Does CaRMS consider which school you went to?

[Kayla]

I'm weighing three options. One is significantly less costly, all international as I'm living internationally but I would like to return home to Canada in the future. Does CaRMS consider which school you went to when matching? Will my choice of school impact my chances of matching in any way?

[anonymouspls]

I've heard some rumblings that CSAs at Australia / Ireland / Western Europe are preferred over CSAs that went to Caribbean. For Caribbean, the big 4 is preferred over the rest of the Caribbean schools.

No matter what tho it will be harder to match compared to CMGs and significantly harder to match to anything beside family medicine / pathology. With the new rules and how easy it is to go from US --> Canada for physicians now, you may want to consider doing residency in the US as well (IMG have better luck there than in Canada) and coming to Canada after. 

[cinnamonstick]

I'm curious- knowing that USMD's will be considered IMGs starting 2026, is it possible that the school name will start to matter more for IMGs in the future? I'm just thinking it might be weird to lump all IMGs together when some might've gone to Harvard/ Yale/ etc.

[zoxy]

16 minutes ago, cinnamonstick said:

I'm just thinking it might be weird to lump all IMGs together when some might've gone to Harvard/ Yale/ etc.

Harvard/Yale grads will not be applying to IMG spots in Canada, which are primarily FM spots in most of Canada. Take a look at the match list for any of those schools, they are very impressive. I doubt you'll find a single FM match for those schools. Yale and Harvard don't even have FM residency programs at their main teaching hospitals.

[When the Moon Forgot]

I attended one of such schools in the US. We definitely do apply for and end up at residency programs in Canada, just not in great number. The change will definitely dissuade us from coming back to Canada unfortunately. Unclear as to how Canadian residency programs will view USMDs going forward after the change though, as we will no longer be considered in the same pool as CMGs. My guess is that within the IMG pool, Canadian residency programs will continue to show strong preference for USMDs. I know of USMDs ending up at FM, gen surg, plastics, psych residency programs in Canada. A list of sample American medical schools includes Harvard (x1), Hopkins (x1), Duke (x1), George Washington (x1), Wayne State (x2), and Dartmouth (x2). It's usually around 10-15 each year. A Canadian friend of mine matched into emerg in the US. He/she probably regrets that decision now considering the abysmal job market for emerg docs in the US.

There are certainly students at these top institutions going into FM -- usually a handful. You can find their match lists here: https://forums.studentdoctor.net/threads/official-2023-match-lists.1476900/

It's usually about 2-3 per year from Harvard and Hopkins. Hopkins had 5 people going into FM in 2021, one of which matched at U of T.

[bearded frog]

5 hours ago, Kayla said:

I'm weighing three options. One is significantly less costly, all international as I'm living internationally but I would like to return home to Canada in the future. Does CaRMS consider which school you went to when matching? Will my choice of school impact my chances of matching in any way?

Programs in CaRMS very much consider the medical school that an IMG graduates from. As discussed above, the Yale graduate is going to be considered differently than Sackler, who will be considered differently from St. George's, who will be considered differently than a non-top 4 Caribbean school, etc.

Also today I learned that Israel is no longer going to be accepting foreign students which had a very good match rate in the US at least.

[rmorelan]

6 hours ago, bearded frog said:

Programs in CaRMS very much consider the medical school that an IMG graduates from. As discussed above, the Yale graduate is going to be considered differently than Sackler, who will be considered differently from St. George's, who will be considered differently than a non-top 4 Caribbean school, etc.

Also today I learned that Israel is no longer going to be accepting foreign students which had a very good match rate in the US at least.

Interesting - did they say why anywhere? 

 

[shikimate]

15 hours ago, zoxy said:

Harvard/Yale grads will not be applying to IMG spots in Canada, which are primarily FM spots in most of Canada. Take a look at the match list for any of those schools, they are very impressive. I doubt you'll find a single FM match for those schools. Yale and Harvard don't even have FM residency programs at their main teaching hospitals.

I never checked those before and when I saw that Yale had 12 derm matches and only 2 FM matches, I was like yeah no Yale grad will be applying for our Rural FM spots with ROS agreements lol.

[bearded frog]

6 hours ago, rmorelan said:

Interesting - did they say why anywhere? 

 

https://thecjn.ca/news/israeli-medical-schools-are-closing-to-canadian-students-and-all-other-international-ones-starting-next-fall/

Sounds like one a few measures to address a domestic doctor shortage.

[zoxy]

3 hours ago, shikimate said:

I never checked those before and when I saw that Yale had 12 derm matches and only 2 FM matches, I was like yeah no Yale grad will be applying for our Rural FM spots with ROS agreements lol.

Even 2 is more than I expected. I think NYU had 0 FM matches a few years back. If I recall correctly, it was the first graduating class that benefited from free tuition for all 4 years.

You always have people who say they would have considered primary care, if they had less medical school debt. I think the evidence points to this not being true.

[rmorelan]

17 hours ago, zoxy said:

Even 2 is more than I expected. I think NYU had 0 FM matches a few years back. If I recall correctly, it was the first graduating class that benefited from free tuition for all 4 years.

