Untrained And Unemployed: Medical Schools Churning Out Doctors Who Can't Find Residencies And Full Time Positions

[uwopremed]

Don't you see sophistry of your argument? You are saying it is bad for the economy that CSAs spend their money on their med education abroad. Good or bad, the real issue is that they don't have a choice - they CANNOT spend their money on their med education in Canada, no matter how much they want to. Exceptions aside, it is not that they've been offered a place in UoT and yet they decided to go to Ireland and spend their money there. In this line of reasoning, you should speak against Canadians studying in US.  I don't know the numbers but there might be more of those than CSAs.  

 

US medical schools, while often private, are not for profit institutions.  As a result, they do not give spots away to Canadians with lower standards, and all US allopathic medical schools are part of the LCME system (along with the three Puerto Rican schools) to which all Canadian schools belong.  They are all similarly accredited, and all are competitive to attend.  There are no US medical schools that cater to Canadians, or make it easier for Canadians to gain admission into versus Americans (most are of course harder, especially state schools).  The total number of Canadians studying in the US and applying to Canada for residency numbers no more than 25 a year - and most choose the US for residency anyways (where their connections are made, or a new romantic partner may live).  IT is a drop in the bucket.

 

CSAs go to for profit programs with much lower standards.  Even the Irish and Australian schools have much lower standards for Canadians than they do for their own Nationals.  The difference is especially stark for schools in central/eastern Europe and Asian.  And of course - a pulse is pretty much all that is required for the Caribbean.  Oh yes...with one thing that is required.  MONEY.  And lots of it.

 

The fact that substandard Canadians can buy an MD and get to make 400K+ a year in Canada, while a better qualified Canadian from a poorer family (that barely missed a cutoff for CAN medical schools) cannot is what absolutely appalls me.   If Canada needs more doctors - increase medical spots and don't let anyone else in.  If Canada does not need more doctors - then still don't let anyone else in.  Rare exceptions for exceptional researchers being wooed to Canada, or people at the few top 5-10 medical schools in the world that chose those schools versus Canadian/US ones maybe.  But that is it. 

 

We have NO obligation to let CSAs make huge incomes on the back of taxpayers that bought their degrees because of wealth.  NOT ONE BIT!  

[older]

CSAs receive the majority of IMG spots, despite being the minority of applicants.

 

In many ways, CSAs and IMGs are casualties of our system, both being fed false hope that only work well for a minority of those given that hope. CSAs are fed that hope by the schools accepting them, who promote the subset of successful CSAs while ignoring the larger subset who are unsuccessful. IMGs are fed that hope by our immigration system which promises of certification pathways in Canada, while failing to inform them of hurdles they'd need to jump and the (low) chances of them succeeding in jumping those hurdles.

 

Closing the pathway for CSAs and IMGs seems like it's closing a door on deserving individuals, but in reality the system already closes the door for the majority of those individuals, it just asks for 4+ years of their life (for CSAs) or a move to Canada (for IMGs) before officially telling them the door is shut. All other arguments aside, we need to do a much better job about being transparent and honest with prospective CSAs and IMGs who might want to practice in Canada.

 

Whoa, the numbers of CSAs more than doubled since 2010 (page 29). Agree with your earlier post  that the issue would not be a big problem if the number od CSAs remained not siginificant and steady. But this trend shows there is definitely a reason for concern if not a red light.

[older]

US medical schools, while often private, are not for profit institutions.  As a result, they do not give spots away to Canadians with lower standards, and all US allopathic medical schools are part of the LCME system (along with the three Puerto Rican schools) to which all Canadian schools belong.  They are all similarly accredited, and all are competitive to attend.  There are no US medical schools that cater to Canadians, or make it easier for Canadians to gain admission into versus Americans (most are of course harder, especially state schools).  The total number of Canadians studying in the US and applying to Canada for residency numbers no more than 25 a year - and most choose the US for residency anyways (where their connections are made, or a new romantic partner may live).  IT is a drop in the bucket.

 

CSAs go to for profit programs with much lower standards.  Even the Irish and Australian schools have much lower standards for Canadians than they do for their own Nationals.  The difference is especially stark for schools in central/eastern Europe and Asian.  And of course - a pulse is pretty much all that is required for the Caribbean.  Oh yes...with one thing that is required.  MONEY.  And lots of it.

