Full CaRMS stats now online

[rmorelan]

I should say that it was a very strange year for radiology - the least competitive year everyone was saying in a very long time. Still not sure why - it caught everyone by surprise.

[sunoah]

since when did obgyn get so competitive

[ralk]

Bit of a different take on the numbers:

 

The following is a list of specialties by the percentage of applicants who were admitted into the specialty in the first round after ranking it as their first choice. That is, I ignore how many spots there were, or individuals who were admitted to their second (or lower) choice. Basically, if a CMG student wanted this field, how likely were they to get it?

 

1 Plastic Surgery 0.520833333

2 Otolaryngology 0.658536585

3 Dermatology 0.659574468

4 Vascular Surgery 0.666666667

5 General Surgery 0.6796875

 

6 Emergency Medicine 0.683673469

7 Public Health 0.6875

8 Urology 0.695652174

9 Neurology Pediatric 0.714285714

10 Cardiac Surgery 0.714285714

 

11 Ophthalmology 0.75

12 Medical Microbiology 0.75

13 OB/GYN 0.758333333

14 Anesthesiology 0.768115942

15 Neurosurgery 0.772727273

 

16 Pediatrics 0.780487805

17 Orthopedic Surgery 0.824324324

18 Diagnostic Radiology 0.831578947

19 Radiation Oncology 0.875

20 Psychiatry 0.936507937

 

21 Neurology 0.9375

22 Physical Med & Rehab 0.944444444

23 Internal Medicine 0.945205479

24 Family Medicine 0.968335036

25 Neuropathology 1

 

26 Anatomical Pathology 1

27 General Pathology 1

28 Hematological Pathology 1

29 Laboratory Medicine 1

30 Medical Genetics 1

31 Nuclear Medicine 1

 

 

Results aren't that different from the other ones posted. Pathology and Nuc Med are pretty much automatic entry; family medicine, internal, psych, and PM&R are pretty close to automatic; anesthesiology, diagnostic radiology, peds, and OB/GYN are of moderate difficulty to enter; emergency medicine and almost all forms of surgery are tough to get into, particularly plastics.

 

The surprises for me were medical microbiology and public health & preventative medicine. Plenty of vacancies in both, but also quite a few individuals who were rejected from the field. Likely a few programs in those specialties that no one wants, yet a few that are quite competitive.

[Med0123]

Interesting. The same applies for cardiac surgery going from the 27th position in "my" ranking to the 10th in yours.

 

This is the first time that CaRMS give you access to that much data allowing us to compare the relative competitiveness between each specialty. However, one may analyse them very carefully as there may be huge variations every year. A good example is indeed radiology.

[ralk]

Interesting. The same applies for cardiac surgery going from the 27th position in "my" ranking to the 10th in yours.

 

This is the first time that CaRMS give you access to that much data allowing us to compare the relative competitiveness between each specialty. However, one may analyse them very carefully as there may be huge variations every year. A good example is indeed radiology.

 

Yeah, it's quite helpful to have that much raw data to get a sense of what's going on - no one interpretation seems to capture it all. For example, in the rankings I posted, General Surgery looks fairly competitive, but it also took 8 people who didn't rank that specialty as their first choice - presumably people rejected from other surgical specialties, who may still have had a strong interest in general surgery. In that sense, I think the rankings you provided are more representative for a field like that

[Med0123]

Yeah, it's quite helpful to have that much raw data to get a sense of what's going on - no one interpretation seems to capture it all. For example, in the rankings I posted, General Surgery looks fairly competitive, but it also took 8 people who didn't rank that specialty as their first choice - presumably people rejected from other surgical specialties, who may still have had a strong interest in general surgery. In that sense, I think the rankings you provided are more representative for a field like that

 

Yeah, I imagine competitive people rejected from plastics, urology or vascular for example might end up in GS as these specialties share a lot with gen surg.

 

But your ranking really catches THE question every 4th year MS wants an answer to:

What is the probability of me being accepted in my first choice specialty in CaRMS 1st iteration?

