Irate UofT grad calls for CaRMS support

[Guest thelaze]

This is an email I and every other 2007 grad received yesterday from a 2006 grad. I've withheld the student's name and the email to Smitherman the student refers to to protect privacy.

 

Hello,

 

To everyone who was at the Bruce Tovee lecture yesterday evening, please find the following e-mail which I had written to the Minister of Health, George Smitherman (some of you had wanted a copy in order to understand what the main points of my argument are).

 

To everyone else: in a very embarassing announcement last night I let my class know that I have been unmatched along with several other students in Ontario. The government is very pleased at having matched 38 IMGs at the expense of Canadian graduates, and sites the 9 "scramble" spots up north as adequate for us 6 Ontario students (despite the fact that we are NOT guaranteed these spots and will "scramble" for them along with the 1200 experienced and willing IMGs who will also apply).

 

I feel cheated and robbed of 4 years of my life (not to mention some $80 000)-- what am I supposed to do with an MD and no residency spot? Who can seriously say that my chances next year will be any better? Who would accept investing so much into something and coming away with so little? If a student can get through a Canadian medical school program (and do very well at it too!) then why shouldn't he/she be guaranteed post-graduate training?

 

There's very little we can do for me and my colleagues but, unless we make noise, 0T7, 8, and 9 will have it even worse-- the plans are to let IMGs participate in the CaRMS match right from the first iteration in coming years!

 

I'm all for strengthening the workforce, but NOT AT THE EXPENSE OF CANADIAN GRADUATES. My future in medicine in this country has been tarnished by this experience and I've really no clear sign from anyone that I'll be able to practice medicine here... so I've nothing to lose by making this problem known publicly. I'll be in parliament with Mr. Smitherman's critic, Elizabeth Witmer, next week to bring this issue to attention. I've also got the papers on it-- but I need the support of the student body, otherwise it'll just sound like sour grapes!

 

Please e-mail Mr. Smitherman and CC his critic to put some pressure and affect change (feel free to use my name if you want to)! Anything you can do would be appreciated...

 

If Mr. Smitherman thinks it a good idea to replace Canadian graduates with international ones, then maybe it would also be a good idea to replace the local Minister of Health with an internationally experienced politician willing to work twice as long for half the pay (?).

 

Hon. George Smitherman

Minister of Health and Long-Term Care

416-327-4300

george.smitherman@moh.gov.on.ca

 

Elizabeth Witmer (CC her so that the MOH is aware that their critics are on it)

Critic, Health

416-325-1306

elizabeth.witmer@pc.ola.org

 

Thank you for your support,

(Name Withheld)

[Guest desiguy8179]

I feel sorry for this guy BUT this issue seems to be isolated to UofT grads and my suspicion is that it arises from the fact that UofT forces its graduates to go for competetive specialities neglecting the importance of primary care as opposed to govt. which keeps inc family med spots as that is their priority. It creates artificial imbalance between speciality and primary care applicants and spots available.

 

PS IMGs spots in ontario are funded and completed separately from Canadian grads.This guy is so frustrated with not matching one yr as opposed to IMGs who sometimes have to drive taxis for years before they get into the system and that too in non competetive fields.

[Guest TimmyMax]

Hey,

 

I don't think that it is accurate to say that U of T FORCES its graduates to go for competitive specialties- it's just that primary care isn't all that attractive to medical graduates, as evidenced by the ever-dropping percentage of students going into family medicine, etc.

As for this email, I'd say that this person is taking the easy way out and blaming the system when s/he should really be trying to discover what it is about him/herself that is so unattractive to programs that discouraged them from ranking him/her. Maybe it was just poor ranking strategy on this person's part. I'd like to get a better idea of who this person is before going off and ranting about how much the system is flawed.

 

Best of luck!

Timmy

[Guest cheech10]

It's not isolated to UofT, nor does UofT force us into competitive specialties. Some of our top students went into family practice this year. As to IMG spots being funded separately, the issue is that IMGs were allowed to match into the second round and compete for the SAME spots as canadian grads, regardless of funding. Also, it's not just not matching one year, as the match rate for 2nd time applicants is much lower than that for everyone else. Anyway, IMHO the key point of this is to apply widely with good backups to ensure that you are not totally dissatisfied with the match as this student was.

