Proportion of each class --> Family

[uwodesperate]

Hey guys,

 

Just out of curiosity, what proportion of each graduating class go into family medicine?

[NLengr]

Hey guys,

 

Just out of curiosity, what proportion of each graduating class go into family medicine?

 

I think it's roughly 35-40% each year on average for all classes in Canada, although it may have been pushed up to 40-45%.

 

Still short of the goal of the CMA and others, which is 50%.

[tooty]

it's all in carms.ca

[10wattbulb]

In 2012, apparently 34.5% of CMGs (graduates of Canadian medical schools) chose family medicine as their first choice. 89.5% of the family medicine quota was filled; there was a total of 1223 family medicine positions offered across Canada and 129 spots were left vacant. Note that 42.5% of CMGs actually ended up in family medicine (main residency match - first iteration). So, there's significantly more CMGs who end up in family med than who wanted it as their first choice.

 

It's also interesting to look at the CMGs who ranked Family Medicine as their 1st choice by medical school...and compare this with those who actually ended up in family med...There's sometimes a big discrepancy (see stats I compiled below).

 

From CaRMS - % Who Ranked Family Medicine as 1st Choice by Med School (PDF doc #27) versus % Who Matched to Family Med (PDF doc # 18):

 

Memorial University of Newfoundland - 27.1% / 40.7%

Dalhousie University - 35.6% / 39.2%

Université Laval - 41.5% / 47.8%

Université de Sherbrooke - 41.3% / 46.5%

Université de Montreal - 40.0% / 45.2%

McGill University - 24.7% / 42.7%

University of Ottawa - 40.6% / 34.7%

Queen's University - 27.9% / 50.6%

University of Toronto - 30.5% / 40%

McMaster University - 28.6% / 41.7%

Northern Ontario School of Medicine - 53.7% / 70.4%

The University of Western Ontario - 41.2% / 34.2%

University of Manitoba - 32.7% / 28.4%

University of Saskatchewan - 31.0% / 29.5%

University of Alberta - 31.6% / 39.4%

University of Calgary - 27.8% / 40.8%

University of British Columbia - 33.5% / 37.8%

 

In bold are the med school that have >10% discrepancy b/w their graduates who wanted family med as a first choice vs. those who ended up in family med.

[DaKirbster]

In 2012, apparently 34.5% of CMGs (graduates of Canadian medical schools) chose family medicine as their first choice. 89.5% of the family medicine quota was filled; there was a total of 1223 family medicine positions offered across Canada and 129 spots were left vacant. Note that 42.5% of CMGs actually ended up in family medicine (main residency match - first iteration). So, there's significantly more CMGs who end up in family med than who wanted it as their first choice.

 

It's also interesting to look at the CMGs who ranked Family Medicine as their 1st choice by medical school...and compare this with those who actually ended up in family med...There's sometimes a big discrepancy (see stats I compiled below).

 

From CaRMS - % Who Ranked Family Medicine as 1st Choice by Med School (PDF doc #27) versus % Who Matched to Family Med (PDF doc # 18):

 

Memorial University of Newfoundland - 27.1% / 40.7%

Dalhousie University - 35.6% / 39.2%

Université Laval - 41.5% / 47.8%

Université de Sherbrooke - 41.3% / 46.5%

Université de Montreal - 40.0% / 45.2%

McGill University - 24.7% / 42.7%

University of Ottawa - 40.6% / 34.7%

Queen's University - 27.9% / 50.6%

University of Toronto - 30.5% / 40%

McMaster University - 28.6% / 41.7%

Northern Ontario School of Medicine - 53.7% / 70.4%

The University of Western Ontario - 41.2% / 34.2%

University of Manitoba - 32.7% / 28.4%

University of Saskatchewan - 31.0% / 29.5%

University of Alberta - 31.6% / 39.4%

University of Calgary - 27.8% / 40.8%

University of British Columbia - 33.5% / 37.8%

 

In bold are the med school that have >10% discrepancy b/w their graduates who wanted family med as a first choice vs. those who ended up in family med.

 

What interests me about these statistics are the schools where the percentage of students who ranked family med as their first choice is higher than those who actually matched to family med - U of Ottawa, UWO, U of Manitoba, and U of S. Does that mean they weren't successful in matching to family med? So where did they go? Or did they just drop out? Very interesting...

