CaRMS 2022 - Ophtho

[dooogs]

2 hours ago, Xbox Skully said:

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. 

Yes another one from u of t was an OD 

[dooogs]

Ophtho is so crazy… compete with nepotism, OD, and research fellows. I feel for the applicants… but I can’t believe money is the only driver here 

[Milaa]

3 hours 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

This is so problematic... And they said medicine is meritocratic 

[indefatigable]

21 hours ago, Milaa said:

This is so problematic... And they said medicine is meritocratic 

I know of other cases across Plastics/ENT/Derm..  

e.g. A colleague mentioned that that the single McGill ENT match last year was the daughter of a senior staff (also available on IG)

I think awareness is the first step in tackling this issue.  

[Milaa]

13 minutes ago, indefatigable said:

I know of other cases across Plastics/ENT/Derm..  A colleague mentioned for the one ENT spot at a program in another year the child of PD or senior staff was chosen for example..  

I think awareness is the first step in tackling this issue.  

Can you pls share what happened in these other specialties?

[indefatigable]

32 minutes ago, Milaa said:

Can you pls share what happened in these other specialties?

There are a number of dynasties in some specialties - it's not too hard to find them.  

I know of a case where basically senior staff mentioned they had taken one resident due to being a relative of an important staff.. another match was a child of supervising PD etc..  

it definitely creates the appearance of significant conflict of interest in these cases, but I don't think there's any real accountability and hard to "prove" even in the most notorious case at UBC (cardiac surgery IMG).  The entire process is so subjective, often based on letters (which can be weighed differently), and is political in of itself..  so nepotism I think is just the next step in the politicization.. e.g. favours for favours etc..  But from the get go having a parent as a powerful staff does definitely give one probably a lot more opportunities than other applicants which could help be more "competitive".

[Xbox Skully]

58 minutes ago, dooogs said:

Ophtho is so crazy… compete with nepotism, OD, and research fellows. I feel for the applicants… but I can’t believe money is the only driver here 

My great uncle was an optho and hated it. He retired at 60 which I think it pretty young. So it’s not everyone’s cup of tea.

[indefatigable]

2 minutes ago, Xbox Skully said:

My great uncle was an optho and hated it. He retired at 60 which I think it pretty young. So it’s not everyone’s cup of tea.

I met a resident who actually transferred out to FM - didn't like the workflow...  (although this was in QC where it is less competitive)..

Next step for ophtho gunners is to learn French lol.

[dooogs]

How many people do they interview compared to spots? They should give out way less interviews if so many ppl go unmatched... at least give them a chance for other specialities 

[1D7]

Earnings is a pretty small factor in Canadian medical student preference for specialty in my experience. Mostly people want to be paid appropriately for more training, but outside of that it's low impact.

Medical students can broadly be divided into two groups, either competitive heavily career driven versus lifestyle oriented. Ophthalmology happens to check both boxes and can draw from a large pool of interested applicants, on top of having a very limited number of spots. Usually a specialty being competitive/popular in and of itself has a draw to it too.

[McMasterMD]

Potential earnings, lifestyle, and vibing with the field definitely play a big role in specialty selection. 

[jb24]

8 hours ago, RandomIntrandom said:

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...

Maybe because of Dr. Glaucomflecken, lol.

[1D7]

43 minutes ago, McMasterMD said:

Potential earnings, lifestyle, and vibing with the field definitely play a big role in specialty selection. 

Interest plays the largest role by far. Otherwise why is peds more competitive than IM?

Why is EM more competitive than radiology? Most medical students can't tolerate minimal patient interaction when it's replaced by high screen time. 25%, 50%, or even 100% more pay isn't going to change that, especially when staring down the barrel of 6 years of training. EM also has a bit of fun factor in med school where you get to do minor procedures, assess patients yourself, and spend 1-on-1 time with staff.

Or alternatively, why are specialties like NSx and cardiac Sx often competitive despite having long training times and a poor job market? These specialties draw certain personalities and interests. Poor $ ROI on training time doesn't change that.

Why is OBGYN typically highly competitive?

Etc. Etc.

