CaRMS changes pending

[Guest thelaze]

Looks like the rumors were based in some fact: things are changing for next year's match. This is an open letter sent to us by our MedSoc from Dr. Joshua Tepper, Assistant Deputy Minister of the Health Human Resources Strategy Division at the MOHLTC:

 

Dear Medical Student

 

I am writing to provide you with information on the future of the national residency match, administered annually by the Canadian Residency Matching Service (CaRMS). I appreciate that you may have concerns with any changes and want to ensure that you have early and clear information.

 

Next week, the Association of Faculties of Medicine of Canada (AFMC) is expected to no longer restrict the first iteration of the match to graduates of Canadian and other LCME accredited medical schools (i.e. most US schools). If this happens, it would impact the 2007 residency match. We are working collaboratively with our provincial counterparts to preserve a national unified residency match process. Ontario has no plans to change our current approach to providing dedicated residency opportunities for both Ontario graduates and international medical graduates (IMGs).

 

I want to reassure you that the Ontario government considers our medical school graduates a cornerstone of our future health care system. I know that there has been concern about the impact of any changes on the career options of Ontario’s graduates. That is why I want to make it clear that regardless of AFMC action, the Government of Ontario will continue to guarantee that there will be at least as many residency positions available in Ontario as there are graduates from Ontario medical schools.

 

International medical graduates also make an important contribution to Ontario’s medical community. To ensure that IMGs have reasonable access to training opportunities and can contribute to alleviating Ontario’s physician shortage, we will continue to offer 200 dedicated positions to IMGs separately from those for our own graduates.

 

You are critical to meeting the future medical needs of the people of Ontario. The Ministry will be certain to keep you informed of any changes that may affect you.

 

Sincerely,

 

Dr. Joshua Tepper

Assistant Deputy Minister

Health Human Resources Strategy Division

[Guest UofA man]

So is the minister saying that the rest of Canada is going to allow IMGs in the first round while Ontario is going to stay with the status quo?

 

To me, sounds like he is saying that Ontario will work with the other provinces as long as they follow Ontario's rules, IMGs and CMGs will be in seperate matching processes. If AFMC decides that there is no restrictions for IMGs then Ontario will go on its own way. Does this sound right? or am I missing something...

 

Thanx Thelaze for keeping everybody up to date....

[Guest therealcrackers]

The unspoken part of Dr. Tepper's little letter is that they don't have a strategy to deal with the bottleneck; doesn't look like they're going to increase the number of residency spots which is what they really need to do. However, in order to do that, they'd have to increase the number of community hospitals involved. Time spent teaching in a community hospital cuts into the fee for service income of the docs. So unless they're willing to pay the community docs for teaching, or put everyone on an alternative funding plan, the schmozzle that is CaRMS with a VERY small excess of available spots will continue. Or get worse if the IMGs are included...

[Guest ssc427]

It will be interesting to see how this all unfolds.

 

If the floodgates are opened to everyone I think it would be sensible to implement a licensing exam prior to residency placement. This would act as a ‘leveller’ as it does in the US. There I think both US grads and FMGs are expected to pass the USMLE first, and indeed many of the FMGs who match in the US do well on the test which is why they edge out their American trained counterparts.

 

From what I understand in Canada most FMGs who match currently do not need to write MCCQE until 1st year of residency.

[Guest moo]

This sounds like it could be a parallel match system. Dedicated spots for C/AMGs. Separate spots for IMGs. I just hope that they don't restrict IMGs to only FM. That would be really unfair.

[Guest Kirsteen]

Hi there,

 

This is a timely post. Last week, while in Toronto on elective I ran into a UofT med student who noted that he had heard that, as of this coming CaRMS round, IMGs were going to be permitted to apply to the first round of the match. I'm not sure where he had heard this information but I found it hard to believe. I am biased (obviously) but hoping that it will not happen this year and that some warning is given to Canadian medical students when/if it does. I'd assume that the USMLE would become a more popular exam than it is currently.

 

Cheers,

Kirsteen

[Guest Jazz]

Hello,

 

I am surprised no one has mentioned this at my school (UBC) yet. My class wouldn't do the carms thing until 08, but allowing IMGs into the 1st round changes EVERYTHING! It would not be hard to imagine the unmatch rate going up multiple times for Canadian grads. Shouldn't CFMS protest against this?