You always have people who say they would have considered primary care, if they had less medical school debt. I think the evidence points to this not being true.

There are a lot of confounds there - first it is the US the gap between family and specialist income is even higher, I would argue the actual job is worse just because of the system you operate in, it takes longer to train in the US for family medicine even with the bump coming here, and there aren't the same legal protections. Of course there are also some people attaching less prestige to the field - which I suppose in the US to date does make some logical sense as their objective system for grading people did have the higher performing students academically accessing other fields.  The loan situation is just adding to that - you have a multi-factorial problem so fixing just one part of it isn't going to solve anything. They probably did consider primary care more than others at other schools may have, but that doesn't mean it would translate to them actually doing it. 

When I was at Harvard and I ran into the same thing or something similar I think - everyone I happened to run into was very much aiming for one of the higher paying fields but it didn't seem to be about the money as much (if so they wouldn't be so many doing years of phd work resulting in correspondingly years of lost income, or going for academic practice with lower income either). That even came out in some of the practice interview sessions we had (hint, putting down any other field in medicine is a great way to not match to the one you are going far.) 

I think a stronger argument for lower tuition is just you get better doctors as you can draw from a larger population of students - Equality of opportunity, although particularly in the US you probably need to fix a large number of steps way before the med school to really pull that off. 

 

Edited May 3, 2023 by rmorelan

[indefatigable]

There are definitely confounders as Internists  do primary care in the US and have the same length of training as FM.  There are also literally twice as many IM vs FM residency position in NRMP (9380 vs 4916) vs CaRMS which has the opposite ratio (538 vs 1629).  So a priori one should expect more IM vs FM matches in the US including at top schools (NRMP, CaRMS).  

For example, the 3-year NYU accelerated MD has a "Primary Care" track but it's through Internal Medicine and there's no Family Medicine there (NYU).   FM in Canada is a successor of GP, but still retains a lot of those generalist characteristics, with hospitalists, GPA, etc,.whereas IM in Canada has much less outpatient.  Patients can't self-refer to specialists in Canada, whereas they can in the US.    

That being said, although FM is near the bottom of the pay scale at the US, it's not very different from IM - perhaps because IM in the US has more of a primary care component, I'm not really sure.  In Canada, IM in some provinces is much better paid than FM i.e. the pay gap is even larger.  Anything surgical in the US is well-paid, as well as gastro/cardiology/derm/radiology..  In Canada, ophthalmology, radiology and cardiology are generally tops - cardiology is one of the highest paid in the US as well.

https://www.medscape.com/slideshow/2022-compensation-overview-6015043?icd=login_success_email_match_norm#3

[zoxy]

6 hours ago, indefatigable said:

There are definitely confounders as Internists  do primary care in the US and have the same length of training as FM.  There are also literally twice as many IM vs FM residency position in NRMP (9380 vs 4916) vs CaRMS which has the opposite ratio (538 vs 1629).  So a priori one should expect more IM vs FM matches in the US including at top schools (NRMP, CaRMS). 

That being said, although FM is near the bottom of the pay scale at the US, it's not very different from IM - perhaps because IM in the US has more of a primary care component,

Yeah, I know that many primary care doctors in the US are IM trained vs FM trained and that FM is considered to be the less "rigorous" option, whatever that means. But many elite US schools tout that 30% or even higher of their class chose to do primary care when ignoring the fact that if you look 4 years after graduation, the vast majority of those folks will be in fellowship of some sort. Yet the schools will include a future Cardiologist as a primary care provider.

As for IM as primary care, the majority of rotations for primary care IM is still inpatient medicine. If interested, you can comapre the Brigham's Primary Care IM residency rotations to UCSFs FM rotations. You'll find that the FM training is much closer to what we'd consider primary care in Canada. 

https://imacademics.brighamandwomens.org/primary-care-dgm/

https://fcm.ucsf.edu/curricular-structure#Year-One

 

[indefatigable]

2 hours ago, zoxy said:

As for IM as primary care, the majority of rotations for primary care IM is still inpatient medicine. If interested, you can comapre the Brigham's Primary Care IM residency rotations to UCSFs FM rotations. You'll find that the FM training is much closer to what we'd consider primary care in Canada. 

https://imacademics.brighamandwomens.org/primary-care-dgm/

https://fcm.ucsf.edu/curricular-structure#Year-One

 

I'm actually less convinced by those schedules.  A lot of the IM "Primary Care" track seems to be more what some FPs do in Canada - e.g. addiction, homeless, indigenous,  LGBTQ care..  I don't see IM doing that in Canada commonly.  I do agree that the the IM Primary Care more hospital/in-patient based but obviously doesn't include any obs/gyn, surgery or psych which is a component of FM training.

FM training in Canada is variable across different programs.  e.g. Prince George at UBC (more acute/inpatient including multiple ER, CTU blocks, ICU, but also addictions,Native Health etc..) under Site information & Sunnybrook FM (maybe a bit closer to the UCSF FM curriculum but more geriatrics/palliative vs newborn/L&D )

https://carms.familymed.ubc.ca/training-sites/prince-george/

https://www.dfcm.utoronto.ca/sunnybrook-health-sciences-centre-0