[Guest desiguy8179]

There have been unmatch UofT grads almost every year,i dont understand is there anything special that has happened this year to UofT.IMGs have been participating in 2nd iteration for more than 10 yrs(match rate of around 12%)so nothing new about that too.

 

Last year UofT had lowest no. of grads among med schools in Canada applying for family medicine(just 20%)

[Guest peachy]

Last year UofT had lowest no. of grads among med schools in Canada applying for family medicine(just 20%)

Yup, in 2005 U of T had the lowest number in Family Med. In 2004 that honour went to UWO. In 2003 It was Alberta.

 

U of T doesn't have a lot of people going into family medicine because (a) that's a problem all across Canada, and ( students don't choose what medical school they attend at random. If you polled students on the first day of medical school, there would already be way more McMaster students who want to do Family than Toronto students. U of T doesn't "force" its graduates to do anything, and to say so is pretty ridiculous.

[Guest heho]

I'm sure that for every person feeling like that man above, there are 50 "Irate internationally trained and experienced doctors who came to Canada for a better life and to support their family, but upon arrival, found out that it's hell in a handbag to get a job in Canada with overseas training".

 

Perhaps I can name 20 in my broader circle of friends.

 

 

Sucks for this guy, but, *there's always next year*.

[Guest CareBear15]

Just out of curiosity, why does everyone think this person is a guy? It could very well be a girl too.

 

Also, this is the first year that IMGs have been allowed to enter the second iteration match in Ontario. This announcement was made roughly two months ago.

 

The situation is really unfortunate, but luckily medical students are trained to adapt and move on.

[Guest Maltara]

I think the original e-mail/post would elicit a lot more support if the author stated how many positions she/he ranked and what the competitiveness of those positions was this year; ditto for the other grads. If 50 grads all think they will make the world's best dermatologists - and well they may! - there simply aren't enough spots.

 

The poster does make a point though; this is definitely a problem. I am a long way from medicine yet, but I would gladly sign a contract saying I would only apply for FM, or that I would practice for sustained periods up North or wherever there is need. To me that's part of the attraction of the career of medicine, the whole "go where the need is most".

 

In other words, if medical schools are accepting too many people who will never apply for certain needed residencies, or who, if relegated into them will not enjoy their practice, then something needs to be done to the system.

[Guest peachy]

Maltara, I might agree with you if there was a huge surplus of specialists floating around in Canada. But that isn't the case. For example, Ontario has a huge shortage of anesthesiologists. Why not allow more students who want to be anesthesiologists train in order to alleviate the shortage? Family medicine isn't the only area where we need more doctors.

 

To me that's part of the attraction of the career of medicine, the whole "go where the need is most".

I think it's great that you want to do that. But ... I don't like the potential implication that people who can't or don't want to live in a rural community are somehow selfishly not as interested in public service. There are a million and one reasons why someone may not have the luxury of choosing to pick up and move somewhere where the "need is most". In addition, just like Family isn't the only specialty with a shortage, rural Canada isn't the only geographic area with a shortage of doctors. Lots of people in big and medium-sized cities can't find doctors either.

[Guest drews97]

I'm not sure too many people would be thrilled with the idea about signing a contract and going where the "need was the greatest" regardless of personal preference. I think that if you are willing to accept a reduced tuition in exchange for agreeing to spend at least a portion of your career where there is need that seems reasonable to me (ie://something similar to how it works for students who joinn the military).

 

Medicine, when it comes down to it, is just a job. It's a great job, and one in which you can make a huge difference, but, at it's essence, is still only one part of your life. People may have other interests and ties which would make them want to stay in T.O, I don't think we can fault someone for it. Just like some people want to go to Africa to practice some medicine there (and I think it's great) other have no interest. That doesn't make them less caring (because trust me, there's a lot of people here in Canada who need help also...check out some of the inner city hospitals in Vancouver or Edmonton).