 

The fact that substandard Canadians can buy an MD and get to make 400K+ a year in Canada, while a better qualified Canadian from a poorer family (that barely missed a cutoff for CAN medical schools) cannot is what absolutely appalls me.   If Canada needs more doctors - increase medical spots and don't let anyone else in.  If Canada does not need more doctors - then still don't let anyone else in.  Rare exceptions for exceptional researchers being wooed to Canada, or people at the few top 5-10 medical schools in the world that chose those schools versus Canadian/US ones maybe.  But that is it. 

 

We have NO obligation to let CSAs make huge incomes on the back of taxpayers that bought their degrees because of wealth.  NOT ONE BIT!  

 

 

While your post illustrates your emotional state, it does not touch the point disputed in the post you quoted  - the impact on CSA's on Canadian economy.

 

To add to the point, it is worth to mention that many Canadians who can afford to study abroad do just that, in all kind of schools. Met quite a few Canadians stydying at LSE, Sorbonne etc (not medics). I suppose they all should feel guilty for their unpatriotic behaviour. 

[ralk]

Don't you see sophistry of your argument? You are saying it is bad for the economy that CSAs spend their money on their med education abroad. Good or bad, the real issue is that they don't have a choice - they CANNOT spend their money on their med education in Canada, no matter how much they want to. Exceptions aside, it is not that they've been offered a place in UoT and yet they decided to go to Ireland and spend their money there. In this line of reasoning, you should speak against Canadians studying in US.  I don't know the numbers but there might be more of those than CSAs.  

 

You've presented a false dichotomy - if CSAs don't spend money on medical education abroad, that money doesn't suddenly disappear even if it doesn't get spent on medical education here. Rather, it would be used for some other purpose. For example, some of those funds could go towards training or education in a field other than medicine. These alternative fields would hopefully have better career opportunities than what CSAs face and better utility for the Canadian economy than residency-less foreign-trained MDs.

 

Canadians going abroad take money out of the Canadian economy, whether they do it for work, study, or education. We live in a global economy, so we accept these losses for the gains we get in return, both direct (through people coming to Canada for work, study, or education) and indirect (through efficiencies gained in a broader market). But because of these losses to the economy, we generally don't incentivize individuals to go abroad unnecessarily, which is what our approach to CSAs does. Back when the CSA option was far less attractive, when students were unable to gain admissions to Canadian Med Schools, they had to move onto other options. That's a good thing - there are lots of good careers out there besides medicine that could use smart, driven people. Whatever else, CSAs are smart, driven people, even if they might not be the optimal candidates for med school at the time they choose to go abroad. With the CSA route open, we provide an incentive to study abroad, even if that incentive comes with significant risks.

 

We have the option to keep CSAs in Canada and give aspiring physicians a stable, more reliable, more transparent path to becoming doctors - train more CMGs, provide fewer IMG residency spots. This strategy would carry it's own costs, just as allowing CSAs to go abroad does, but as I've tried to detail, there are advantages to this strategy as well which don't exist with the current system. Arguably most importantly, we would have control over those costs and could take steps to minimize them if we chose to. With CSAs, we effectively give up any control over the process - we can't control numbers, quality, or costs. 

 

Whoa, the numbers of CSAs more than doubled since 2010 (page 29). Agree with your earlier post  that the issue would not be a big problem if the number od CSAs remained not siginificant and steady. But this trend shows there is definitely a reason for concern if not a red light.

 

Yeah, that's why there's been such a focus on this. If the numbers were low or at least stable, CSAs would be a minor concern, if one at all. But there are nearly as many CSAs as there are medical students in Ontario, possibly more. The current system has created an incentive strong enough to convince hundreds each year to go overseas to study medicine, with what appears to be more every year choosing that pathway. Maybe what I'm proposing isn't the ideal option, but the status quo is unacceptable.

[JohnGrisham]

Don't you see sophistry of your argument? You are saying it is bad for the economy that CSAs spend their money on their med education abroad. Good or bad, the real issue is that they don't have a choice - they CANNOT spend their money on their med education in Canada, no matter how much they want to. Exceptions aside, it is not that they've been offered a place in UoT and yet they decided to go to Ireland and spend their money there. In this line of reasoning, you should speak against Canadians studying in US.  I don't know the numbers but there might be more of those than CSAs.

 

I can gaurantee the number of canadians studying in the US is far less than abroad. Far less.

[GrouchoMarx]

I find it unfortunate that hard work and sacrifice is not really necessary anymore for a career in medicine, as long as you can afford a plane ticket and half-mil tuition costs.

