CaRMS 2024 Full Data is now available

[abcd1288]

https://www.carms.ca/pdfs/carms-forum-2024.pdf

Radiology and anesthesia continue to be a bloodbath this year. Interested to hear people's thoughts and analyses on the data.

[1D7]

Some interesting points:

1. FM remains the most popular choice by far for 1st choice discipline, and positions filled has continued to increase/recover: There has been some doom and gloom regarding the specialty on this forum, but it has successfully staved off attempts to increase its training length and billing codes/payments are stable or increased in most provinces. I doubt NPs will be making a significant dent in the volume of patients available to FMs, considering the situation is much further along in the US and primary care is still in a shortage.

2. Radiology hasn't been this competitive for 20 years or so. There was a large drop in interesting in the late 201X's (both Canada & US), probably related to fears regarding AI and outsourcing of teleradiology. I think a combination of COVID decreasing interest in direct patient interactions, desensitization to the fears of AI/outsourcing, and increasing clinical dependence on diagnostic imaging has led to radiology's popularity bouncing back.

3. Radonc has had an even sharper jump in interest. This field historically had a terrible job market for many years, but from what I've heard the market has drastically improved.

4. Other...

• Home school advantage seems to have returned back to normal levels (peak of 85%, now 76%). I would imagine this is related to away electives being back.
• This year had the highest match rate to top 3 choices (85.6%).
• Trend of fewer unmatched CMGs (1st iteration) changing their first choice discipline for the second round. I suspect students continue to be a bit less fearful of being unmatched now that unmatched pathways are better established in most schools.

 

Quote

Radiology and anesthesia continue to be a bloodbath this year. Interested to hear people's thoughts and analyses on the data.

Anesthesia has always been fairly competitive, this is not really that much different from past years. I think some surgical specialties had less interest than usual which makes it looks a bit worse.

[AnonymousTree]

Seems that many surgical specialties were not as popular this year. Obgyn, urology, gen surg and even ENT had good match rates

[ChemPetE]

Rad onc is a big surprise in the final stats, but I will say the program where I am at had a big demand this year. We actually had fewer applicants than the prior year, but way more local and regional candidates. We had some stellar applicants of which some were very very keen to match to our program, more than we had spots for, and it is was bittersweet to know that we can't take everyone (but such is the life of carms). We are such a small discipline, a small variation year to year can influence things greatly. I will also mention that in years prior where there have been more unmatched spot than not, there is a subsequent year with a glut of applicants (did people see it as an 'accessible' specialty?).

But yes - great surprise that it is the 6th most competitive specialty this past year (ignoring integrated family & peds research tracks).

At the end of the day, with more job availability and the (current) decline in public appeal for family medicine (hopefully this changes), I see it remaining one of the more popular specialties. I do love what I do and it is a pretty sweet and unique gig in medicine.

[MedicineLCS]

4 hours ago, 1D7 said:

FM remains the most popular choice by far for 1st choice discipline, and positions filled has continued to increase/recover

Some of this is programs playing tricks in round 1. This was discussed at the forum but essentially Ontario and Alberta programs used the reversion tool to match IMGs they would have matched in round 2 in round 1. They have also were more aggressive in recruiting IMGs this year, the trend is that the number of IMG matches to FM is set to almost double in 5 years (2020 to 2025) if the trend continues. There is some relief in that CMG interest didn't decline more this year (went up slightly) but it's still less than 10 years ago by a not so healthy margin. My discussions with residents and classmates doing FM as well is there's a deep aversion to generalism and longitudinal for most. Lots of people interested in niche work and EM/Hospitalist though...

What's notable to me is we see the same pattern each year; panic/complaining/anecdotes about lack of interviews in whatever discipline it is (radiology, IM, etc...) And then the CaRMS data comes out and it's either a very small change OR got less competitive. The lesson to any clerk reading this is that don't trust everything you read on the internet (only the CaRMS report, pages 69-71 to be exact). 

