ummm...HUH? Post - Grad

[Guest kanayo101]

hi everybody!

 

ok, i've got the pre-med thing all down packed and know what to do. however, what i'm confused about is what happens after 4th year med school? you get your MD then...? how does residency work? how do you go into a specialty? what specialties are available? is emergency medicine even a specialty?

 

thanks!

 

ps - if you have UBC or British Columbia specific info, i'd appreciate it too!

[Guest Ian Wong]

So, after you get into med school, you need to start thinking about which specialty you want to go into. Most premeds don't know very much about each specialty; in fact, that was one of my interview questions: name as many specialties in medicine as you can. I ran out of jobs after about 12, but there's dramatically more than that.

 

Medical students basically apply to residency positions at teaching hospitals and universities across Canada. Any site where there is a medical school also has facilities to train residents (what a med student is after he/she graduates) in their specialty of choice. After residency, you can go out and start working independantly, or you can continue even more training afterwards in something called a fellowship. A person training in a fellowship is known as a fellow.

 

After medical school in Canada, you are given the MD behind your name, and therefore can now refer to yourself as a doctor. However, in order to practise medicine, you need to be certified federally, and I believe be approved provincially, and you can't get either until you've completed a residency. Some examples of residencies include: Family Medicine, General Surgery, Pediatrics, Emergency Medicine, etc. You can see the complete list here: www.carms.ca

 

Medical students "match" into specialty programs, and this is co-ordinated by a national organization known as the Canadian Residency Matching Service, or CaRMS for short. It's just like applying to medical school all over again, and perhaps it's best that I use an example here. Suppose that I wanted to go into General Surgery. By checking the CaRMS website, I see that there are General Surgery programs in most major cities across Canada, but the cities that I'd like to live in include Vancouver and Toronto.

 

In my senior years of medical school, I am likely to schedule electives in the General Surgery departments in UBC and U of Toronto, and meet the faculty of both departments. At the beginning of fourth year, I submit my General Surgery application to CaRMS, which includes reference letters from general surgeons, any research experience, and my grades from medical school. CaRMS will then send this application to the General Surgery departments in UBC and Toronto. If those departments like me, then I will get an interview, and will have to fly there for a face-to-face meeting.

 

If I still decide that I like both programs, then I inform CaRMS of this. Simultaneously, if the UBC department likes me, but Toronto doesn't, they will inform CaRMS of that. On Match Day, in March of fourth year med, CaRMS will mail me that I've matched into General Surgery, and will spend the next 5 years training as a resident in General Surgery. The first year of residency is often referred to as an internship, so a first year resident may also be called an intern.

 

Once those five years are completed, I am now licensed as a General Surgeon, and can set up a practice of my own. However, suppose that I like a certain area of General Surgery more than others. Suppose hypothetically that I wanted to help remove tumours from cancer patients. There is a Surgical Oncology fellowship offered in Edmonton at the University of Alberta. If I apply for that fellowship, and receive it, then I move to Edmonton and train for 2-3 years as a Surgical Oncology fellow. On completing that fellowship, I am now licensed not only to do General Surgery, but can also remove tumours.

 

That's not to say that General Surgeons don't also remove tumours, but I would have more training in that area, and patients would be more likely to be referred to me, particularly if the removal is a difficult one.

 

There's a list of all the specialties/residencies on the CaRMS website. Unfortunately, there's no listing of fellowships that I know of. And yes, Emergency Medicine is a specialty of its own.

 

Ian

UBC, Med 3

[Guest kanayo101]

sorry ian for taking so long to reply to your reply...

 

 

thanks for your help though. so, let's get this straight. if i want to go into something like pediatric oncology or pediatric pulmonary medicine, i would have to do my residency in pediatrics than a fellowship in either oncology or pm right??

 

one more thing. autobiographical essays and interview questions. where can i get samples?

[Guest Ian Wong]

As far as I know, yes. You'd do pediatrics first, and then get the fellowship afterwards.