[rmorelan]

What interests me about these statistics are the schools where the percentage of students who ranked family med as their first choice is higher than those who actually matched to family med - U of Ottawa, UWO, U of Manitoba, and U of S. Does that mean they weren't successful in matching to family med? So where did they go? Or did they just drop out? Very interesting...

 

that is interesting - some of it is I guess we are using first round statistics so those people may have gone into family in the second round. Also some people are less interested in discipline than location - so they may have picked say TO family, followed by TO internal, TO....... there were several people in my class restricted from moving for family or other personal reasons for instance. Just because someone picked family first it doesn't even mean they are entirely committed to family.

 

Still the skew seems odd never the less.

[BlurstOfTimes]

I think a more telling statistic for primary care recruitment would be the percentages of CCFP grads that actually practice family medicine full-time. My guess would be the number is lower, and probably significantly so, than the 40% or so that match to it.

 

Hmm, not sure if this data is readily available but it would be interesting to see each year how many students match to CCFP-EM programs... then subtract those numbers from the CaRMS data (as above) from two years prior to get a slightly more accurate number of students actually practicing FM.

[NutritionRunner]

Hmm, not sure if this data is readily available but it would be interesting to see each year how many students match to CCFP-EM programs... then subtract those numbers from the CaRMS data (as above) from two years prior to get a slightly more accurate number of students actually practicing FM.

 

Even so, a lot of "FM" doctors don't practice "family medicine." I've run across this as I'm looking for a new family doctor. Some of these "family doctors" have incredibly restricted practices - ie. they only do low-risk obs, or only do menopausal women's health, or only do sports medicine, or only do diabetes care (I guess for those who are stable and don't need to see an endocrinologist) or only do some sort of other very restricted practice. Let me tell you, it's been a real pain trying to find a family doctor accepting patients (and I don't even live in a rural area). It's so bad I'm actually contemplating taking an extra semester of university, just so I can continue to have student health services available!

[BlurstOfTimes]

Even so, a lot of "FM" doctors don't practice "family medicine." I've run across this as I'm looking for a new family doctor. Some of these "family doctors" have incredibly restricted practices - ie. they only do low-risk obs, or only do menopausal women's health, or only do sports medicine, or only do diabetes care (I guess for those who are stable and don't need to see an endocrinologist) or only do some sort of other very restricted practice. Let me tell you, it's been a real pain trying to find a family doctor accepting patients (and I don't even live in a rural area). It's so bad I'm actually contemplating taking an extra semester of university, just so I can continue to have student health services available!

 

Yeah, that's why I said "somewhat accurate" - it would take out the CCFP-EM people at least, but there are definitely a lot more like the ones you mentioned who would be harder to filter out statistically. I've heard some horror stories about trying to find a family doctor these days, which is awful. My 80-year-old grandma is dealing with it right now actually, and the process sounds like it's been pretty ethically questionable to me - she's seen a couple of doctors who have insisted on basically going through an interview process before they decide whether to take her on as a patient, and so far she hasn't found anyone who is willing to.

[rmorelan]

Even so, a lot of "FM" doctors don't practice "family medicine." I've run across this as I'm looking for a new family doctor. Some of these "family doctors" have incredibly restricted practices - ie. they only do low-risk obs, or only do menopausal women's health, or only do sports medicine, or only do diabetes care (I guess for those who are stable and don't need to see an endocrinologist) or only do some sort of other very restricted practice. Let me tell you, it's been a real pain trying to find a family doctor accepting patients (and I don't even live in a rural area). It's so bad I'm actually contemplating taking an extra semester of university, just so I can continue to have student health services available!

 

or even unstable diabetes - after two weeks in one of those practises I am at a lost to the difference between an endocrinologist and FM with that as a focus for strictly speaking diabetic care. The problem is relatively simple I guess to understand. Both types worked there and did exactly the same thing as far as I could tell.

[bloh]

or even unable diabetes - after two weeks in one of those practises I am at a lost to the difference between an endocrinologist and FM with that as a focus for strictly speaking diabetic care. The problem is relatively simple I guess to understand. Both types worked there and did exactly the same thing as far as I could tell.

 

There shouldn't be a difference if the FM is indeed strictly focusing on diabetes care. The problem arises in that guidelines/evidence changes so frequently so ideally it's best to see a specialist for the more complex cases because they're more likely to be up to date than someone who is the jack of all trades (ie. an average FM). It's actually quite unfair how much unneeded flack GPs get from specialists. I remember working with a peds emerg physician who was quite belligerent about a GP that prescribed a macrolide for typical pneumonia. It's silly because the guidelines literally changed 2 years ago but who is to be up to date on all the random little details that change nearly every year.

