Your thoughts? A CSA opinion.

[MonkeyDLuffy]

What are your thoughts on this opinion piece?

 

http://www.vancouversun.com/touch/opinion/op-ed/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical/9714934/story.html?rel=1515483

[ralk]

What are your thoughts on this opinion piece?

 

http://www.vancouversun.com/touch/opinion/op-ed/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical/9714934/story.html?rel=1515483

 

Many (though not all) Canadians studying abroad are intelligent and would be more-than-able physicians. Training abroad isn't always super high quality, but often it is up to our standards and certainly not a barrier to students being capable physicians. There are definitely strong CSAs who get rejected from residency despite being qualified.

 

However, opening the door for CSAs to compete for residency spots on the same level of CMGs, or even above the level of standard IMGs would be a mistake. The influx of physicians is regulated not just to ensure quality, but also to promote fairness for applicants, and more importantly, to ensure that the mix of physicians meets the needs of Canadian patients.

 

Admission to medical school is already highly slanted towards those who are wealthy and those who have physicians as parents. A major barrier to access to physicians is location, which is why many schools take geography into account, because the trend for applicants is to prefer major cities.

 

CSAs take both those trends and amplify them. They tend to be richer, more likely to have physicians as parents, and to want to practice in major cities. Importantly, the CSA route - which often has lower requirements for entry - is not available for many individuals from lower income families. Opening the gates for CSAs will encourage more of them, which means more physicians from already-wealthy families. It would be, in effect, further discrimination against potential physicians from less wealthy families, as it would provide a viable back door to being a Canadian doctor for those from wealthier families. And, since CSAs bypass the geographical requirements many schools have put in place (and tend to want to practice in major cities anyway), they would exacerbate the current problem of physician distribution.

 

Therefore, if anything, CSA access to practicing in Canada should be further curbed, not expanded - not because there's anything wrong with CSA quality.

[A-Stark]

What are your thoughts on this opinion piece?

 

http://www.vancouversun.com/touch/opinion/op-ed/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical/9714934/story.html?rel=1515483

 

It's comprised of a series of assertions made without attribution or support, some of which are demonstrably false, and most of which are made out of context. And all of which are biased, with the author's role as president of the Society for Canadians Studying Medicine Abroad equivalent to "Interests declared".

 

Some more background on the author:

 

B.C. mom may face bankruptcy after court's decision:

 

VANCOUVER - A Surrey, B.C. mother who sued the medical team involved in the delivery of her severely injured son now will be bankrupted by a B.C. Court of Appeal decision forcing her to pay for the civil trial, her husband says.

 

''We figure it will be close to $1 million once all the bills are in and tallied,'' complained the mother, Rosemary Pawliuk, who is a lawyer.

 

Her husband, Carlos Brito, also a lawyer, was equally downcast.

 

''Call us bitter - we lost,'' he said. ''But when you read these judgments they make no sense.''

 

Their son Elliott, now 15, has cerebral palsy, is non-verbal, spastic and a quadriplegic. His fraternal twin sister Terilyn was born healthy.

 

Brito said he believes the decision last week will put a chill on others who fear they have been victims of medical malpractice. ''Other people will be reluctant to bring suit now, knowing they could be hit with this kind of bill,'' he said. ''My wife will have to declare bankruptcy.''

 

Otherwise, she should be careful about what changes she advocates for. It is extremely unlikely that IMGs will be allowed to compete directly with CMGs for the same spaces in the first round - and even if they could, it is very questionable whether this would be to their benefit. Prior to 2006, there was a patchwork system where some provinces only allowed IMGs to apply in the second round.

Many programs get pressured to create IMG spaces by policymakers, but they'll often sooner not fill them at all or else get a CMG in the second round than fill some spots.