[Guest thelaze]

The CFMS has been active in adding its voice to this discussion, along with CAIR. They've been in contact with the AFMC and have been letting us know what's been going on.

 

Here's a position paper on IMG's in the match written back in 2003 that's on the CFMS website

[Guest UWOMED2005]

Nobody should be surprised by this move to include IMGs in the first round.

 

Why?

 

1) federal and provincial govt's have been campaigning for the last few years on helping to solve the doctor shortage by utilizing 'all those doctors trained in other countries and now driving taxis and delivering pizzas in Canada'

 

2) If you've been paying attention, you'd realize there's been at least one recent court case looking at the constitutionality of excluding IMGs in the first round. Manitoba has had to include IMGs in the first round for at least or year or two now. . . as dictacted by the courts.

 

If you think about it, this (unfortunately for the Canadian grads) makes sense. What we've been saying for years was a two-sided message: 1) That foreign trained grads were at least good enough to participate in CaRMS BUT 2) These people should be be put at a significant disadvantage based on nothing more than being foreign trained - ie we won't let them compete with everyone else and let the program directors decide.

 

Doesn't sound all that a) constitutional and Canadian

 

We have had a system setup to protect Canadian grads. And it shouldn't surprise people it's been challenged.

 

Ideally, IMGs shouldn't be exposed to the Canadian residency system at all! We should have some alternative system designed for them so this isn't an issue at all.

[Guest satsumargirl]

1) federal and provincial govt's have been campaigning for the last few years on helping to solve the doctor shortage by utilizing 'all those doctors trained in other countries and now driving taxis and delivering pizzas in Canada'

 

But unless they increase the number of spots accross the various specialties, allowing IMGs to participate in the first round of Carms really doesn`t help solve the shortage problem.

 

Does anyone know if the number of spots will be increased as part of the plan.

 

From the post above it sounds like at least Ontario plans of keeping the number of available spots equal to the number of Ontario grads.

[Guest UWOMED2005]

The other question that has to be asked is:

 

How much will this change matter?

 

Seriously.

 

The continual fear I hear from medical students is that a Romanian opthalmologist with 10 yrs of experience will come in and steal all the ophthalmology spots, ditto a Chinese dermatologist for derm, ditto a South African for radiology, etc.

 

I don't buy it. As I previously stated, Manitoba has had to have IMGs in the first round for the last few years. I don't think the PGY-1s in plastics, ophtho, derm, emerg, radiology, ENT are all IMGs.

 

Program directors usually feel more comfortable with a KNOWN quantity. Most of the applicants to any given program will make excellent residents. Getting the "best" candidate (particularly if there's any risk) is less important than getting a NOT getting a screwup.

 

Many IMGs are phenomenal. Many are not. And it's sometimes hard to figure out. I spent two years in South Africa - in my honest opinion, most of their medical schools offer a clerkship experience SUPERIOR to that in Canada - there's more time in clinical training, and more of a spirit of independence for the clerks. . . clerks and interns (ie PGY-1 GP residents!) regularly perform C-sections, appendectomies, etc.

 

But I also happen to know there are a few schools in SA that are newer, have radically different curriculum. . . and many of the SA docs I worked with were so-so on these school's graduates. I know about this because I spent time in South Africa. If I'm a Program Director who doesn't have the time to do that research, do you think I'm going to want to take the time to try to figure that detail out? Or take the safer bet close to home who is more of a known quantity?

 

Imagine this same phenomenon in play when trying to assess IMG applicants from across the globe. How the heck is a program director supposed to remember if Azerbaijan has better medical schools than Thailand? Or Nepal? Not to mention a great medical school does not a great resident make. Ooh - What a headache!

 

I'm sure some IMGs will do quite well in the 1st round. As they should - like I said, I worked with a number of young South African doctors who would make fantastic residents in Canada, if they so chose. And I've worked with excellent IMG residents from elsewhere as well. But I don't think the effect will be as great as imagined.

[Guest UWOMED2005]

But unless they increase the number of spots accross the various specialties, allowing IMGs to participate in the first round of Carms really doesn`t help solve the shortage problem.

 

I always find it interesting to watch premeds go on and on about med school spots. . . not worrying about the QUALITY of those spots. Then they get to medical school and point out to the premeds that rapdly increasing spots might affect quality.

 

It's likewise for medical students and residency spots.