[ralk]

But your ranking really catches THE question every 4th year MS wants an answer to:

What is the probability of me being accepted in my first choice specialty in CaRMS 1st iteration?

 

That's what I was going for (and wanted to know myself! )

[in2bat0r]

I'm also surprised about how competitive emergency was, I didn't think it was overly popular...

[Med0123]

I'm also surprised about how competitive emergency was, I didn't think it was overly popular...

 

In my opinion, EM is fairly competitive for 5 reasons candidates often won't say during their interviews

 

1- The quality of training. You basically spend 5 years of doing emergency medicine instead of 1 year in the 2 + 1 route giving you tools to pretty much handle anything after your residency. Residents often get additionnal training in toxicology, advanced ultrasound, trauma, etc. (ok they will say this one)

 

2- Job opportunities. It is increasingly harder to be hired by a major metropolitan center as an emergency physician with the 2 + 1 route. Being FRCPC opens you that door more easily.

 

3- The "quality of life". Shift work, no follow up. More and more trainee like that.

 

4- No family medicine TLC.

 

5- Instant gratification (not always, but often).

[rmorelan]

Yeah, I imagine competitive people rejected from plastics, urology or vascular for example might end up in GS as these specialties share a lot with gen surg.

 

But your ranking really catches THE question every 4th year MS wants an answer to:

What is the probability of me being accepted in my first choice specialty in CaRMS 1st iteration?

 

ha pretty odd ball year for that - still interesting!

[BoyInTheBubble]

In my opinion, EM is fairly competitive for 5 reasons candidates often won't say during their interviews

 

2- Job opportunities. It is increasingly harder to be hired by a major metropolitan center as an emergency physician with the 2 + 1 route. Being FRCPC opens you that door more easily.

 

It is increasingly harder to be hired by a major metropolitan centre.

 

Of those that do in emergency medicine, plenty are 2+1. So I'm not so sure that part is correct.

[mddegree]

In my opinion, EM is fairly competitive for 5 reasons candidates often won't say during their interviews

 

1- The quality of training. You basically spend 5 years of doing emergency medicine instead of 1 year in the 2 + 1 route giving you tools to pretty much handle anything after your residency. Residents often get additionnal training in toxicology, advanced ultrasound, trauma, etc. (ok they will say this one)

 

2- Job opportunities. It is increasingly harder to be hired by a major metropolitan center as an emergency physician with the 2 + 1 route. Being FRCPC opens you that door more easily.

 

3- The "quality of life". Shift work, no follow up. More and more trainee like that.

 

4- No family medicine TLC.

 

5- Instant gratification (not always, but often).

 

What is family medicine TLC?

[A-Stark]

"Tender Loving Care", I would surmise.

[bloh]

In my opinion, EM is fairly competitive for 5 reasons candidates often won't say during their interviews

 

1- The quality of training. You basically spend 5 years of doing emergency medicine instead of 1 year in the 2 + 1 route giving you tools to pretty much handle anything after your residency. Residents often get additionnal training in toxicology, advanced ultrasound, trauma, etc. (ok they will say this one)

 

2- Job opportunities. It is increasingly harder to be hired by a major metropolitan center as an emergency physician with the 2 + 1 route. Being FRCPC opens you that door more easily.

 

3- The "quality of life". Shift work, no follow up. More and more trainee like that.

 

4- No family medicine TLC.

 

5- Instant gratification (not always, but often).

6. Number of spots is relatively low. This is why 2+1 has flourished.

[aristarchus]

Reviewing the 2013 R1-match CaRMS statistics, IMGs obtained more positions in the open 2nd iteration matching process. Many schools are not choosing unmatched CMG applicants in the 2nd iteration of CaRMS as shown in Table 51/52.

 

Outside of Quebec, the number of IMGs matched at each school favours IMGs over CMGs. Data is shown by school with #CMG matched to #IMG matched: UBC (3/12), Western (4/15), U of A (2/7), McMaster (4/14), UofS (6/20), Memorial (3/8), NOSM (3/7), Dalhousie (6/9), UofC (2/2), UofO (12/12), Queen's (7/4), Laval (4/2), Sherbrooke (9/3), Montreal (4/1), McGill (6/1).