 

I would have more sympathy for CSAs if they actually put in the same amount of time to apply to med school as CMGs. The fact - from the CaRMS 2010 IMG report - that up to a quarter of them don't apply to med school in Canada at all should give us some pause, as should the fact that CSAs comprise an increasing proportion of IMGs in residency training programs (and not less, as the author claims). Her comments about supposed medical school "rankings" and standardized exams (even discussing pass/fail) do not merit any response.

 

And as for her lawsuit, I will simply state that CMPA is an excellent organization.

[leviathan]

Many (though not all) Canadians studying abroad are intelligent and would be more-than-able physicians. Training abroad isn't always super high quality, but often it is up to our standards and certainly not a barrier to students being capable physicians. There are definitely strong CSAs who get rejected from residency despite being qualified.

 

However, opening the door for CSAs to compete for residency spots on the same level of CMGs, or even above the level of standard IMGs would be a mistake. The influx of physicians is regulated not just to ensure quality, but also to promote fairness for applicants, and more importantly, to ensure that the mix of physicians meets the needs of Canadian patients.

 

Admission to medical school is already highly slanted towards those who are wealthy and those who have physicians as parents. A major barrier to access to physicians is location, which is why many schools take geography into account, because the trend for applicants is to prefer major cities.

 

CSAs take both those trends and amplify them. They tend to be richer, more likely to have physicians as parents, and to want to practice in major cities. Importantly, the CSA route - which often has lower requirements for entry - is not available for many individuals from lower income families. Opening the gates for CSAs will encourage more of them, which means more physicians from already-wealthy families. It would be, in effect, further discrimination against potential physicians from less wealthy families, as it would provide a viable back door to being a Canadian doctor for those from wealthier families. And, since CSAs bypass the geographical requirements many schools have put in place (and tend to want to practice in major cities anyway), they would exacerbate the current problem of physician distribution.

 

Therefore, if anything, CSA access to practicing in Canada should be further curbed, not expanded - not because there's anything wrong with CSA quality.

Applicants from certain geographic regions or low income families still can get into medical school the same way they could before. In addition, students coming from underserved areas are much more likely to get chosen for a residency position in the same area, so that part wouldn't change either.

 

The difference is that you would add an extra pool of physicians from which to choose the best residents. At the end of the day I don't think Canadians care whether their doctor comes from a rich or poor family, or from a Canadian school or a foreign school - they just want the most qualified physician to take care of them. And while many foreign schools and graduates aren't up to Canadian standards, it's obvious that only the highest qualified applicants from good schools with excellent letters of rec from Canadian staff, the dean's letter, high board scores, research etc. would get ranked...plus on top of that is the licensing exam, so I don't think there's any concern about quality or competency.

 

Having said all that, I still do think there should be a reasonable guarantee of a residency spot for CMGs without worrying about losing a spot to a better IMG, even if it meant Canadians might not get the best doctor. At the end of the day, I'm not sure if we should change the system, out of fairness to CMGs.

[Vidhya]

On the political side, our medical schools are all publically funded institutions. We use taxpayer money to train MDs and fund residency programs. It seems ethically at odds to take public funds to train MDs and then not guarantee them a post-graduate spot somewhere in Canada, effectively rendering these students unemployable and wasting the initial cost of educating them. I just don't see how we can fundamentally change the system in a way that would result in CMGs not having an opportunity at gaining a residency.

 

I do feel we should improve our current IMG/CSA options, including opening more IMG/CSA slots in underrepresented rural areas or specialties, etc. Many people are perfectly happy to take these positions and sign a return of service contract if it will enable them to license in Canada. But as long as medical education is publically funded, I can't see any major change to our selection preference towards CMGs.

 

If we turn this around, I'm surprised more CSA students aren't outraged at their education countries (Ireland, Aus, etc) charging them outrageously high tuition and then effectively kicking them to the curb once they graduate. I personally have a huge problem with this. Obviously some educate themselves well on the reality of the match and come back (leviathan for example) but it seems like such a money grab for those students who are simply impatient about getting admitted.