[Guest windymountain2003]

Dear Hon. Smitherman,

 

I am writing to express my disappointment and sadness with the recent changes in CARMs. I feel that Canadian medical students should be given priority in the first round of CARMs. IMGs should be given a chance to fill the spots that do not fill in the first round. I feel that as Canadian students, we deserve preference for many reasons: we have been dedicated Canadians for most if not all of our lives, we have a greater knowledge of the country and its health care system, and we have spent years meeting the standards set by Canadian medical schools. We have also had our education heavily subsidized by the government, and to lose all of this money on students who go abroad is not cost effective. The public is very upset when it hears of Canadian-trained doctors moving overseas to work. If Canadians are not given a fair chance of matching to the career and location of their choice, it will only further discourage us from staying here. Also, we have established families in certain locations, and would benefit more from having a choice of location than a new IMG with no ties to a community in Canada.

 

Having the freedom to choose my career and community is the most important motivator in my life. I sincerely feel that you are removing some of my freedom by allowing foreign-trained doctors into the first round of CARMs. I ask that you reconsider your decision, thinking of your own child finishing 8 years of post-secondary training, graduating from a Canadian MD program, and finding that he or she cannot match to the location or field that he/she has dreamed of since high school.

 

Thank you,

 

WM

[Guest happy2bme]

I feel that as Canadian students, we deserve preference for many reasons: we have been dedicated Canadians for most if not all of our lives, we have a greater knowledge of the country and its health care system,

 

That reasoning may fly for some IMG, but there are many Canadians training in Ireland, Austraila, U.K, and the Caribbean that have been "dedicated Canadians" and have knowledge of our country and system. These Canadian IMG's can argue that they are more dedicated since they made great sacrifices by leaving this great country to practice medicine. Although for most it was more likely a case of having trouble getting into the medschools here in Canada, which, lets be honest, have some of the highest entrance requirements anywhere! But really how much difference is there between a 3.5 vs. 3.7 student, except that the 3.7 student will more than likely get interviews and the 3.5 will likely not. Alot of the older docs out in practice would never had made it to an interview with the current requirements for entrance!

 

I think your point of having highly subsidized canadian students go unmatched is right on the money! That in itself should be reason enough to give preference to grads of Canadian schools in the first and second rounds!

 

Does anyone actually know if this Irate student even tried to employ a good matching strategy. For all we know they could have made 3 plastics choices and nothing else. In that case, I would say that it's their own fault for not choosing and ranking appropriately.

 

Just my thoughts, and little else!

Cheers!

[Guest UofA man]

Why should canadian grads have the right to the first round and canadians that went over seas not have the same right. The arguements that I have heard are:

 

1. The tax payers money is going to waste. Well if you take a canadian IMG instead of canadian grad, you still get one doctor trained. So for the money the tax payer gets the equivalent number of doctors, so there is no waste of Canadian taxpayers money.

 

2. The canadian grad knows more about the health care system. Well a Canadian IMG will have spent many years in Canada before they went overseas and will understand the system, plus most have done some electives in Canada, and finally some have prevoius health care orientated jobs, and practiced for a time in Canada.

 

3. How would families/student feel that they spends 8 years in post secondary education and then cannot find a place in Canada to train in. Well how do you think Canadian citizens that went over seas to study and their families feel when they can't return to Canada after sacrificing 4 years of being away. They have ties to canada as well.

 

4. Canadian grads are more qualified. Just becase you got into a Candian medical school does make you more qualified, all that you had was the right fit for the school that accepted you. There are schools around the world that train very good doctors that are just as qualified as Canadian grads. Do you think that Australians, Irish and British citizens (to name a few) are getting sub standard health care because they are not being treated by a canadian grad. Candian students going to school in these places do very well in these schools.

 

Finally I would like to point out as a Canadian citizen I should have the same oppurtunity as any one else when it come to my career, as long as I meet the same qualification standards (there are many foreign schools that have a very good tract records for their students that write the MCCQE). I believe if you look at our constitution it will be there somewhere.

 

isn't the answer that we need more trained doctors with the crisis of doctor shortage getting worse and worse, not who gets into the first round and who doesn't. The solution to the problem is we need to get more residency spots so that the Canadian public will access to the health care they deserve.

