialties are relatively better paid in QC (not public health though..)?
• something about the practice of ophtho in QC vs ROC?
• random fluctuation due to smaller applicant pool?
• something else?

It's interesting to me why med student ranking choices would be different based on a similar renumeration$$$/work in/out of QC - are there other factors to be aware of which could help at a systems level?

[quibble]

55 minutes ago, indefatigable said:

What I don't understand is why is QC different?

• in QC, Ophtho grosses 691K (highest) with post-overhoed 582K (2nd only to carcio-vascular Sx)
• in QC, Ophtho was 4th LEAST competitive specialty last year (after public health, medical genomics, psych, all other surgical disciplines...)

Is this..

• more financially driven/financially pressured ROC students? (but rads is not that competitive which also has reputation of earnings..)?  higher debt?
• other specialties are relatively better paid in QC (not public health though..)?
• something about the practice of ophtho in QC vs ROC?
• random fluctuation due to smaller applicant pool?
• something else?

It's interesting to me why med student ranking choices would be different based on a similar renumeration$$$/work in/out of QC - are there other factors to be aware of which could help at a systems level?

For starters, the fact that QC tuition is $4K/yr during med school really does have an impact on people's choices of residency. Most QC students graduate with little to no debt, but on average, much lower than ROC. In the US, the amount of debt that med students are graduating with is astronomical, and the research shows that this has impacts on residency choices. QC students also get into med school at younger ages meaning they incur less upfront costs (e.g., undergrad, MCAT prep, etc.). 

[zoxy]

On 4/18/2022 at 6:43 PM, indefatigable said:

What I don't understand is why is QC different?

It's pretty simple IMO and has two reasons.

1)More Ophtho spots per student. Quebec has 12, ROC has 24. While Quebec has 870ish grads per year while ROC has 2000ish. This makes it a much better ratio for Quebec schools. Similar advantage for Quebec grads in Dermatology as well but Surgery favours ROC graduates.

2)Quebec schools are more female and it's always dudes who are Ophtho gunners. It's like that in the US as well, but not to the same extent as Canada.

I'd also speculate that with Montreal being cheaper than Toronto and Vancouver and with Quebec having higher taxes, there's less incentive to make boatloads of money. Plus the whole liberte egalite fraternite stereotype. Statistically, Quebec is far more left-wing than ROC.  Without Quebec, Canada would look positively American.

[zoxy]

22 minutes ago, quibble said:

 In the US, the amount of debt that med students are graduating with is astronomical, and the research shows that this has impacts on residency choices.

No it doesn't. NYU just graduated its most recent grad class which had free tuition and there were ZERO family med matches. Most elite US schools have very low debt burdens but no one matches to lower paying specialties. Plenty of Derm matches though. The proportion of applicants that end up in primary care(including IM without specializing) of any kind is extremely small in those elite schools. It's just a nonsense excuse that people give for gunning for Derm because it's cush and pays very well.

There's no shame in doing that, but please, don't insult our intelligence. You can easily service a debt burden of 300K USD with family doctors salary of 270K USD a year. Besides, there are geneours federal debt repayment programs if you work in an undeserved area in primary care in the US.

 

[indefatigable]

12 hours ago, quibble said:

For starters, the fact that QC tuition is $4K/yr during med school really does have an impact on people's choices of residency. Most QC students graduate with little to no debt, but on average, much lower than ROC. In the US, the amount of debt that med students are graduating with is astronomical, and the research shows that this has impacts on residency choices. QC students also get into med school at younger ages meaning they incur less upfront costs (e.g., undergrad, MCAT prep, etc.). 

I was thinking about that but wondered why rads is more competitive in QC vs ROC even though it is high-paying in both.  It was my original hypothesis though.  

11 hours ago, zoxy said:

1)More Ophtho spots per student. Quebec has 12, ROC has 24. While Quebec has 870ish grads per year while ROC has 2000ish. This makes it a much better ratio for Quebec schools. Similar advantage for Quebec grads in Dermatology as well but Surgery favours ROC graduates.

2)Quebec schools are more female and it's always dudes who are Ophtho gunners. It's like that in the US as well, but not to the same extent as Canada.

I'd also speculate that with Montreal being cheaper than Toronto and Vancouver and with Quebec having higher taxes, there's less incentive to make boatloads of money. Plus the whole liberte egalite fraternite stereotype. Statistically, Quebec is far more left-wing than ROC.  Without Quebec, ROC would look positively American.

1)  The ratio isn't shockingly different - but I agree does explain the relative lack of competitiveness vs other surgical specialties (e.g. neurosurg with 20 in ROC vs 2 spots in QC).  But, derm has an even more favourable ratio in QC vs ROC and is still very competitive.  And it doesn't explain why medical genomics which has 4 spots in QC and 4 in ROC nor public health (which has also has a 1:2 ratio) are more competitive than ophtho within QC.  We can agree, however, that surgical disciplines may be less competitive in QC overall normalizing for the actual available number of spots.  