[leviathan]

On the political side, our medical schools are all publically funded institutions. We use taxpayer money to train MDs and fund residency programs. It seems ethically at odds to take public funds to train MDs and then not guarantee them a post-graduate spot somewhere in Canada, effectively rendering these students unemployable and wasting the initial cost of educating them. I just don't see how we can fundamentally change the system in a way that would result in CMGs not having an opportunity at gaining a residency.

So lots of people use this argument, and I appreciate where you're coming from, but I disagree. You're right that we use our taxpayer money to train a doctor to take care of us. If at the end of the day we paid money and there's an extra doctor taking care of us (who is even better qualified and who funded his/her own training), then we haven't lost any money. The only situation where a CMG going unmatched would be a waste of money is if there was still an unfilled residency spot, OR if there weren't enough spots to train all of the graduating CMGs.

 

I do feel we should improve our current IMG/CSA options, including opening more IMG/CSA slots in underrepresented rural areas or specialties, etc. Many people are perfectly happy to take these positions and sign a return of service contract if it will enable them to license in Canada. But as long as medical education is publically funded, I can't see any major change to our selection preference towards CMGs.

We can have return of service spots, but they shouldn't be reserved for IMGs, nor should the current CMG spots be reserved for CMGs. If a doctor attends a WHO-accredited medical school, is a Canadian citizen, and is able to pass the requisite licensing exams, they should be seen as eligible (but not necessarily more qualified than a CMG) for a residency spot, in the eyes of the law. Of course as I've mentioned, I appreciate that it would be unfair to expect CMGs to compete against with such a tight ratio of spots even without IMGs added into the mix. Conversely, they do have that system in the US where they have ~6,000 spots in excess of the number of graduating US MDs, and I think it's fair there.

[rehabscience]

So lots of people use this argument, and I appreciate where you're coming from, but I disagree. You're right that we use our taxpayer money to train a doctor to take care of us. If at the end of the day we paid money and there's an extra doctor taking care of us (who is even better qualified and who funded his/her own training), then we haven't lost any money. The only situation where a CMG going unmatched would be a waste of money is if there was still an unfilled residency spot, OR if there weren't enough spots to train all of the graduating CMGs.

 

 

We can have return of service spots, but they shouldn't be reserved for IMGs, nor should the current CMG spots be reserved for CMGs. If a doctor attends a WHO-accredited medical school, is a Canadian citizen, and is able to pass the requisite licensing exams, they should be seen as eligible (but not necessarily more qualified than a CMG) for a residency spot, in the eyes of the law. Of course as I've mentioned, I appreciate that it would be unfair to expect CMGs to compete against with such a tight ratio of spots even without IMGs added into the mix. Conversely, they do have that system in the US where they have ~6,000 spots in excess of the number of graduating US MDs, and I think it's fair there.

 

 

The fact is residency positions are limited, and on that basis alone, it would make zero sense for CMG's NOT to get priority for them, because they are funded positions. If it wasn't the case, then we should start charging the full cost and then make it a free-for all for positions.

 

"OR if there weren't enough spots to train all of the graduating CMGs. "

 

This is the fact, if you opened it up as a free-for-all, there would be CMGs who wouldn't graduate.

 

If you've taken a look at http://socasma.com/ you would realize how terribly inaccurate and fanatical most of the information is.

 

I respect you leviathan, but I wanted to make sure you weren't supportive of the SOCASMA type ilk, in its current state of false information and emotion invoking nonsense.

[Let'sGo1990]

So lots of people use this argument, and I appreciate where you're coming from, but I disagree. You're right that we use our taxpayer money to train a doctor to take care of us. If at the end of the day we paid money and there's an extra doctor taking care of us (who is even better qualified and who funded his/her own training), then we haven't lost any money. The only situation where a CMG going unmatched would be a waste of money is if there was still an unfilled residency spot, OR if there weren't enough spots to train all of the graduating CMGs.

