CaRMs and the future for IMGs?

[Dr. Jan Intor]

So i've spent the last few months doing copious amounts of research into everything that goes into being an IMG. I've been accepted to a few Caribbean schools and Queensland in Australia and have seen all the CaRMs reports on IMGs and am fully aware of the obstacles that I would face coming back if I attend any of these schools. I've even called various residency programs ranging from Family Med to Physical Med & Rehab and they have all told me that an IMG is an IMG and it doesnt matter if you are a CSA who grew up in Toronto or a true IMG who just recently immigrated to Canada (Although the CaRMs reports of IMGs show a larger percentage of CSAs are matching than true IMGs --> http://tinyurl.com/d98w9wq ).

 

What I want to ask and get some information on from you guys is if you know what the future is trending towards? I know within the US the AAMC reports are suggesting that due to increased US med enrollment that a 1:1 US grad to residency spot is on the horizon and should be reached by about 2016. In Australia (according to OzTREKK) historically the Internship positions have been almost guaranteed to IMG's studying there because of the surplus of Internship spots to Australian Grads. But new med schools and increased enrollment in AUS is trending towards less and less Internship positions available to IMGs as well. But what about Canada and CaRMS?? If I start this January/Feb (2013) I anticipate being in the 2017 or 2018 cycle. I know there is nothing definitive but do you know/what do you think is going to happen in Canada? Seats have been increasing in Canadian schools but since IMGs have their own Quota my real question is what will happen with that IMG quota in the next 4-6 years? Will they address physician shortages by increasing these quotas? Can a possible CSA distinction be put into place?? I know it may all be speculation but I would really appreciate your thoughts.

 

Thanks in advance!

[cardiomegaly]

It's honestly too unpredictable to say. A lot can change in 5 years. From 2007 to 2012 there has been an increase of almost 700 medical students (from 2000-2672) and just over 600 new residency positions, maintaining almost a 1:1.1 ratio. Each province does its own thing with respects to managing IMGs - in Ontario, there are designated spots in the first round; in Alberta there is a separate AIMG program; in Quebec and Manitoba their first rounds are open to all applicants.

 

The next few years of graduates will be the largest seen in Canada. There is already a squeeze in terms of residency positions (speaking from an Alberta perspective, it's very obvious the government didn't think far enough). And if you look even farther, there has been some recent debate and articles published about job shortages in many procedural based and specialist positions. So it's much, much more complicated than "can we accept more IMGs".

 

Something like 20% of practicing staff physicians are foreign trained - it's no secret we are dependent on IMGs especially in rural areas. But the landscape is changing and with more and more canadian grads who are finding themselves after 12-15 years of schooling to be unemployed, things are getting scary. There's a push from the public to have more doctors, but what they don't understand it its the allocation of where and what type of doctors. There's a push back from the specialists because there are simply no jobs in OR based specialties. I've talked to ortho, gen surg, obsgyn, ent and other residents and the end of the road is bleak, but everyone remains optimistic because there are lots of old docs who are supposed to retire... but once those jobs are snapped up where do we go? We don't have the infrastructure to support 8 new general surgeons in the Edmonton area each and every year. So something has to give.

 

It gets even more sticky because of who is advocating loudly for CSAs. I acknowledge that many CSAs come from more prestigious schools than I trained at, and that their quality of training can be very high. On the other hand there are some bad apples out there too. But it's Dr. Mommy and Dr. Daddy who sit in high rank administrative positions who are pleading for the system to change so that their dearest son or daughter can come home and treat Canadian citizens without fighting through the other thousand IMG applicants. And the biggest problem is when you try to discriminate a CSA vs. a new Canadian citizen or permanent resident foreign trained doc - you can't without violating some sort of human rights. (there's a great CFMS article about it).

Especially if they could have graduated from the exact same school. An English immigrant turned Canadian citizen who went to St. Andrews verses a Canadian born who went to St. Andrews - how can you give priority to one? People also like to quote the CaRMs CSA study in 2010 where over 20% of CSAs are children of physicians, and CSAs on average have less applications than the average Canadian matriculant. Most Canadian students I know who have applied several times, redone degrees and put in many years of hard work to finally end up in Canada would be mighty pissed to lose their residency spot. That argument itself has been beaten into the ground on this forum, along with the subsidized education argument and the "who deserves it more" entitlement. Oh and also the "we train overseas residents because the Saudi government pays for them why can't we just give these spots to CSAs" - that one doesn't work because those residents can NOT stay in Canada, and often work in specialties where there are ZERO jobs ie. neurosurg, cardiac surg and basically they provide resident coverage which is cheaper than paying clinical extenders.