 

 

[hero147]

4 hours ago, 1D7 said:

Anesthesia has always been fairly competitive, this is not really that much different from past years. I think some surgical specialties had less interest than usual which makes it looks a bit worse.

It is definitely becoming more popular but this is also backed up with an increase in spots nationwide likely in response to the anesthesia shortage we have. Hence why some people may think its been getting more competitive. 

[shikimate]

it's really stupid they changed the name of pathology specialties, and haven't done a thing to merge the 4 pathology specialties into 1. Med students can't even decide on 1, let alone 4.

also the low salary is a big deterrent. People might notice pathology in QC is quite popular. That's because they are FFS and you can make 600K+, as much as surgeons. Compare to meager 375K in ON, 380K in BC (less than the new FM deal, mind you). 

 

[abcd1288]

55 minutes ago, shikimate said:

it's really stupid they changed the name of pathology specialties, and haven't done a thing to merge the 4 pathology specialties into 1. Med students can't even decide on 1, let alone 4.

also the low salary is a big deterrent. People might notice pathology in QC is quite popular. That's because they are FFS and you can make 600K+, as much as surgeons. Compare to meager 375K in ON, 380K in BC (less than the new FM deal, mind you). 

 

I think the US combined AP/CP into 1 specialty, but hematopath and neuropath are still separated? Honestly, I didn't even know neuropath is its own specialty. 

[ChemPetE]

All I know is dermpath rakes it in the US apparently. We lost ours to the states 

[Findanus]

5 hours ago, shikimate said:

it's really stupid they changed the name of pathology specialties, and haven't done a thing to merge the 4 pathology specialties into 1. Med students can't even decide on 1, let alone 4.

also the low salary is a big deterrent. People might notice pathology in QC is quite popular. That's because they are FFS and you can make 600K+, as much as surgeons. Compare to meager 375K in ON, 380K in BC (less than the new FM deal, mind you). 

 

The pay being so low in Ontario is due to the community hospitals affiliating themselves with one of the various academic centers. This allows them to insource foreign trained pathologists at cut rates, without them having to earn Canadian qualifications, because educational/academic licenses can be used to circumvent the expected criteria.

It's not worth the liability to practice pathology in Ontario.

I'm glad pathology put the word diagnostic in there. It's about time, as far as I'm concerned.

Canadian students interested in pathology should only pursue DCP because it gives you clin path certification, which allows you to cross the border more easily. More leverage.

 

 

 

[shikimate]

We should've just adopted the APCP name, make HP and NP fellowship only like US.

DP can be lucrative, but it's not the gold mine it used to be. Every 2 years I read about CMS cutting rates in US. You'll still have the top dogs at UCSF making a kill with consults but for 99% of other folks it's been a battle trying to make up the cuts by reading more slides or hiring junior non-partners with questionable skills.

UHN is notoriously bad for getting a million IMGs as fellows, mostly Arabic and African. They'll work them like a donkey for few years paying them 90K while getting 500K in RVU out of them. They're tied to UHN because that's the only way for them to keep their visa and eventually after they squeeze them dry they allow them to write the Canadian exam and then go work at another academic center. 

And not to mention the CMPA rates for pathology in ON is atrocious, just check line item 21 on their fee schedule. How many mistakes are pathologist making in ON?

DCP is great but most students have their brain washed that they have to do AP then 2 fellowships just to find jobz otherwise they can't signs out an appendicitis without a GI fellowship. Plus the DCP at Mac doesn't have a great reputation so that kinda puts off ON students from doing DCP and there are no other programs in ON. The DCP programs out west are great as far as I've heard. The DAL DCP program is also solid and pumps out practice-ready residents that are in HIGH demand on the east coast.

[jb202]

Plastic Surgery and Dermatology still extremely competitive. No change there. Not sure what to make of that integrated emergency medicine and family medicine position (personally I don't think that should be a thing). Interesting to see surgical specialties have less interest ie. ENT become less competitive, and Urology. Rad Onc increasing in competitiveness too.