 

That unmatched CMG is still a sunk investment despite having an IMG fill his/her shoes - money that could have been used elsewhere.

[rehabscience]

That unmatched CMG is still a sunk investment despite having an IMG fill his/her shoes - money that could have been used elsewhere.

 

This. x100.

[Savac]

That unmatched CMG is still a sunk investment despite having an IMG fill his/her shoes - money that could have been used elsewhere.

 

Yeah, exactly.

 

Why don't we just stop training CMGs completely and use IMGs? Imagine all the money we'll save.

[Vidhya]

Going back to taxpayer money, I see what you're saying Leviathan, but here's another thought. If we argue that it's not a waste of taxpayer money to fund a Canadian to receive an MD who subsequently can't obtain a residency, simply because that residency spot was filled by a CSA/IMG, then we run the risk of arguing that we shouldn't fund medical school in Canada at all and the burden of education can be placed entirely on students who train elsewhere.

 

After all, why take public funds, use them to train a student to receive an MD who may not be able to become a physician due to a lack of residency spots and then give these same residency spots to students who trained elsewhere and funded their own education. It doesn't make much sense and runs the risk of the public questioning the need for medical schools in Canada to begin with. If we want to take an extreme example, we could argue that the tremendous number of CSAs and IMGs who receive excellent education elsewhere, negates the need to spend public funds on training MD's here. All public funds could be reallocated to other areas desperately in need of increased funding and the universities can focus simply on residency training of qualified CSAs/IMGs.

 

Edit: People above me summed up my thoughts more eloquently in one line then I did in a huge post haha.

[A-Stark]

So lots of people use this argument, and I appreciate where you're coming from, but I disagree. You're right that we use our taxpayer money to train a doctor to take care of us. If at the end of the day we paid money and there's an extra doctor taking care of us (who is even better qualified and who funded his/her own training), then we haven't lost any money. The only situation where a CMG going unmatched would be a waste of money is if there was still an unfilled residency spot, OR if there weren't enough spots to train all of the graduating CMGs.

 

Medical education is a continuum that includes both undergraduate and postgraduate training. There is no justification for viewing it as anything else, even though the applications are considered separately. This is not an issue of qualifications but of health human resources planning with respect to the funding of medical training positions. The "continuum" aspect remains the official CAIR policy.

 

We can have return of service spots, but they shouldn't be reserved for IMGs, nor should the current CMG spots be reserved for CMGs. If a doctor attends a WHO-accredited medical school, is a Canadian citizen, and is able to pass the requisite licensing exams, they should be seen as eligible (but not necessarily more qualified than a CMG) for a residency spot, in the eyes of the law. Of course as I've mentioned, I appreciate that it would be unfair to expect CMGs to compete against with such a tight ratio of spots even without IMGs added into the mix. Conversely, they do have that system in the US where they have ~6,000 spots in excess of the number of graduating US MDs, and I think it's fair there.

 

But the WHO is not an accreditation body and does not enforce or require the kinds of detailed standards developed by CACMS and the LCME. Current CMG spots must remain "reserved" for CMG because they reflect funded positions in Canadian medical schools; there is absolutely no reason not to ensure that spots are available to every Canadian medical graduate. Otherwise there would be a fundamental discontinuity in training programs that fails to reflect the reality of how training and certification work. It is not possible for Canadian policymakers to take into account a variable number of CSAs who do not follow the "usual" CMG path, about a quarter or more of which do not apply to Canadian medical schools at all. There is really no way they can be adequately accommodated.

[leviathan]

Going back to taxpayer money, I see what you're saying Leviathan, but here's another thought. If we argue that it's not a waste of taxpayer money to fund a Canadian to receive an MD who subsequently can't obtain a residency, simply because that residency spot was filled by a CSA/IMG, then we run the risk of arguing that we shouldn't fund medical school in Canada at all and the burden of education can be placed entirely on students who train elsewhere.

