Matching for residency

[Guest Shidi]

Hello,

 

I was looking through the information of the matching for a residency. I have a quick question.

Let’s say you really want to go on to the Emergency Medicine Residency, and you don't match. Can you wait until next year and try again, I know it sounds weird and no one has probably asked it before, but I mean if it is your passion, could you theoretically wait for the next matching?

 

Thanks!

 

Chris

[Guest Ian Wong]

Yes. Theoretically, if you don't match, you can keep re-applying to CaRMS each year until you do. Of course, each year that you sit out is like losing a full year's worth of a doctor's income post-residency, not to mention that all your student loan debts start piling up.

 

I'm going to move this to the CaRMS forum.

 

Ian

UBC, Med 3

[Guest UWOMED2005]

Yep, you can wait another year to match. During the CaRMS match, you have the opportunity to rank any program you're interested in. You don't have to rank any program you aren't interested in. . . but that leaves you with the possibility of being "unmatched" in the first round. If a spot is still available in the program you want in the second round (relatively unlikely for some of the competitive programs like Emerg), you can try going for it again, though there is the danger of not matching in the second round either. You can also choose to forgo the match for that year and try again the next year.

 

I've heard EXTREMELY differing points of view, however, on whether that is a good strategy. Many students at Western in recent years have been opting to only rank their first choice programs, and the past two years that has meant a fair number have gone unmatched (6 this past year.) Also, seems like a few of the people shooting for competitive residencies this year echoed that strategy. . . if you look at the CaRMS stats for unmatched people's first choice discipline (www.carms.ca/stats/pgy-1_...dns.htm#2) you'll notice that most of the people who didn't match this year were shooting for competitive residencies like opthalmology, ENT, radiology, plastics, or urology.

 

On the plus side, theoretically during that year off you could do research or extra clinical electives in your field of interest to boost your resume. Also, if you are REALLY, REALLY sold on a specialty and wouldn't be happy in something a little less competitive, it might be worth taking a year off considering you'll probably be doing the specialty you choose for the rest of your life. One of the orthopedics residents here spoke during a career night, and particularly stressed that point. He graduated from Dal, and had a friend who was shooting for opthalmology and didn't match the first year. His friend was adamant about not doing family medicine (most of the spots in the 2nd round are in family though specialties often do have spots open) so decided to wait until the next year to apply again. That following year, I think I remember him saying his friend did match to opthalmology (or at least some other fairly competitive surgical specialty.)

 

But waiting a year to reenter the match can also be an extremely risky proposition! I talked to some of our 4th years about it, and many of them were highly against the idea. First problem is that you've got to carry that debt you've accumulated for an extra year. That's pretty minor. Much more significantly, the programs you're applying know that you've taken the year off, and some of the 4th years I talked to theorize that makes you look like a less attractive candidate. After all, if the programs you want wouldn't take you last year, why should they take you this year? Is there something about you they don't know that caused you to be rejected by the programs last year? I don't know if that's paranoia or there's something to it. . . but if you look at the match statistics for "prior year graduates" in 2002 (www.carms.ca/stats/stats2...m#vacant2) you'll notice that only 50% matched to their first choice discipline, with 68.2% matching to one of their top 3 choices. That's a fair bit lower than the overall average (62% to 1st choice program, 85% to one of the top 3). . . though that could be a reflection of people entering the match a second time going for more competitive programs.

 

One note about Emergency medicine specifically. . . not all Emerg docs complete the 5-year Emergency residency!! There's a one year pogram in Emergency medicine for graduates of Family medicine programs. The total training time for that option is 3 years (2 years Family medicine, 1 year emerg.) While not all hospitals (particularly large academic hospitals) will hire graduates of this program for their ERs, many hospitals will (including many of the suburban Toronto hospitals and those in smaller centers.) When I asked a graduate of the 3 year option what the difference between the two programs was, he replied that "the 5 year program is a waste of time." Of course, he'd obviously be partial, having completed the 3-year program. . . And on one final note, I've heard rumours that some hospitals are so desperate for doctors to help them out in the ER, that they're hiring Family Physicians without the extra ER training. I know that's true of many small rural centres, but I've also heard some of the larger hospitals are thinking about hiring Family Physicians to supplement the ER docs by helping with some of the less urgent cases that should have probably gone to a family physician in the first place. Not sure if that's true or not, but from what I've heard from some of the 3-year ER guys who came through family medicine, often their family medicine training is more suited to some of the stuff they see in the ER than the ER training!