 

Anyways I think the numbers for CSAs who are more successful than the average IMG reflect the importance of doing clinical rotations in Canada and having reference letters here - something that is logistically easier to do as a fourth year international medical student than a fully trained physician looking to redo a residency in order to practice.

 

Some food for thought. It's a very, very complex problem.

 

Read this:

http://www.cfms.org/attachments/article/163/CFMS%20position%20paper%20on%20CSAs,%20IMGs%20and%20capacity%20SGM%202012%20edits.pdf

[leviathan]

Very good post cardiomegaly.

 

I agree. With the job crunch doctors are facing, the gov't might close the doors to IMGs because they aren't needed anymore. Conversely with the retiring physician population, and the predicted increase in demand from baby boomers, the demand might INCREASE and they might need to add more residency spots for both CMGs and IMGs alike. Or a third alternative is with the exploding health care budget, the gov't might increase their reliance on midlevel providers thus preventing a need for more doctors, bringing us back to square one.

 

As for your comment about CaRMS statistics. Well, assuming the poll was representative (there are many reasons it probably isn't), there are many IMGs who knew from square one that they'd never get into a Canadian medical school and didn't waste their time. The students who apply 2,3,4 times in Canada are the ones who are sitting on the borderline with 3.6 GPAs and 29 MCATs. They have a reason to keep trying in Canada as they know eventually they'll get in.

 

This has been beaten to death (and I've been part of those beatings!) but IMGs aren't taking some 'easy route', when it's really about 100x more difficult to be an IMG than a CMG. Either route to being a physician is difficult, it just depends whether that difficulty is experienced before or at the end of medical school. Personally I feel like it is much easier to just sit around reapplying yearly while doing post-bacc programs to artificially boost your GPA. Then after you get into a medical school it's pass/fail and you have no worries about finding a residency, even if you're the most incompetent med student on the planet. Now if you worked hard getting into a Canadian school then you earned that right to be on easy street, the point I was trying to make is that we should try to be less judgmental of others or presume to know why they made decisions in their life.

[Dr. Jan Intor]

Thank you both for your thoughts. I'm really torn, I'm on the edge for canada but nothing special (3.74 last 2 years, 29 mcat). I don't know whether to essentially put life on hold for couple years and stay in a stagnant place to try and improve stats and stay in school to try and get into Canada or just take the risk and take a step into IMG world and deal with the hurdles as they come. I, as I'm sure a lot of you, know a lot of people who gave up on medicine and are pursuing other careers but I know this is what I want and its so disheartening when you read all the stats. The way I see it is that My chance of getting into a Canadian Med School would be roughly the same as my chance of getting a residency in Canada as an IMG (with the US as an alternate back-up)

 

lol maybe I should give it all up and work for few more years get my MBA, go into Health admin so I can boss some doctors around

[leviathan]

3.74 is good enough for a US school, maybe MD and definitely DO. That is a reasonable alternative to a Canadian school as they're LCME accredited and you can apply to CaRMS in the first round and/or have no problem matching in the US.

[Dr.Henderson]

3.74 is good enough for a US school, maybe MD and definitely DO. That is a reasonable alternative to a Canadian school as they're LCME accredited and you can apply to CaRMS in the first round and/or have no problem matching in the US.

 

This is sound advice, OP. You should definitely exhaust U.S. options as well before going international if your goal is to return to Canada, especially if you'd prefer to do residency here. If you study in the U.S. you can apply first round to CaRMS with Canadian grads.

 

It sounds like you've done good research on the international side of things, make sure you check into the U.S. MD and DO routes

 

Best of luck to you.

[rswim]

All very good points on this blog. This is the most informative blog on the issue that I have seen thus far.

 

I think that the most important part is that you recognize the challenges that lay ahead and it sounds like you do.

 

As you mentioned, the odds of getting a residency back in Canada are probably about the same as the odds of getting into a Canadian school, the only downside of taking the risk and going away is the potential debt that you will incur whereas if you wait and continue doing things in Canada but are unlucky enough not to get in you will likely have found another fascinating and rewarding career.

 

It is very hard to predict what the future will bring. If we plan on bringing in more mid level providers, perhaps that will open up rewarding and interesting new career options for Canadians who are on the cusp of getting into Canadian Schools (this seems increasingly likely and seems to make sense).

