CaRMS changes pending

[Guest noncestvrai]

IMG can match in the first round in Qc.

 

noncestvrai

[Guest Kirsteen]

Hi there,

 

The side-effects of the aforementioned changes are already beginning to roll in for this year's match. I heard a couple of days ago that the interview period and Match Day were going to be delayed this year (unlike the Feb. 22 Match Day this past CaRMS cycle) due to the expected increase in applications this year. Sure enough, I just checked out the CaRMS site and the timeline for the above events have been pushed forward.

 

Cheers,

Kirsteen

[Guest Erica2008]

Hi Kirsteen,

 

If the CaRMS dates have been pushed back, will this affect our ability to enter the American match if we do not match to our desired specialty in the first round?

 

Erica

[Guest yda]

2007 match day in Canada: March 14

 

2007 match day in US: March 12

 

It seems that the Canadian match is happening BEFORE the American match

[Guest EJL]

The date for the CARMS match is March 14th.

 

The date for the NRMP match is March 15th.

 

This means that the American match is after the Canadian one, but they're around the same time. It'll be interesting to see whether more Canadians will opt to participate in the US match this year, given the increasing competition despite the lack of adding additional residency spots in Canada.

 

EJL

[Guest moo]

You mean AFTER the US match...

[Guest yda]

Hi NMJ,

 

From the NRMP site:

 

On March 12, 2007 "Applicant matched and unmatched information posted to the Web site at 12:00 noon eastern time."

 

March 15, 2007 is "match day".

 

So if a CMG finds out on March 12 that he/she has matched to the US, will he/she be kicked out the Canadian match?

 

Can you clear up the confusion?

 

Thanks, Yda

[Guest MDintraining]

Actually, this timing is going to make for a really interesting match...

 

I read thru the FAQs on the NRMP website (link follows)

 

www.nrmp.org/res_match/fa...html#new01

 

It says that on Monday March 12, you find out if you matched to one of your ranked programs. From what I understand, you don't find out which program you matched to until March 15. Between those dates, the people who find out they did not match in the USA can scramble for unfilled positions.

 

If you only chose one program in the states, you would know on the 12th whether you got in or not. Then you could pull out of the Canadian match before the 14th if you matched to that program. However, if you apply to more than one US program, you couldn't know for sure which one you matched to until the 15th, after the CARMS match day on the 14th. So you could apply to just one program and then pull out of the Canadian match just in time if you wanted to.

[Guest Da Birdie]

For those interested, CaRMS website just updated their 2006 stats page

[Guest extrachromasome]

Does anyone have any news on the Carms changes? Has there been any new information released this past week?

Thanks

[Guest ploughboy]

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Hey,

 

There's lots of stuff happening behind the scenes. Here's what our VP-External (who happens to be the Ontario Rep for CFMS) sent out concerning the meeting on May 25th:

 

"Dear students, today the stakeholders of Medical Edcation (CFMS, CAIR, Ministry of Health, AFMC, Post Grad Medical Education, Undergraduate Medical Education) will be meeting today to discuss the matching process of CaRMS in light of the recently passed resolution by AFMC. Last week I sent out a response from AFMC and today, I send you a joint response from CFMS and CAIR. These issues outlined in the letter will be brought up again at the meeting, in hopes of devising a truly pan-Canadian parallel match. I will keep everyone up to date as more information comes my way..."

 

And here's the latest letter from CFMS to the AFMC, with a few formatting changes. As before, every med student should have received a copy of this, but I'm posting to keep our colleagues in the class of 2010 apprised of what's going on, as well as for historical interest (assuming that ezboard doesn't get hacked again...)

 

"May 24, 2006

 

Dr. Nick Busing

President & CEO AFMC

774 Echo Drive

Ottawa, ON K1S 5P2

 

Dear Dr. Busing:

 

Thank you for your May 17th letter addressed to the medical students of Canada attempting to clarify the facts of the recent AFMC decision. We are writing a joint response as the CMFS and CAIR, on behalf of Canadian medical students and post-graduate trainees, to express our dismay at the misrepresentation of several of the issues articulated in your letter. As the AFMC decision could very drastically affect medical students as well as the physician landscape in Canada, we feel compelled to clarify several of the points you raised.

 

In your letter, you state that AFMC/ACMC made the original decision to restrict the first round of the CaRMS match in 1993, implying that the right to reverse this decision would also be that of AFMC. We understand that the decision to reserve dedicated first round match residency positions was (rightfully) made by the Provincial Ministries of Health on behalf of the Canadian public many years before. If the original match policy was made to reflect society?s values and the public interest in ensuring the completion of training for graduates of Canadian medical schools (GCMS), we argue that a drastic alteration to that policy deserves the same consideration.