 

For both autobiographical essay advice and sample interview questions, start at: premed101.com and click on the relevant links in the title bar. As for samples, your essay should really be about yourself. As far as the format goes, I've got a couple samples of format types, but the most important rules are to be specific, and to provide examples to back up your statements.

 

Ian

UBC, Med 3

[Guest SillySally]

Now Ian when you say once you have completed your surgical residency you can set up your own practice. How does a surgeon set up his/her own pravtice. As a sugeon would you not work in the hospital as part of their staff? Aren't there many specialties ie Anthesiology, Radiology where you just work in the hospital and not in your own practice?

 

Thanks Ian

Sally

[Guest Ian Wong]

A surgeon has an office outside the hospital, just like a family doctor. A family doctor will refer you his/her patient, and after you get their history and physical exam, and decide they need surgery, you book a surgery time at the hospital that you are affliated with.

 

You will get paid by the government for seeing the patient in your office, and then again by the government for performing the actual surgery.

 

The hospital gives you operating room time, and staffs the OR with nurses, techs etc, because in return for working at that hospital, you also agree to take on responsibilities like being on call, seeing Emergency patients, etc.

 

Radiologists again can work outside in their private offices. As soon as the X-Ray department takes the scans, they simply send them over to your office and you read them and send them back to the original doctor who requested the scan. Again, you bill the government for the scan interpretation. Lots of Anes work in the hospitals in the OR, but some have their own offices where they do non-surgical stuff. ie. Pain consultant

 

Ian

UBC, Med 3

[Guest curious]

hi, I saw on the carms stats page that 5.8% of the graduates were unmatched. What happens to them? Just curious.

[Guest Ian Wong]

If those people remain unmatched for both the first and second rounds of the CaRMS match, then it just means that they will not be doing a residency starting that year. Many people will re-apply to CaRMS for the following year. Other people may just put the MD into their resume, and start a graduate degree that ties into their medical training (eg. law, MBA, MSc or PhD, Public Health, Epidemiology etc). Others may head out for jobs in industry, such as consultants for drug companies, biomedical research companies and so on.

 

Basically, all it means is that those individuals aren't doing a residency for that year. They may do one in future years, or may not go into clinical medicine at all, and rather find alternate sources of employment that may or may not draw on the knowledge they've acquired as MD's.

 

Ian

UBC, Med 3

[Guest j]

What about people who aren't matched into their first choice? Are they obligated to take a second or third choice, or do they often decide to wait a year and try again for their first choice?

 

The whole matching idea seems so scary!! Looking at the CARMS website, and seeing that the thing that I think I'd be most interested in has only one spot! Don't people typically, at the time of the match, have a particular interest in a particular residency?

 

It seems like much more pressure than applying for med school, because the stakes are so much higher! If I have my heart set on a particular residency, should I be trying to involve myself in research relating to it before even starting med school? Yikes!!

[Guest Ian Wong]

During CaRMS, you apply to as many programs as you want and can afford. As a result, you could apply for 2-3 different specialties simultaneously, and rank them accordingly.

 

Therefore, if you didn't match into your first choice specialty, the computer that coordinates the match would then try to find you a spot in your second choice specialty, and so on until you match. If you don't match that year, you can reapply again the next year.

 

Some residencies are extremely competitive. Right now, residencies in Plastic Surgery, Derm, Ophthalmology, and ENT (and probably others) often only have one spot available per university, if that. As a result, it's really tough to say whether or not you will match into those specialties.

 

Doing research before med school might be useful, but realistically, you'd be a much more effective researcher once you had clinical experience and some medical background (unless you already do). Also, I'd say a very large proportion of each class actually changes their mind regarding specialty choices once in med school, so that extra research might not even come in too useful once you get to Med 4 and are applying to CaRMS. You could be using that free time to do fun stuff instead.

 

Ian

UBC, Med 3

[Guest monkey]

hey Ian,

 

i wonder: Since for competitive programs there are usually only one spot/uni....,why dont medschools still retain competition as much as undergrad/premed have? it only makes sense...as having competition in premed does i guess.