 

I can tell you that current CMGs are now starting to mobilize to make sure that they protect their positions as they certainly do not want to entertain another battle like they did to get into a Canadian School in the first place. Like was mentioned in a previous post though Dr. Mom and Dr. Dad of the CSAs are a daunting task force to oppose.

[MLDM]

First off, great Scrubs references!

 

I'm a Torontonian starting at St. George's in Grenada this August and have gone through all the info on returning to Canada just like everyone else. I have a 3.82 GPA, 31P MCAT, a publication in JPET and I was a varsity athlete for 3 years and volunteered at Sick Kids when I wasn't in the lab during the summers. I'd consider myself a decent applicant but I didn't get a single interview last round (maybe I doesn't write no good). Personally, I'm not sure it's worth waiting around for years re-applying when Canadian med schools are only getting more competitive (look at UofT, at this rate in a couple of years the average matriculant is going to have a 4.0).

 

There are some alternate routes back into Canada that I'm thinking of pursuing:

1) I'm starting at SGU now and at the same time I've already applied to AMCAS and OMSAS again. This is pretty expensive since it'll cost you 5 years of tuition but being a US grad will get you into the first round of CaRMs and Canadian tuition will end up saving you a bundle in the end if you get in.

2) Bust my ass at SGU and try to get as many electives done in Canada as the gov't will allow for reference letters then apply for residency (12 SGU grads matched in Canada, mostly at UofT, this year).

3) It's arguably easier to get a residency in the states as an IMG that did his/her clinical years there then try to return Canada via Pathway 4 (http://www.cpso.on.ca/policies/policies/default.aspx?ID=2354).

 

At any rate, you have to figure out whether your aspirations of practicing medicine are greater than where you see yourself living. If you're serious, I think that the choice is obvious. I hope I gave you some good ideas.

[thegame11]

First off, great Scrubs references!

 

I'm a Torontonian starting at St. George's in Grenada this August and have gone through all the info on returning to Canada just like everyone else. I have a 3.82 GPA, 31P MCAT, a publication in JPET and I was a varsity athlete for 3 years and volunteered at Sick Kids when I wasn't in the lab during the summers. I'd consider myself a decent applicant but I didn't get a single interview last round (maybe I doesn't write no good). Personally, I'm not sure it's worth waiting around for years re-applying when Canadian med schools are only getting more competitive (look at UofT, at this rate in a couple of years the average matriculant is going to have a 4.0).

 

There are some alternate routes back into Canada that I'm thinking of pursuing:

1) I'm starting at SGU now and at the same time I've already applied to AMCAS and OMSAS again. This is pretty expensive since it'll cost you 5 years of tuition but being a US grad will get you into the first round of CaRMs and Canadian tuition will end up saving you a bundle in the end if you get in.

2) Bust my ass at SGU and try to get as many electives done in Canada as the gov't will allow for reference letters then apply for residency (12 SGU grads matched in Canada, mostly at UofT, this year).

3) It's arguably easier to get a residency in the states as an IMG that did his/her clinical years there then try to return Canada via Pathway 4 (http://www.cpso.on.ca/policies/policies/default.aspx?ID=2354).

 

At any rate, you have to figure out whether your aspirations of practicing medicine are greater than where you see yourself living. If you're serious, I think that the choice is obvious. I hope I gave you some good ideas.

 

 

1) When you apply to AMCAS and OMSAS, they ask you whether you are enrolled in a medical school currently or in the past. Are you going to lie on your applications?

 

2) How will you manage going to multiple interviews and keeping up with your school work? What if you have some required thing like anatomy practical during the days you have interviews?

 

3) Why are you overlooking DO schools? With your stats, you are pretty much guaranteed to get into a DO school. I think most people agree that getting into an American residency is easier coming from a DO school than SGU.

[Slashsev]

going to the islands means you have 0 chance of return to canada (the numbers speak for themselfs considering now how many more students have gone international in the very recent years AND HOW little the can gov has done to support medical programs)...cutbacks are already starting

 

let alone finding a JOB/rez in the US...as a international med from SGU AND as a canadian you are shot in the foot 2 times

 

 

you will face visa issues

and will have the bottom crap of residence programs in less than preffered locations...your chance of anything outside of family med is also shot

 

...38.5% of internationals have found rez spots(that is if you can graduate SGU- bc afterall they do want to make money off your back..it is a for profit inst- and they know there are not alote of spots so the best way to to make the schools look good is to cutout the extra fat)

 

you are living in a very delusion my friend or have drank to much of the sgu koolaide

 

you never once wondered how their numbers are BETTER than most american schools...not just once?their faculties are also not the best...the UK SGU med program grad are also not allowed to work in several states or to do residencies

 

you reckless admission is also asking for long term trouble

 

the DO is the best bet for canadians now, esp with MSU trying to make new grounds...at the worst you have a position in the US

[Slashsev]

1 last rant..lol

 

to the number that show international doctore in canada

 

first off those MDs where accepted from an admission process many years ago

 

secondly of those accepted now many of them are #1 in their respective fields and have had SEVERAL years of experience working as physicians...