2) You're right that the sex balance for med students in QC is significantly more female- maybe that could explain part of the variability.  It's not something that I would have considered.    

I think Montreal is a city of contradictions - yes there is more left-wing, social consciousness, but it also has a lot of bling - e.g. Ferrari festival, fashion, kind of culturally similar to NYC in some ways.  Definitely saw many students & residents without any aversion to bling/spending either.. and I'm not sure whether med students are delving into in the intricacies of micro-economics & taxes when choosing specialties either (in general haha - forum people could be excepted).  Finally, specialist income is markedly higher on avg in QC suggesting that MDs are not disincentivized to earn $$$ despite higher tax rates.  

So in sum i) surgical disciplines in QC generally have much tighter ratios - ophtho is exception ii) more skewed sex ratio could result in different choices  

 

[Aetherus]

6 hours ago, Med135 said:

Hi friends,

I wanted to start a conversation on here about the craziness of ophthalmology this year. I've heard from multiple people that they've never seen a year this competitive before - of course it's always competitive but somehow this year it was worse than usual? It's also interesting that the research fellowships are actually more competitive than ophthalmology residency positions (this year anyways). I guess lots of us had the wrong assumption that if we didn't match, we would do a research fellowship and probably match next year.

Anyways, just some of my thoughts. I hope my fellow unmatched ophtho hopefuls are doing okay. I truly believe that we are all incredible, accomplished, kind-hearted people and the future holds great things for us, but the uncertainty of these days is really the worst. Feel free to reply if you're in the same boat and we can have an existential crisis together. If not, I just wanted to post this for next year's unmatched ophthalmology hopefuls to remind them that they are not alone.

Side note: I feel like we only ever hear from unmatched students who did a research fellowship and matched to ophthalmology. What about the inevitably large number of people who don't fit into that group? Do they match second iteration? Do a fifth year? Something else? What specialties do they match to? Have they found happiness outside of ophthalmology?

I'm sorry you went unmatched. The match is an imperfect system to distribute a finite resource. 

With regards to this year being the most competitive year, we will have to wait for the data to be released. As it stands, 2020 was the most competitive year and 2018 was the second most competitive year since they started tracking this. It does seem that the number of applicants alternates with every even year being more competitive. Based on what I have heard, I think it is unlikely this year will match 2020. Unfortunately, there are many people who don't get any interviews for Ophtho every year. In fact, you can generally figure this number out by looking at the difference between people who ranked Ophtho First and the total number of applicants.

In terms of the Research Fellowships, I don't doubt they are competitive as there are only a few (Ike Ahmed and Kashif Baig) who have any type of track record. But to say they are more competitive than the Ophtho spots is a gross exaggeration. 

Unfortunately, several qualified applicants go unmatched for Ophthalmology every year. I think there are many people who are oblivious of how competitive the specialty is, even with everyone telling them. 

Best of Luck with the research year and hopefully round 2 works out better!

[quibble]

58 minutes ago, zoxy said:

No it doesn't. NYU just graduated its most recent grad class which had free tuition and there were ZERO family med matches. Most elite US schools have very low debt burdens but no one matches to lower paying specialties. Plenty of Derm matches though. The proportion of applicants that end up in primary care(including IM without specializing) of any kind is extremely small in those elite schools. It's just a nonsense excuse that people give for gunning for Derm because it's cush and pays very well.

There's no shame in doing that, but please, don't insult our intelligence. You can easily service a debt burden of 300K USD with family doctors salary of 270K USD a year. Besides, there are geneours federal debt repayment programs if you work in an undeserved area in primary care in the US.

 

"Twenty articles from the USA found that the presence of significant debt was associated with higher paying specialty choice. Eight articles found debt was associated with a greater degree with lower paying specialties like primary care/family practice and academic medicine, compared with other medical and surgical specialties. Nine US publications found that debt did not significantly influence specialty choice. Four studies found that debt levels had an effect on specialty choice, but did not clarify in which direction.

One of the most authoritative studies in this area was a longitudinal study of 4916 US medical students, conducted by Grayson et al from 1992 to 2012. This study found that first-year and fourth-year medical students wanting to pursue high paying non-primary care careers anticipated a greater debt burden, placed higher importance on income and anticipated greater incomes, compared with their same-year peers seeking a career in primary care. Moreover, 31% of those reporting intending to pursue primary care at year 1 had decided to switch to a higher paying specialty by year 4, with debt and income appearing to be driving factors. Another longitudinal study by Jeffe et al found that from 1997 to 2006, the proportion of medical students with at least US$150 000 total debt at graduation rose from 6.7% to 35.9%, in conjunction with a decline in the number of physicians pursuing generalised primary care. Similarly, Schwartz et al found greater debt in 2007 compared with 1990, and students in 2007 were more likely to report that debt repayments pushed them away from primary care careers. More recently, high debt levels (US$150 000–US$249 999) of family medicine residents were associated with decreased odds of working in a government organisation, and very high debt levels (>US$250 000) associated with decreased odds of academic practice or geriatric fellowships.