 

When I see CSAs struggling through their internship I wonder what I was doing all those weekend nights in undergrad and on the wards and in the OR and delivery room. I should have been doing what the CSAs had done and gone out, lived life, skated by with a 3.2 instead of busting my ass for a 4.0. What's the difference, we ended up in the same place anyway.

[uwopremed]

I find it unfortunate that hard work and sacrifice is not really necessary anymore for a career in medicine, as long as you can afford a plane ticket and half-mil tuition costs.

 

When I see CSAs struggling through their internship I wonder what I was doing all those weekend nights in undergrad and on the wards and in the OR and delivery room. I should have been doing what the CSAs had done and gone out, lived life, skated by with a 3.2 instead of busting my ass for a 4.0. What's the difference, we ended up in the same place anyway.3.

3.2??  I know of a few cases of 2.5s at terrible Canadian schools that went abroad (one to a medical school in southern india paid for by daddy), AND still managed to come back to Canada.  Works as a hospitalist, is not that great, but finds a way to make so much money that he owns two new super sports cars.  The other case is a woman working as a neurologist.

 

Not to mention the kids with 70s in high school that go abroad to a direct program as well!!  Some of them have slipped back into Canada as well....

[LittleDaisy]

In my humble opinion, those cases are rare.

If you look at CaRMs statistics for 2015: http://www.carms.ca/en/data-and-reports/r-1/reports-2015/

The odds of matching as CSAs or IMGs are not very promising.

I heard that even though some programs have reserved spots for IMGs in the first round, some programs would prefer not giving those spots and deliberately leave them open. 

3.2??  I know of a few cases of 2.5s at terrible Canadian schools that went abroad (one to a medical school in southern india paid for by daddy), AND still managed to come back to Canada.  Works as a hospitalist, is not that great, but finds a way to make so much money that he owns two new super sports cars.  The other case is a woman working as a neurologist.

 

Not to mention the kids with 70s in high school that go abroad to a direct program as well!!  Some of them have slipped back into Canada as well....

[guy30]

I find it unfortunate that hard work and sacrifice is not really necessary anymore for a career in medicine, as long as you can afford a plane ticket and half-mil tuition costs.

 

When I see CSAs struggling through their internship I wonder what I was doing all those weekend nights in undergrad and on the wards and in the OR and delivery room. I should have been doing what the CSAs had done and gone out, lived life, skated by with a 3.2 instead of busting my ass for a 4.0. What's the difference, we ended up in the same place anyway.

 

Hard work and sacrifice are only a part of it, but where you live matters quite a bit too.  Canada is hardly a true meritocracy when it comes to medical admissions.  Many of those that get a 3.8 or 3.9 GPA in Ontario go abroad after trying for several years while they watch their counterparts in Quebec, Saskatchewan, Manitoba etc. get in with less.

 

When admissions averages are now getting into the 3.95 or 4.0 averages in certain provinces, you're really just splitting hairs when it comes to future outcomes in the group of students that apply to medicine.  Does a 4.0 student really do that much better than a 3.9 or 3.8 GPA student in the long run?  What type of undergrad and courses did the 4.0 student take?

 

Also if you want to talk about hard work and sacrifice, you're preaching to the choir if you're talking to IMG's as a whole (particularly since their marks etc. still matter throughout medical school and beyond).  It's not exactly easy getting into the Canadian system (nor should it be) amongst thousands of applicants for a few hundred spots in CARMS.  Interestingly enough, the 2015 match statistics show that there were only 238 new (year 2015) graduates applying/participating in the IMG pool for the match.  Assuming these are all CSA's that just graduated, that is hardly the thousands of CSA's flooding the system people are worried about?  I would imagine those CSA's that didn't apply to CARMS in the year they graduated would of done residency elsewhere such as in the US (particularly for Caribbean grads) or whatever country they trained in (Australia, Ireland, UK etc.) but it's interesting the stats show that many of them didn't even bother applying in Canada anyways.

[...]

.

[older]

I can gaurantee the number of canadians studying in the US is far less than abroad. Far less.

 

fair enough, but ralk's point is that anybody going to study abroad is taking money from Canadian economy. So I pointed out that some go to US, and quite a number goes elsewhere to study other programs than medicine. Arguably it is bad, but it's  just part of life getting global, and not unique to medicine.  The difference is that whilst people have a free choice to study economy or French  here or abroad, the same is not true in med education. Having  door slammed in Canada, people use another options available to them and study abroad.  Giving up the chosen profession in the name of a greater good is not an option for a rational individual. It's the system that creates this - not individuals. I suppose we all agree on that. Hostility directed on CSAs is misplaced.