It is very rare that money plays any significant role in specialty selection over the years I've interacted with medical students.

[McMasterMD]

I think a lot of apples and oranges were compared.

Interest does play a role, I agree with that. I just think that it doesn't play the largest role by far. 

Let's take one field for comparison, for example, orthopedics. In the US, orthos make fantastic money + have the potential to have a decent lifestyle in private practice e.g. spine surgeons make 800K USD on average. Whereas, in Canada, there are very few ortho jobs, they are unemployed, overworked and underpaid. So...guess where the specialty is a lot more competitive and it is a lot harder to match to ortho? On the other hand, ophthos make ~300K or so in the US vs 700K in Canada. Surprise surprise - it is a lot harder to get into an ophtho program here in Canada. There are likely exceptions to this observation - sure.

Bottom line, interest does play a role, but income and lifestyle do as well. Cut the salary of ophthos here in Canada in half, and you will see half the number of applicants. Just my deux cents. 

[indefatigable]

On 4/21/2022 at 6:43 PM, McMasterMD said:

Potential earnings, lifestyle, and vibing with the field definitely play a big role in specialty selection. 

On 4/21/2022 at 7:16 PM, 1D7 said:

Interest plays the largest role by far. Otherwise why is peds more competitive than IM?

I think that "interest" in a field is often a reflection of all the above factors, including earnings (could include private) and lifestyle, and more - e.g. training length and difficulty, job market & flexibility (including geographic), work-flow (e.g. procedures vs reading imaging), setting (inpatient or outpatient), variety, perceived prestige and intellectual curiosity, competitiveness (either direction) etc.. - the sweet spot is when a discipline checks the boxes that are personally important and subjective. 

While I agree that for earnings is not the major driver of interest for many students, I know for a fact that it can be a decider for some.  

I also don't think competitiveness is always a great indicator of interest either because quota sizes can be different.  In the example of peds vs IM, both core disciplines, IM has almost 4 times quota of Peds - so even if many more applicants rank IM first than Peds, Peds is still more competitive because of the difference in quota - even if there's more student "interest" in IM.

Competitiveness to me just shows the relative difficulty of matching to the discipline and some may wonder if their "interest" in the discipline is sufficient to go through hoops to be competitive.  To some it may increase interest in the discipline and to others it may cause a decrease.

[shikimate]

It's funny the consensus here is medical students don't choose specialty based on money.

If you visit the actual physician financial independence group most posts are about not having enough money lol, like I bill 600k a year can I afford a 3M house in TO that kinda thing.

[shikimate]

The second most popular post on there is comparing how much the OP bill relative to ophtho lol. Like inevitably an army of family docs rise from below and complain they make 250k while some optho make 2.5M.

Then inevitably the anonymous post comments gets shut down. Then another one will emerge next week. Rinse and repeat ad infinatum 

[indefatigable]

1 hour ago, shikimate said:

It's funny the consensus here is medical students don't choose specialty based on money.

If you visit the actual physician financial independence group most posts are about not having enough money lol, like I bill 600k a year can I afford a 3M house in TO that kinda thing.

It's not actually inconsistent though..  Different career stages and different priorities.  And this is a "financial independence group" so I'd expect most discussion to center around money and earnings.  

As was pointed out above (and available through CaRMS website), med students do not rank specialties according to strict financial order suggesting that decisions aren't made on purely financial grounds in many cases even if becomes a more important focus later on in career.  It's not to say that some students aren't focused primarily on earnings from the beginning though..  

[zoxy]

On 4/21/2022 at 8:25 PM, shikimate said:

The second most popular post on there is comparing how much the OP bill relative to ophtho lol. Like inevitably an army of family docs rise from below and complain they make 250k while some optho make 2.5M.

Then inevitably the anonymous post comments gets shut down. Then another one will emerge next week. Rinse and repeat ad infinatum 

I'm honestly shocked that Ophtho billings haven't been corrected yet. It's been like this since forever.