 

I sit on numerous committees at U of C. There is some concern here that it may difficult for some programs to handle anticipated increases in CaRMS spots as well as non-CaRMS IMG spots. If there aren't enough preceptors and patients, residency programs will suffer. And Calgary has a better population-to-resident+med-student ratio than many schools in Canada.

 

Be careful what you wish for.

[Guest Kirsteen]

Hi there,

 

On this note, while in Toronto on a General Surgery elective I was working with a resident (incidentally, who was excellent re: his clinical knowledge and interpersonal skills) who was admitted to the UofT Gen Surg program last year via an IMG stream. He hails from Africa originally and noted that UofT accepted a couple of folks via this IMG stream to the program last year. Although last year's CaRMS site noted that UofT offered 10 Gen Surg spots, he mentioned that 12 people were accepted to the program (the two extras coming from schools exterior to North America).

 

Maybe I had my head in the bushes last year, but was there an announcement that Ontario/UofT was accepting IMGs in the first round of CaRMS?

 

Cheers,

Kirsteen

[Guest ssc427]

2) If you've been paying attention, you'd realize there's been at least one recent court case looking at the constitutionality of excluding IMGs in the first round. Manitoba has had to include IMGs in the first round for at least or year or two now. . . as dictacted by the courts.

 

Where are people getting this info about Manitoba? Both CaRMS and the UofM website say that IMGs can only apply in the second round. Quick bonehead searches in google didn't reveal anything about this court case either. Do you know of a press release or something people could look at? I'm interested in the details of the case.

 

That foreign trained grads were at least good enough to participate in CaRMS BUT 2) These people should be be put at a significant disadvantage based on nothing more than being foreign trained - ie we won't let them compete with everyone else and let the program directors decide.

Doesn't sound all that a) constitutional and Canadian

 

So there will not be a distinction between Canadian citizen IMGs and non-Canadian IMGs? This does not seem right. I don't understand why you think the current system isn't constitutional. Most medical schools don't admit non-Canadians. Is that non-constitutional? In fact, most Universities period have different streams for international students. Is that non-constitutional? They're funded by Canadian tax dollars, so shouldn't they be given preferentially to the people paying for the education? Same is true for residency.

[Guest UWOMED2005]

I cannot claim to be an expert in IMG training options. My understanding is that this topic is actually quite complicated.

 

My understanding is that Ontario historically has had an entirely separate stream for IMGs - ie IMGs don't use CaRMS. Many of the other provinces allowed IMGs into CaRMS. I know here in Alberta there are both options: U of C family medicine currently has 6 spots assigned specifically for IMGs, then a slew of other spots for CaRMS spots. . . which IMGs might be eligible if they took that route. I remember talking to a South African and Ethiopian IMG here about it to clarify, but the system is quite complicated and I am not an expert on the details.

 

The court case in manitoba was sometime around 2002/2003/2004. I received information through the CFMS about it. My understanding was the final resolution was allowing manitoba IMGs access to the first round. Out of curiosity I looked at some fo the match statistics for this year. As I am neither an IMG nor from Manitoba I didn't investigate further. This was a few years ago so I don't remember the exact details. . . you'll have to use something a little more sophisticated than google to get further info.

 

Few IMGs who go into Canadian residency programs use it as a launching pad for careers into other countries. . . the exception being some countries like Saudi and Kuwait who fund us to train their residents. That's different - those residents don't use CaRMS or the IMG stream. . . they have a separate arrangement made by their country.

 

We are looking here at 3 types of CaRMS applicants:

 

1) Canadian born, Canadian citizen, trains at Canadian school

 

2) Canadian born, Canadian citizen, trained abroad

 

3) Foreign born, Canadian citizen or landed immigrant, trained abroad

 

ALL are Canadians now. All are doctors.

 

Foreign doctors generally do NOT come to Canada just for residency. . . not even to just work here for a few months. If you're willing to go through the @#%$ to get licensed here, it's only worth it if you plan on working here permanently. When I worked in South Africa with SA docs. . . that was the big deterrent to trying to work in Canada. Many SA docs will work for a year in Australia or England than return. . . the ones that move to Canada do it to stay. It's not worth it otherwise!

 

By allowing IMGs the second round, you are saying they are all good enough to train and become doctors in Canada.

 

But by banning some from the second round only because they trained elsewhere and not allowing them to compete of their own merits. . . that sounds like discrimination.

