Your thoughts? A CSA opinion.

[ralk]

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

 

Almost by definition no. It's not a new pool, just a old one that hasn't fully trickled out. 2nd year CMG applicants can only increase in number when the number of successful 1st year CMG applicants is lower the year before. It's a conserved quantity. CSA numbers are bounded only by the criteria of foreign schools - criteria which are significantly lower than Canadian med schools.

 

More importantly, 2nd year CMG applicants had to pass every hurdle that 1st year CMG applicants did - including the entry requirements put in place to promote quality and provide a population of physicians responsive to the geography of health care needs in this country. 2nd year CMG applicants are still essentially under the sovereignty of the Canadian Medical Education system - CSAs bypass that system when it's inconvenient for them.

[daftjustice]

Almost by definition no. It's not a new pool, just a old one that hasn't fully trickled out. 2nd year CMG applicants can only increase in number when the number of successful 1st year CMG applicants is lower the year before. It's a conserved quantity. CSA numbers are bounded only by the criteria of foreign schools - criteria which are significantly lower than Canadian med schools.

 

Sorry, I am a little confused and just want to see if I understand correctly.

 

Does this mean that since a 2nd year CMG applicant didn't take a residency spot in their original CaRMs year, a spot is still available to be filled, thus no problem? I.e. essentially that residency spot still exists and that they therefore did not contribute to a higher applicant:residency position ratio?

[A-Stark]

Traditionally residency spots are allocated to provide a 1.1:1 ratio of spots to applicants, with an aim of providing space to residents seeking program changes or re-entry. This also includes some degree of flexibility to prior year graduates, who make up 3-4% of total applicants. They don't do very well, though, and over a third go unmatched.

[ralk]

Sorry, I am a little confused and just want to see if I understand correctly.

 

Does this mean that since a 2nd year CMG applicant didn't take a residency spot in their original CaRMs year, a spot is still available to be filled, thus no problem? I.e. essentially that residency spot still exists and that they therefore did not contribute to a higher applicant:residency position ratio?

 

Residency spots aren't carried over based on CMGs who don't match, though as A-Stark says, the system is set up to allow some previous-year graduates to match.

 

However, my argument against CSAs has nothing to do with year-to-year competitiveness for residency positions, but rather the balance of physicians coming through the pipeline overall. The process for med school admissions is set up to get a balance of physicians that will properly serve the population of this country, particularly when it comes to geography. CSAs subvert that process, and so even if every CMG matched, CSAs would disturb that balance if they were to match in sufficient numbers.

[daftjustice]

However, my argument against CSAs has nothing to do with year-to-year competitiveness for residency positions, but rather the balance of physicians coming through the pipeline overall. The process for med school admissions is set up to get a balance of physicians that will properly serve the population of this country, particularly when it comes to geography. CSAs subvert that process, and so even if every CMG matched, CSAs would disturb that balance if they were to match in sufficient numbers.

 

I think I agree with you ralk. From an oversupply point of view, CSAs do pose a problem. I don't even have that big of an issue against the ROS's they are subject to, which I think are a fair trade off in exchange for being able to practice medicine in Canada.

 

I don't quite see how the Canadian med school admissions policies are really fixing the physician distribution issues, but that's probably just because I don't know the ins and outs. How do they do this? How do they control for applicants who are of rural origin but will go urban once they graduate? (I have no idea what the incidence of this is, I'm just curious).

 

Btw, I am not a CSA or a CMG (yet), just trying to gain a better idea of this issue.

[ralk]

I think I agree with you ralk. From an oversupply point of view, CSAs do pose a problem. I don't even have that big of an issue against the ROS's they are subject to, which I think are a fair trade off in exchange for being able to practice medicine in Canada.

 

I don't quite see how the Canadian med school admissions policies are really fixing the physician distribution issues, but that's probably just because I don't know the ins and outs. How do they do this? How do they control for applicants who are of rural origin but will go urban once they graduate? (I have no idea what the incidence of this is, I'm just curious).

 

Btw, I am not a CSA or a CMG (yet), just trying to gain a better idea of this issue.

 

Canadian med schools, besides often being located in underserved areas, have explicit preferences for students from underserved areas. Research has shown both increase the likelihood a student will end up practicing in that area. Some will go urban, of course, for a variety of reasons, but in smaller numbers than students from overserved areas.