Although less frequently examined, loan types were also found to play a role in specialty choice. For example, Bazzoli examined both subsidised loans with lower interest rates that only accrue after graduation/residency, and health education assistance loans (HEAL) which had comparatively higher interest rates with accrual beginning from the date of taking the loan (ie, unsubsidised). Higher relative debt accrued from subsidised loan programmes seemed to predict primary care as a specialty choice, whereas higher (unsubsidised) HEAL debt was associated with higher paying specialties. These findings were consistent with more recent studies of osteopathic medical students. Conversely, Nguyen and Bounds found that only 24% chose primary care despite having no student debt."

Pisaniello MS, Asahina AT, Bacchi S, et al Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review BMJ Open 2019;9:e029980. doi: 10.1136/bmjopen-2019-029980

[medmedmed132]

First: I did not apply ophtho, but good friends of mine did and went unmatched. (I am also unmatched but from a separate specialty lol).

It seems especially crazy this year, but mostly due to the musical chairs of ophthalmology. I don't think that some schools were that "competitive" if that makes sense, but instead chose people with specific attributes for the school (Prairie schools usually taking Prairies people etc). The other issue is what you've described regarding home schools. Some of the schools took 100% home school applicants, and most places took 50% at least. So from this perspective, unless you're the chosen candidate for your school, your odds of beating out a home school candidate at another school that you have no exposure at (no visiting electives!) is nearly 0. In the past year though, this trend was a little shifted as I think the first COVID batch was more diversified in terms of non-home school people being picked (I think).

Regarding fellowships... I don't think many or any people match after not doing a fellowship and re-trying. My friend has told me of 1 person (over the past 5 years) who has done it successfully. The fellowships themselves are beneficial likely, but it is also probably that these were top candidates who just didn't fit a specific school in the first round (ie. not their home school's choice, etc). Fellowships also seem to depend on the person, the fellowship... and like CaRMS always, the pool of people in the next class too.

I believe most of the unmatched pool goes 2nd iteration or tries for a ophtho + 2nd specialty the next year, often with less or no interviews in ophtho, therefore feeding into the backup specialty. I don't think I can produce that data as the sample size would be too small and it's probably unpublished.

[Aetherus]

45 minutes ago, medmedmed132 said:

First: I did not apply ophtho, but good friends of mine did and went unmatched. (I am also unmatched but from a separate specialty lol).

It seems especially crazy this year, but mostly due to the musical chairs of ophthalmology. I don't think that some schools were that "competitive" if that makes sense, but instead chose people with specific attributes for the school (Prairie schools usually taking Prairies people etc). The other issue is what you've described regarding home schools. Some of the schools took 100% home school applicants, and most places took 50% at least. So from this perspective, unless you're the chosen candidate for your school, your odds of beating out a home school candidate at another school that you have no exposure at (no visiting electives!) is nearly 0. In the past year though, this trend was a little shifted as I think the first COVID batch was more diversified in terms of non-home school people being picked (I think).

Regarding fellowships... I don't think many or any people match after not doing a fellowship and re-trying. My friend has told me of 1 person (over the past 5 years) who has done it successfully. The fellowships themselves are beneficial likely, but it is also probably that these were top candidates who just didn't fit a specific school in the first round (ie. not their home school's choice, etc). Fellowships also seem to depend on the person, the fellowship... and like CaRMS always, the pool of people in the next class too.

I believe most of the unmatched pool goes 2nd iteration or tries for a ophtho + 2nd specialty the next year, often with less or no interviews in ophtho, therefore feeding into the backup specialty. I don't think I can produce that data as the sample size would be too small and it's probably unpublished.

Lots of speculation. I don’t think you absolutely need to do the fellowships to get into Ophtho on round 2. As long as you can show the committee what you have done with your year off, I think you have a change of matching. 
I know of a few people who matched without doing a research fellowship after going unmatched.

[zoxy]

14 hours ago, quibble said:

"Twenty articles from the USA found that the presence of significant debt was associated with higher paying specialty choice. Eight articles found debt was associated with a greater degree with lower paying specialties like primary care/family practice and academic medicine, compared with other medical and surgical specialties. Nine US publications found that debt did not significantly influence specialty choice. Four studies found that debt levels had an effect on specialty choice, but did not clarify in which direction.

