Your thoughts? A CSA opinion.

[advair250]

One final thing, just because your posts keep coming up when i do various other searches.. you posted this:

 

" Posts: 2,660

I know someone that went to Poznan. I don't want to repeat what I've said in about the last 10 threads on this forum, but it doesn't seem like a good idea unless they let you do clerkship in the states."

 

I just find it interesting that you are willing to offer cheaper polish schools as viable options to low SES premeds who can't afford the more reputable and better track record with match rate schools. I'm not arguing that you can't match with a polish degree, but I am saying that they aren't nearly as successful for matching back than other degrees like carib, and uk/ireland etc.

[ralk]

Right, so lower PERCENTAGE, but you haven't actually lowered the absolute number of SES people getting into medical school by having more CSAs around, so their chances haven't been affected. I fail to see how that percentage / statistic has any meaning.

 

We've been over why the percentage is important at least 5 times in this thread already... but rather than repeat myself, let's try something else...

 

Let's take your logic and turn it around. Let's keep the number of IMG residency spots at the exact same level, but expand CMG residency spots - sure, the percentage of IMGs would be lower, but the absolute number hasn't changed. IMGs still have the exact same chance of matching back here, so it's just as fair as it was before, right?

[leviathan]

We're really beating a dead horse here by this point eh?

 

We've been over why the percentage is important at least 5 times in this thread already... but rather than repeat myself, let's try something else...

 

Let's take your logic and turn it around. Let's keep the number of IMG residency spots at the exact same level, but expand CMG residency spots - sure, the percentage of IMGs would be lower, but the absolute number hasn't changed. IMGs still have the exact same chance of matching back here, so it's just as fair as it was before, right?

I'm assuming you're arguing it isn't fair because they are adding more enrollment to CMGs and not to CSAs? Well it is fair actually, because we should be focusing on expanding CMG enrollment and not poaching IMGs from other countries, or encouraging people to go the CSA route.

 

Based on your point above, it seems like you are saying that we should be expanding medical student seats, rather than letting in more IMGs/CSAs, so that more people from low SES can have a chance to be admitted? I would fully support that idea, except that the government feels we have an adequate number of medical school seats and residency seats at present, and refuses to spend more money expanding that. The only reason IMGs are really allowed to match at this point is that there is funding coming for underserviced regions who agree to let them match in exchange for service.

 

The only way we can expand med school enrollment at this point would be with a return of service attached at the point of entry into med school. It's not necessarily a terrible idea, however there are a lot of other issues involved that are for a different discussion.

[Edict]

We're really beating a dead horse here by this point eh?

 

 

I'm assuming you're arguing it isn't fair because they are adding more enrollment to CMGs and not to CSAs? Well it is fair actually, because we should be focusing on expanding CMG enrollment and not poaching IMGs from other countries, or encouraging people to go the CSA route.

 

Based on your point above, it seems like you are saying that we should be expanding medical student seats, rather than letting in more IMGs/CSAs, so that more people from low SES can have a chance to be admitted? I would fully support that idea, except that the government feels we have an adequate number of medical school seats and residency seats at present, and refuses to spend more money expanding that. The only reason IMGs are really allowed to match at this point is that there is funding coming for underserviced regions who agree to let them match in exchange for service.

 

The only way we can expand med school enrollment at this point would be with a return of service attached at the point of entry into med school. It's not necessarily a terrible idea, however there are a lot of other issues involved that are for a different discussion.

 

Does anyone think theres too much government regulation? Sometimes I think theres just too much debate into all this regulation and that regulation. Just let everything slide and let the free market sort it out. If doctors in rural areas got paid more than city doctors (which is happening in the US), you'd start to see a balance. Ex. in NYC new cardiology jobs pay around 200k whereas a cardiology job in rural Nebraska is at 450k. Also the free market will result in rural jobs being more available than city jobs.

[leviathan]

One final thing, just because your posts keep coming up when i do various other searches.. you posted this:

 

" Posts: 2,660

I know someone that went to Poznan. I don't want to repeat what I've said in about the last 10 threads on this forum, but it doesn't seem like a good idea unless they let you do clerkship in the states."