 

just my 2 cents.

[Guest Paco]

if anyone, med student or not, is interested in bringing this topic to the eyes of the media, please contact me at paco340c@hotmail.com,

 

thank you

[Guest strider2004]

The tax payers money is going to waste. Well if you take a canadian IMG instead of canadian grad, you still get one doctor trained. So for the money the tax payer gets the equivalent number of doctors, so there is no waste of Canadian taxpayers money.

 

Tax payer money WOULD be going to waste if a foreign grad were given a spot over a canadian grad. If we could fill our residency spots with IMGs, then what's the point in having canadian medical schools in the first place?? We could ust have NO medical schools and just rely on foreign physicians to fill the void. That would be the ultimate in tax savings.

 

Canadian med students don't pay 100% of their training cost. It is HEAVILY subsidized by the government. It would be a waste to subsidize a canadian through med school then not have him/her graduate into a practising physician. It is also a waste if this student were to go to the states instead of stay in canada because it is OUR country that has invested in the education of that student.

 

One argument that hasn't been brought up is that by allowing IMGs to match in the first round, we may be causing more of a brain drain from other parts of the world into Canada. This is fine for us as a nation, but terrible for those countries who may need the doctors even more. Wasn't it S. Africa that sent a letter to the Canadian gov't requesting that we stop taking away their doctors?

[Guest ovaovum]

not to start an IMG war....but I think this is a great topic for discussion...

 

I agree that its a waste of taxpayers money if they subsidize med students, only to have those med students not pursue residency...no residency=no license..so where do those med students end up? its a waste of the 1000$ needed to train them and not letting then secure a residency..the caveat though assumes that its a waste, ONLY of they don't secure a residency...failure to unmatch doesnt mean they can't secure it in the future...

 

I suspect along with timmymax that there's just more to it than IMG's taking spots from canadian grads...we just don't know the full story..

 

it is is quite devestating not to match...

 

at the same time tho, canadian med grads should not have to face extra competition from IMGs....we should get first choice in residency pics, not because we're "superior" but because we went to med school in canada, were subsidized by taxpayers, were evaluated under the canadian health care system etc....the priority should be set for canadian meds grads...

 

imgs should not be allowed to match into 1st iteration for the reasons mention aboved...

 

also, while i am not saying that stating that imgs from ireland, europe, australia are sub-standard..if we choose to let those imgs come into 1 round/2nd or whatever, then what about countries like singapore, hong kong, india and pakistan - does that mean these countries have poor quality education? there was a lawsuit done in BC regarding this...

 

with respect to doctor shortage, yes we need to address this, but not at the expense of the quality of the doctors we admit...canada arguablely (read the literature) has one of the highest standards in medical care - by highest i mean if you go to a random hospital in rural Saskatchen or Vancouver, you'll get great care - compare this with the US where the medical care is hit or miss..heck even the training programs are hit and miss.....in canada if you wanna be an internist, you will get solid training in any program in canada...but in the USA your SOL if you choose the wrong program....

[Guest UofA man]

Strider, I don't believe you understand my point, I am talking about Canadians that for some reason or another went to medical school ouside of Canada, not people who have just immigrated to Canada. So we are not talking about a global brain drain, instead this is a way of bringing Canadians back home and preventing a brain drain from Canada. Otherwise the option for these students is to go and do their residency training in other countries, and then at that point likely not ever return to Canada again. Again I am saying that if the Canadian public puts in money to train say 100 doctors, they should expect 100 qualified doctors in return. If they are Canadians that went to a medical school in Canada, or a Canadian that went to medical school in other places, what does it make a difference where they went, as long as they that are qualified.

 

By closing Canadian medical schools do you think there would be enough doctors coming into Canada to fully sustain the number needed to treat the Canadian public. Why do people use such extremes in their arguements, the are not realistics. What is the difference between a Canadian that went to the U.S. for medical school (they are allowed in the first round) and someone that went to England, Ireland or Australia.

