Irate UofT grad calls for CaRMS support

[Guest climberchick]

I disagree... why do you think Canadian IMG and Foreign IMG automatically have to be considered in the same pool? There is a difference... in terms of english (or french) langauge ability... knowledge of Canada.... etc...

In my humble oppinion... (on top of the fact that more residency spots are needed)... I believe that as a Canadian citizen one should have the right to enter Carms... the same as those canadians studying in the US can... If one can sufficiently passed the board exams... and especially if one has completed elective rotations in Canada... then what's the difference? Basically nothing, except that Canada is gaining physicians that they otherwise would not have due to limited medschool seats. All this being said i do understand that Canadian graduates deserve a residency spot (if they have done well on boards and filled in Carms application sufficiently that is). But the way I see it... if every canadian graduate wanted ortho or something like that... not every grad would get it... so really... what's the difference.... i see none... no speciality is garanteed.. even if IMG were left out of the match..!!!

 

Just my two cents... sorry for the rambling,

I am not an IMG by the way,

Climber

[Guest moo]

I find it hard to believe that this person did not match into the second round unless he/she did not rank enough programs, which it sounds like he/she didn't.

 

Even if the Ontario govt wants to ensure that every Ontario grad gets a post-graduate spot, I don't think this person would've been appeased. It sounds like this person thinks that he/she is too good to go up north.

[Guest Maltara]

To respond to a few points made by Peachy/drews:

 

I apologize if I implied FM was the only specialty in shortage. What I was getting at was that there should be more formal incentives to attract medical students to needed specialties. Over time, these incentives would have to shift based on increased/decreased need.

 

Again, I was also just citing "the North" as one of many potentially underserved areas. Large cities can fall into that category too.

 

As to the point about public service and whether there should be postivie/negative incentives, I really see nothing wrong with it. Medicine is not just "another job" insofar as it is highly subsidized and regulated by all levels of government. To the extent that millions of dollars are poured into medical schools by governments, do they not have the right to stack the odds so that their graduates go where they are needed? Wouldn't you agree that if 50% of all Canadian MDs packed up and went to the U.S., the gov't would have the right to intervene?

 

To cite two anecdotal examples I have read about on this board, apparently Canada is training too many neurosurgeons. I would say that has to be rectified given that other specialties have a shortage. Secondly, the South African healthcare system has all doctors practice as GPs before specializing, or so I recall. I am not saying this is the solution for Canada, but a chronic shortage of certain specialties is not sustainable. The argument might be made that if incentives were put in place for certain specialties, they wouldn't get the "best" medical graduates; e.g. if the gov't somehow encouraged more people to go into anesthesiology or FM, less people would apply for Med school. But is no anesthesiologist better than a slightly less (read: 3.75 GPA vs 3.8 GPA) "qualified" one? It's not like there aren't hundreds, even thousands, of people rejected from med school who would accept the incentives even if it meant they could never be an ophthalmologist.

[Guest CareBear15]

Yes, back in the day all Canadian medical graduates could all rotate in a common PGY-1 year and declare themselves a family doctor if they wanted.

 

However, it was the family doctors themselves that became incensed and decided that it was wrong for someone to call themselves a family physician after only one year of training, and thus the situation is as it is now (and the creation of the CFPC).

 

I don't think it's as simple as having everyone be licensed as GPs to end the family doctor shortage.

 

I think this year's CaRMS match has mainly brought into the spotlight the major issue medical students face now: there are just not enough residency spots. To have to compete for the same number with extra competition is daunting and upsetting.

[Guest strider2004]

The argument might be made that if incentives were put in place for certain specialties, they wouldn't get the "best" medical graduates; e.g. if the gov't somehow encouraged more people to go into anesthesiology or FM, less people would apply for Med school. But is no anesthesiologist better than a slightly less (read: 3.75 GPA vs 3.8 GPA) "qualified" one?

 

There already ARE incentives for people to go into certain geographical areas, or even to go into the military. However, it would be very difficult to recruit premed students for specific medical specialties so early. It's already very difficult for med students to pick their specialty so early in their careers. It would be IMPOSSIBLE to make them pick even before med school. I am currently in a specialty that I didn't understand before I went into med school and I'd bet 70% of my colleagues are the same way.

 

Also, simply raising the number of residency spots isn't always the best answer. At Queen's we're finding difficulty in not only placing med students, but also placing residents. You need a certain amount of exposure to diseases to get adequate training and by diluting the pool of residents, you are reducing everyone else's exposure and practice. The Family Medicine centre can't physically house more family medicine residents because there isn't the office space! My school's most attractive quality (small centre which means more independence, more procedures) gets diluted with the addition of too many residents. You can't just shuttle everyone off to rural centres either because they often don't have the proper infrastructure to give residents teaching.