[rmorelan]

There shouldn't be a difference if the FM is indeed strictly focusing on diabetes care. The problem arises in that guidelines/evidence changes so frequently so ideally it's best to see a specialist for the more complex cases because they're more likely to be up to date than someone who is the jack of all trades (ie. an average FM). It's actually quite unfair how much unneeded flack GPs get from specialists. I remember working with a peds emerg physician who was quite belligerent about a GP that prescribed a macrolide for typical pneumonia. It's silly because the guidelines literally changed 2 years ago but who is to be up to date on all the random little details that change nearly every year.

 

I agree - an FM that really focuses on one area would have no disadvantage in that area I think compared to a specialist. In my mind they both would have specialized - self directed learning after all is how any doctor stays on top of things.

[spontaneouscombustion]

Makes you wonder what the point of specializing in the first place is. Particularly for non-procedure based specialties that are mostly out patient (rheum, endo, allergy, etc.). I guess you get to bill a bit more for a consult?

[rmorelan]

Makes you wonder what the point of specializing in the first place is. Particularly for non-procedure based specialties that are mostly out patient (rheum, endo, allergy, etc.). I guess you get to bill a bit more for a consult?

 

well I mean at some point you need the broader background - I am not saying an FM can relatively easily do a full rheum clinic with all the possible problems walking in the door. I am just saying that there are large subsets are that I think are manageable with a focused practise. I don't think that FM docs diabetes patients were disadvantaged in any way for instance - in fact since it was a family doc doing things there were advantages in terms of potential scope

[leviathan]

There shouldn't be a difference if the FM is indeed strictly focusing on diabetes care. The problem arises in that guidelines/evidence changes so frequently so ideally it's best to see a specialist for the more complex cases because they're more likely to be up to date than someone who is the jack of all trades (ie. an average FM). It's actually quite unfair how much unneeded flack GPs get from specialists. I remember working with a peds emerg physician who was quite belligerent about a GP that prescribed a macrolide for typical pneumonia. It's silly because the guidelines literally changed 2 years ago but who is to be up to date on all the random little details that change nearly every year.

What guidelines say you can't use a macrolide for CAP?

[Lactic Folly]

well I mean at some point you need the broader background - I am not saying an FM can relatively easily do a full rheum clinic with all the possible problems walking in the door.

 

Exactly, like running a clinic in scleroderma, or vasculitis...

[quackster]

New guidelines say amox is first line for CAP in kids.

[Birdy]

New guidelines say amox is first line for CAP in kids.

 

Interesting. My son was always treated with macrolides for pneumonia. Curious why the guidelines changed.

[leviathan]

New guidelines say amox is first line for CAP in kids.

What new guidelines? Amox has been first line in kids for at least 10 years, probably longer.

 

Macrolides are still fine for adults with some exceptions.

[quackster]

http://www.cps.ca/documents/position/pneumonia-management-children-youth

 

maybe I should have clarified amox for non severe pneumonia.

[A-Stark]

Why do the guidelines suggest amp for "non-severe" pneumonia? You're going to admit someone for iv Abx if they're not really that sick?

 

I'll have to read about the sens and spec of the signs and symptoms of atypical pneumonia, but I'm not sure it's defensible to treat with something that lacks atypical coverage. Though macrolide resistance is a relevant concern.

[Slipstream]

In 2012, apparently 34.5% of CMGs (graduates of Canadian medical schools) chose family medicine as their first choice. 89.5% of the family medicine quota was filled; there was a total of 1223 family medicine positions offered across Canada and 129 spots were left vacant. Note that 42.5% of CMGs actually ended up in family medicine (main residency match - first iteration). So, there's significantly more CMGs who end up in family med than who wanted it as their first choice.

 

It's also interesting to look at the CMGs who ranked Family Medicine as their 1st choice by medical school...and compare this with those who actually ended up in family med...There's sometimes a big discrepancy (see stats I compiled below).