One of the most authoritative studies in this area was a longitudinal study of 4916 US medical students, conducted by Grayson et al from 1992 to 2012. This study found that first-year and fourth-year medical students wanting to pursue high paying non-primary care careers anticipated a greater debt burden, placed higher importance on income and anticipated greater incomes, compared with their same-year peers seeking a career in primary care. Moreover, 31% of those reporting intending to pursue primary care at year 1 had decided to switch to a higher paying specialty by year 4, with debt and income appearing to be driving factors. Another longitudinal study by Jeffe et al found that from 1997 to 2006, the proportion of medical students with at least US$150 000 total debt at graduation rose from 6.7% to 35.9%, in conjunction with a decline in the number of physicians pursuing generalised primary care. Similarly, Schwartz et al found greater debt in 2007 compared with 1990, and students in 2007 were more likely to report that debt repayments pushed them away from primary care careers. More recently, high debt levels (US$150 000–US$249 999) of family medicine residents were associated with decreased odds of working in a government organisation, and very high debt levels (>US$250 000) associated with decreased odds of academic practice or geriatric fellowships.

Although less frequently examined, loan types were also found to play a role in specialty choice. For example, Bazzoli examined both subsidised loans with lower interest rates that only accrue after graduation/residency, and health education assistance loans (HEAL) which had comparatively higher interest rates with accrual beginning from the date of taking the loan (ie, unsubsidised). Higher relative debt accrued from subsidised loan programmes seemed to predict primary care as a specialty choice, whereas higher (unsubsidised) HEAL debt was associated with higher paying specialties. These findings were consistent with more recent studies of osteopathic medical students. Conversely, Nguyen and Bounds found that only 24% chose primary care despite having no student debt."

Pisaniello MS, Asahina AT, Bacchi S, et al Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review BMJ Open 2019;9:e029980. doi: 10.1136/bmjopen-2019-029980

This is a lit review. Anyway, those studies that they(and you) cite seem to be all surveys that rely on questionnaires. Questionnaires are useless, especially when it comes to things like money, ethics, power, morals etc. Don't look at what people say, look at the data about what they do. If you look at what they do, you'll realize that specialty choice isn't dictated by debt levels.

People love to act holier than thou and say that they can't do FM because they have too much debt. As I said before, even the lowest paying specialties in the US, FM or Peds shouldn't struggle in paying off their debt. A married FM with a stay at home spouse in high tax California will have a take home of 195K USD assuming 270K USD in earnings(270 is the MGMA median, AMGA is slightly higher for FM). In low tax Washington state that would be 210K after taxes. Even with a debt burden of 300K USD, it's more than manageable on an FM income.

Data:

https://pubmed.ncbi.nlm.nih.gov/31660960/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868367/

https://pubmed.ncbi.nlm.nih.gov/16846185/

[Med2000]

Echoing above, I feel like all schools had a bunch of ophtho applicants this year, like more than usual (and all of whom sounded super strong). Did others find this to be the case as well or was it select schools flooding the pool? 

[RandomIntrandom]

There were allegedly over 100 applicants for Ophtho this year. Even the research fellowships are insane - I have heard of the big ones receiving over 20 applications for 2 spots...

[anonymousRA]

Apparently half of the Toronto optho spots were taken by children of prominent attendings. One is a current Vice Chair and former PD and the other is a world-renowned ophthalmologist in charge of the Toronto research fellowship. 

Nepotism is very wide-spread in the small surgical programs

[yellow daisy]

58 minutes ago, anonymousRA said:

Apparently half of the Toronto optho spots were taken by children of prominent attendings. One is a current Vice Chair and former PD and the other is a world-renowned ophthalmologist in charge of the Toronto research fellowship. 

Nepotism is very wide-spread in the small surgical programs

Yes heard this as well and I believe it's also on their IG page. 

[Xbox Skully]

1 hour ago, anonymousRA said:

Apparently half of the Toronto optho spots were taken by children of prominent attendings. One is a current Vice Chair and former PD and the other is a world-renowned ophthalmologist in charge of the Toronto research fellowship. 

Nepotism is very wide-spread in the small surgical programs

Were any of them MD,OD applicants. Every year one or two ODs go to medical school with the hopes of hitting that ophthalmology lottery. And I bet this is also an issue in the undergrad admissions process. In the us it probably happens as well but there are much more seats so their is still more opportunities to match. There is a reason America is the land of opportunity. 

[shikimate]

https://thetyee.ca/News/2015/02/06/Former-Cabinet-Minister-Wins-UBC-Residency/

[quibble]

12 minutes ago, shikimate said:

https://thetyee.ca/News/2015/02/06/Former-Cabinet-Minister-Wins-UBC-Residency/

Nepotism is alive and well.