 

I know this is actually a pretty huge problem in the medical school population. Many schools had to physically build bigger classrooms after the governments announced new student spots without first consulting the med schools. It's great when a school opens up 10 new spots, not so great when they all have to sit on the floor.

[Guest RedBull33]

This story is not complete without knowing how the U of T student, who went unmatched, ranked his/her programs.

 

Does anyone have this information?

 

If they only ranked Derm/Plastics (for eg) for both iterations, not having a 'backup', then IMHO it's tough to feel too sorry for them. Try again next year.

 

Also, the last caveat: it doesn't matter how academically gifted a medical student you are, how many extra curric's, how many papers you published, if the committee doesn't think you will fit into the team/department, if they don't feel they can count on you, forget about it.

[Guest TimmyMax]

Hey,

 

I agree with RedBull30. More information is needed on this matter before we can arrive at a conclusion regarding this student's situation.

 

Best of luck!

Timmy

[Guest UWOMED2005]

Also, the last caveat: it doesn't matter how academically gifted a medical student you are, how many extra curric's, how many papers you published, if the committee doesn't think you will fit into the team/department, if they don't feel they can count on you, forget about it.

 

Amen to that.

 

Matching to an ubercompetitive specialty is not about "earning" the spot. It's about being the right fit. And having the right competition.

 

* Says the resident who only ranked family medicine. . . ALL advice should be taken with a grain of salt:rollin

[Guest extrachromasome]

Well, I'm an IMG (2007) from a European medical school and have a few things to say.

 

1. There is all this talk about wasting tax payers money. I'm borrowing from the government with subsudised Canada student loans during medical school. If I have to go to the US to train, isn't that also a waste.

2. Of all the provinces Ontario is still the most difficult for IMG's to access training spots. For example, even the CaRMS 2 acquired family medicine spots require a salary free assesment period (months). Not so for other provinces.

3. I think it is extremely short sighted of this Irate Student to fly off the handle because he/she is one of the very few students to not match. There was obviously a reason for this. Take it on the chin. Why should a bottom of the class, least appropriate for the position (eg gunning for optho and then applying for family medicine because that's what's left in CaRMS 2) student acquire a residency ahead of a hard working, well trained, bright Canadian student who went to medical school outside Canada's borders.

4. I feel for this student but all other nationalities that I've talked to example USA, Norway, Germany, the students cannot believe the prejudice and difficulty Canadians who train outside Canada have of returning to their own country afterward.

5. Myself and many of my colleagues will have around 6 months of electives done in Canada by graduation, and so yes, we too are familiar with our country's health care system.

 

And to the person who posted their letter on this thread, before you send it, research your facts and edit it, please. IMG's are now allowed into CaRMS 2, not CaRMS 1. We still have to wait for all Canadian students to match before we can apply for a shot at what is left over.:b

[Guest extrachromasome]

Windymountain, your letter is terrible, I just looked at it again. Please do not send this. You state that

 

"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."

 

Come on, you are obviously refering to foreign born IMG's but if you had your facts straight, you would know that every applicant through CaRMS must be a Canadian citizen or resident. How is it possible that these are people with no ties to a community in Canada? You are spreading misinformation.

[Guest aneliz]

I think people were referring to 'wasting' taxpayer money in that medical school tuition is heavily subsidized in Canada by the gov't (ie: much as we pay, we don't pay anywhere close to it all in tuition).

 

By taking IMG's (who did not have a Cdn gov't subsidized medical school seat) and not Cdn grads, we essentially waste the money that was paid by the gov't and still get the same number of docs at the end.

 

Yes, you are receiving Cdn gov't student loans to pay your tuition out-of-country... however, you will (or are supposed to) pay this back. Yes, the gov't is subsidizing your interest while you are a student, but it isn't costing them anywhere close to what it costs the gov't to fund a medical school seat.

 

I agree with you that Cdn students that attend a recognized, equivalent program medical school outside Canada (Ireland, USA, Australia, etc) should be allowed to compete for residency positions with the Cdn grads.... especially if they have done Cdn electives during their med school training. However, the reason *why* it is so difficult for you to come back and why there are so many restrictions is because there are so few residency positions.

 

What really needs to happen is that the number of residency spots needs to increase by a long shot (so the ratio of spots to grads is more like the US) and then we would go a long way to 1. increasing the number of practicing physicians and 2. making it easier for IMGs to get a license.