 

I just find it interesting that you are willing to offer cheaper polish schools as viable options to low SES premeds who can't afford the more reputable and better track record with match rate schools. I'm not arguing that you can't match with a polish degree, but I am saying that they aren't nearly as successful for matching back than other degrees like carib, and uk/ireland etc.

Since you're digging up all my old posts, you'll notice I'm pretty consistent over the past 4 years with recommending against ALL foreign schools, regardless of the quality of that school. It's a bad idea for anyone because of the limitation of post-grad training positions. I also don't see specifically where I said anything about Poland, so why you're constantly saying that I'm not sure.

[ralk]

We're really beating a dead horse here by this point eh?

 

 

I'm assuming you're arguing it isn't fair because they are adding more enrollment to CMGs and not to CSAs? Well it is fair actually, because we should be focusing on expanding CMG enrollment and not poaching IMGs from other countries, or encouraging people to go the CSA route.

 

Based on your point above, it seems like you are saying that we should be expanding medical student seats, rather than letting in more IMGs/CSAs, so that more people from low SES can have a chance to be admitted? I would fully support that idea, except that the government feels we have an adequate number of medical school seats and residency seats at present, and refuses to spend more money expanding that. The only reason IMGs are really allowed to match at this point is that there is funding coming for underserviced regions who agree to let them match in exchange for service.

 

The only way we can expand med school enrollment at this point would be with a return of service attached at the point of entry into med school. It's not necessarily a terrible idea, however there are a lot of other issues involved that are for a different discussion.

 

So your argument is that the government won't make changes to the medical education system for CMGs... so the government should make changes to the system for CSAs? That's assuming a fairly rigid view of government policy in a very specific direction, and is completely false - provincial governments make changes to the number of CMG spots and residency positions available every single year, including some fairly significant expansions in the past decade.

 

More to the point, for residency positions, an IMG position costs just as much as a CMG position, and many are not in rural areas (again, there are more CMG residency spots in rural areas than IMG spots). We had a large number of unmatched CMGs this year, including 39 people in the first round going for family. Simply switching spots from IMG to CMG spots would directly lead to more CMGs coming through, without any change in funding.

[leviathan]

So your argument is that the government won't make changes to the medical education system for CMGs... so the government should make changes to the system for CSAs? That's assuming a fairly rigid view of government policy in a very specific direction, and is completely false - provincial governments make changes to the number of CMG spots and residency positions available every single year, including some fairly significant expansions in the past decade.

 

More to the point, for residency positions, an IMG position costs just as much as a CMG position, and many are not in rural areas (again, there are more CMG residency spots in rural areas than IMG spots). We had a large number of unmatched CMGs this year, including 39 people in the first round going for family. Simply switching spots from IMG to CMG spots would directly lead to more CMGs coming through, without any change in funding.

 

That's not true, and I think that's where you don't quite understand the dynamics involved with IMGs. We can't just seamlessly switch IMG to CMG spots, because those IMG spots have alternate funding sources (ministry / communities) with attached ROS contracts. Yes we could open those IMG spots to CMGs but they would come with a ROS contract and I don't know how popular that would be. If CMGs were willing to sign those contracts similar to IMGs then you are right that it could be done, and I don't see any problem with that.

[advair250]

Since you're digging up all my old posts, you'll notice I'm pretty consistent over the past 4 years with recommending against ALL foreign schools, regardless of the quality of that school. It's a bad idea for anyone because of the limitation of post-grad training positions. I also don't see specifically where I said anything about Poland, so why you're constantly saying that I'm not sure.

 

Just so we're clear, I am not digging up your posts haha:p They just show up whenever I do searches to learn more about different pre-med related options.

 

I also don't see specifically where I said anything about Poland, so why you're constantly saying that I'm not sure.

 

Specifically post 117 + post 120, you're response to me saying that it would be difficult to attend a reputable school, where even the cheapest one would still be expensive and out of reach for low ses. I stated that the cheaper ones, such as poland, don't have as good match rates in NA like Saba, which is relatively much cheaper even than the other schools in Carib/Uk/Ireland - where an even larger # of CSAs are at.

