Would a CaRMS "Unmatched Megathread" be helpful here?

[Andrew]

Hi everyone, it's been a long time since I was last here (2015 seems to have been my last posting), but I've been around since at least 2007. This forum has been very helpful to me over the years from Premed, to Med, to Residency and including going Unmatched back in 2010. I haven't really been following CaRMS much but it seems the number of "Unmatched" graduates has vastly increased (to 140 in 2018?) and it seems to be a much bigger problem than when I graduated.

I recently came across this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378156/ and it prompted me to come back here.

I found it helpful to read that article, and it really validated my own personal experience "Unmatched" in 2010. I noticed this myself when I went unmatched that there is/was a lack of support from UME and also there is definitely a shame/stigma. I'm wondering if the creation of a thread where people can just anonymously share their personal experiences and feedback/support would be appropriate to maintain over the years (seems every year there is creation of a new "Unmatched thread", but what if we collect these experiences in 1 post.)

[Andrew]

I'll start by sharing my own personal experience, and this is through the lens of now being 39 years old and having been in family practice since 2013. I now have a daughter.

First of all, to this day, I still feel a great shame about "Unmatching", to the point, that I don't like to tell anyone else, and I consider it to be among the top 3 failures of my life. For this reason, I will anonymously share my experience. Even though this happened many years ago, it still triggers me.

I recall going unmatched after applying to a competitive surgical specialty, I then broadly applied to "leftover" family medicine (including rural) spots in the second round and still went Unmatched. When I reflect upon this, I think applying to competitive specialties always carries an inherent risk, however I do bear some fault in that I was not "networking" as much as I could/should have. I believe that more important than your actual skills/knowledge, is how well the Program Director/Residents perceive you and and as such, its very important to use your 2-week elective time to become "buddies" with them, and I did not do a good enough job of this.

With that being said, I recall feeling very embarassed and ashamed. UME basically told me to apply for everything leftover, and while I've read of other candidates not wanting to get on board with this, I quickly adjusted my mindset to be willing to take any leftover positions, even still, I went Unmatched after 2 iterations that year. I believe there is definitely a Stigma of others looking at you and trying to figure out exactly what was wrong or why you didn't get matched. Specifically, I recall the faculty at my UME arranging for 2+ "practice interviews" and they seemed quite surprised when they found no obvious defect in my interviewing. My first piece of advice is BELIEVE IN YOURSELF, you are a worthy candidate, there is likely nothing wrong with you, the problem is with CaRMS.

I recall feeling so angry that wanted to approach a newspaper to write a story on this. My dad told me not to do this. I recall a few years later, a University of Toronto unmatched student did just this before committing suicide. https://www.thestar.com/news/canada/2017/06/17/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads.html

I recall being down (although not clinically depressed), and I slept a lot of the day. I recall not wanting to attend graduation, and I only attended because my parents insisted that I go. I recall not feeling joy when I went up to receive my diploma. I lost a year to being unmatched. During this year, I received a Clerkship status from the school so that I could continue doing electives, but I recall that this really sucked, having to do essentially another year of clerkship in the same hospital as all my classmates who were now PGY-1. I did a few rotations, but I recall that I spent a lot of time just sleeping during the day or playing video games. Even matching to Family Medicine the following year was a real struggle, and I perceive that I was viewed as "damaged goods" or with "something inherently wrong with me" (this is my perception, from what I felt, I don't know if it's real).

During my Residency, I had a wonderful preceptor, who told me two things which I believe have served me well since:

The first was "Everything happens for a reason" and the second is "You will get the patients you deserve".

Using these principles, I was able to better accept what had happened to me and find my own version of happiness in life.

I can now reflect on nearly 10 years of being in Practice. Medicine is only half my life (and not my full life as it might have been if I had become a surgeon). I have a lot of free time for family, friends and personal interests. This is possible in family medicine but not surgery.

I can say that overall, I'm happy with where I'm at, I'm happy with work/life balance, and I no longer regret what happened to me (although I do sometimes wonder what the other path would have been like).

I don't try to please every patient, some patients cannot be pleased. I can be who I am, practice (within standard) the way I believe is correct, and the patients that appreciate this will stay with me.

 

I hope that my experiences can support others who go unmatched in the future, and I am also available by DM for people that are unmatched in the future if you want to talk or need support. (although I apologize in advance because I don't check this forum often).

[shikimate]

A lot of idea to chew for med students I find in your story: 

"I believe that more important than your actual skills/knowledge, is how well the Program Director/Residents perceive you and and as such, its very important to use your 2-week elective time to become "buddies" with them"

"there is likely nothing wrong with you, the problem is with CaRMS"

"I was able to better accept what had happened to me and find my own version of happiness in life."

"I don't try to please every patient, some patients cannot be pleased. I can be who I am, practice (within standard) the way I believe is correct, and the patients that appreciate this will stay with me."

[shikimate]

I think the same thing can be said about every step of the process after matching, including fellowship, job, even job advancement and retirement.

basically as much as doctors are goal oriented people and love planning, there will always be unexpected twists and turns. Having an open mind to accept curveball is important. 

I can almost guarantee that in residency and early in career, everyone will struggle at one point in time and question why they're doing what they're doing. I think a bigger question is why have you not found your niche in this ecosystem? The more years you spend in this field, the more doors open and you realize aside from what you learned in med school and residency, there are many sub-specialties and areas where you can exercise your expertise and find satisfaction in what you do.

Also the mindset has changed. The old timers who work 996 until they're 85 and croak 2 months after folding their practice is no longer how people want to work and live.

FIRE is raging amongst physicians and people are paying more attention than ever to things outside their work. Now this is because low funding has effectively shaved the real income (adjusted for inflation) for many years now and generally productivity has not improved. But anyhow, that's a different topic for another day.

 

[Andrew]

First graph is available off google search from http://www.afmc.ca/sites/default/files/pdf/AFMC_reportreducingunmatchedcdnmg_EN.pdf but the report cannot be accessed anymore.

Second graph is directly from CaRMS.

[bearded frog]

3 minutes ago, Andrew said:

You should probably use current data that includes the last 5 years...

[Andrew]

Yes, thank you, I was looking for that exact graph, my bad, I actually went on the CaRMS website, clicked on "data and reports" but it is not easy to find that graph you posted. I remember back in my day they simply had one .pdf with all the relevant graphs, tables and statistics easily readable, now I see the screenshot below under "data and reports" and clicking on each of those subsections brought me nowhere close to the graph you posted. To me it almost seems like they are obscuring data by intentionally making it difficult to find.

Anyway my intention in creating this thread is simply as a place for sharing experiences and support. It looks to me that the magnitude of the problem is becoming far greater (if you can believe I think in my year 2010 there were around 6 total unmatched CMGs after 2nd iteration and the UME basically treated me like an anomaly or rounding error). It's shocking to me to see that in 2022 there were 35+48=83 unmatched CMGs.

I can only hope that UME support has improved and that SOMEONE is working on a way to fix CaRMS.