[older]

Hard work and sacrifice are only a part of it, but where you live matters quite a bit too.  Canada is hardly a true meritocracy when it comes to medical admissions.  Many of those that get a 3.8 or 3.9 GPA in Ontario go abroad after trying for several years while they watch their counterparts in Quebec, Saskatchewan, Manitoba etc. get in with less.

 

When admissions averages are now getting into the 3.95 or 4.0 averages in certain provinces, you're really just splitting hairs when it comes to future outcomes in the group of students that apply to medicine.  Does a 4.0 student really do that much better than a 3.9 or 3.8 GPA student in the long run?  What type of undergrad and courses did the 4.0 student take?

 

Also if you want to talk about hard work and sacrifice, you're preaching to the choir if you're talking to IMG's as a whole (particularly since their marks etc. still matter throughout medical school and beyond).  It's not exactly easy getting into the Canadian system (nor should it be) amongst thousands of applicants for a few hundred spots in CARMS.  Interestingly enough, the 2015 match statistics show that there were only 238 new (year 2015) graduates applying/participating in the IMG pool for the match.  Assuming these are all CSA's that just graduated, that is hardly the thousands of CSA's flooding the system people are worried about?  I would imagine those CSA's that didn't apply to CARMS in the year they graduated would of done residency elsewhere such as in the US (particularly for Caribbean grads) or whatever country they trained in (Australia, Ireland, UK etc.) but it's interesting the stats show that many of them didn't even bother applying in Canada anyways.

 

Good points. Medical admissions are intended to be on merit, but can be, and are,  manipulated. Just read the threads for prospective medical students on this forum. I am shaking my head reading it -  choosing "easier' programs or "easier" classess, adding useless additional courses, years, degress - all this for the sole purpose of bumping  GPA by a fraction of percent. Then applying to schools that calculate GPA to their advantage (3.95 GPA is not 3.95 if you count only 2 years, for example). On the top of it, collecting "right" ECs, which they are not interested in, and otherwise they would never take. And in the right "quantity". Last but not the least, moving to a different province to apply as IP and get an easier pass with an uncompetitive GPA!

 

These manipulations are hardly compatible with the concept of pure hard work and sacrifice as a ticket to Canadian med school. It is not surprising  that in the example above, somebody with 3.8 or 3.9 GPA in Ontario, and not being able to get in, would choose to go abroad instead of trying all those tricks.

 

The overhelming majority of med applicants are serious and hard working people. Some are more lucky than others, some know better how to play the system, and some are indeed (marginally) "better'" (if grades are the measure of it)  than their still very capable competition. So we get in,  look down at those who didn't, and spew contempt on them if they choose another path instead of humbly retreating.   

 

The pictures painted in some of the above posts, those of dumb and lazy CSAs with GPA 2.2  who buy their medical diplomas abroad are just as far from truth as the pictures of saintly CMGs. True, there might be outrageous exceptions, but they wouldn't last in med school, yet alone in medical profession.

[uwopremed]

Good points. Medical admissions are intended to be on merit, but can be, and are,  manipulated. Just read the threads for prospective medical students on this forum. I am shaking my head reading it -  choosing "easier' programs or "easier" classess, adding useless additional courses, years, degress - all this for the sole purpose of bumping  GPA by a fraction of percent. Then applying to schools that calculate GPA to their advantage (3.95 GPA is not 3.95 if you count only 2 years, for example). On the top of it, collecting "right" ECs, which they are not interested in, and otherwise they would never take. And in the right "quantity". Last but not the least, moving to a different province to apply as IP and get an easier pass with an uncompetitive GPA!

 

These manipulations are hardly compatible with the concept of pure hard work and sacrifice as a ticket to Canadian med school. It is not surprising  that in the example above, somebody with 3.8 or 3.9 GPA in Ontario, and not being able to get in, would choose to go abroad instead of trying all those tricks.

 

The overhelming majority of med applicants are serious and hard working people. Some are more lucky than others, some know better how to play the system, and some are indeed (marginally) "better'" (if grades are the measure of it)  than their still very capable competition. So we get in,  look down at those who didn't, and spew contempt on them if they choose another path instead of humbly retreating.   