 

Personally, I think there should be 2 entirely separate streams: CaRMS (specifically for grads of Canadian schools without question) AND an entirely different system of training/accreditation for IMGs (both Can born and otherwise) who have either finished foreign residencies are not. . . and BOTH streams should have opportunities to accredit for ALL specialties.

 

But that's just me.

[Guest marbledust]

and BOTH streams should have opportunities to accredit for ALL specialties.

 

I agree this would be the ideal situation. But how could something like this possibly work--how would the spots in each specialty be divided up in a logical and fair way? For example, if a school has 2 Emerg spots what would happen? Would 1 be open for Canadian grads and 1 for IMGs? That would, on paper at least, be the fairest way to do things. But what happens when there is only 1 derm spot up for grabs?

 

I know that is one of the models under consideration, but I don't see how it would work without a whole lot of controversy. Think of the relatively minor stink raised by certain soon-to-be U of T grad and multiple it by many others when prime speciality/location spots are taken away from Canadian grads. Just speculating....I don't really have an opinion on it either way right now.

[Guest UWOMED2005]

Think of the relatively minor stink raised by certain soon-to-be U of T grad and multiple it by many others when prime speciality/location spots are taken away from Canadian grads.

 

Ok, this might be playing semantics, and many might disagree with me. I don't see why it is that us Canadian medical school graduates feel we should be entitled to the residency of our choice. These aren't "our spots" to be taken away. . . they're the program's spots to assign. . . to the best candidate* as they see fit.

 

Why do we medical school graduates feel we should be entitled to the residency spot of our choice? Is it because of the debts we assume? MBA students take on similar debts with no guarantee of employee. Likewise law students aren't guaranteed the articling of their choice, or that their practice will be successful.

 

Besides, like I already argued I don't think this will have the impact med students think. Yes, some additional spots will go to IMGs. But I would hazard to guess for most directors, if there is a qualified Canadian applicant from a medical school whose product their familiar with they would prefer this to candidate who went to a medical school they're not familiar with as that would be a bit of a risk. . . even if the school had a good reputation and/or was from a country with a reputation of having good medical schools (ie UK, South Africa, USA, etc.) We already see this phenomenon in play here seeing as (on average) more spots in the competitive specialties tend to go to students from the home school than students from other schools (though, yes medical students often do match to residency programs at schools other than their own.)

 

* caveat - this should be the best candidate likely to practice in Canada. Considering our doctor shortage, I would agree that we shouldn't be training docs for the rest of the world - but I've already discussed the fact residency applicants typically aren't planning on practicing elsewhere.

[Guest ssc427]

I don't see why it is that us Canadian medical school graduates feel we should be entitled to the residency of our choice.

 

I don't think Canadian medical students are entitled to the residency of their choice. But I do think they are entitled to residency. This is of course providing they demonstrate adequate planning and sense. The UofT case is one where the student did not plan very well. With a 1:1 ratio of medical students : res spots it seems ridiculous to introduce 600+ additional applicants. What do you propose to do with the Canadian med students who are left unmatched? This seems like an awful waste of tax dollars to train these people through their MDs and have them head south (the most likely path for unmatched Canadians).

[Guest peachy]

I don't see why it is that us Canadian medical school graduates feel we should be entitled to the residency of our choice.

I certainly don't expect we should be "entitled" to the residency of our choice, but I do believe that we ought to have a reasonable shot at the residency of our choice, or at least at some residency other than family, if that is what we want. (I'm NOT knocking family, I'm just saying that isn't good to have students forced into one particular specialty.) I mean, areas that are hypercompetitive, like ophtho or plastics are one thing entirely. But for huge areas that edge into primary care like pediatrics or internal or obgyn or psych? I think it's reasonable to expect that most (not all, but most) of the students who want that as their first choice should be able to get it. And with the ratio of spots to applicants potentially dropping to less than 1:1, this seems less and less likely.

[Guest marbledust]

I don't see why it is that us Canadian medical school graduates feel we should be entitled to the residency of our choice. These aren't "our spots" to be taken away. . . they're the program's spots to assign. . . to the best candidate* as they see fit.