 

You're response was to defend poland and say that those who matched were happy with their training. Leaving out the fact that poland's match rates are actually quite low compared to the other options, some of which are much more expensive(Saba) and the ones that are even much much much (x1000) more expensive.

 

While yes, I did bring up Poland, and inferred other cheaper schools relative to Saba, you defended them indirectly in the context of our discussion.

[leviathan]

^^ I see what you mean about Poland. The way I feel, as I mentioned, is I don't think it's a good idea to go to ANY foreign school. I know I'm a hypocrite by saying that, but it's partially because I went through at what I feel was the tail end of a time when it used to be feasible to at least match in a non-competitive position in the US.

 

So I'm glad we had this discussion, and that we kept it civil. To summarize the whole back and forth we've been doing, I think there's three issues we've been going over:

 

1. CSAs increase the proportion of 'privileged' people becoming doctors in our country - What I've mentioned is that I don't think it matters. We might have to agree to disagree on that.

 

2. Only people of privilege can attend foreign schools - While it's obviously easier for wealthier people to attend, and the 'survey' reflects that, it's certainly not restricted to them. If someone from a middle class family wants to study abroad, it's harder, but definitely possible. Myself and numerous classmates of mine are examples of that, and we're far from 'exceptions' to the rule. The preponderance of these wealthy students in the survey are all at the Irish / Aus schools, and don't reflect the less expensive schools like Saba.

 

3. CSAs make it harder for people of low SES to become doctors, because they decrease the incentive of government to increase domestic enrollment and physician production - This is not true. The govt is definitely not looking at expanding med school seats any more, and I don't think anyone thinks that would be a good idea. Also, the IMG spots that exist are specially funded with return of service contracts. Unless we open those up to both IMGs and CMGs, then it currently has no bearing on how easy it is for a low SES person to get into med school, because those spots don't influence capacity for CMG physician production.

[advair250]

10character

[jfdes]

...

 

If you can provide me EVEN one school that is cheaper then even SABA, which I have set as the benchmark for relatively cheap and decent CARMS match stats, then I will publicly for the whole wide viewership of 10 premeds on PM101, redact all my previous statements.

 

...

 

Speaking as one of the 10 premeds who actually read through all of this, I must say that the discussion provided here from all parties has been very interesting and insightful, on a topic that I have very little knowledge about

[hamham]

Coming from Vancouver, I'm not bitter in the least about that either. Having said that, I heard UBC's IM program isn't the best, and is even under review right now.

 

UBC is not bitter about it either. Every year, we received countless applications from bright CMGs and IMGs. If you think you are too good for our programs, so be it. We have more than enough talented applicants interested in our programs.

[leviathan]

Every year, we received countless applications from bright CMGs and IMGs. If you think you are too good for our programs, so be it. We have more than enough talented applicants interested in our programs.

Too good for your programs? Exactly where was that said? That's an interesting talent you have, to read the exact opposite of what I actually wrote. The whole point is you didn't have countless applications - the majority of IMGs including myself were not eligible to apply to UBC up until this year.

[A-Stark]

I'm sure a med student just finishing first year is well positioned to comment on the national reputations of, say, the UBC IM and general surgery programs.

[hamham]

Too good for your programs? Exactly where was that said? That's an interesting talent you have, to read the exact opposite of what I actually wrote. The whole point is you didn't have countless applications - the majority of IMGs including myself were not eligible to apply to UBC up until this year.

 

The majority of newly grad CSAs you mean. For your info, there are a lot of IMGs (mostly immigrant physicians and repeated CSAs) who applied to UBC every yr. It's just that demand exceeds supply, and we cannot offer everyone a spot. Your tone in your initial post gave the impression that you are too good for UBC.

[hamham]

I'm sure a med student just finishing first year is well positioned to comment on the national reputations of, say, the UBC IM and general surgery programs.