 

The pictures painted in some of the above posts, those of dumb and lazy CSAs with GPA 2.2  who buy their medical diplomas abroad are just as far from truth as the pictures of saintly CMGs. True, there might be outrageous exceptions, but they wouldn't last in med school, yet alone in medical profession.

 

The majority of top deserving medical applicants, no matter where they are from, do in fact get in.  It's the borderline people that do not always get in.  Even if one took a harder program and only got a 3.90 GPA - with a solid MCAT they stand a fantastic chance at Queen's, McMaster, and Western.  And with 2 or so shots - almost everyone I know with a decent GPA and MCAT got into medical school.  And most into more than 1 school (that is why waitlists do move quite a lot - the top students get into multiple schools). There is a borderline category type person - and some of those will get in, and some won't. 

 

In regards to Canada not being a meritocracy - the provinces fund their own health care systems, and in regards to admissions - are pretty much separate countries.  So of course it might be easier for someone in Saskatchewan to get into medical school than Ontario (though their mark cutoffs seem higher than some Ontario schools).  These are different places with different taxpayers subsidizing the education.   Some, like Quebec, are so different, I'm still amazed that they even use CaRMS (they used to not used CaRMS - or at least the francophone schools, until relatively recently). 

 

Canada does not need a million cookie cutter unoriginal Toronto and Vancouver kids that are doing medicine so their parents can boast about them in their home countries doing medicine, and then not caring about the vast segments of Canada that do not have long term doctors anyways. 

 

And lastly, Older, Canada should be fully self sufficient at producing it's own physicians.  We should not depend on OTHER countries, and should not let Canadians BUY their degrees.  If the Canadian medical admissions seems unfair to you - it is sort of unfair to almost everyone (whether rich or poor).  CSAs ruin any sort of meritocracy we already have - it's the 1% passing on the 1% to their children, often grossly unworthy, simply because they have money.

[ralk]

Well, this thread has gotten a bit more interesting, glad to see more people chiming in.

 

I don't think CSAs are avoiding hard work and sacrifice - I'd call leaving the country for four years a sacrifice and since most face tough odds of matching back, many work very hard. I'd argue the typical CSA has to work harder to match to a residency in Canada than CMGs. However, effort put in after getting into medical school has never been the concern, but rather effort before getting into medical school, because that is the main checkpoint to becoming a physician in Canada for Canadians. Canadian-born USMDs have many of the same attributes as CSAs - they tend to have been unable to matriculate to a Canadian Med School, they have to be able to afford the expense which is typically significant, and they tend not to be from underservices areas and/or populations. However, because USMD programs have entrance requirements for Canadian applicants that rivals those of Canadian schools (with different criteria), the number of USMD students from Canada is fairly low and has been relatively stable for decades. I disagree with disparaging CSAs as a group for their work ethic, but by the same token, their efforts in med school don't provide justification for opening the doors to them either. While accusations of poor work ethic stir moral objections to CSAs, it's simply not the relevant issue for most individual CSAs.

 

Still, there are a few concerning exceptions. Residency selection is very susceptible to favouritism or even outright nepotism. Residency programs are small and largely depend on subjective criteria, so if an applicant has an inside edge, it can make a major difference. For CMGs this is less of a problem since Canadian med school admissions are fairly impersonal (meaning CMGs have to show some objective competency before getting to the residency stage) and virtually all CMGs gain a residency position somewhere. These factors don't apply to CSAs and can lead to some of the stories uwopremed details, as well as more public cases such as the UBC Cardiac Surgery resident whose dad just happened to be head of the department.

 

In terms of CSAs doing residency in other countries, options are fairly limited without dual citizenship. The US is probably the only other viable pathway. I can't explain why so few IMGs (and by extension, CSAs) are applying to Canadian residencies in their graduating year, but part of that may be semantics, depending on what they consider a "current year graduate". Given the clear preference of CSAs to return to Canada, it's hard to see why they wouldn't at least apply to Canadian residencies when they were able.

 

As for IMGs providing new perspectives and skills, incoming residents are hardly the only or the main way we communicate knowledge and abilities with the rest of the world. Many CMGs do electives abroad. Many Canadian residents do fellowships or research abroad. We train each other when new techniques are developed and communicate with each other when new discoveries are made. Anyone involved in research interacts with our foreign counterparts on a regular basis, through journal articles, joint projects, and international comparative studies - heck, even as a 2nd year med student, I spoke directly with researchers from the UK, South America and China just a few months ago. In addition, CSAs are not trained physicians, so they likely won't have any unique skills to bring to the table (same could be said for CMGs). We already choose to interact with the global community in ways that benefit both us and them, we don't need CSAs for that.