Anesthesia seems to have increasing interest, but doesn't look like a blood bath to me, but I'm just looking at page 111.

[1D7]

26 minutes ago, jb202 said:

Plastic Surgery and Dermatology still extremely competitive. No change there. Not sure what to make of that integrated emergency medicine and family medicine position (personally I don't think that should be a thing). Interesting to see surgical specialties have less interest ie. ENT become less competitive, and Urology. Rad Onc increasing in competitiveness too.

Anesthesia seems to have increasing interest, but doesn't look like a blood bath to me, but I'm just looking at page 111.

What's wrong with the integrated FM+EM integrated position? Lots of specialties started out that way and then it became the standard (e.g. many surgical specialties once required GSx training first). It does make the 5 year FR pathway less appealing, but perhaps it's the need for 5 years of training that should be questioned, when the American pathway is 3 years.

The reduction in surgical interest is probably an anomaly.

[hero147]

25 minutes ago, 1D7 said:

What's wrong with the integrated FM+EM integrated position? Lots of specialties started out that way and then it became the standard (e.g. many surgical specialties once required GSx training first). It does make the 5 year FR pathway less appealing, but perhaps it's the need for 5 years of training that should be questioned, when the American pathway is 3 years.

The reduction in surgical interest is probably an anomaly.

Depends I think. If most graduates of that program just do emerg full time, then one has to wonder what the point was to spend so much time doing fam med training? If most graduates do a mix of family med and emerg, it makes more sense. 

[jb202]

11 hours ago, hero147 said:

Depends I think. If most graduates of that program just do emerg full time, then one has to wonder what the point was to spend so much time doing fam med training? If most graduates do a mix of family med and emerg, it makes more sense. 

Whats the point of this pathway if you can do FM then do a FM+1 in emergency? 

[hero147]

11 hours ago, jb202 said:

Whats the point of this pathway if you can do FM then do a FM+1 in emergency? 

Seems much less stressful to just be preselected/guaranteed for the +1 in emerg rather than worry about applying when youre in residency. 

[abcd1288]

1 hour ago, hero147 said:

Seems much less stressful to just be preselected/guaranteed for the +1 in emerg rather than worry about applying when youre in residency. 

Also seems that these programs are offered at Dal only, which is reflective of the physician shortage in the Nova Scotia/St. John's/New Brunswick region.

[shikimate]

honestly they should put up more of these FM+EM options because we are begging regular FM to cover our ER these days. Would help a lot of these unmatched CMG too

[Sceptical]

On a similar note, perhaps there should be more programs like the new Queens MD-FM rather than let CMG FM numbers be decided during CARMS. 

[CGreens]

6 hours ago, Sceptical said:

On a similar note, perhaps there should be more programs like the new Queens MD-FM rather than let CMG FM numbers be decided during CARMS. 

On this note, I think a combined three year MD program (like McMaster) with automatic entry into a 2 year FM residency program associated with the program would be ideal. Total would be five years and you can start training the students from day one knowing that they will be family physicians and that the students have self-selected to be family physicians. One incentive to this model of course would be shaving a year off of training compared to the traditional 4+2 programs. 

[abcd1288]

27 minutes ago, CGreens said:

On this note, I think a combined three year MD program (like McMaster) with automatic entry into a 2 year FM residency program associated with the program would be ideal. Total would be five years and you can start training the students from day one knowing that they will be family physicians and that the students have self-selected to be family physicians. One incentive to this model of course would be shaving a year off of training compared to the traditional 4+2 programs. 

The other potential issue is that this approach doesn't prevent students from pursuing FM+1, which is what quite a bit of burned out FM physicians are doing. The government needs to make FM more appealing, yet they choose to hamper down on anti-physician and insist on bringing in FMGs to solve this issue.