 

However, in the end i'm glad that 1st and 2nd yr in many medschools is now pass/fail...so CaRMS doesnt know of our exact percentage...or do they!?!??!

 

thanks!

[Guest UWOMED2005]

No. Western won't even allow US to see our final percentages for our classes - it's strictly H/P/F and moving seems to be moving to P/F (clerkship will be P/F for the 2005 and 2006 classes at UWO.)

 

In med school, you can't rely on your grades to make you stand out - you have to be a bit more creative. From what I've heard, yes having all 'H's looks better than all 'P's, but more important for residencies is what you've done before (ie B.Sc, Master's, PhD, volunteer experiences,) research, your clinical performance as based on reference letters from docs on your clerkship & electives, and what you've done with your summers (clinical & research electives, etc.). Thing is, for residency each individual program is free to come up with their own formula so there really is no right answer as to how to make yourself the "best" candidate for all residency programs!

[Guest driedcaribou]

Man... it sounds very scary to be unmatched....

 

 

Was the whole applying to a specialty a shock for many of you?

 

It sounds like the path to practicing medicine is full of many hoops to jump through... I was naive to think that getting into a school was the hard part.

[Guest UWOMED2005]

Getting into med school IS the hardest part, unless you're set on a competitive specialty. Every year, there are more residency spots than students. The system doesn't want you to not match. . . it's useless for Canada to have a bunch of unused MDs sitting around doing nothing, particularly in lieu of the current physician crisis. As long as you're not too picky about what you apply to and apply to enough programs, then you'll match somewhere.

 

The kicker is if you really, really want something competitive such as Ophthalmology, Plastics, Derm, ENT, Urology or Emerg. I know at least for Ophtho, there were about 74 applications for the 1 spot here. After people are selected for interviews, usually about 30 people each year rank Ophtho #1 for the approximately 15-20 spots. Obviously, the system can't cram all 30 of those people into the 15-20 spots.

 

Now, most of those people will "back-up" ophthalmology with another specialty such as gen surg. But the problem is then if you're matched to gen surg, you're legally bound to start that residency in gen surg. So, sometimes a candidate decides they're so set on a specialty that they would rather risk not being matched in the first round of CaRMS and then reasess what to do rather then being forced into a residency program they will hate. I have heard of other scenarios for being unmatched, but that is by far the most common scenario: Great medical student who simply chose to accept nothing less than their top choice for specialty and then didn't have the cards fall in the right place.

 

But not matching isn't the end of the world. There is a second round of CaRMS, and there are always spots left over for anyone who didn't match. Sometimes there's some pretty choice spots left as well, but the majority are in the "less competitive" specialties. Or, you can take a year off and do extra research and clinical electives to boost your application (aka the "5th year") and reapply both to Canadian AND American programs in your desired specialty.

 

Hope this helps explain things and lighten some fears.

[Guest kellyl20]

Just wondering out loud whether physical appearance/presence have much to do with being successfully matched in the competitive specialties.

Is it generally true that taller or more attractive in appearance candidates do better in the match. Opinions anyone?

[Guest driedcaribou]

I'm sure sexier candidates get a higher priority.

 

I've heard attaching risque photos of yourself in the application also helps.

 

[Guest physiology]

I think being goodlooking, having a great smile, and wonderful charisma helps you in most areas of life.

 

I mean, as superficial as it sounds, it's the truth. We all have idealized stereotypes of what people should be, and before I get too philosophical, I think it'd help.

 

If there were two applicants, both being identical in all aspects, I'd probably choose the better looking one.

[Guest kellyl20]

Physiology: I agree with you. And for guys probably a good height would really help (since most people are average looking).

[Guest UWOMED2005]

Of course if you're stupid, bumbling, smell bad, have no social skills and have no personality. . . then you could look like Anna Kournikova and still not do well.

 

I know plenty of hotties in this world who are basically bums and ugly people who are quite successful.

[Guest Lakers4life]

Hot girls never seem to have any problems do they...

[Guest UWOMED2005]

Ooh, I don't know about that. I know of a few hot girls doing absolutely nothing with their lives right now. That's a stereotype.