 

An important question for the AFMC which has a goal to increase undergraduate Canadian medical positions to 3000 students per year (http://www.afmc.ca/advocacy-policy-statements-e.php) is why are unmatched Canadian Medical Students (N=80/160 participating in 2nd iteration) less suitable for these positions than IMG students?

 

There is a Royal college position statement that each Canadian medical student is entitled to a Canadian residency position, this doesn't seem to be happening.

[leviathan]

With the exception of those who didn't apply smartly in the first round, or just got unlucky, the other CMGs who don't match in the first round were probably not very strong candidates. I know some very strong IMGs who waited out for the second round to apply so they didn't have to take a return of service, so that might explain the preference.

[aristarchus]

With the exception of those who didn't apply smartly in the first round, or just got unlucky, the other CMGs who don't match in the first round were probably not very strong candidates. I know some very strong IMGs who waited out for the second round to apply so they didn't have to take a return of service, so that might explain the preference.

 

As one of those unmatched CMGs, I'd respectfully disagree. Any student applying to a single discipline risks being unmatched, overall 87% of CMGs match to their 1st choice discipline. The discipline I applied to was significantly below this average. Interviews are subjective, and I'd assume that most CMGs, myself included, studied hard to get the GPA and MCAT in undergrad to enter a Canadian med school. Once in med school, most CMGs continue to work hard and pass each clerkship rotation. Just a fraction of the work that goes into completing clerkship is captured in the academic record and in discipline-specific letters of reference.

 

Backing up in the 1st iteration is in some cases not possible despite a student's willingness to practice in an alternative discipline, e.g., elective and clerkship schedule.

 

Without spots dedicated for CMGs in the 2nd iteration, IMGs will gain more positions based on the volume of IMG applicants. I believe some IMG applicants stand out if for example they were practicing physicians in another country.

 

I looked over the data from my prior post, and it appears that despite more IMGs matching compared to CMGs, CMGs still have a higher odds of matching in the 2nd iteration (OR = 5.26) based on the following (80/160)/(127/1335).

 

I believe any motivated CMG should be able to practice in residency (supervised practice) within any field regardless of how they spent their elective time. The CFMS should advocate for dedicated CMG positions in the 2nd iteration. There needs to be some way of ensuring that each willing CMG obtains a residency position. This would only reduce the number of IMGs matching to Canada by ~5% and would ensure that the investment made by Canadians to train Canadian physicians is not lost due to the arbitrary obstacle to furthering one's education imposed by the CaRMS process.

[leviathan]

As one of those unmatched CMGs, I'd respectfully disagree. Any student applying to a single discipline risks being unmatched, overall 87% of CMGs match to their 1st choice discipline. The discipline I applied to was significantly below this average. Interviews are subjective, and I'd assume that most CMGs, myself included, studied hard to get the GPA and MCAT in undergrad to enter a Canadian med school. Once in med school, most CMGs continue to work hard and pass each clerkship rotation. Just a fraction of the work that goes into completing clerkship is captured in the academic record and in discipline-specific letters of reference.

 

Backing up in the 1st iteration is in some cases not possible despite a student's willingness to practice in an alternative discipline, e.g., elective and clerkship schedule.

 

Without spots dedicated for CMGs in the 2nd iteration, IMGs will gain more positions based on the volume of IMG applicants. I believe some IMG applicants stand out if for example they were practicing physicians in another country.

 

I looked over the data from my prior post, and it appears that despite more IMGs matching compared to CMGs, CMGs still have a higher odds of matching in the 2nd iteration (OR = 5.26) based on the following (80/160)/(127/1335).

 

I believe any motivated CMG should be able to practice in residency (supervised practice) within any field regardless of how they spent their elective time. The CFMS should advocate for dedicated CMG positions in the 2nd iteration. There needs to be some way of ensuring that each willing CMG obtains a residency position. This would only reduce the number of IMGs matching to Canada by ~5% and would ensure that the investment made by Canadians to train Canadian physicians is not lost due to the arbitrary obstacle to furthering one's education imposed by the CaRMS process.