 

Along a similiar train of thought, if someone goes to a Canadian medical school and then decides that they want to do their residency in the U.S. and settle there after their training, is that not also not wasting Canadian tax payers $$$. Also since medical school is supported by the provincial goverments, any student that goes to another province for training and practices in a province that is not where they went to medical school is that not wasting the $$$ of the tax payers of the province in which they went to medical school? I don't hear any Canadian grads wanting these practices to stop, because they want the carreer options, and they should be allowed that option. Well Canadian IMGs want to be afforded the same option (that includes the option of vying for a spot in Canada in a field of their choice), and since they are Canadian citizens they should also be given this option.

[Guest thelaze]

I'm glad this has generated so much discussion. I think this is an important issue for us and the public. IMO, the crucial point is that there aren't enough residency spots for everyone, IMG's included. If you don't increase residency spots at the same time that you are increasing med school enrollment and allowing more IMG's into the system, then you aren't fixing the problem of the physician shortage.

 

Anyway, I thought for completeness' sake I'd post our associate dean's email to our class in response to our concerns:

 

 

Dear Medical Student Colleagues:

 

As many of you know, there have recently been a number of important concerns raised by students regarding the outcome of this year's CaRMS match process.

 

In Ontario, this year was the first year that International Medical Graduates (IMGs) were allowed to compete and enter into the second iteration of the CaRMS match, which previously had been reserved for unmatched Canadian graduates only.

 

Overall, our graduating students were very successful in this year's match. However, two students have remained unmatched after the second iteration of CaRMS. This was not an unusual number, and there are more unfilled positions after the second iteration than unmatched students.

 

The Council of the Faculties of Medicine of Ontario (COFM) Deans have been in close communication with the Ministry of Health and Long-Term Care (MOHLTC), which sets the number of Post-Graduate Residency positions in Ontario. The MOHLTC has reiterated its position that it is committed to ensuring that every Canadian Medical Graduate (CMG) in Ontario gets matched to a post-graduate training program. This commitment does not mean that all CMG's get matched to the program or location they wish, however it does imply a commitment to a reasonable match process.

 

The COFM Deans have also emphasized to the MOHLTC the critical importance of increasing the number of Post Graduate training positions in Ontario, particularly in response to undergraduate enrolment expansion.

 

With regards to next year's CaRMS match, no final decisions have been made yet regarding process. This will be discussed at the Association of Faculties of Medicine (AFMC) meeting at the end of April. Although the decision about process is made by AFMC Deans, the provincial Ministries of Health set each province's criteria.

 

All Deans in Canada, and particularly the Ontario Deans are committed to ensure that next year's CaRMS match takes place via a process that will not disadvantage CMG's, and they are advocating for sufficient positions in the match to allow flexibility for CMGs and IMGs.

 

We will keep you informed as further developments occur.

 

Best wishes- Jay

__________________________________

Jay Rosenfield MD, MEd, FRCPC

Associate Dean

Undergraduate Medical Education

Faculty of Medicine, University of Toronto

[Guest satsumargirl]

The tax payers money is going to waste. Well if you take a canadian IMG instead of canadian grad, you still get one doctor trained. So for the money the tax payer gets the equivalent number of doctors, so there is no waste of Canadian taxpayers money.

 

While it may not be a waste in terms of dollars, it is still a waste. Why invest money and time is selecting the most appropriate applicants and training them to be able to serve the needs of Canadians if you then also don`t invest in their residency training. It just doesn`t make any sense.

 

What I don`t really understand (I am a few years away from applying to CARMS so really haven't considered the whole match process) is what the idea is behind having IMGs applying to the second round of CARMS when they haven't done this in the past. I abolultely believe that Canada should make better use of foreign trained Canadian MDs...HOWEVER, these physicians should ADD to the total number of physicians. If an IMG takes a spot and bumps a Canadian trained MD in the process then how are we any further ahead in the process of trying to address our shortage of physicians?

So...were the total number or residency spots increased this year?

[Guest Kirsteen]

Hi there satsumagirl,

 

Yes, indeed, a number of new spots were added to the CaRMS process this year. Not a huge amount, but a few.