 

The AFMC claims that the current match system is invalid according to 'all legal advice.' It is not the case that 'all legal advice' finds the current system is invalid, given that our legal counsel found very compelling reasons to believe that the current match is both lawful and constitutional. If the AFMC is supporting such a drastic change on the basis of legal advice, it has an obligation to make that advice public. To date, the AFMC has not accepted our offer to share our legal advice, insisting that its advice remain confidential while at the same time publicly disclosing its supposed conclusion.

 

It is of some significance that neither the CFMS nor CAIR, as major stakeholders in the matching system, were invited to take part in the AFMC-led PGME Match Working Group investigating the issue of integrating IMGs into the match. Of note, the AFMC working group included representatives from CaRMS, yet both CFMS and CAIR who sit on the CaRMS board of directors were not privy to this information.

 

Finally, the AFMC seems to absolve themselves of responsibility for their policy decision by stating that the provincial ministries of health will determine the actual implementation of their decision. Notwithstanding the innumerable problems associated with allowing varying match implementation rules and eligibility between provinces, we are dismayed that the AFMC, after venturing into this issue, would seek to assign responsibility for the consequences of their actions. Your letter attempts to reassure students that the Provinces are likely to translate the threatening AFMC resolutions into reasonable policy. However, until these reassurances become written policy, one can only assume that the final CaRMS system will reflect the current AFMC resolution, which has alarmed many stakeholders across Canada.

 

As you know, both the CFMS and CAIR will be attending the national stakeholders' forum in Ottawa on May 25th. To date, we have been clear in our communications regarding the disastrous implications of even one province allowing an open first round of the matching system for Canadian medical students and the Canadian medical education system.

 

We would consider the following as successful outcomes for this week's meeting:

 

1. The AFMC would be prepared to formally clarify, and if necessary reverse, the intent of their motions to ensure continued first round dedicated residency positions for GCMS

 

2. A truly national match ? all provinces with residency positions would agree to participate in a uniformly administered first and second round match.

 

3. All provinces would agree to separate and dedicated positions for GCMS in the first round. IMGs may also have separate dedicated positions in the match.

 

4. There would be no diminution in the proportion of residency positions made available in a dedicated first round for graduates of Canadian medical schools.

 

5. Any province not agreeing to the above stipulations would not have access to the national matching process.

 

CFMS and CAIR are hesitant to support a match that falls short of these fundamental principles.

 

Sincerely,

 

Andre Benard, MD

President, CFMS

 

Jerry Maniate, MD, FRCPC

President, CAIR"

 

 

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[Guest extrachromasome]

Does anyone have any recent info about these changes. From what I understand there was a meeting supposed to happen early June?

 

Thanks

[Guest Goniometer]

Has anybody heard anything about the pending CaRMS changes lately?

 

The AFMC stated earlier that everything would be released by July 1, 06 but I haven't heard anything recently.

[Guest Kirsteen]

Hi there,

 

Here is an update (as of today) re: IMGs and this year's CaRMS match. (Interesting that Saskatchewan and Alberta appear to have opted out...)

 

Cheers,

Kirsteen

[Guest noncestvrai]

I could get screwed big time here...in Qc, but I don't know the policies of the College, so, we'll see.

 

Since I'm into a competitive field. Well, more pressure for me to do well on the USMLE...

 

noncestvrai

[Guest little endian]

Just out of curiosity, what is the "return of service obligations for IMGs" listed in the chart?

[Guest Kirsteen]

Hi there,

 

The return of service obligations look to be under the control of each province, but they probably include a certain number of months/years of service in that province post-residency.

 

Cheers,

Kirsteen

[Guest ploughboy]

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Ya, usually return-of-service is done in an under-serviced area, which is generally far away from large academic centres and from what some people would consider civilization (I say that with a smile, since I grew up in the middle of nowhere and intend to return there someday).

 

As for CaRMS updates - CFMS has sent out an email update which I've put off posting since a) I'm too lazy to cut-and-paste it and the tone was rather...bitter and I wasn't sure I wanted to post it. Every med student should have gotten a copy anyhow - bug your school's CFMS rep if you didn't get the latest update., If there are incoming med 1s who are really keen I suppose I could post or PM it. Suffice it to say that it sounds like CFMS isn't being included in the process as much as they'd like to be (or ought to be IMHO)

 

Prosit,

 

pb

 

 

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[Guest noncestvrai]

Post it.

 

I didn't get it.

 

noncestvrai

[Guest ploughboy]

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Hey,

 

You should get after your CFMS rep to keep you up-to-date. This is kind of an important issue...

 

Anyway, here for the record is the latest from Dr. Bernard in all its lengthy glory. Grab a glass of your favourite beverage and settle down on the couch -- it's a long one...

