Backing up with family vs. 2nd iteration

[Guest Onlyothernameleft]

Hi everyone, I am new to this forum and will be applying to a relatively competitive specialty during the next year's CaRMS match.

 

Generally speaking, it seems like family medicine is the only viable backup. I was just wondering if anyone has opinions on backing up with family in 1st iteration vs. seeing what's available in 2nd iteration. My thought is that there will always be FM spots open in the 2nd iteration, although it might not be where you'd prefer to go (it's only for 2 years anyway!) I think I'll be happy doing family, but also want to keep my options open for possibly other interesting disciplines in the 2nd iteration. I was actually wondering how feasible this is and if anyone has any input or insight into this process.

[A-Stark]

There is absolutely no downside to applying to as many programs as you can in the 1st iteration and going to as many interviews as you can. Each additional program costs you about $25, which is a pittance in the end.

 

Do NOT rely on what might possibly be in the 2nd iteration. It's true that there are always family spots available, but there is NO DOWNSIDE to backing up in the 1st iteration. Absolutely none. It is also reasonable to apply to two specialties with family as a backup, though it is very difficult to prepare competitive applications for more than one discipline, and it can make for a more irregular interview schedule.

 

Sask IM looks to be a fairly viable backup too.

[Jochi1543]

There actually is not a whole lot of family med spots open in the 2nd iteration this year (west/central, anyway). The few that are probably aren't very exciting (Fort McMurray, anyone? Remote/rural northern BC? Northern Saskatchewan?) and open to IMGs, so you'll be competing with a gazillion qualified physicians who will likely do a much better job of selling themselves to a rural program. So I wouldn't count on matching to back-up FM in 2nd round.

[ellorie]

So as a matter of interest, are there any other specialties that are so non-competitive that you don't need to back up? This year it seems like there were more/better psych spots in the second round than there were family.

[itimebomb2]

There is absolutely no downside to applying to as many programs as you can in the 1st iteration and going to as many interviews as you can. Each additional program costs you about $25, which is a pittance in the end.

 

Do NOT rely on what might possibly be in the 2nd iteration. It's true that there are always family spots available, but there is NO DOWNSIDE to backing up in the 1st iteration. Absolutely none. It is also reasonable to apply to two specialties with family as a backup, though it is very difficult to prepare competitive applications for more than one discipline, and it can make for a more irregular interview schedule.

 

Sask IM looks to be a fairly viable backup too.

 

I wouldn't say there's no downside at all. The downside is that you don't get to see what is open in the 2nd iteration. I think its safe to say that the "competition" for second round spots is considerably less stiff -- for example this year, there will be a uro, derm, rads, IM, ENT, ortho spot open that a program will be trying to fill with a random candidate - and likely very few people will apply, so you're changes might be half decent. If you ended up backing up with family, you woulnd't otherwise have a shot at that.

 

That being said, that's a very marginal benefit... I'd personally rather back up with Family because I think that's a great career.

[rmorelan]

Hi everyone, I am new to this forum and will be applying to a relatively competitive specialty during the next year's CaRMS match.

 

Generally speaking, it seems like family medicine is the only viable backup. I was just wondering if anyone has opinions on backing up with family in 1st iteration vs. seeing what's available in 2nd iteration. My thought is that there will always be FM spots open in the 2nd iteration, although it might not be where you'd prefer to go (it's only for 2 years anyway!) I think I'll be happy doing family, but also want to keep my options open for possibly other interesting disciplines in the 2nd iteration. I was actually wondering how feasible this is and if anyone has any input or insight into this process.

 

Looking at the second round it is increasingly becoming bleak - I mean there really isn't much there except family and psych, and anything "interesting" either is something they probably don't want to fill or absolutely swarmed by applicants - often really, really good applicants. Those family spots in round two are becoming pretty competitive as well - you have 5 days to prepare your second round applications post match day, your competition has prepared for that for months and months.

 

Do you have letters of reference that would be positively viewed by the few possible remaining spots in almost random disciplines? - you are competing against people that may even have completed residency in another part of the world in exactly that discipline (one of our anaesthesia IMGs I know had 2 canadian fellowships in that field plus his home residency program overseas - matched to first year anaesthesia this year so is a PGY1). You have other recent medical students from programs that aren't pass/fail - so all their high grades are up for display vs you who is pass/fail and didn't match in round one - forcing the questions of why didn't you? You have swarms of Canadians trying to get home of course as well. Things like that make up some of your competition. I think it is logical to be scared of round two, unless you are willing to wait a year and reapply, and your programs of course would look favourably at that.