 

ROS's are basically bandaids - they work for as long as they're in effect, but don't produce long-term supply solutions.

[daftjustice]

Canadian med schools, besides often being located in underserved areas, have explicit preferences for students from underserved areas. Research has shown both increase the likelihood a student will end up practicing in that area. Some will go urban, of course, for a variety of reasons, but in smaller numbers than students from overserved areas.

 

ROS's are basically bandaids - they work for as long as they're in effect, but don't produce long-term supply solutions.

 

Research is research I guess.

 

Hell, I've lived in every major urban Canadian city over the course of my life but spend most of my free time up north in the Rockies in AB and BC but I never "lived" there....totally unverifiable unfortunately. I would love to be able to sign a long-term ROS (read: half or more of my hypothetical medical career) to any rural area in Northern Alberta or BC if it made it any easier to become a doctor.

 

I'd just pack up my skis and my satellite dish and bring them with me.

 

Would I really have to move to a rural area for X+ years to get this advantage? Is there some way to genuinely convey this willingness despite not being a rural applicant?

[ralk]

Research is research I guess.

 

Hell, I've lived in every major urban Canadian city over the course of my life but spend most of my free time up north in the Rockies in AB and BC but I never "lived" there....totally unverifiable unfortunately. I would love to be able to sign a long-term ROS (read: half or more of my hypothetical medical career) to any rural area in Northern Alberta or BC if it made it any easier to become a doctor.

 

I'd just pack up my skis and my satellite dish and bring them with me.

 

Would I really have to move to a rural area for X+ years to get this advantage? Is there some way to genuinely convey this willingness despite not being a rural applicant?

 

Vacationing somewhere and living there are two completely different things. It's easy to say you like a place when you only do fun things there.

 

Long term ROS's have significant drawbacks. Med school applicants can get pretty desperate, and will commit to just about anything to get in, so even a long ROS wouldn't dissuade those who would rather practice elsewhere. In addition, they would severely hamper labour mobility. We want physicians to move where they're needed and where they'd be most valuable, and it's hard to predict in advance where that will be for any individual person. If a student turns out to be a masterful cardiac surgeon, it makes no sense to hold them to an ROS in Moosonee. Geography-based admissions to med school influences location preferences without restricting movement.

[A-Stark]

In light of how the second iteration went today for (at least some people I know), I don't think the current system is sustainable. For anyone.

[GrouchoMarx]

In light of how the second iteration went today for (at least some people I know), I don't think the current system is sustainable. For anyone.

 

How did the 2nd iteration go? What makes you state that it is unsustainable?

[jfdes]

In light of how the second iteration went today for (at least some people I know), I don't think the current system is sustainable. For anyone.

 

Yikes, that sounds scary. More details please, for those of us who aren't yet there?

[daftjustice]

Vacationing somewhere and living there are two completely different things. It's easy to say you like a place when you only do fun things there.

 

Long term ROS's have significant drawbacks. Med school applicants can get pretty desperate, and will commit to just about anything to get in, so even a long ROS wouldn't dissuade those who would rather practice elsewhere. In addition, they would severely hamper labour mobility. We want physicians to move where they're needed and where they'd be most valuable, and it's hard to predict in advance where that will be for any individual person. If a student turns out to be a masterful cardiac surgeon, it makes no sense to hold them to an ROS in Moosonee. Geography-based admissions to med school influences location preferences without restricting movement.

 

I guess I should explain myself better. Lived in FSJ in northeastern BC for a year and a half...and loved it. Certainly enough time to know if "rural" (I'm honestly unsure if a population < 30,000 qualifies as rural or not for med school purposes) life was for me. But, I've also lived in Montreal for 6 years, Calgary for 12, Halifax for 2, Victoria, B.C. for 4 and Toronto for 1.5.....I don't know how to qualify myself to be honest..

 

I guess my issue is, I would be willing to go wherever I am needed in Canada, and am not tied down to particular city or town. And I bet that I am not the only Canadian like this, desperate or not.

 

But let's say that the government (or whoever else administers the ROS's) decides that someone tied down to a Moosonee ROS would be better used somewhere else....surely they could include a clause to facilitate that into the ROS, no?

[A-Stark]

Yikes, that sounds scary. More details please, for those of us who aren't yet there?

 

I don't know if what I've heard is at all representative of the second iteration in general, so I'm not going to elaborate for now if that's ok.