 

pb

 

A message from Andre Bernard, President of CFMS:

 

As many of you know, the most pressing issue before us as of late has been the potential changes to the Carms Match for 2007 (i.e, this coming year). First, a summary: By a decision of the Association of Faculties of Medicine of Canada (AFMC; formerly ACMC; also known as "the Deans") in 1992/1993, the first iteration of the Carms match was limited to only graduates of Canadian medical schools. This decision was taken for a number of reasons, the chief one being that there were limited post-graduate training spots following cutbacks and the Deans wanted to protect the integrity of the Canadian system. Since that time, with the exception of Quebec, each medical school in Canada, in tandem with its respective ministry of health, has supported a match system whereby GCMS (Grads of Canadian Medical Schools) had exclusive access to the first round, with IMGs and GCMSs accessing the second round, as determined by each Ministry of Health/medical school.

 

In recent years, there have been numerous attempts at litigation directed at the medical schools, CaRMS, and governments from IMGs who believed that the existing system discriminates unjustly. These claims have brought forward accusations that the present system violates the Canadian Charter of Rights and Freedoms as well as other federal and provincial equality laws.

 

Now, it's important to clarify what we mean by IMGs. International medical graduates is a bit of a catch-all label for all individuals who have trained at non-LCME/US accredited schools. Many - indeed, most - are Canadian citizens or landed immigrants. Most IMGs trained abroad and then immigrated to Canada, but an important subset of IMGs are those Canadian citizens/landed immigrants who have gone abroad for medical training (for example, to schools in the Caribbean, Ireland/UK, Australia, among others). The claim by those who brought forth suits was that there Charter and constitutional rights were violated by a system that offers preferential opportunity to GCMS's. All of the suits to date have been dismissed on technicalities (with the exception of one which is ongoing in Manitoba). No recent suit has yet been tested by the courts. There was, however, a suit a number of years back which demonstrated a precedent supporting the present system (this was, in fact, defended in part by Steven Barrett, the lawyer for the Canadian Association of Internes and Residents).

 

The entire issue of "opening the first round of the match" has been discussed for a number of years, both behind the scenes and within the formal forums of AFMC. The stated concern has been two-fold: (1) with the increasing numbers of lawsuits, AFMC believes that there is a certain inevitability to a case being brought to either human rights tribunal or a civil trial. (2) there is a suggestion that opening up the first round is the right thing to do in order to address the perceived view that the current system is unjustly discriminatory.

 

I want to separate those two out for a moment and speak more generally about how this issue interfaces with broader health human resources issues. In is undoubtedly apparent to everyone in Canada that the present system is suffering a tremendous lack of physicians that now cuts across all specialties including primary care. At the same time, there is a growing concern that there are a large number of people in Canada, either citizens or landed immigrants, who have received their medical training abroad (again, either prior to immigrating or those who have left to study medicine abroad), who are not able to work because their training is not fully accredited. Many of these individuals have indeed practiced for many years abroad. A great deal of public pressure has grown to find mechanisms to systematize these people into the workforce. To date, this has been a provincial scheme with many provinces adopting specialized IMG-entrance programs aimed at establishing credentials or re-admitting for post-graduate training. In whatever case, there is a widely held understanding that most IMGs require re-training to be able to successfully integrated into the Canadian system. There is hard data demonstrating that a typical IMG post-grad trainee requires more resources to train than a GCMS. But the issue in short is that there is a large amount of pressure to get these people into the physician workforce.

 

In response to the concerns about (1) litigation, (2) "doing the 'right' thing", and if I may be so bold, (3) public pressure, the AFMC raised the issue of discontinuing their restriction of the first round of the match last year. There were significant concerns raised at that time and AFMC committed to examining the issue more carefully and undertaking a consultation process with all major stakeholders. Indeed, at the meeting of the Canadian Medical Forum (a round-table of national medical organizations including the CFMS and CAIR), the AFMC reported back that they would be tabling a discussion document for stakeholders this past winter. Well, nothing ever got circulated to us. In the weeks leading up to the April meeting of AFMC, we heard rumours that the Carms-IMG/opening the match discussion would take place. Together with CAIR, we planned a response to these rumours during our meetings there.

 

The CFMS and CAIR stood together arguing that any decision to put IMGs and CMGs in competition with one another in the first round would be detrimental to both parties as well as the training system at large. The arguments are elaborated further in the attached letter we sent the AFMC and Deans on May 1 3.pdf>. Regardless of the sound arguments raised, the Deans came forward with a multipoint resolution essentially saying that the first round of the match would be open beginning this year. The resolutions also offered a rather toothless reassurance that "all graduates of Canadian medical schools be 'assured' access to a residency position in Canada to complete training necessary to enter practice". I say toothless because the Deans went on to say that the Ministries of Health for each province would be charged with operationalizing the match. In other words, the Deans passed a policy that others would implement. And at the time the resolution was passed (and even today), there is no plan concretely in place.