 

Small points as well - second round is expensive in application fees - you have to pay again and for every program you apply to. Of course you need to apply to more programs likely as your odds drop at any one place. Kind of a slap in the face in my mind.

[A-Stark]

I wouldn't say there's no downside at all. The downside is that you don't get to see what is open in the 2nd iteration. I think its safe to say that the "competition" for second round spots is considerably less stiff -- for example this year, there will be a uro, derm, rads, IM, ENT, ortho spot open that a program will be trying to fill with a random candidate - and likely very few people will apply, so you're changes might be half decent. If you ended up backing up with family, you woulnd't otherwise have a shot at that.

 

That being said, that's a very marginal benefit... I'd personally rather back up with Family because I think that's a great career.

 

First, you absolutely get to see what is open in the 2nd iteration and the list of unfilled positions is currently linked directly from the CaRMS homepage.

 

Otherwise, this is just completely wrong. It is not only NOT "safe to say" that competition for second round spots is "less stiff". It is the EXACT opposite of that and often far, far, far more competitive. The handful of IM spots last year, for example, were incredibly competitive, to the point that otherwise strong candidates didn't even get them. And you seem to have missed the point that the 2nd iteration is open to everyone, even people with prior postgrad training and, of course, all IMGs.

 

You can apply for any spot in the 1st iteration and any backing up should be done there. Do not rely on the 2nd iteration for anything. Even the match rate for CMGs is lower, about 62%, and for IMGs it's abysmal, <10%. Every spot is "open" in the 1st iteration. Why would anyone want to wait for the random leftovers in the 2nd?

[rmorelan]

I wouldn't say there's no downside at all. The downside is that you don't get to see what is open in the 2nd iteration. I think its safe to say that the "competition" for second round spots is considerably less stiff -- for example this year, there will be a uro, derm, rads, IM, ENT, ortho spot open that a program will be trying to fill with a random candidate - and likely very few people will apply, so you're changes might be half decent. If you ended up backing up with family, you woulnd't otherwise have a shot at that.

 

That being said, that's a very marginal benefit... I'd personally rather back up with Family because I think that's a great career.

 

Those spots will be still swarmed - and worse some don't even exist with the school having no desire to fill them. They have to go through the motion but this is how a school opts out of using a spot. Schools absolutely don't have to take someone for every spot the offer.

 

The second round is far more competitive than the first. Vastly so.

[thebouque]

If you end up in the 2nd round, you have a fair chance at a pathology program, by far the best medical specialty

[rmorelan]

If you end up in the 2nd round, you have a fair chance at a pathology program, by far the best medical specialty

 

ha There is a lot going for that field.

 

Of course you would have nearly 100% chance of getting it in round one.

[itimebomb2]

First, you absolutely get to see what is open in the 2nd iteration and the list of unfilled positions is currently linked directly from the CaRMS homepage.

 

What I mean is that you can't see what's going to be left over until the second round happens... obviously you can see them now...

 

My point is if you want a run at a subspecialty in the second round rather than conceding into family, then its something to think about. An obscure chance at ortho/uro/derm/rads/etc is still better than no chance at all for some people. Yes, its competitive, but almost everyone applying will be as woefully unprepared as you (or an IMG...).

 

A small number of people will match 2nd round to something awesome, so you can't say that nothing good can come of it at all. It's just not very likely.

[Med0123]

Yes, some people do match into competitive specialty in the 2nd iteration, but they are the exception.

 

Last year one of my friends fail to match into rads and gen surg, he went into the 2nd iteration and matched into urology.

 

Another of my friends tried to match obgyn last year, she failed, did few months of research, reapplied this year, still failed, she is now screwed and will plan to match in some obscure FM program.

 

I have the exact same story with one of my friend who first tried ortho during the 1st iteration last year, failed, then uro and NM in 2nd iteration, failed again, ortho this year in 1st iteration, failed, and he will try FM now...

 

My advice: all-in during the 1st iteration, you DO NOT want to struggle into the 2nd round or research years watching your friends continuing their lives while you are stuck between MD school and residency.