[Guest studentz]

The ratio of residency spots to graduates will never approach what it is in the US without a fundamental change in the way residency programs are offered here. In the US many hospitals that would otherwise be classified as community hospitals offer residency spots, and at some in only a few specialties. This is not the case here, where all residency positions are government-funded and you essentially apply to a medical school, not a hospital, for a position. Thus, all of the "bodies" (i.e. medical schools) that offer residency spots in this country are essentially full-service centres representing all the specialties except for a few in one or two cases. Canada has a ton of hospitals without teaching status that do not host residents, but likely could, even if just in family, emerg or gen surg. UofT's expansion to Mississauga will likely help with this in the GTA at least. However, much more has to be done in this area before we see a situation that even remotely resembles what there is in the US. Whether this can happen given the nature of our health system is another matter.

 

I can say that quite a few people at Toronto are not exactly happy with the way this student has conducted himself/herself. There are rumblings that he/she aimed too high, and too narrow, essentially putting himself/herself out on a limb. I also don't know where this "IMGs in the first iteration" idea came from.

[Guest patentforamenovale]

There are rumblings that he/she aimed too high, and too narrow, essentially putting himself/herself out on a limb.

 

Yeah, you're right... she did come to 0T9 and said that she wanted only plastics... but at the same time, i cant help but feel sorry for her. Imagine yourself in a situation like this, 4 years of med school done, $100,000 in debt and nowhere to go. And I know that she should have played the Carms game better, but I still do feel bad for her.

[Guest TimmyMax]

Hey,

 

If she said that she only wanted plastics, then what did she choose in the 2nd round? I'm pretty sure that there weren't any plastics spots left over after round 1.

It is beginning to sound like this person did aim too high and too narrow! I mean, sure, it's sad that this person went through 4 years of medical school and $100K to end up without a job, but the best piece of advice that I got when I was going through CaRMS was to always have a backup plan. A PD told me that no one would ever hold having a backup plan against you (and nor should they). A single elective in family would have definitely helped this person in that respect.

It sounds like this person went all out on a limb and lost. Unfortunately, this is the reality of CaRMS- some people rank only a limited number of programs in a single specialty and while some turn out well, there are some who do not turn out well at all. Sadly, some specialties (ie: plastics) are more competitive than others, and whenever there is competition, there are going to be winners and there are going to be losers. It sounds like this person was one of the losers (obviously), but not having a good backup plan sounds like the biggest mistake of all, in my mind.

In this day and age, unless the government wakes up and opens up more residency spots, competition is going to get a lot worse before it gets any better, so you have to be prepared for the worst. Don't be afraid to have a backup specialty in mind when you are applying. Family programs hate it when someone with 4 months of plastics, derm, optho, insert specialty here, electives apply to them as a backup- they aren't stupid and they can spot someone who is doing that a mile away. At least show them the decency of having an elective in your backup specialty. It will pay endless dividends if you ever find yourself in a less-than-ideal situation after the 1st round of CaRMS.

 

Best of luck!

Timmy

[Guest ssc427]

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.

 

 

I think the thing is that US schools are LCME accredited. None of the schools in the UK, Ireland or Aus are (as far as I know). I can say having lived in England for 5 years that the system is night and day different over here. And do you think that these guys, who call themselves UK docs should be allowed to practice? There are quite a few of strange med schools like this in London and other places.

I don’t want to sound elitist but I wouldn’t feel comfortable allowing my kids to be treated by one of these docs.

 

I just think if we are going to open all our doors to IMGs there should be some way of checking the schools first as there are so many dubious ‘for profit’ schools out there. I’m sure (I hope) the various governments are considering this before opening the floodgates.

 

I very much agree with your second satement about Canadian grads taking their training elsewhere though.

[Guest RoseSmurfette]

I don't really know a lot about this subject, but don't students enter Australian, UK, and Irish medical schools after high school whereas student enter Canadian and US medical schools after university? I was under the impression that most med schools outside North America give Bachelor degrees...the differences in how the systems work may account for why Canadian students who've studied in the US are treated differently (ie. compete in first round iteration of CARMS).

[Guest moo]

Yes there are dubious medical schools in the UK (St. Chris?). But many UK schools are of high quality. In fact, there are many faculty members at Canadian medical schools who obtained their medical degrees outside of Canada. This was in an era where practicing in Canada after training abroad was a lot easier. In addition, many Canadian medical schools allow graduates of foreign medical schools (who are not Canadian citizens) to train as residents and fellows, treating Canadians in the meantime. Programs like these are funded by the government of the sponsoring country. (I've seen graduates of Saudi Arabia, Iran, Australia, even the Caribbean.) The issue of not allowing IMGs into Canadian residencies is not simply due to a lower quality of med schools outside of North America, but politics.