 

It's easy to feel this way after one has matched. If you were in the classes of 2007 or 2008 would you have the same opinion? Or if you had been going for something more competitive than family medicine? I don't really have an opinion on the issue either way--but I already have a residency spot, so Monday morning quarterbacking is very easy. If I was graduating next year, I would probably be getting worried right now :rolleyes

 

As for having the residency of your choice, I have mixed feelings on that. Having gone through carmage, I don't think it is the ideal system. And of course its isn't possible or practical to give everyone their spot of choice. However, after investing a considerable amount of time and money, I do feel I was, to a certain degree, entitled to at least apply to all the available residency spots of my choice. And I do feel intitled to a residency spot (not in a specific location or speciality) so that I actually can practice in Canada some day.

 

But another side to this is that Canadian medical grads are very heavily subsidized by the government through all stages of training. IMGs aren't. So if that perspective is taken, then yes I feel that Canadian grads should be entitled to residency spots ahead of IMGs. I'm not slagging IMGs. I just think they need to be brought into the system outside of a formalized match. The problem is I don't know how that could be done either

[Guest satsumargirl]

I sit on numerous committees at U of C. There is some concern here that it may difficult for some programs to handle anticipated increases in CaRMS spots as well as non-CaRMS IMG spots. If there aren't enough preceptors and patients, residency programs will suffer. And Calgary has a better population-to-resident+med-student ratio than many schools in Canada.

 

Certainly I was not suggesting that the number of residency spots be increased at the expense of the quality of the programs. I was not even suggesting that the number of residency spots be increased.

 

I was merely pointing out that if allowing IMGs to compete in the first round of Carms is an attempt to help solve the shortage of physicians...then it doesn`t help the problem as the numbers will stay the same if the actual number of spots remains the same.

[Guest UWOMED2005]

I figured I'd take some flack for some of my comments.

 

It's easy to feel this way after one has matched. If you were in the classes of 2007 or 2008 would you have the same opinion?

 

Actually, when I first heard about this IMG in the 1st round issue back in the middle of medical school - I had to admit to myself I could understand the argument that it was unfair to restrict them from the 1st round.

[Guest marbledust]

I figured I'd take some flack for some of my comments

.

The flack was directed at your comments--not you personally

[Guest UWOMED2005]

Likewise, my comments about entitlement are directed at observations while in medical school, rather than anybody specifically posting here.

 

Two last pts concerning the following quote:

 

With a 1:1 ratio of medical students : res spots it seems ridiculous to introduce 600+ additional applicants.

 

a) actually, those 600+ additional applicants are already part of the match. The reality is they're just given a relatively unfair disadvantage of being excluded until most of the spots are gone.

 

Canadian medical grads will always have what I consider a fair advantage: they are from schools program directors are familiar with!

 

I think the point some responders are missing is . Take a look at how Canadian grads do in the 2nd round - the vast majority match to one of their choices, despite being outnumbered by IMGs!! The 2nd round Canadian applicants who enter the match are currently competing in an environment where IMGs are not restricted. Most match to what they want (albeit, of what's left.) If 2nd round Canadians do fine against the IMG ophthalmologists, plastic surgeons, orthopods, OBGYNs, etc - why do you think 1st round Canadians won't!?!

 

Trust me, because they are often "unpredictable"* program directors are wary of IMGs. Rightly or wrongly. You are not going to see the scenario you're worried about!

 

* Personally, I have worked both with outstanding and less than outstanding IMGs. The point is that for program directors, it's difficult to predict whether an IMG will be good or not - so many would prefer not to take the risk!

[Guest PhantomPhoenix]

This to me looks like an attempt to duplicate the American system. The likely outcome with be more residency positions in the future, in which case the number of residency positions will be eventually significantly greater than the number of canadian medical graduates. Its always cheaper to just pay for more residency positions than to pay for medical school positions in addition to the residency positions. Basically, the Canadian government is taking to the cheap route in dealing with the doctor shortage.

 

Canadian graduates will continue to have the advantage, because they were trained already in the Canadian system, just like in the US, American grads have the advantage over IMGs. IMGs applying in the US are usually only successful if they have higher USMLE scores than the American grad, considerable experience in the US through ciinical rotations, and speak English well. Even then, if u check out the US system, u will see that bulk of IMG in the US match to less competitive specialities.

 

Where I think this will have the biggest impact, will be in bringing back Canadians who went abroad for Medical School, who usually end up in the US. I think that could very well be the aim of all this. You might see IMG's doing clinical rotations during their 4th year now at Canadian institutions instead of American ones to get the necessary experience in the Canadian system to help them during matching.