[A-Stark]

What I mean is that you can't see what's going to be left over until the second round happens... obviously you can see them now...

 

So? The unfilled spaces in the second round are *completely* unpredictable and vary considerably from year-to-year. You cannot under any circumstances rely on any subspecialties being available in the second round.

 

My point is if you want a run at a subspecialty in the second round rather than conceding into family, then its something to think about. An obscure chance at ortho/uro/derm/rads/etc is still better than no chance at all for some people. Yes, its competitive, but almost everyone applying will be as woefully unprepared as you (or an IMG...).

 

No, it is absolutely not something to think about. I don't know why you are suggesting otherwise, and I can only assume that you have no familiarity with the second iteration. It's often not an obscure chance at certain specialties but no chance at all. To take one example, there is exactly one IMG anesthesia spot in the second iteration this year. And last year? Not one. Last year the only urology or rads programs available were francophone spots in Quebec. Your argument only makes sense if you desperately want a lab specialty, though it fails even there since there is no reason why a decent applicant should not be able to get one in the first iteration.

 

So, respectfully, I offer that you should stop suggesting risky ranking strategies based on the readily disprovable assumption that anything like ortho/uro/derm/rads/etc will show up in the second iteration. And even when they do, your chances are much, much worse and you will have a 30-40% chance of going unmatched entirely.

 

A small number of people will match 2nd round to something awesome, so you can't say that nothing good can come of it at all. It's just not very likely.

 

It's a vanishingly small number. Of the friends I know who went into the second iteration last year, one ended up in another (non-competitive) discipline on the other side of the country (but reasonably happy about it), two ended up in their preferred discipline but far from where they wanted to be, one got his/her preferred location in a completely different specialty, and only one got exactly what he/she had wanted in the first place (and only then by getting a theoretically IMG spot with half the local department advocating for him/her), and still hardly in something known as a "lifestyle" specialty.

 

So, it's true that many people end up happy or at least ok with what they get, but the trauma of the process coupled with the uncertainty is hardly worth it.

 

You cannot bet your career (and your debt) on a risky strategy and expect to get what you originally wanted in the second round. That is absolutely false, unwise, and a thoroughly bad idea.

[bloh]

I think this is a sound decision if you are happy with family medicine in a non-deal place. There's a ton of spots across the country leftover. The fact that IMGs can apply, doesn't mean that they will rain on your parade; most programs would pick a CMG, especially if you're a good candidate with some electives in it. And if you were borderline competitive for a competative specialty, then that would be you.

 

There's a lot of luck involved in getting some of the more competitive specialties. And you may get lucky if the programs misrank and end up with an empty spot. No one is saying that this procedure can't backfire but most good applicants can still end up in FM if they take this route. I'm not sure why Astark is so militantly against this.

[bloh]

 

 

 

It's a vanishingly small number. Of the friends I know who went into the second iteration last year, one ended up in another (non-competitive) discipline on the other side of the country (but reasonably happy about it POSITIVE), two ended up in their preferred discipline POSITIVEx2 but far from where they wanted to be, one got his/her preferred location POSITIVE in a completely different specialty, and only one got exactly what he/she had wanted in the first place SUPER POSITIVE(and only then by getting a theoretically IMG spot with half the local department advocating for him/her), and still hardly in something known as a "lifestyle" specialty.

 

 

Your anecdotal evidence actually directly shows how it's not a non-viable strategy...

[A-Stark]

I think this is a sound decision if you are happy with family medicine in a non-deal place. There's a ton of spots across the country leftover. The fact that IMGs can apply, doesn't mean that they will rain on your parade; most programs would pick a CMG, especially if you're a good candidate with some electives in it. And if you were borderline competitive for a competative specialty, then that would be you.

 

If you are happy with family medicine as a backup, then you should apply to it in the first iteration. Period. There is no sensible rationale to expect there to be unfilled spots in an arbitrary competitive specialty. Keep in mind also that as many as half the spots in the second iteration are francophone, so unless you're French-speaking it's even worse than it appears with the raw numbers.

 

The presence of a handful of surgical subspecialty spots this year is a red herring. Last year there were family spaces, a small number of IM, a bunch of lab/path spots, and exactly two EM spots and 3-4 francophone rads/uro spots. Hardly an inspiring selection, and not at all helpful to anyone going for plastics, anesthesia, derm, ophtho, or even IM to some extent.