[ralk]

I thought so too until I read this:

 

http://www.vancouversun.com/news/Opinion+Canada+shuts+door+Canadian+doctors+foreign+medical+schools/9714934/story.html

 

"A few residency training positions were created in an International Medical Graduate stream specifically for immigrant physicians after a 1999 human-rights case. Canadians who studied abroad are told they are entitled to compete for these few positions because they, as immigrant physicians, are international medical graduates. But barriers have been put in place to protect these jobs for immigrant physicians. So CSAs very rarely receive any of these IMG positions."

 

That's just absurd.

 

General call for more information from anyone who might know: the author of this article claims in the comments that the average CMG applied 2.95 times to Canadian med schools (vs 1.76 for CSAs), a statistic repeated in the CaRMS CSA report, but the supporting citation given in the CaRMS CSA report doesn't seem to include that number anywhere. The closest statistic I can find in that source puts the average number of application cycles by CMGs before admissions around 1.62, with 85% of admitted CMGs on their first or second application cycle, and nowhere near the 2.95 stat quoted in the CSA report. I know the "3 application cycles before admission" stat gets thrown around often enough, but does anyone have a reliable, direct source for that figure?

[penguin04]

General call for more information from anyone who might know: the author of this article claims in the comments that the average CMG applied 2.95 times to Canadian med schools (vs 1.76 for CSAs), a statistic repeated in the CaRMS CSA report, but the supporting citation given in the CaRMS CSA report doesn't seem to include that number anywhere. The closest statistic I can find in that source puts the average number of application cycles by CMGs before admissions around 1.62, with 85% of admitted CMGs on their first or second application cycle, and nowhere near the 2.95 stat quoted in the CSA report. I know the "3 application cycles before admission" stat gets thrown around often enough, but does anyone have a reliable, direct source for that figure?

The most recent figure I could find of the data was from 2007 published in an AFMC report on medical student demographics. It listed the figure at 2.65 application attempts per successful applicant. I'll try to hunt down the source tonight and will edit my post with the link once found.

[ralk]

The most recent figure I could find of the data was from 2007 published in an AFMC report on medical student demographics. It listed the figure at 2.65 application attempts per successful applicant. I'll try to hunt down the source tonight and will edit my post with the link once found.

 

The 2009 AFMC report is what I looked at and I can't find that stat. They do list successful applicants by the year they first applied, which is where I got the 1.62, but even that's an overestimate since applicants don't always apply each and every year after their first cycle. I'm really having trouble seeing where the 2+ cycles for admissions comes from, so I really appreciate any insight you might have.

[penguin04]

The 2009 AFMC report is what I looked at and I can't find that stat. They do list successful applicants by the year they first applied, which is where I got the 1.62, but even that's an overestimate since applicants don't always apply each and every year after their first cycle. I'm really having trouble seeing where the 2+ cycles for admissions comes from, so I really appreciate any insight you might have.

You're right, I meant the 2009 report but the data they have on repeated applications is from 2007/2008. But now that I look at the document again (which is here in case anyone is interested: https://www.afmc.ca/pdf/cmes/CMES2009.pdf), they never actually report a figure... Although the CaRMS 2010 CSA report uses that document as a citation for their 2.95 application attempts per successful matriculant... I'll do some more digging. I remember finding something forever ago, but it involved a lot of Google searching, haha.

[JohnGrisham]

Hard work and sacrifice are only a part of it, but where you live matters quite a bit too.  Canada is hardly a true meritocracy when it comes to medical admissions.  Many of those that get a 3.8 or 3.9 GPA in Ontario go abroad after trying for several years while they watch their counterparts in Quebec, Saskatchewan, Manitoba etc. get in with less.

 

When admissions averages are now getting into the 3.95 or 4.0 averages in certain provinces, you're really just splitting hairs when it comes to future outcomes in the group of students that apply to medicine.  Does a 4.0 student really do that much better than a 3.9 or 3.8 GPA student in the long run?  What type of undergrad and courses did the 4.0 student take?