 

Cheers,

Kirsteen

[Guest TimmyMax]

Hey,

 

It's important to mention that the number of new CaRMS spots added this year did not offset the increase in medical school enrollment 4 years ago. I'm not sure what the ratio of residency spots to medical school graduates was this past year, but I can guarantee that it is sub-optimal. I believe that someone (I'm not sure who) quoted that the "optimal" ratio of residency spots to medical school graduates was something along the lines of 1.2:1. The ratio in recent years has been closer to 1.02:1 or something like that. Clearly, if we are going to be allowing more people into medical schools, we should be increasing the number of residency spots for when they graduate proportionally.

 

Best of luck!

Timmy

[Guest aneliz]

As noted previously, it would be interesting to know what disciplines the unmatched UofT student applied to... and how narrow their rank list was (or wasn't).

 

There is a clearly different situation if said person ranked something like derm or plastics only in the first round and then ranked only one program in the second round than someone that applied to a less competitive specialty and then applied widely to the left-over spots in the second round.

 

If the second situation is the case, and this UOfT grad was 'out competed' for a spot by an IMG, I think that is a problem that needs to be addressed.

 

The government of Ontario has spent a lot of money subsidizing our medical education. The number of medical school seats have been steadily expanded over recent years, and are going to be expanded again. However, if the number of residency spots are not going to increase, or the number of people competing for those residency spots is going to exponentially increase (by letting the 1000's of IMG's into the first round), then we are not really accomplishing the goal of increasing the number of practicing physicians in Ontario. We are simply creating a bottle-neck effect while spending more on undergraduate medical education...

 

Last year, there was a slight increase in the number of residency spots. Interestingly, the major increase was in teh province of BC (greatly in excess of their number of graduates) while the great increase in med school graduates was in ONtario. Not so surprisingly, the excess Ontario graduates went to BC for residency. And, the research shows, that people are most likely to practice where they do their residency. So, good work Ontario. They increased the number of med school graduates, refused to increase the number of residency spots to try and 'force' the increased grads into family medicine by matching the number of residency spots in Ontario to graduates 1:1 and essentially gave all of their increased graduates to BC. An excellent use of Ontario tax-payer money.

 

I am not against appropriately qualified IMG's practicing in Canada. We desperately need more physicians (and not just up north or in family medicine). If everyone had a family doctor to make referrals for them to appropriate specialists, you would soon find that there are incredible shortages of most specialists too. It is just that it is hidden right now by the shortage of gatekeepers that keep people from getting referred.

 

However, increasing the number of praciticing physicians should not be done at the expense of allowing Canadian graduates to be fully trained.

[Guest scooter]

A lot of talk has been going on about the difference between a foreigner foreign trained doctor and a canadian that studied outside and is returning. I was looking into it (i got into a canadian school though) but only if I couldn't go to a Canadian school. I knew that I wouldn't be able to enter carms till the second round and that was a risk/reality that I knew about when i was thinking of leaving.

Yes, it is easy to say Australians and Irish get great health care and they train doctors well but what about Poland? What about Slovakia, Hungary , RUssia??? All of these countries have English programs that are designed mainly for Canadians and Americans who want to return after. They are popping up everywhere so who gets to choose which schools are training adequate doctors. There are stories of private british schools that have their school upstairs from a pizza hut... maybe they train doctors just as well, but maybe they don't.

Also, if you go to Ireland you are going to have a hard time staying there if you want. There program for foreigners is designed to send their students back.

As for the brain-drain the moment you let in Canadians who studied abroad in then you have to let all IMGs. What is the difference for Carms if they have a Canadian passport or not if they studied at the same school in Russia? It will result in making it easier for doctors to leave countries where they are desperately needed, like in Africa. Their governments often paid a lot to train them abroad and expect them to come back (ie Oxford accepts a few people each year that are sponsored by their own government that doesn't have adequate training facilities).

The obvious solution is to open up more Residency positions- if we need more anesthesiests then train more... i don't think it is much more complicated than that.

Scooter

[Guest scooter]

so what about canadians who go to Russia, Poland, Private schools for their education... are they at par with Aus and Irish trained?? Both schools are training them to return them to Canada (after studying in Ireland, it is very hard to practice their -much like the Carms second round thing)

And if you let one IMG into first round then you ahve to accept them all and that does cause a brain-drain.

Scooter