[ralk]

I guess I should explain myself better. Lived in FSJ in northeastern BC for a year and a half...and loved it. Certainly enough time to know if "rural" (I'm honestly unsure if a population < 30,000 qualifies as rural or not for med school purposes) life was for me. But, I've also lived in Montreal for 6 years, Calgary for 12, Halifax for 2, Victoria, B.C. for 4 and Toronto for 1.5.....I don't know how to qualify myself to be honest..

 

I guess my issue is, I would be willing to go wherever I am needed in Canada, and am not tied down to particular city or town. And I bet that I am not the only Canadian like this, desperate or not.

 

But let's say that the government (or whoever else administers the ROS's) decides that someone tied down to a Moosonee ROS would be better used somewhere else....surely they could include a clause to facilitate that into the ROS, no?

 

You might qualify for geographic status at some schools, each school has their own requirements for that. Stated willingness to move, however, isn't enough - everyone would make that promise, and even the ones who mean it initially would break that promise more often than not. Most people (not just physicians) end up living near where they were born and educated, for a number of very good reasons.

 

As for an opt-out clause in an ROS, think about that for a second. Anyone who disliked where they worked would find a way to make themselves more valuable somewhere else and we'd be back at square one. Besides, I'm pretty left-of-centre politically, but the government dictating who's valuable enough to void contracts and who's not sounds like a good formula for abuse, and likely a violation of several civil liberties.

[daftjustice]

You might qualify for geographic status at some schools, each school has their own requirements for that. Stated willingness to move, however, isn't enough - everyone would make that promise, and even the ones who mean it initially would break that promise more often than not. Most people (not just physicians) end up living near where they were born and educated, for a number of very good reasons.

 

As for an opt-out clause in an ROS, think about that for a second. Anyone who disliked where they worked would find a way to make themselves more valuable somewhere else and we'd be back at square one. Besides, I'm pretty left-of-centre politically, but the government dictating who's valuable enough to void contracts and who's not sounds like a good formula for abuse, and likely a violation of several civil liberties.

 

 

I didn't mean an opt-out clause that the physician controlled. Rather, one that was controlled by the gov't...I meant if the ministry of Health (or whatever) recognizes a need for a particular Doctor's skill set somewhere else, they could lift the ROS off of them in such a situation, given that the Doctor was also willing.

[ralk]

I didn't mean an opt-out clause that the physician controlled. Rather, one that was controlled by the gov't...I meant if the ministry of Health (or whatever) recognizes a need for a particular Doctor's skill set somewhere else, they could lift the ROS off of them in such a situation, given that the Doctor was also willing.

 

That's the situation I was referring to as well. It would likely make the whole point of the ROS ineffective because physicians would figure out what to do to meet those government requirements to have the ROS lifted. And because a government official is not likely to have a good grasp as to what constitutes a valid reason to move, there is a huge potential for abuse, or at a minimum, a return to the origin problem of poor labour mobility for physicians.

 

It is very difficult, for numerous constitutional reasons, to restrict someone's movement within the country against their will. An ROS is a contract, yes, so that makes it somewhat enforceable, but even the current, short-term ROS's can be broken (often with a financial penalty).

[Laika]

A timely article, for those with access to CMAJ:

 

http://www.cmaj.ca/content/186/7/552.full.html?etoc

[A-Stark]

Blah, as if I remember my CMA username or password... will have to wait for the print edition to arrive.

[ArchEnemy]

Blah, as if I remember my CMA username or password... will have to wait for the print edition to arrive.

 

You have to create a CMAJ account (which is separate from CMA account).

[in2bat0r]

I wonder if this instigated the opinion piece lol - that last part was a zinger!

[A-Stark]

That would mean finding my CMA number. Hard enough keeping track of my CMPA and College registration numbers.

 

The print edition should arrive in the next couple days.

[advair250]

Can you post a copy of it?

[jfdes]

Can you post a copy of it?

 

Or even throw it up on mediafire or something, I'd be really interested in reading this article as well if possible!

[Laika]

Blah, as if I remember my CMA username or password... will have to wait for the print edition to arrive.

 

For those who don't have a subscription, you likely have free access through your university.

[NLengr]

That would mean finding my CMA number. Hard enough keeping track of my CMPA and College registration numbers.

 

The print edition should arrive in the next couple days.

 

Agree, to much work for online access