International Medical Graudates Trying to Return

[lostintime]

Yeah I love how this system is basically alluding to the fact that undergraduate and medical studies elsewhere is equivalent to Canada, which really isn't true in many cases. Even for med school applications, they don't even accept grades from some random undergrad university as part of your GPA assessment (of course with the exception of more reputable universities etc), why is it all of a sudden okay now for IMG's at the resident level?

 

I think it is too bad that the government is taking these short-cuts to supposedly address the problem of the doctor shortage. And yeah I agree the general internship makes a lot more sense since at least you're getting CMG's who have all trained at a certain level. Although I would think that would extend the amount of training time for other specialties.

[apache]

just call national protectionism what it is… top 5 percentile on usmle's plus being from iran means borderline pass and being an american grad… its worse in canada...

 

 

Yeah I love how this system is basically alluding to the fact that undergraduate and medical studies elsewhere is equivalent to Canada, which really isn't true in many cases. Even for med school applications, they don't even accept grades from some random undergrad university as part of your GPA assessment (of course with the exception of more reputable universities etc), why is it all of a sudden okay now for IMG's at the resident level?

 

I think it is too bad that the government is taking these short-cuts to supposedly address the problem of the doctor shortage. And yeah I agree the general internship makes a lot more sense since at least you're getting CMG's who have all trained at a certain level. Although I would think that would extend the amount of training time for other specialties.

[leviathan]

Also true; however, the fact remains that there are larger systemic issues that need to be addressed before we proceed to the issue at hand in this thread. Those jobs are hypothetical, they're needed but they're not there so bringing in CSAs to fill the void as many articles purport would help alleviate a doctor shortage, doesn't actually help solve anything as it stands.

Oh yeah, I didn't mean to imply it would.I was just raising a completely separate issue, unrelated to this thread, about how a lack of jobs doesn't mean a lack of shortage. And we need to keep fighting the government, who is limiting the number of jobs available to specialists to keep down costs.

 

The most pressing issue is a shortage of family physicians, in rural areas. That's my biased opinion as someone from a rural area that isn't on a wait list to see a specialist, of course. There are jobs there, right now, tons of them waiting to be filled and we can't fill them. We're recruiting docs internationally for those jobs, they fulfill their contract and move on to larger centres (I've lost a few family docs this way). If CSAs were primarily wanting to fill a void that's urgently needed, like family med in rural areas, I'd be banging on doors, writing letters, and handing out flyers for them:) . 21% is just discouraging, and how many of those are actually interested in somewhere outside a major centre?

21% is discouraging, but that's just based off a survey that had unreliable collection methods. It wasn't randomized, nor was it distributed to every CSA, nor was every CSA even aware of it. After I filled it out, most other people I talked to did not know about this survey. It had lots of interesting results based off those who responded, but I wouldn't generalize it to all CSAs.

 

For the record, I selected family medicine as my intended specialty.

[medigeek]

The issue is that family medicine shouldn't be a specialty at all. The CCFP like to moan about how medical school does not prepare one for general practice - sure, but what about a one-year internship? No evidence has supported that the lame "family medicine" residency produces better physicians than the one-year internship. You do know that it was called "internship for slow learners" back in the day, right?

 

If we were to return to the general internship model, our supply of family physicians would go from the paltry x% that go into family medicine, to 100% of all graduating physicians. Not all of them would stay generalists, but I bet a lot more of them would than what we have now. This "rural doctor shortage" wasn't much of an issue until the CCFP wanted to make "family medicine" a lame 2 year residency.

 

Of course, the CCFP(which I am sure stands for cantankerous caterwauling flailing pre-adolescents) would rather be proudly delusional than soberly pragmatic. They would rather recruit FMGs with dubious skills and credentials than open the gates of general practice to all CMGs. What a bunch of idiots. I can't fathom the stupidity!

 

How can someone possibly be a high quality doctor after just a one year internship? In the US, family med is 3 years... which makes more sense generally considering you're expected to know a bit of EVERYTHING.

[A-Stark]

How can someone possibly be a high quality doctor after just a one year internship? In the US, family med is 3 years... which makes more sense generally considering you're expected to know a bit of EVERYTHING.

 

Certainly being a generalist is hard, but what is the evidence that an extra year of training improves practice or outcome?

[medigeek]

Certainly being a generalist is hard, but what is the evidence that an extra year of training improves practice or outcome?

 

In the long run? It probably has no effect (experience > training). But it is in the short run that counts... the physician's level of clinical knowledge/skills will naturally not be as high with only 1 year of internship. So more than likely, the qualify of clinical care will be lower for his/her first few years of work. Or at least, not as confident.