 

After all, why take public funds, use them to train a student to receive an MD who may not be able to become a physician due to a lack of residency spots and then give these same residency spots to students who trained elsewhere and funded their own education. It doesn't make much sense and runs the risk of the public questioning the need for medical schools in Canada to begin with. If we want to take an extreme example, we could argue that the tremendous number of CSAs and IMGs who receive excellent education elsewhere, negates the need to spend public funds on training MD's here. All public funds could be reallocated to other areas desperately in need of increased funding and the universities can focus simply on residency training of qualified CSAs/IMGs.

 

Edit: People above me summed up my thoughts more eloquently in one line then I did in a huge post haha.

 

The reason is that the vast majority of CMGs are still more suited for residency spots here than the majority of IMGs. If all the IMGs were better, then you'd be absolutely correct that we should be saving our money and spending it elsewhere. But we know that's definitely not true at all. The majority of tax money spent on Canadian med schools is a very smart investment in our healthcare system. But no investment is perfect, or risk-free. Once in awhile you make a bad investment.

 

As a taxpayer, imagine someone telling you that you could make an investment in a mutual fund. You're told that 95% of the stocks in that fund (the 95% of CMGs who graduate as the most qualified for their spots) are going to give you positive returns. For the remaining 5% they will come up negative. Now imagine now that someone told you the remaining 5% of stocks would be automatically switched for better stocks (the top IMG applicants), without any penalty. That would be a pretty amazing investment, wouldn't you think?

[leviathan]

But the WHO is not an accreditation body and does not enforce or require the kinds of detailed standards developed by CACMS and the LCME. Current CMG spots must remain "reserved" for CMG because they reflect funded positions in Canadian medical schools; there is absolutely no reason not to ensure that spots are available to every Canadian medical graduate. Otherwise there would be a fundamental discontinuity in training programs that fails to reflect the reality of how training and certification work. It is not possible for Canadian policymakers to take into account a variable number of CSAs who do not follow the "usual" CMG path, about a quarter or more of which do not apply to Canadian medical schools at all. There is really no way they can be adequately accommodated.

If this was true, then why are US graduates allowed to compete for and take away spots from CMGs?

 

At any rate, I don't disagree with you that we shouldn't allow open competition with our current limitation of residency spots. That said, if we had an excess capacity like the US, then there'd be no reason we shouldn't. Do you agree with that?

[A-Stark]

Those "bad investments" still seem to end up matching. Otherwise you seem to be implying that said "5%" who, we might infer, fail to match are "bad investments".

 

As for the top IMG applicants, while sometimes these are CSAs, this is not always the case by any stretch. There is no lawful way to distinguish between "classical" IMGs and CSAs.

[leviathan]

Those "bad investments" still seem to end up matching. Otherwise you seem to be implying that said "5%" who, we might infer, fail to match are "bad investments".

 

As for the top IMG applicants, while sometimes these are CSAs, this is not always the case by any stretch. There is no lawful way to distinguish between "classical" IMGs and CSAs.

What I meant by bad investments is, there was a better stock out there (an IMG stock, if you will), who would have paid out better than about 5% of the CMG 'stocks' in the fund.

 

As for whether the IMG is a CSA, I hope I didn't imply it had to be. Quite often that person might be a foreign-born IMG.

[A-Stark]

If this was true, then why are US graduates allowed to compete for and take away spots from CMGs?

 

At any rate, I don't disagree with you that we shouldn't allow open competition with our current limitation of residency spots. That said, if we had an excess capacity like the US, then there'd be no reason we shouldn't. Do you agree with that?

 

US graduates from LCME-accredited schools can compete, yes, though the total numbers are fairly small.

 

In any case, we don't really have any excess capacity. Even the Gulf state residents only represent (arguably) excess training capacity. They certainly don't represent excess employment capacity.