 

Sorry to hear about your difficulties. Because of your circumstances I would say you were dealt a bad hand/unlucky. I'm not saying it's fair that you didn't match, I'm just proposing an explanation for why there may be proportionally so many IMGs matching in the second round.

 

I do think there should be open competition for spots in the second round. While the majority of Canadians might work hard, I think there does need to be some fire under each student to motivate those who otherwise put in no effort if they had a guarantee of a job. Canadian students should have a relative guarantee of a position somewhere in the country, but only within reason. The first round gives them that reasonable guarantee.

 

The investment made to trade a Canadian is not 'lost' if they aren't matched, as the government doesn't have to respend the same amount of money if an IMG got the spot. That person cost the govenment $0 to train, so there's no net loss. At the end of the day I think Canadians want the best physicians for the job. If an IMG is far superior, and there is a CMG who really is questionable in quality and never put in any effort in med school, why should they deserve that spot?

[rogerroger]

 

I am of the belief that IMGs should be scrutinized more heavily. Doing medical school in the Carib is not the same as the UK is not the same as Karachi is not the same as Burkena Faso etc. To lump them all under the IMG banner is an oversimplification.

 

I imagine that the suspect differences between international schools are considered unofficially at the program level. Not a very PC topic but still important. If all other things are equal would a program not choose the grad from a well known and respected school vs a grad from a less reliable institution? Some programs also seem to be more open to particular international schools. I know a few programs with disproportionate numbers of IMGs from particular Irish or Australian schools for instance. I would imagine this is at least in part due to a program developing a level of trust in a particular school over the years.

[leviathan]

If what you are saying is indeed true, then IMGs should be able to apply in round one. Free competition for all.

 

To say that it is ok for them to apply to round two implies that their training is on the whole not sufficient enough for most fields, but for those left over, its better to have someone potentially unqualified do the jobs than nobody at all.

.

That's not what I said at all. I said that Canadian grads should have a reasonable guarantee of a residency spot in their own country without having to compete with foreign grads. That exists as the first round. It has nothing to do with 'quality' of a graduate. In fact I said the opposite, that IMGs who are superior in quality deserve those spots in the second round.

[rmorelan]

Nice debate.

 

I understand what you meant, but if an IMG is good enough to compete in the 2nd round, why not the first?

 

If the barrier exists to allow CMGs to get residencies, then shouldn't IMGs be banned until all CMGs get residency positions(or declare their unwillingness to stoop)? Why leave the 130 or so unmatched behind, or make them compete against super IMGs who would have gotten positions in round 1 had they been allowed to apply?

 

That being said, I'm of the position that we need to take a harder look at overseas medical programs before we can accept their training as adequate. Right now the barrier is set too low.

 

On another note, is it not also unfortunate that the fields/programs that are probably in the most dire need for quality residents are the ones that have to settle for the leavings?

 

there could be another reason as well the government could prefer one group over the other - CMGs in general may be more likely to remain working in the province they are trained or work in particular areas of need (without external pressures to do so) etc. Although mostly I think the rules are the way they are because of the massive backlash you would get if they were changed.

[leviathan]

Nice debate.

 

I understand what you meant, but if an IMG is good enough to compete in the 2nd round, why not the first?

IMGs are good enough to compete in either round, but I think it's fair that we let Canadians get a shot at all the positions first. The ratios are so close to 1:1 that it really would be unfair if they have to compete with every medical graduate in the entire world who decides to apply. Once the second round comes around, I think that is a fair point in time to open up the match to everybody.

 

On another note, is it not also unfortunate that the fields/programs that are probably in the most dire need for quality residents are the ones that have to settle for the leavings?

I agree it's totally unfortunate. As an example I think family is probably one of the most intellectually challenging fields in medicine, at least if you want to do it WELL. There is just such an overwhelming amount of knowledge you need to excel at it. On the flip side, you don't need to know much if you just want to be a mediocre doctor.