 

If we're going to talk about extra training being unneccessary, we can apply that to some IM (or maybe all?) IM subspecialties. Why not just do 1 year of IM and 3 years of cards? We can probably apply it to any field generally.

[A-Stark]

In the long run? It probably has no effect (experience > training). But it is in the short run that counts... the physician's level of clinical knowledge/skills will naturally not be as high with only 1 year of internship. So more than likely, the qualify of clinical care will be lower for his/her first few years of work. Or at least, not as confident.

 

That assumes that the rotating internship was equivalent to an R1 year in most family med programs. This debate is not new: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705273/pdf/canmedaj01478-0147.pdf

 

If we're going to talk about extra training being unneccessary, we can apply that to some IM (or maybe all?) IM subspecialties. Why not just do 1 year of IM and 3 years of cards? We can probably apply it to any field generally.

 

But these are Royal College specialties and go well beyond the requirements of general licensure. A better question might be whether someone could sit the IM Royal College exams with only a year of postgrad training.

[leviathan]

Doesn't your training affect how you work as a GP? How does experience improve their ability down the line when there's no feedback when they're doing something right or wrong?

[gongshow]

RIP blog - you have been a great study distraction

[2012canfm]

To brooksbane:

 

Have you actually been treated for a reasonable amount of time by a physcian who is a certificant of the CCFP vs a general practitioner ?

 

I have - and boy there is a difference especially on the prevention side of things. Until you have actually experienced the difference between the two as a patient, or until you can actually present a basis for your statements, I do not think you are qualified to make that assessement.

 

I am so so so happy you are not a PD or in charge of anything except your self. As a CSA (yup I said the word - I feel like saying it in your presence - would inflict some kind of darth vader response) - I have been accepted into an FM position(FM FM FM !) in canada - based on my merits on the EE , electives and amazing LORs. If you ever spoke to me in person the way you speak on these forums(arrogance and full of a sense of superiority) you would have another thing coming to you. Its nice to know you are brave behind a computer though.

 

To all those IMGs out there -

 

do not listen to brooksbane or anyone else who tries to discourage you. You are all courageous in that you followed your dreams and in end the only approval that you need is the PDs, not *some* elitist uptight canadian medical students barely able to hide their misplaced aggression and element of superiority. (only the ones who have shown it, i find in general most are quite well adjusted, friendly people)

For the record - I dont agree that CSA should have any advantage over IMGs but may the best person for the job get it. Currently - culturewise/language wise CSAs do better, but there are some immigrant IMGs who do great.

I think its really rich of people to come here and judge others. (ie. IMGs who judge CSAs, canadian med students who judge CSAs differently than IMGs).

I mean really??? Just be productive, get along with your team WHOMEVER they are, and stop whining. Life is not fair, we all know that, do the best with what you have, if that includes getting a degree from India, Carribean, USA, Canada, so be it.

Good luck - any CSA or all IMGs who are going for next year s carms match - please feel free to PM me. I may not be able to respond promply as I have to study for the LMCC part 1 but I do promise to get around to it.

[blizzah]

What is a CSA?

[2012canfm]

Canadian Studying Abroad

[DeeDoc]

What is a CSA?

 

Canadian Student Abroad

[aaronjw]

Gets out popcorn and waits for the reply although I am not sure we'll see one. BB tends to duck the tough questions when directed in his way

[NLengr]

To brooksbane:

 

Have you actually been treated for a reasonable amount of time by a physcian who is a certificant of the CCFP vs a general practitioner ?

 

I have - and boy there is a difference especially on the prevention side of things. Until you have actually experienced the difference between the two as a patient, or until you can actually present a basis for your statements, I do not think you are qualified to make that assessement. .

 

I actually looked this up once. I found one study comparing GP to CCFP practice patterns several years post residency. The authors said they were identical.

 

That's a study. You are using anecdotal experience with a couple docs. If you have contradicting evidence then you should post it cause it would be good to see.

 

If someone wants to dig it out, I put it up about a month ago.

[NLengr]

"The only thing I was able to find was a study from 1985 by L. Curry in Canadian Family Physician that showed after a few years in practice there was no difference in practice patterns between those from CCFP vs. internship. Which would seem to support the argument that there is no difference."

 

Found it. March 15 thread.

[2012canfm]

NLengr - My point was to say that - nobody here can prove there IS NOT a difference, and including a study from 1985 does little to help your cause for obvious reasons, one being the many curriculum changes that FM residency has undergone. But -you are absolutely right - it was antedotal evidence, but it was a difference that I experienced. So I personally cannot agree with Brooksbane's statement or bashing of FM as a respected profession. And if he feels so strongly maybe he should take it up with the appropriate authorities concerned.

 

I find it pointless to argue with you or anyone on this thread, I just felt compelled to stand up for those who do choose FM residency as their preference as well as for the IMG situation.