 

For your info, I never once commented on the reputation of UBC's programs. It might be the worst in the country. It might be under intense review. I don't know. All I know is that there are more applicants than spots available, and we cannot afford to offer every applicant a spot.

 

It seems like you have completed med sch, maybe even residency. So kudos to you. But using your position to put down other juniors is not cool. Don't assume that one knows less simply b/c he/she is merely a premed/med student.

[leviathan]

The majority of newly grad CSAs you mean. For your info, there are a lot of IMGs (mostly immigrant physicians and repeated CSAs) who applied to UBC every yr. It's just that demand exceeds supply, and we cannot offer everyone a spot. Your tone in your initial post gave the impression that you are too good for UBC.

Nobody at all was talking about 'supply and demand'. The vast majority of applicants were barred from applying. The only people eligible to apply were those who failed to match one or multiple times in the past, or immigrants who haven't practiced medicine for years. While some of those people in each category might be strong candidates, the majority would not be the best pick for BC. That's BC's loss anyway.

 

I also don't know how you'd get the impression I thought I was 'too good for UBC' when I said I was bitter that I couldn't apply. That's pretty much the exact opposite.

[leviathan]

It seems like you have completed med sch, maybe even residency. So kudos to you. But using your position to put down other juniors is not cool. Don't assume that one knows less simply b/c he/she is merely a premed/med student.

It's a pretty safe bet that an M1 is not going to know much first-hand about the quality of residency programs.

[ratatat]

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.

 

[hamham]

http://www.vancouversun.com/news/Opinion+right+doctors+with+right+training/9995105/story.html

 

A recently published reply to the original article. This reply was written by representatives from CFMS and UBC Med UG society.

 

Edit: It's not really a reply. More like an "opinion".

[fugacity]

http://www.vancouversun.com/news/Opinion+right+doctors+with+right+training/9995105/story.html

 

A recently published reply to the original article. This reply was written by representatives from CFMS and UBC Med UG society.

 

Edit: It's not really a reply. More like an "opinion".

 

Nothing against Gurinder, but there seemed to be an extreme lack of opinion on something that is titled 'opinion'. When I first read this article, I didn't even know it was written as a 'reply' to the CSA article when people kept sharing this on facebook.

[leviathan]

Seemed like a long-winded article that didn't really make a lot of sense. If they think the training is so superior, then they shouldn't be worried about IMGs applying for the same spots.

 

Also if they only want home-grown doctors practicing in Canada, then they shouldn't be defending American schools in one breath and bashing foreign schools in the next.

[hamham]

Nothing against Gurinder, but there seemed to be an extreme lack of opinion on something that is titled 'opinion'. When I first read this article, I didn't even know it was written as a 'reply' to the CSA article when people kept sharing this on facebook.

 

Couldn't have said this better myself.

 

I was expecting a reply (with more "opinions") to the original article when the ubc med ug society mentioned that it was preparing a letter together with others from cfms. I think the authors wanted to keep the article's tone as neutral as possible without being argumentative or defensive. But they did not realize that in so doing, they have created an article that fails to address the concerns raised in the original article. I think Rosemary Pawliuk won't give up so easily, and it won't be long before she comes knocking on our door with her 2nd masterpiece.

[fugacity]

Couldn't have said this better myself.

 

I was expecting a reply (with more "opinions") to the original article when the ubc med ug society mentioned that it was preparing a letter together with others from cfms. I think the authors wanted to keep the article's tone as neutral as possible without being argumentative or defensive. But they did not realize that in so doing, they have created an article that fails to address the concerns raised in the original article. I think Rosemary Pawliuk won't give up so easily, and it won't be long before she comes knocking on our door with her 2nd masterpiece.

 

I agree with you 100%. At the same time, I guess I can understand why they wrote a soft and weak article. You and I are in the same class, and you know how far our class would go to stay away from controversy. So why even reply? Newspaper articles carry little weight as they are, not to mention when an individual with a conflict of interest authors one. I only hope they (and also us on this forum) handle the next article better, if there is one.

[leviathan]

There are obvious conflicts of interest on both sides of the table. It would be good for an impartial person or group to go over all the facts and decide the best thing to do.