[rogerroger]

It probably would be more fair to open up all first round spots to IMGs, especially those who hold Canadian citizenship. They should get rid of strict grographic restraints on return of service too if they are good enough to match in the 1st round.

 

This would allow CaRMS to be more skills based. It would probably be better for patients too... As a CMG I know we would always still have a massive advantage during CaRMS even if things were opened up fully to IMGs. CMGs will always have more networking opportunities, this is the most important part of CaRMS, and CMGs will be very familiar with our medical system. Another massive advantage come electives, and CaRMS.

 

Another benefit of leveling the playing field is that it would push Canadian schools to do more. Canadian schools don't have to innovate much to get decent match stats. It would be naive to assume our Canadian schools provide an education which is not surpassed elsewhere. If other schools are producing world class grads and they want to specialize in Canada, let them come. Maybe Canadian schools would be improved by a real sense of competition.

 

I know it is easy for me to say this after being on the other side of CaRMS... However, besides protecting CMGs from being unmatched there is little benefit conveyed by the current system when viewed from the patient care perspective.

[aristarchus]

It probably would be more fair to open up all first round spots to IMGs, especially those who hold Canadian citizenship. They should get rid of strict grographic restraints on return of service too if they are good enough to match in the 1st round.

 

This would allow CaRMS to be more skills based. It would probably be better for patients too... As a CMG I know we would always still have a massive advantage during CaRMS even if things were opened up fully to IMGs. CMGs will always have more networking opportunities, this is the most important part of CaRMS, and CMGs will be very familiar with our medical system. Another massive advantage come electives, and CaRMS.

 

Another benefit of leveling the playing field is that it would push Canadian schools to do more. Canadian schools don't have to innovate much to get decent match stats. It would be naive to assume our Canadian schools provide an education which is not surpassed elsewhere. If other schools are producing world class grads and they want to specialize in Canada, let them come. Maybe Canadian schools would be improved by a real sense of competition.

 

I know it is easy for me to say this after being on the other side of CaRMS... However, besides protecting CMGs from being unmatched there is little benefit conveyed by the current system when viewed from the patient care perspective.

 

What you are proposing is a system similar to the US. Outside of the US, countries take care of their own medical graduates. For example, countries which take Canadians as medical students, e.g., UK, Ireland, Australia, and the Caribbean place restrictions on Canadians trained in their system to access local residency programs. This is the very reason why we have so many partially trained MDs (i.e., no prior residency) applying to Canadian residency programs. These international programs have no problem overlooking these applicants in favour of local applicants.

 

It is true that CMGs understand the medical system more than IMGs. This is the very reason why CMGs should be chosen in preference to IMGs. The education committee of the AFMC is the best place to address your concerns regarding Canadian programs not innovating enough. The metric most schools use to judge their training programs is student success on the MCCQE I not match rates. The result of this test isn't even available when students are applying to CaRMS.

 

I think that the CFMS should pressure the AFMC to remove dedicated spots for IMGs in the first iteration of CaRMS. IMGs should be used to fill positions after the 2nd iteration of CaRMS. I realize that the chances of this are small because the number of unmatched Canadians is only 5%.

 

Look back at your medical undergraduate teaching in medical errors. Medicine tends to blame an individual for a medical error but system failures are the main cause of most medical errors. In a similar way, practicing MDs will blame unmatched CMGs for being unmatched. The reality of the matter is there is a large systemic component to the growing number of unmatched CMGs.

[leviathan]

That proposed system works in the US because they have a surplus of about 6000 post-grad positions every year. US grads will still match, but they may match in a less desirable location or specialty than what they had planned unless they truly are a terrible candidate. If we had a similar surplus in Canada then it would be okay to open up the first round to everyone.

 

From a patient-care perspective we should have the most qualified doctors training in our residency system. From an education perspective, it would not make sense to open up a program that requires 4 years of serious time and money investment without a reasonable guarantee of a job at the end of it. Can you imagine if we tried to run a 4 year nursing school and tell the grads that even if you pass all your courses, and pass your licensing exams, there's a chance you won't be allowed to work as a nurse ever in your life? It doesn't seem fair.