 

I agree that neither of us will ever find "evidence" to each others satisfaction. That being said, IMHO I do believe that FM residency will not be dissolved anytime soon.

[2012canfm]

Its kind of funny how that works eh? If you are an experienced physician with lots of practice in clinical medicine, you are likely going to be less competitive than a total newb with some book smarts. It is true, just kind of strange

 

Just to answer this question :

 

The reason the PDs like fresh graduates is because older foreign born IMGs (FMGs) are thought to less ..for lack of a better word, teachable. Apparently - during the early days when provinces started working with IMGs, they noticed that there were some issues with attitude(not wanting to adapt to the Canadian system), resentment(learning from someone younger than you), less in touch with the patient centered model etc. Now these are generalizations which will not be true for every FMG and may not even be accurate, but again this is thought to be the reason why PDs prefer fresh grads. Easier to teach, much more willing to learn and adapt quickly, I can think of other reasons but then everyone will call me ageist.

 

**NB: these are not my opinions only the possible reasons I have heard from other IMGs in the system or who have passed out of the system and are practicing**

[A-Stark]

NLengr - My point was to say that - nobody here can prove there IS NOT a difference, and including a study from 1985 does little to help your cause for obvious reasons, one being the many curriculum changes that FM residency has undergone. But -you are absolutely right - it was antedotal evidence, but it was a difference that I experienced. So I personally cannot agree with Brooksbane's statement or bashing of FM as a respected profession. And if he feels so strongly maybe he should take it up with the appropriate authorities concerned.

 

I find it pointless to argue with you or anyone on this thread, I just felt compelled to stand up for those who do choose FM residency as their preference as well as for the IMG situation.

 

I agree that neither of us will ever find "evidence" to each others satisfaction. That being said, IMHO I do believe that FM residency will not be dissolved anytime soon.

 

I don't think you're appreciating the reasons why many of us view the demise of the rotating internship and general licensure in such a negative light. The effect of this (along with the establishment of CaRMS) has been to greatly reduce the pool of potential generalists and introduce considerable inflexibility in postgraduate training. Unsure of what you want to do? Too bad - programs will look with suspicion on having the "wrong" electives (i.e. outside or "too far" outside the relevant residency program) and the incentive to concentrate electives in a single specialty becomes greater each year. Good luck switching - there are many roadblocks to it - and while re-entry positions exist, it is considerably more difficult than in times past.

 

Before CaRMS and (anecdotally) in its early days, you could do a rotating internship, go out into practice for a while, figure out what you like best, or immediately enter a specialty. There was no ridiculous requirement to pick a a career path in Med 3 (or earlier at Calgary or Mac!). Perhaps you don't appreciate this as a CSA, but with the demise of the internship year and general licensure came a loss of generalist, broad-based training in favour of students doing 10 weeks of ENT or 12 weeks of anesthesia - and I don't think this been to anyone's benefit.

[2012canfm]

The argument was : whether a CFPC certificant is equivalent to a general practitioner, it was NOT as you have somehow accelerated to whether or not I appreciate the benefits of a rotating internship.

 

As a CSA (now family medicine resident) - I understand a lot of things probably just as well as you - just not why you have turned this issue into something its not - please read above.

[lostintime]

Uh those aren't exactly isolated issues. They are connected concepts. People are allowed to argue around surrounding points to support their ideas even if it doesn't support yours.

[2012canfm]

lost -

 

how does saying that a rotating internship is beneficial for medical students (not arguing against that) in anyway support whether or not that general practitioner who underwent that rotating internship is equal in skill to an doc with a CCPF? I dont follow the logic.

 

I never implied people were not allowed to argue either side, but I can pick and choose what I want to argue about - and its not about rotating internship related as they are , its clearly not what I was discussing.

 

Anyways- it has been interesting reading everyone's comments here and I wish everyone the best!

[seeking1]

Further evidence to my point of it being the case that foreign trained physicians who have poor English comprehension are selected against: http://www.dailymail.co.uk/news/article-2131317/Foreign-doctors-speak-proper-English-struck-off.html

[Mourning Cloak]

Further evidence to my point of it being the case that foreign trained physicians who have poor English comprehension are selected against: http://www.dailymail.co.uk/news/article-2131317/Foreign-doctors-speak-proper-English-struck-off.html

 

This sounds like a good idea.

 

If you can't communicate, you shouldn't be practicing medicine. It's just too dangerous.

[seeking1]

This sounds like a good idea.

 

If you can't communicate, you shouldn't be practicing medicine.

 

Whats interesting though is that the UK is starting to select more against fellow EU countries. In other words, they're trying to favor Canada more than they do Germany. This is going to get weird/painful.