The US had the exact same issue with Ophtho but the CMS just keeps slashing their payments. For example, a non-complicated cataract surgery(Code 66984) was cut from from $654 in 2019 to $557 for 2020, and that $654 is less than what it used to be. For comparison's sake, it was $816 in 2013. And despite Canadian Opthos saying fee cuts would ruin them, the CMS fee cuts didn't put American Ophthos in the breadlines. Ophtho is fairly midpack down there in pay right now, similar to General Surgery for example

American Ophtho residencies  don't have any problems filling their spots with graduating USMDs either. Average Step scores are still fairly high, but it's nowhere near as competitive as Derm or Plastics down there or Ophtho here in Canada.

[1D7]

19 hours ago, shikimate said:

It's funny the consensus here is medical students don't choose specialty based on money.

If you visit the actual physician financial independence group most posts are about not having enough money lol, like I bill 600k a year can I afford a 3M house in TO that kinda thing.

I would agree that money and lifestyle become exponentially more important as you age, especially with more expenses and dependents. Most people's families take priority over their careers, and for that you need money to sustain nice activities, privileged schooling, etc. Physicians are also not really significantly changing their scope of practice a few years out from training, and lifestyle is kind of stable... there isn't really much else to talk about except complain about work & how to make more money.

I maintain that it is rare for money to be a significant factor in a medical student's decision on their specialty choice outside of wanting to be paid appropriately for level of training. I never said it was a nonfactor, but it is below importance vs. interest (which in itself includes liking the work, academic mentors, tolerating the bread and butter, etc.) and lifestyle (which includes hours, training length, call, and job availability).

[McMasterMD]

I’m unsure which medical students don't consider lifestyle or money when picking a specialty, and only/primarily pursue their interests. Haven’t met that many of them. Good for them though. Not that many knights on white horses around.
 

I’m also glad that you’ve encountered a lot of idealists in your career. Kinda curious what field you’re in. Maybe I should switch into it!

 

[shikimate]

You guys bring up some good points. Perspectives certainly change over time. When I was undergrad I thought someone making 100K a year was top notch. Then in med school you think if you make 250K a year it's top notch. Then when you are in residency you think 500K a year is not a bad deal. Then when you're out working a few years you complain making 2M a year isn't enough to keep up with the Joneses lol.

I've met some people who doesn't really "care" about money per se, I found they belonged to 2 camps. Camp A are people from really wealthy families that have more wealth than they can spent so whether they make 200K a year or 400K a year doesn't really matter when your family wealth is measured in millions.

Camp B are people who kinda blissfully ignore money/finances in the name of either academic or humanitarian ideals. Good for them if that's what they are passionate about, but you can't just not "care" about money because that's what makes the world go around.  If you are in academia you still have to apply and manage your grants, and if you are in humanitarian causes soliciting donations and governmental grants is still a big part of the "business".

[mdlifecrisis]

4 minutes ago, shikimate said:

You guys bring up some good points. Perspectives certainly change over time. When I was undergrad I thought someone making 100K a year was top notch. Then in med school you think if you make 250K a year it's top notch. Then when you are in residency you think 500K a year is not a bad deal. Then when you're out working a few years you complain making 2M a year isn't enough to keep up with the Joneses lol.

I've met some people who doesn't really "care" about money per se, I found they belonged to 2 camps. Camp A are people from really wealthy families that have more wealth than they can spent so whether they make 200K a year or 400K a year doesn't really matter when your family wealth is measured in millions.

Camp B are people who kinda blissfully ignore money/finances in the name of either academic or humanitarian ideals. Good for them if that's what they are passionate about, but you can't just not "care" about money because that's what makes the world go around.  If you are in academia you still have to apply and manage your grants, and if you are in humanitarian causes soliciting donations and governmental grants is still a big part of the "business".

you forgot camp C, which are the people who have set up streams of passive income where their money is no longer tied to how much time they put in and they can just do whatever they enjoy doing

[shikimate]

3 minutes ago, mdlifecrisis said:

you forgot camp C, which are the people who have set up streams of passive income where their money is no longer tied to how much time they put in and they can just do whatever they enjoy doing

damn you're right, I totally forgot.

on a side note, I know someone who declined med school acceptance in favor of getting into tech and bought BTC for pocket change many years ago lol. Needless to say they've long "retired".