[Guest JSS02]

The Toronto Star article with this person's story is up now...check it out here.

[Guest ssc427]

So what do students like this person normally do? She wanted plastic surgery and applied to ONLY this field and got burned. I have no idea about her motivations for doing this but I can imagine I might be in a similar pickle in 4 years.

 

I am not even med student but having done my PhD related to the field I want to specialize in I am fairly certain I know what I want to do in residency. That being said it is a fairly competitive specialty.

 

So should the person in this story have gone to a few safety interviews in FP or something? Even though as people have pointed out it would be evident that you are simply using FP or whatever as plan B.

 

What do most people who want competitive specialties do? Do you pick a few back-ups anyways? Do you do your PGY-1 year and reapply?

[Guest peachy]

What I find most confusing about this story is, why did she not take a year off, shore up her application, and then reapply to plastics? Or apply to the US next year where there are more spots? One year isn't the end of the world, and if someone was so committed to plastics that they didn't want to back up first round with something else, and felt that they had a strong enough application to do this in the first place, then why not keep working at it a bit longer?

 

As to the discussion about IMGs competing for the same places as Canadian students, to me it's not an issue of fairness in terms of our rights to the spots, but just fairness in the competition itself. I fail to see how any Canadian grad can compete against an IMG who has spent fifteen years in the field for which they are applying!

[Guest JSS02]

Hmm, I don't know what "most" people do, but the ones I know who have gone unmatched either went for a second round spot (usually family medicine), or took the year off and tried again the next year, including applying to American programs. I know someone who matched to a very competitive specialty in Canada this February, after taking the year off to do research. Some will try applying to a 5 year program that's still available and then trying to switch into their original specialty if a spot opens up, as that is usually easier than switching from family medicine because you have 5 years of funding vs. 2. If a Canadian grad is applying in the second round it's pretty obvious that whatever he/she is applying for is a backup, so I don't know how much programs will hold that against them. Also, you can't "reapply" while in a residency program (e.g. after PGY1), but you can try transferring if someone in your program of choice switches out for whatever reason.

 

I don't know this U of T person's whole story, but even after the second round there are still 7 family med spots available (Thunder Bay, Sudbury, and McMaster rural) so it's possible she just ranked a small number of places in the second round, and wasn't "displaced" by an IMG but just by other Canadian grads.

[Guest marbledust]

You know....I have a very hard time finding sympathy for someone who chose (apparently) to rank only plastics programs in the first round. Going all-out for an uber-specialty is mighty risky business: if you are lucky enough to land a spot, you have it made; if not, things can be very grim. It really is boom or bust.

 

I think "blaming" the inclusion of IMGs doesn't apply here at all. She took a gamble with her matching strategy and lost. That's what happened....

[Guest RoseSmurfette]

Obviously applying for just plastics positions is risky, but what is an appropriate backup?

[Guest moo]

I think what's inappropriate is for her to announce to the entire class her feelings about IMGs. As peachy said above, I think it's extremely arrogant for her to think she is better than IMGs, who not only seek a better life for their family in Canada, but who also are willing to go where very few Canadian grads will. I met a Chinese doctor on one of my FM interviews who was in his 40s, with a family and everything and was just so happy to be in this country practicing medicine... and he was an MD/PhD back in China. I highly doubt she didn't get a plastics spot because she was displaced by some IMG. Sure, she didn't match, and it's devastating, but maybe she should do some research next year, beef up her CV and try again next year. It's not the end of the world. Many people have gone unmatched and have done great things. On another note, I think this is where a common PGY-1 year would be helpful. In the US, I know someone in my class who didn't match into ENT and he scrambled for a surgery prelim year at my institution and will reapply next year. That way, he can start straight at the PGY-2 level instead.

 

And as for the "poaching" of physicians from other countries: well, maybe the government should rethink their policy of multiculturalism. I don't think it's fair to sell potential immigrants on how great Canada is, and then deny them the right to work in their desired profession when they get here.

[Guest RedBull33]

This is complete sour grapes. You risk a lot when you go for plastics, and when you don't get it then you try again next year, as an above poster mentioned.

 

The Star, blaming IMGs for your 'problem' of not matching plastics, is out of bounds.

 

What she got was a good dose of humility, which is probably a good thing. We all need that at some point.