[Guest Carolyn]

UWO is right about the 3 year vs. the 5 year... I am hoping to "waste" two extra years in the 5 year programme for the following reasons:

 

1) Want to be able to work in any large academic hospital

2) Potentially want to do a masters as a part of my training -- the programmes will often supplement that (I think at Ottawa it is "highly suggested" that you do a masters in Epi)

3) Opportunity to develop areas of specialty

4) Get involved in research early in my career with some mentors through the programme.

 

Finally, I was advised to try and look into the future and figure out what I'd want to be doing if I "burned out" from working in the crazy ER environment. Many say do Family Practice - if that is the case then you should do the 3yr... However, I know that I would want to teach, do research, perhaps admin -- so I believe that the 5 yr is the better route for me...

 

Just my two cents...

[Guest UWOMED2005]

Excellent points about the pros and cons of the 3 vs. 5 year Emerg specialties, Carolyn. I hadn't really thought of it that way. That's an excellent way of comparing the two streams. BTW - I wasn't actually saying the 5 year program was "just a waste of time". . . I was just quoting what someone else told me!

[Guest Carolyn]

I know you weren't but I would actually agree with that resident's comments depending on what an applicants plans

were in the future.

[Guest UWOMED2005]

Agreed. While I don't like the idea of thinking of additional training as "a waste of time," considering the current focus on "life-long learning" in medicine (ie just because residency ends doesn't mean your training does!) I see his argument as well (BTW - he wasn't a resident, but a practicing 3-year Emerg doc.)

 

It looks like you've done some research into Emergency. It's actually an interest of mine as well (along with a gazillion other specialties at this point. . . choosing a medical specialty almost seems like too much of a good thing!) I was curious - what sort of research opportunities are available in Emergency medicine?

[Guest Carolyn]

There are very diverse areas - from creating guidelines for diagnosis (eg. Ian Stiell from Ottawa is quite famous for his Ottawa Ankle Rules and now the CT Head Scan Rules), to alot of administration research (e.g. overcrowding etc.), toxicology, trauma, international, disaster medicine epidemiology etc. etc.... I can't say I've read as much research on pathophys, but more for aiding in clinical practice.

[Guest shidi]

Hey guys, thanks a ton! Both UWOMED2005 and Carolyn.. You've given me something to think about. I obviously cannot say for certain about what I will do in the future because I am so far from Med school (although I am sure that i want to go into medicine) the 5-year program seems like a better option... in addition to the points made by Carolyn, the 5-year program gives you a chance to build up experience and other opportunities. If I would ever choose ER work, I think I would strive to go for that 5-year program because it gives you more training for larger hospitals where perhaps things are more hectic and you need that extra experience to deal with the cases presented to you.

 

I have another question I will just ask you guys, just because we're on the topic.. I went to that site for the matching... and I saw that for Emerg Medicine, only 1 person was not matched.. (maybe I read it wrong) but how come many people don't see Emerg Med as being a competitive field, I have heard from others that the pay is good, and after your residency the hours are reasonable (i.e. after residency your not pulling 12 hour shifts every other day) I could be wrong about that though.. That is why I am asking.

 

I am in Biology right now... and we have been doing some very cool things lately with DNA, body-systems, dissections. etc. I think medicine would be the best career in the world... combing science with people... in my opinion it can't get any better, and I hold the utmost respect for you guys that are in med school right now... it will be awhile but I'll be a moderator for one of the schools in this forum.. just give me a few years Thanks guys!

 

PS: what does ENT stand for? Some specialty I am assuming...

 

Thanks again!!

 

Chris

[Guest Ian Wong]

Chris,

 

What you saw was a little deceiving. The link that you clicked on does indeed show a number of 1 beside EM.

 

www.carms.ca/stats/pgy-1_2002/table11-unmatchcdns.htm#2

 

However, that one person is someone who not only didn't get into EM, but also didn't get into any OTHER specialties either, such as Family Medicine, General Surgery, Pathology, etc. As a result, most likely this individual wanted only to be an EM doctor, and did not apply to any other specialties as a backup. As a result, this person will probably re-apply next year to EM residencies again, and hope to be accepted at that time. Kind of like applying to med school; if you don't get in the first time, you can keep re-applying.

 

On the other hand, if you look at this link,

 

www.carms.ca/stats/stats2002.htm#first

 

you'll see that under EM, 45% of people matched into EM at their first choice location, while 72% of people matched into EM at some location, not necessarily their first choice.