[ralk]

Applicants from certain geographic regions or low income families still can get into medical school the same way they could before. In addition, students coming from underserved areas are much more likely to get chosen for a residency position in the same area, so that part wouldn't change either.

 

The difference is that you would add an extra pool of physicians from which to choose the best residents. At the end of the day I don't think Canadians care whether their doctor comes from a rich or poor family, or from a Canadian school or a foreign school - they just want the most qualified physician to take care of them. And while many foreign schools and graduates aren't up to Canadian standards, it's obvious that only the highest qualified applicants from good schools with excellent letters of rec from Canadian staff, the dean's letter, high board scores, research etc. would get ranked...plus on top of that is the licensing exam, so I don't think there's any concern about quality or competency.

 

Having said all that, I still do think there should be a reasonable guarantee of a residency spot for CMGs without worrying about losing a spot to a better IMG, even if it meant Canadians might not get the best doctor. At the end of the day, I'm not sure if we should change the system, out of fairness to CMGs.

 

You hit on exactly the problem - CSAs are an additional pool of applicants. That's the back door that I'm talking about: one option for students who don't come from means, two for students that do. Saying "but there's still that one option!" doesn't eliminate the imbalance presented by the second option for rich students. That's inherently discriminatory, and degrades quality of care for patients. When you only take the best from a subset of potential physicians, you lose the best from that other subset - there are poor students, who would take the CSA option if it were available to them, who would make great physicians too, but they can't, because they were born to the wrong family. Furthermore, there's reasonable evidence to suggest that patients connect more, and are subsequently treated better, by physicians with similar backgrounds to them. A lot of our patients are not rich, and having a mix of physicians that more closely resembles the mix of patients we have allows for improved service. It's a lot easier to understand the difficulties of a patient struggling to put food on the table when you've gone hungry yourself.

 

In addition, while a patient may not care if their physician grew up in the same town as them, the problem we see constantly is that physicians are generally unwilling to go to some towns. A CSA can be a great physician, but it does little good if they want to practice in Toronto when they're needed in Timmins. Again, CSAs bypass the geographical considerations most med school incorporate into their admissions process and generally want to practice in overserved areas. A patient may not care where their physician trained, but they do care if they have access to a physician. CMGs, particularly those from underserved areas, are much more likely to practice where they're needed when compared to CSAs.

[Edict]

What are your thoughts on this opinion piece?

 

http://www.vancouversun.com/touch/opinion/op-ed/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical/9714934/story.html?rel=1515483

 

I disagree with this article.

 

First of all the author has bias: "http://www.canada.com/topics/news/national/story.html?id=ac6178ed-c3b8-42a9-bdb2-dc7d2d94ce1b&k=85434", the author is also President of the CSA association.

 

Second of all, the article is sensationalist, although most media articles are.

 

"So CSAs very rarely receive any of these IMG positions" - Isn't true, most of the IMG positions are given out to CSAs

 

"The most recent study done by the Canadian Residency Matching Service in 2010 found Canadian students chose to study at international medical schools for various reasons. The study found 27 per cent never applied to a Canadian medical school. Almost two thirds, 64 per cent, never applied or applied only one time. The average Canadian medical school student applied three times before getting in." - To the layman, they could interpret this as saying that CMGs aren't as good as CSAs since they applied 3 times (i know, if you know anything it seems pretty obvious but it could be interpreted that way)

 

"Canada does not have the best medical schools in the world. The Times International Higher Education Rankings for 2013-14 ranks Oxford in England first. Three of the top five medical schools are in the U.K., where many CSAs choose to study." - First of all, The Times is based on research, second of all, the article tries to imply that a lot of CSAs study at Oxford when in reality the vast vast majority don't (only 2 or 3 every few years gain admission to Oxbridge for medicine).

 

"The Society of Canadians Studying Medicine Abroad says this institutional prejudice and protectionism ensures B.C. does not get the best Canadian doctors available." - She's basically quoting herself

 

I agree with some of the article, but her main premise is that CMGs and IMGs should be competing for the same spots like in the US. In reality, the reserved spots actually work out better for IMGs as if competition was open, IMGs would likely fare worse.