 

There's a lot of luck involved in getting some of the more competitive specialties. And you may get lucky if the programs misrank and end up with an empty spot. No one is saying that this procedure can't backfire but most good applicants can still end up in FM if they take this route. I'm not sure why Astark is so militantly against this.

 

Because it's a profoundly stupid idea based on wishful thinking that you will win the second iteration lottery, even though your "winning ticket" may not even be entered into the draw.

 

I disagree that luck has much to do with it either. If you go for a competitive specialty, structure your electives appropriately, and avoid red flags, bad interviews, etc. then you have done all you can do. If you don't quite make it, you're far better off matching to something and trying to switch or otherwise making the best of what you have. You have absolutely no guarantee that what you wanted will even be available in the second round, let alone whether you'll be able to get it. You're much more likely not to.

 

Your anecdotal evidence actually directly shows how it's not a non-viable strategy...

 

No, it doesn't, because (1) I didn't mention the other 6-7 people who didn't match in the 1st iteration and (2) I didn't emphasize that none of these people matched into anything that is traditionally competitive. Because they didn't. I suppose if you really want IM, you could rely on there being unfilled spots in Sask and NOSM, but that's about the only example I can think of where spots are reliably available in the second iteration, apart from lab/path. That doesn't really mean it makes any sense, of course, since it's still much easier and safer to apply to as much as possible in the first iteration.

 

You can, of course, choose to rank - or not rank - anything you want.

[cdnmaple]

If you are happy with family medicine as a backup, then you should apply to it in the first iteration. Period. There is no sensible rationale to expect there to be unfilled spots in an arbitrary competitive specialty. Keep in mind also that as many as half the spots in the second iteration are francophone, so unless you're French-speaking it's even worse than it appears with the raw numbers.

 

Once again, for emphasis.

 

You do not want to RELY on the second round for anything. The second round is not the same beast. The numbers are even harsher than they appear -- those francophone spots, for example, aren't even just in Quebec. There's a relative deluge of applicants for a comparatively tiny number of positions, and I don't doubt that programs are forced to resort to strict filter systems to even decide which applicants to look at, and there's more than a few babies being thrown out with the bathwater. You cannot merrily assume that just because you are a CMG you will have some silver-spooned chance. CMGs go unmatched in the second round too.

 

If you would be happy with FM (or some other less-competitive specialty than whatever it is you think you want), then apply for it in the first round. If you aren't sure, then maybe going to the interviews will help you decide where you will rank it, if at all.

 

If you don't think you would be happy with any other specialty, ever ever ever, and you aren't applying to the US, then be aware of the risk you are taking. Being an unemployed MD is the suck.

[cardiomegaly]

There is a lot of very sound and realistic advice from senior members of this forum here.

 

Students are always going to fall for the anecdotal evidence that one person managed to match to an ultra competitive specialty in the second round that magically appeared that year. You won't be hearing about the more common story of going unmatched in the second round, because it's not as sexy to talk about it. Remember that in CaRMs, always assume you are the rule, NOT the exception.

 

There are 294 positions in the second round, 202 which are English speaking.

 

Gone are the days where you can rely on a second round position in family medicine. I whole-heartedly agree that if you would consider it in first round, you should apply then. I don't think I will ever understand the mentality that of being committed to doing one specialty and that specialty only. I love the specialty that I matched to this year but I can easily see myself being in 3 or 4 other areas, if Plan A didn't work out. Almost everyone has a plan B when they apply to medicine, why is it any different when it comes to CaRMs?

[cdnmaple]

There are 294 positions in the second round, 202 which are English speaking.

 

At my last count, for this year, 190 do not require French. The psychiatry in Montfort apparently requires bilingualism, despite it not saying so clearly on the program description on CaRMS -- this may be hearsay, but it also doesn't seem unlikely.

 

But that's just getting nit-picky about the numbers. The gist is the same.

[Real Beef]

Almost everyone has a plan B when they apply to medicine, why is it any different when it comes to CaRMs?

 

+1000

 

I am going to make a generalization (which is always dangerous) ... I think there are a lot of medical students who have had very little failure in their lives and when applying to Carms they think that this good fortune in their lives will continue. Unfortunately this fairy tale life tends to end at some point when the competition gets stiffer such as for the residency match or competing for the few coveted jobs in certain sub-specialties. I wouldn't rely on a self-perceived golden touch forever, better to back up realistically.