 

Again, kind of like applying to med school. Even if you didn't get into your first choice location, you still got accepted somewhere and are happy enough for the opportunity to get trained.

 

What this 72% means then, is that of all the applicants who applied to get into an EM residency, only 72% got it, which means the other 28% probably went into their backup specialty, such as Family Medicine, General Surgery, Pathology, etc. In that 28% of people who didn't get into EM, a grand total of 1 person not only didn't get into EM, but not into a backup specialty either (probably because he/she didn't apply to any), and that's what that 1 person you saw in the first URL was all about.

 

Therefore, with 28% of the applicant pool not getting into their top choice of EM, it's a pretty competitive specialty.

 

Hope that helped.

 

Oh, by the way, ENT refers to an Ear, Nose, and Throat surgeon, otherwise known as a otolaryngologist. Depending on their training, they can do stuff like fix punctured ear drums or drain fluid out of an infected ear, insert cochlear implants to help deaf kids hear, take out tonsils, do cosmetic surgery on the face, take out thyroid cancers, and tumours in your salivary glands, laser polyps off your vocal chords, help remove tumours growing near your brainstem, and a whole bunch of other neat and wonderful things. The popularity of ENT is on an upswing at the moment, and it's one of the more competive specialties to enter in either Canada or the US.

 

As a little bit of trivia, in lots of cartoons and such, doctors are often portrayed as wearing a little mirror on a headband around their forehead. The head mirror is a tool used virtually exclusively by the otolaryngologist, as it reflects light foreward along your line of vision, and is therefore exceptionally handy when trying to look into the back of someone's mouth or nose.

 

Ian

UBC, Med 3

[Guest mying]

What do people know about doing an extra year of general rotations, sort of like an old-school rotating internship? I've heard of people doing this as recently as this year (in the maritimes, in that case).

[Guest Shidi]

Holy, cleared everything up!

 

Thanks a lot Ian, it certainly puts into perspective the competitiveness of EM, as well as other specialties now that I look at that web site. Your a third year right? So will you be picking what specialties you want in the beginning of forth year?

 

Thanks again!

 

Chris

[Guest Ian Wong]

Hi mying,

 

Some residencies have what they call a rotating first year, or a rotating internship still. I think this varies with each province however, and at the end of this R1 year, you are licensed as a family doctor. In BC, specialties that do have this rotating year (seems to be called a "rotor year" here) include ophthalmology, psychiatry, and radiology. I'm sure there are many others. ENT unfortunately for me, is not one of these specialties.

 

As a result, after your R1 rotor year, if your specialty has one, you can sit for your Royal College exam in Family Practice, and if you pass, you can work as a family doctor and bill for patients seen as if you were a practising family doctor. This is known as moon-lighting, and so if you have the extra time, you can really boost your income by working as a family doctor on the side while you continue in residency.

 

The mandatory rotating internship of old, where EVERY medical school graduate would go through a year divided in general medicine stuff like: Pediatrics, Ob/GYN, Internal Medicine, and General Surgery don't apply any more. After this rotating internship, you could either start work immediately as a general practitioner, or go back for specialty training. I believe this rotating internship was abolished in the early to mid 90's, and it doesn't look like it's coming back any time soon.

 

Virtually all of the doctors I've worked with who went through the rotating internship said it was a good experience to have done, and then to have worked before re-entering residency. Invariably, these people made great residents because they had a chance to get some real work experience, figure out their strengths and weaknesses, and what they really wanted out of a specialty and career, and were therefore able to make stronger decisions when choosing a specialty to commit to.

 

As I understand it, this is the situation in BC, and I would assume elsewhere in Canada too, but I don't know.

 

Ian

UBC, Med 3

[Guest Carolyn]

Wow that is amazing - I hadn't realized that was how the moon-lighting works...

 

Unless things have changed in the last year, you can't moonlight in Ontario - I was at a PAIRO (Ont Residents group) meeting last year and they were talking about pushing to get it back in but I haven't heard that it happened at all.

[Guest mying]

The rotating internship I heard described was stand-alone... he hadn't been accepted to the specialty he wanted (say, CaRMS 2000), so he did this instead and met the program directors of the specialty he wanted (I don't know what it was) while doing this internship, and reapplied and was accepted into their program in CaRMS 2001. (The actual years are totally made up ) I think he was a Mac grad, actually, or at least someplace in Ontario. I don't think he wrote any exams or anything, it sounded like it was more like just doing a really long, paid, clinical elective. I guess I'll have to look more into it (later, much much later, must pass exams first).