 

not off the bat residency students...

 

 

andddd as an SGU/int grad

 

you will be forced into a ROS program..so youll see 4-5-6 of your time in the middle of nowhere...

 

from thennnn on...then u will go to toronto and START your clinic...

[Slashsev]

the canadian economy has been hollowed out and will see a round of mass exits from highly talented individuals (look at europe now) ...theres is no respect for the healthcare field anylonger

 

considering we offer "social healthcare" its a shame..how much can the canadian gov abuse the public?

 

canada is being held by chinese pillars- toronto and vancouver...only matter of time before that will die out...

 

you probably can be more successful as condo salesmen without a highschool education in canada than as a doctor!

[A Second Daniel]

you probably can be more successful as condo salesmen without a highschool education in canada than as a doctor!

 

Tell it to the radiologists who bill $6 million.

 

http://www.torontosun.com/2012/07/16/number-of-millionaire-doctors-in-ontario-appalls-health-minister

[leviathan]

Tell it to the radiologists who bill $6 million.

 

http://www.torontosun.com/2012/07/16/number-of-millionaire-doctors-in-ontario-appalls-health-minister

Those days will be over soon.

[Dr. Jan Intor]

lol encouraging stuff. I think everything can be looked at both ways. If you go on mostly negatives, our housing "bubble" will soon crash, we'll all owe more money than our assets are worth and we'll die while waiting to get treated at local hospital because there is a doctor shortage. That's IF we don't get shot while attending a bbq or going to see a movie....If you want to go somewhere in life u have to make a move. Otherwise we can be happy making 50k a year renting an apartment till we grow old and our kids dump our asses in retirement homes they can barely afford.

[canuck]

lol encouraging stuff. I think everything can be looked at both ways. If you go on mostly negatives, our housing "bubble" will soon crash, we'll all owe more money than our assets are worth and we'll die while waiting to get treated at local hospital because there is a doctor shortage. That's IF we don't get shot while attending a bbq or going to see a movie....If you want to go somewhere in life u have to make a move. Otherwise we can be happy making 50k a year renting an apartment till we grow old and our kids dump our asses in retirement homes they can barely afford.

 

Well said my friend, well said!

[leviathan]

You're basically going to the casino and making a 200-300k bet here. People will have different opinions on what odds they're willing to play the game.

[Dr. Jan Intor]

You're basically going to the casino and making a 200-300k bet here. People will have different opinions on what odds they're willing to play the game.

 

very true and all things considered probably worse odds than a coin flip! But at least I think its less about just straight luck and you can do your part to make the odds as favorable for yourself as possible even though you arent starting off with the best of hands going to an international school.

[Slashsev]

i just wanted that poster

 

who believes that going to SGU and doing well will land him a spot here...

 

is on a collision course....

 

you better get a good plan B

 

bc youll stuggle to land a position in the US

[1234]

Tell it to the radiologists who bill $6 million.

 

http://www.torontosun.com/2012/07/16/number-of-millionaire-doctors-in-ontario-appalls-health-minister

 

Do you know how much those doctors work? And how slick they are at what they do? That radiologist is probably working 24/7 and is amazingly good at his job, whether it be interventional. If he were just slacking, he would have lawsuit after lawsuit on his name due to missed pathology or adverse outcomes in intervention.

 

People just whine about salary. If you were working as hard and well as some of those doctors, you would be asking for similar remuneration. He isn't on salary. He is busting his balls to see an extremely high volume.

[1234]

lol encouraging stuff. I think everything can be looked at both ways. If you go on mostly negatives, our housing "bubble" will soon crash, we'll all owe more money than our assets are worth and we'll die while waiting to get treated at local hospital because there is a doctor shortage. That's IF we don't get shot while attending a bbq or going to see a movie....If you want to go somewhere in life u have to make a move. Otherwise we can be happy making 50k a year renting an apartment till we grow old and our kids dump our asses in retirement homes they can barely afford.

 

Some times the best move is to do nothing but think. If your ideas are mediocre, it doesn't make sense to make a move for the sake of it. Act on great ideas, even if there is risk provided the risk is tolerable.