 

Beef

[bloh]

And for the record, none of us actually have data to say that "only a minority" manage to scramble in the 2nd stage. For all we know, the vast majority of them find a spot.

[A-Stark]

And for the record, none of us actually have data to say that "only a minority" manage to scramble in the 2nd stage. For all we know, the vast majority of them find a spot.

 

Scramble? 2nd stage? Why are you using US terminology (that's outdated no less)?

 

And of course we have data: http://carms.ca/pdfs/2012R1_MatchResults/49_Summary%20of%20Match%20Results_en-%202nd%20Iteration.pdf

 

In the 2012 Second Iteration there were 125 new graduates and 52 prior year graduates participating. Of those, 84 and 27 were matched, respectively, with an overall match rate of 62.7%. There were unmatched 2012 grads at every school except for NOSM. There were no more than about 5 or 6 specialty spots in "ROAD" areas (and none of those were "O, A, or D", with the only "R" being francophone). The vast majority did not get their first choice discipline in the first iteration because no spots were available at all. Do you understand that people end up in specialties that they never applied for in the first place? I'm not even talking about family medicine.

 

I never said "only a minority" match in the 2nd iteration, but the match rate is certainly much, much worse, and that doesn't account for the fact that you are far less likely to get what you wanted in the first place.

 

This year you will have a better chance of moving to Saskatoon or Regina than in previous years, though, or perhaps Sudbury or Thunder Bay. Last year these IM programs got some good (even great) people in the 2nd iteration, but do you want to end up in a program where the majority of your co-residents didn't want to be there or even doing that specialty in the first place?

 

I honestly feel really bad for the Sask IM program especially - my experience interviewing there was really positive but it's a really long way for me. We still don't know how many unmatched there were across the country, but it is likely to be competitive there once again for the 2nd iteration, so much so that last year some people didn't even get a spot there or ended up not getting IM at all.

[ACHQ]

We still don't know how many unmatched there were across the country

 

http://www.pgme.utoronto.ca/content/2013-canadian-resident-matching-service-carms-pgme-results

 

according to this apparently 130 people went unmatched.

[rmorelan]

http://www.pgme.utoronto.ca/content/2013-canadian-resident-matching-service-carms-pgme-results

 

according to this apparently 130 people went unmatched.

 

Hey, that is a nice summary page - 5% overall didn't match round one. Good to know!

[rmorelan]

Scramble? 2nd stage? Why are you using US terminology (that's outdated no less)?

 

And of course we have data: http://carms.ca/pdfs/2012R1_MatchResults/49_Summary%20of%20Match%20Results_en-%202nd%20Iteration.pdf

 

In the 2012 Second Iteration there were 125 new graduates and 52 prior year graduates participating. Of those, 84 and 27 were matched, respectively, with an overall match rate of 62.7%. There were unmatched 2012 grads at every school except for NOSM. There were no more than about 5 or 6 specialty spots in "ROAD" areas (and none of those were "O, A, or D", with the only "R" being francophone). The vast majority did not get their first choice discipline in the first iteration because no spots were available at all. Do you understand that people end up in specialties that they never applied for in the first place? I'm not even talking about family medicine.

 

I never said "only a minority" match in the 2nd iteration, but the match rate is certainly much, much worse, and that doesn't account for the fact that you are far less likely to get what you wanted in the first place.

 

Kind of scary that even in round 2 for the subset with a year more to build up some form of network and develop research still about a 50% match.

 

This year you will have a better chance of moving to Saskatoon or Regina than in previous years, though, or perhaps Sudbury or Thunder Bay. Last year these IM programs got some good (even great) people in the 2nd iteration, but do you want to end up in a program where the majority of your co-residents didn't want to be there or even doing that specialty in the first place?

 

I honestly feel really bad for the Sask IM program especially - my experience interviewing there was really positive but it's a really long way for me. We still don't know how many unmatched there were across the country, but it is likely to be competitive there once again for the 2nd iteration, so much so that last year some people didn't even get a spot there or ended up not getting IM at all.

 

Did we get a good reason why so many spots went unfilled there? I mean I know it is out of the way but so are a lot of other places, and why just that program having so many unfilled even at that school.