[leviathan]

CSAs rarely get the IMG positions in BC, which is what the author was talking about (this is a Vancouver-based news article).

[Mourning Cloak]

Medical education is a continuum that includes both undergraduate and postgraduate training. There is no justification for viewing it as anything else, even though the applications are considered separately. This is not an issue of qualifications but of health human resources planning with respect to the funding of medical training positions. The "continuum" aspect remains the official CAIR policy.

 

 

 

But the WHO is not an accreditation body and does not enforce or require the kinds of detailed standards developed by CACMS and the LCME. Current CMG spots must remain "reserved" for CMG because they reflect funded positions in Canadian medical schools; there is absolutely no reason not to ensure that spots are available to every Canadian medical graduate. Otherwise there would be a fundamental discontinuity in training programs that fails to reflect the reality of how training and certification work. It is not possible for Canadian policymakers to take into account a variable number of CSAs who do not follow the "usual" CMG path, about a quarter or more of which do not apply to Canadian medical schools at all. There is really no way they can be adequately accommodated.

 

This. (10 char)

[A-Stark]

CSAs rarely get the IMG positions in BC, which is what the author was talking about (this is a Vancouver-based news article).

 

Is that an evidence-based claim? The 2012 CAPER report shows that the number of non-Visa IMG trainees in BC rose from 77 in 2007 to 125 in 2011. As a proportion of total IMG trainees nationally, BC's share rose from 5.3% to 5.8% over the same period.

[daftjustice]

Medical education is a continuum that includes both undergraduate and postgraduate training. There is no justification for viewing it as anything else, even though the applications are considered separately. This is not an issue of qualifications but of health human resources planning with respect to the funding of medical training positions. The "continuum" aspect remains the official CAIR policy.

 

Well isn't this thread interesting. A lot of valid points have been made that I hadn't considered in favour of CMGs and residency spots.

 

A-Stark, I guess that I have a question to explore along your line of reasoning. You mentioned that Med school and PGME are but a continuum of medical education and shouldn't really be thought of as separate, especially from a human resources planning perspective.

 

What do you think about the CMGs that would rather re-apply a second time through CaRMs for their dream specialty as opposed to taking what they could in their own year of CaRMs? In principle, this should also disturb the ratio of applicants to residency spots in subsequent years in CaRMs

 

You hit on exactly the problem - CSAs are an additional pool of applicants.

 

Wouldn't these CMGs who end up applying in a second year of CaRMs also be an additional pool of applicants that create human resource planning challenges too? Admittedly, these CMGs in question are few in number compared to the swelling numbers of CSAs and are thus likely to be less of a challenge. However, I wonder if the principle of "the continuum of medical education" is really the best defense.

 

Just wondering out loud

[A-Stark]

What do you think about the CMGs that would rather re-apply a second time through CaRMs for their dream specialty as opposed to taking what they could in their own year of CaRMs? In principle, this should also disturb the ratio of applicants to residency spots in subsequent years in CaRMs

 

[...]

 

Wouldn't these CMGs who end up applying in a second year of CaRMs also be an additional pool of applicants that create human resource planning challenges too? Admittedly, these CMGs in question are few in number compared to the swelling numbers of CSAs and are thus likely to be less of a challenge. However, I wonder if the principle of "the continuum of medical education" is really the best defense.

 

Just wondering out loud

 

You're right that these CMGs are few in number - so few, indeed, that their numbers are fairly insignificant. I personally only know one guy who did this in order to match to ophtho. Unfortunately, prior year graduates have a much lower success rate in subsequent years, meaning that this is an extremely high risk strategy. In general, it's a much better idea to match to a second choice and try to switch than to hold out for the "dream".

[daftjustice]

But do you think they should be allowed to do so? In principle?