 

Immediately after the resolution was passed, the CFMS and CAIR were on site to raise questions and concerns about this course of action. We were assured that although it "seemed" like it would be an open first-round match, there would be a "embedded, parallel" match in most jurisdictions. Asking why there wasn't unanimity, we were told that there were several provinces that were holding out. Further, we asked what were the plans -- had they been developed, how, exactly, would the match look in each province. No one knew -- it was in the hands of the provincial ministries to figure out before July 1st of this year.

 

At this point we struck a joint CFMS-CAIR task force to gather our energies around the issue. What became apparent was that a short-sighted decision was being taken by the AFMC to cover off invalid (arguably) concerns about liability, cloaked in rhetoric that they were doing the right thing, when the implications of the decision were unknown (or likely bad) and no meaningful consultation process had been undertaken.

 

The CFMS immediately demanded an all stakeholders meeting gathering together CFMS, CAIR, Ministries of Health (MOHs), AFMC, and other relevant stakeholders. The President and CEO of AFMC was keen to have this meeting and it was organized for late in May. I had initially asked for a third-party moderator to chair the meeting (in response to being asked to co-chairing it with AFMC). This was flatly denied because in the minds of AFMC this would not be needed.

 

Honestly, the stakeholders meeting was the worst meeting experience I've ever taken part in. We went into the meeting with open minds about discussing the issue. We were clearly told that the decision was made (with abovementioned arguments) and that it was being implemented. We were even told by several parties that student/resident concerns were important but we weren't really equal stakeholders in the process. I continued to ask for details from the ministries of how the match will/would be implemented this year. They said they might have details by mid-June, that it would be likely an "embedded, parallel match" in most provinces. There would be no time to consult and we could come to the table next year after we saw how it went. The AFMC continued to emphasize that there would be no poor sequelae for Canadian medical students yet there was a refusal to explain how med students would be protected. As a last ditch-effort, the CFMS asked for a one year moratorium on implementing the decision. AFMC said that this would be unlikely but they would go back and discuss. We also offered to the ministries to meet with them one-on-one to provide our concerns. They never got back to us either.

 

It was brutal. Basically, the message was "you have nothing to say in this matter"

 

Meanwhile, it was evident that several of the Deans had begun talking to medical students locally. In at least one medical school, the Dean said to medical students not to worry because in the end post-grad programs would favour CMGs anyway. Again, the hypocrisy of this is paramount as the primary rationale for opening the match was to restore, by their arguments, fundamental justice to the process. Well, it seemed by these reports that it was simply a passing of the buck.

 

A week after the stakeholders meeting, on June 6, the Canadian Medical Forum met in Ottawa. This is a gathering of all major national medical organizations including AFMC, CMA, CFMS, CAIR, the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, the Federation of Medical Regulatory Authorities of Canada, etc, etc. At this meeting, we reported on the events to date. There was resounding support for us, with both the RCPSC and CFPC coming out with formal letters asking for a moratorium on the decision, demanding meaningful consultation. The CMA at its Board meeting a week before passed a resolution disapproving of AFMC's decision and asking for a moratorium as well. So here we had nearly every national medical organization standing up and saying the same thing.

 

What happened? Nothing. AFMC came back stating that there would be no moratorium, and that the MoHs plans would be forthcoming.

 

And that's essentially where we are today. Waiting, one week from July 1st, the "magic day". I've been out of the loop for the past week because of a death in the family, but there have been no new developments at all.

 

We've been routinely reassured that there will now be an "embedded, parallel match" in each province, but this raises a new issue of creating a fragmented match where each province creates its own mechanism of how to deal with GCMSs/IMGs. The fragmentation could lead to downstream policy decisions of worse consequence. Increasingly we are hearing provinces talking about looking after their own (medical students)... Yet there is a failure to understand the mobility of graduating medical students.

 

And we're pondering next steps right now. Along the way we contemplated raising this publicly, but the issue is so very complex that it would likely look poorly upon medical students if this entered the public forum. After all, the general public is more concerned about getting a physician than the idiosyncrasies of residency training.

 

What should we do next? Well, for one I think it is the responsibility of the CFMS to inform its members of what has happened. We are continuing to work on your behalf but I think it is time that reps give thought to how to proceed. The Executive DOES NOT support going to the media. Many of you have met with your Deans but perhaps follow-ups are in order.

 

I'll leave it at that for this email. Please email me with your thoughts, concerns, and ideas.

 

All the best,

André

 

 

André Bernard, MD

President

Canadian Federation of Medical Students

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[Guest walton1]

Do you think it was wise to publish a letter that appears to be intended for medical students only on a public forum? (Especially considering the second-to-last paragraph.) Was André OK with that?

 

 

wally