 

From CaRMS - % Who Ranked Family Medicine as 1st Choice by Med School (PDF doc #27) versus % Who Matched to Family Med (PDF doc # 18):

 

Memorial University of Newfoundland - 27.1% / 40.7%

Dalhousie University - 35.6% / 39.2%

Université Laval - 41.5% / 47.8%

Université de Sherbrooke - 41.3% / 46.5%

Université de Montreal - 40.0% / 45.2%

McGill University - 24.7% / 42.7%

University of Ottawa - 40.6% / 34.7%

Queen's University - 27.9% / 50.6%

University of Toronto - 30.5% / 40%

McMaster University - 28.6% / 41.7%

Northern Ontario School of Medicine - 53.7% / 70.4%

The University of Western Ontario - 41.2% / 34.2%

University of Manitoba - 32.7% / 28.4%

University of Saskatchewan - 31.0% / 29.5%

University of Alberta - 31.6% / 39.4%

University of Calgary - 27.8% / 40.8%

University of British Columbia - 33.5% / 37.8%

 

In bold are the med school that have >10% discrepancy b/w their graduates who wanted family med as a first choice vs. those who ended up in family med.

 

Hey I think these stats are incorrect... The document #18 is by "school of residency", not graduation. Having gone over the CaRMS stats myself when picking schools, many of the bolded schools match their student to their first choice discipline 95% of the time. So 15% of grads matching to family when they didn't pick it doesn't make sense. Document 18 shows the percentage of residency spots at the school as a fraction of the total residency spots. That's why the numbers are so similar between schools, and that is why sometimes more people pick FM at Ottawa than appeared to match - it just means UOttawa has a lower percentage of spots in FM for its residency than the percentage of its student who pick FM - not a very useful comparison, as you can see.

 

I think CaRMS stats can be confusing, and the titles aren't very explanatory. But I think that we haven't used them correctly here, and in fact most schools in Canada match their students 90%+ of the time to their first choice discipline, so there are few schools ( definitely not queens and McGill ) where >10% of people get FM if they didn't rank it.

[Slipstream]

Hey guys,

 

Just out of curiosity, what proportion of each graduating class go into family medicine?

 

As I mentioned above, there is a difference between schools, and it would be best to look at the number of graduates who choose family as their first choice. More than 90% of them match to it, so those statistics are a good indicator of how many people choose FM at a given school.

[quackster]

Why do the guidelines suggest amp for "non-severe" pneumonia? You're going to admit someone for iv Abx if they're not really that sick?

 

I'll have to read about the sens and spec of the signs and symptoms of atypical pneumonia, but I'm not sure it's defensible to treat with something that lacks atypical coverage. Though macrolide resistance is a relevant concern.

 

it's my understanding that the guidelines were changed because of macrolide resistance, and that atypical bugs were rare enough justifying treating with amox first. At least that's what we were taught.

[10wattbulb]

Hey I think these stats are incorrect... The document #18 is by "school of residency", not graduation. Having gone over the CaRMS stats myself when picking schools, many of the bolded schools match their student to their first choice discipline 95% of the time. So 15% of grads matching to family when they didn't pick it doesn't make sense. Document 18 shows the percentage of residency spots at the school as a fraction of the total residency spots. That's why the numbers are so similar between schools, and that is why sometimes more people pick FM at Ottawa than appeared to match - it just means UOttawa has a lower percentage of spots in FM for its residency than the percentage of its student who pick FM - not a very useful comparison, as you can see.

 

I think CaRMS stats can be confusing, and the titles aren't very explanatory. But I think that we haven't used them correctly here, and in fact most schools in Canada match their students 90%+ of the time to their first choice discipline, so there are few schools ( definitely not queens and McGill ) where >10% of people get FM if they didn't rank it.

 

Yes, you're actually right. I compared doc #27 with the wrong doc #18, thinking that they were both referring to the same thing, i.e. 'by school of graduation,' when in fact doc #18 is 'by school of residency.' So we don't actually know how many students from X med school actually got into family medicine, but it should be close (though somewhat higher) than the number who chose FM as their first choice. Now the stats make much more sense.

 

So, let's just look at doc #27: CMGs who chose Family Med as their 1st choice, by school of graduation

 

Memorial University of Newfoundland - 27.1%

Dalhousie University - 35.6%

Université Laval - 41.5%

Université de Sherbrooke - 41.3%

Université de Montreal - 40.0%

McGill University - 24.7%

University of Ottawa - 40.6%

Queen's University - 27.9%

University of Toronto - 30.5%

McMaster University - 28.6%

Northern Ontario School of Medicine - 53.7%

The University of Western Ontario - 41.2%

University of Manitoba - 32.7%

University of Saskatchewan - 31.0%

University of Alberta - 31.6%

University of Calgary - 27.8%

University of British Columbia - 33.5%

 

One things is for sure: 34.5% of CMGs chose FM as their first choice, but ~41% ended up in FM.