 

Also if you want to talk about hard work and sacrifice, you're preaching to the choir if you're talking to IMG's as a whole (particularly since their marks etc. still matter throughout medical school and beyond).  It's not exactly easy getting into the Canadian system (nor should it be) amongst thousands of applicants for a few hundred spots in CARMS.  Interestingly enough, the 2015 match statistics show that there were only 238 new (year 2015) graduates applying/participating in the IMG pool for the match.  Assuming these are all CSA's that just graduated, that is hardly the thousands of CSA's flooding the system people are worried about?  I would imagine those CSA's that didn't apply to CARMS in the year they graduated would of done residency elsewhere such as in the US (particularly for Caribbean grads) or whatever country they trained in (Australia, Ireland, UK etc.) but it's interesting the stats show that many of them didn't even bother applying in Canada anyways.

I'd add that many people who are CSAs that I know are simply just not applying to CaRMS because of the barriers and sticking with the U.S. match. Many U.S. students I know are focusing on NRMP, and not even bothering with Carms. Sadly.

[...]

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[ralk]

Unfortunately, as most will attest to, fellowships, joint studies and conversations does not make up for the intellectual capital of bringing in foreign trained physicians. Matching IMGs provides their perspective immediately to their mates and cascades the availability of their ideas if they are thought worthwhile by their peers. These ideas and providing a supervised route for newcomers to practice in Canada are certainly primary considerations for policy makers and graduate program directors and the two strongest arguments for the inclusion of IMGs in the match. I suspect that most of the discussion had by specialists is around maximizing percentage points of placed CMGs while allowing for IMG placement for the above reasons and the tradeoffs involved.

 

Now, in fairness I haven't been following this thread closely but it seems that the main point of contention is just administration of CSAs. Someone sourced a claim earlier that they make up a majority of IMG spots. If that's the case someone ought to articulate why we're letting IMGs match in the first place. (I looked for this and for the 2.7 cycles number in vain last night before giving up and resenting the time spent.. ) If I'm right about the reasons, CSAs should be placed into their own category or they can practice for a while in the country that trained them before coming back and matching here.

 

I have trouble believing that IMG residents are a primary way in which we intellectually interact with the rest of the world, or that losing them would curtail our exchange of ideas and skills with other countries. After all, IMG residents were a relative rarity only a few decades ago and we managed to communicate ideas and teach skills across borders reasonably well back then too. Likewise, Canadian physicians don't emigrate in large numbers to many countries, yet ideas and perspectives developed here often get adopted in those countries. As I said, CMGs often train abroad and many were born outside of Canada, so there are many instances of experiences abroad being directly incorporated into our physician population. You state that IMGs bring irreplaceable knowledge or skills as though this is a widely accepted viewpoint, but I'm not aware of any studies which indicate that and my personal experiences do not support that conclusion - could you provide some evidence or justification for that statement?

 

CSAs cannot be treated differently than IMGs for legal reasons. It would be considered discrimination by country of origin, which is against the Charter of Rights and Freedoms. I can think of a few potential work-arounds, but any half-competent judge would see through those work-arounds pretty quickly. There's no feasible way to cut CSAs off without cutting other IMGs off too. Whether CSAs can train in the country where they received their medical degree is up to those countries and most don't let them do so. The schools want money from CSAs, not to train them as fully qualified physicians in their own country.

[...]

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[guy30]

After all, IMG residents were a relative rarity only a few decades ago and we managed to communicate ideas and teach skills across borders reasonably well back then too. 

 

Just wanted to note that according to the CIHI, in the 1970's, 33% of the Canadian physician workforce was made up of IMG's.  This has slowly declined to 22.4% in 2007 and I would imagine it would be around 25% or more in 2015.  Canada has clearly been 'benefiting' from/utilizing a significant IMG workforce for a very long time which has helped shape Canadian healthcare. It's interesting to note that your boss, or even your bosses boss, may actually often be an IMG.

 

Since when is an international education considered such a bad thing?  Canada is made up not only on the basis of immigrants, but also on the diversity of international expertise that makes our country competitive in the world.  Heck, some of Canada's greatest medical discoveries were made by people who were IMGs.  I agree that diversity in education helps add to our population (provided people are deemed qualified and meet the high standards necessary to practice medicine/enter residency by the appropriate licensing authorities already in place of course).

[older]

 

 

And lastly, Older, Canada should be fully self sufficient at producing it's own physicians.  We should not depend on OTHER countries, and should not let Canadians BUY their degrees.  If the Canadian medical admissions seems unfair to you - it is sort of unfair to almost everyone (whether rich or poor).  CSAs ruin any sort of meritocracy we already have - it's the 1% passing on the 1% to their children, often grossly unworthy, simply because they have money.

 

I don't disagree that Canada should be self-sufficient. But as guy30 points out in the post above, Canadian physician workforce historically included, and continue to include, large number of  IMGs who greatly contributed to Canadian healthcare. While gradual increase in self-sufficiently  is a good thing, Canada will hopefully not abandon its vision as inclusive society open to immigrants. It does not seem in Canadian spirit to push out IMGs,  or discriminate just in this one professional category because we want medical job market tightly controlled.

 

Canadian admission system is not necessarily unfair, schools do their best, and a perfect system does not exist. I just pointed out that applicants take advantage of every weakness and every opportunity, and studying abroad is no more "unfair" than, for example, moving to another province that has lower admission requirements. 

 

Whilst wealth creates additional opportunity (which seems to be a sore point for you) the notion on "buing" a medical diploma is simply ridiculous. Such people would not last in the system. The challenges in further training and medical practice are enormous, and even people prepared through excellent education system have their struggles.  But if this is your genuine concern, perhaps you should advocate tighter controls rather than labeling majority of CSAs as "grossly unworthy".  

[ralk]

I'm not arguing that it's the primary way we interact intellectually with the world or anything of the sort. (What?) Nor that they bring irreplaceable knowledge or skills. (And so I won't be justifying a strawman.) Do you feel that the inclusions of IMGs does not contribute to the care of our population? Because that is the novel viewpoint. If you're going to ask for sources you should be quantifying statements above that I bolded since if I understand this correctly, your position is those cases are sufficient contact with what everyone else is doing...

 

 

Again these are very strong, definite statements which are the opposite of convincing to me, in any case.

 

I'm certainly not arguing IMGs contribute nothing, I'm saying there are alternatives to obtaining what they contribute. If they don't bring irreplaceable knowledge or skills, then by definition, they can be replaced. I guess I'm confused as to what your actual argument is - you've stated that IMGs bring knowledge and skills to Canada in a way that isn't replicated by other methods, but that what they contribute isn't irreplaceable, which seems to be a contradiction. I wasn't trying to argue against a strawman. Could you clarify your position?

 

As for separating CSAs from IMGs in the residency match, those statements are simply my understanding of the legal framework surrounding residency selection, not my personal preference for how I want the system to work. I'm not really opposed to having a system that distinguishes CSAs from other IMGs, but my understanding is that it would be unconstitutional.

 

Just wanted to note that according to the CIHI, in the 1970's, 33% of the Canadian physician workforce was made up of IMG's.  This has slowly declined to 22.4% in 2007 and I would imagine it would be around 25% or more in 2015.  Canada has clearly been 'benefiting' from/utilizing a significant IMG workforce for a very long time which has helped shape Canadian healthcare. It's interesting to note that your boss, or even your bosses boss, may actually often be an IMG.

 

Since when is an international education considered such a bad thing?  Canada is made up not only on the basis of immigrants, but also on the diversity of international expertise that makes our country competitive in the world.  Heck, some of Canada's greatest medical discoveries were made by people who were IMGs.  I agree that diversity in education helps add to our population (provided people are deemed qualified and meet the high standards necessary to practice medicine/enter residency by the appropriate licensing authorities already in place of course).

 

I chose my words carefully - IMGs have always represented a good percentage of Canadian physicians, but not of Canadian residents, which is what I wrote. There are alternative ways for some IMGs to become certified in Canada that does not involve doing a full residency and this whole thread has been about those full residency positions. In the past, very few IMGs came through the CaRMS-administered residency match relative to CMGs.

 

I've worked with many IMG physicians, most of whom are very good doctors. I have had several "bosses" be IMGs (though as a hospital employee, my actual bosses were other hospital employees, not the physicians contracted by the hospital to work in my department... in any case, I took direction from those physicians).

 

International education is not a bad thing in general - it's can be a very positive thing - but every international educational experience is different. International experiences are not automatically beneficial simply because they're international. We have to judge educational experiences abroad on the specifics of their merits and my whole argument this entire time is that when it comes to IMGs and in particular CSAs, the merits of their medical training abroad does not overcome the downsides of including them in the residency matching process instead of training more CMGs. Diversity of education is a worthwhile goal if there were no trade-offs, but when it comes to IMGs, there appear to be meaningful trade-offs.