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

[evans]

Except many IMGs who are studying abroad are 3.5+ or at times near 4.0.

 

Don't kid yourself into thinking that you or I are any more special than many of those who have to go abroad.  Getting into a Canadian school, is a lot of luck more than anything. Basic supply and demand - there are way too many qualified applicants for seats. And sometimes those who don't make it into a Canadian school, still have the desire to be a doctor - and take a harder route elsewhere to reach it.

 

But yes, it is a conscious decision and they should know the current political climate and restrictions they may or may not face in wanting to return. Thats why I always tell people to look at USMD and USDO schools first before elsewhere, based purely on the politics of it all in ultimately securing a residency slot.

 

First: there's a huge difference between 3.5+ and 4.0.

 

• I don't find a 3.5 impressive given, that the average acceptance these days is around 3.90
• Say it is a 4.0 student. It makes no sense that this student would be an international student. Why would someone with a 4.0 study in Ireland (with no guarantee of residency) if s/he could apply to the states? Or gain some worldly experience to strengthen his CV for a year? Or get a rocking MCAT score and apply to Manitoba? -- I very much doubt that these students who got 4.0 but then studied at an international med school exist.

[rmorelan]

 

These IMG arguments are quite strange.

 

Okay, say you want to take the best of the best IMGs. From every international school in the world. (And these IMGs are likely to NOT be Canadians as if they were so incredibly bright, they would have gotten into some Canadian Med School)

 

• What follows is that you are creating a system that relies on the foreign talent of international medical graduates
• Is this ethical? Many countries struggle to train doctors. I have a friend from a particular region in Africa where the government paid for all of their students to study abroad. Every one of those students and doctors that don't return is devastating for them

 

Moreover, current practices of letting in IMGs are creating a much huger problem in my opinion:

• Having IMG spots open for those Canadians and RELYING on the fact that there will be Canadians who choose to study abroad will: create an incentive for students to study medicine internationally
• There are 3500 Canadians studying medicine abroad. How many of them will you think can come back?
• The fact that we are creating a de facto route for Canadians (who have the money to study medicine in Ireland) is adding to the problem of Canadians who study medicine elsewhere and can't do residency anywhere

 

 

ethics of it is yeah a big concern - and it does create all kinds of problems as you mentioned. 

 

only point I would make about it is none of those problems are for the hospital accepting the resident - they are simply arguing they want the best they can get - and sometimes that means an IMG - because their focused concern is solely their patients and making sure they are cared for. They reap all the benefit and none of the issues. 

 

what will be interesting is what will happen that have held ourselves at very high enrollment for quite some time. If or when that falls - and residency positions with them - then things are going to get very interesting. 

[JohnGrisham]

 

First: there's a huge difference between 3.5+ and 4.0.

 

• I don't find a 3.5 impressive given, that the average acceptance these days is around 3.90
• Say it is a 4.0 student. It makes no sense that this student would be an international student. Why would someone with a 4.0 study in Ireland (with no guarantee of residency) if s/he could apply to the states? Or gain some worldly experience to strengthen his CV for a year? Or get a rocking MCAT score and apply to Manitoba? -- I very much doubt that these students who got 4.0 but then studied at an international med school exist.

 

Right, but the only reason the average acceptance is 3.9(which it is definitely not, if you account for all schools in Canada across the board) is because of SUPPLY/DEMAND and NOT because that is what is needed to be successful in medical school and residency/beyond. People need to understand that.

 

And no, even a 4.0 is not a gaurantee in the US by any means. Why? Because there is MORE TO A MEDICAL SCHOOL APPLICATION THAN YOUR GPA. 

 

As for people with 3.8+, i know of at least 50+ I have crossed paths with by via various means, whom are currently studying in ireland, Australia and even the US(USDO) that would classify them as IMGs in Canada. I also have friends in the carribean from my original undergrad graduating class, who knew their 3.5 wouldn't cut it in Canada without years of extra work. Guess what? The ones that made it through (I do know 2 that had to decel and are scraping by), are either just about to start their residencies in the US at very strong programs, and others who are entering 4th year pretty much gauranteed to match well - because they absolutely destroyed their US board exams. 

 

The MCAT means nothing, especially verbal, and ruins many prospective CMGs chances every year. 

 

Don't get me wrong, there are also a lot of people that shouldn't be in the Carribean or elsewhere for medical school due to their poor stats etc. But guess what? They will either fail out after the first year or two - or they will make it through all 4 years and prove that they did have what it takes to make it all the way. Don't kid yourself into thinking that they are somehow "passing through", because if they are they not going to be competitive enough to get a residency, and will have a useless 300K$ piece of paper. And then, if they are lucky enough they will secure a residency spots somewhere in the US, Canada or their country of education.  Some people who had rough starts to university or the likes, who end up with still respectable GPAs, but ones that cut-off Canada from being an option (due to that elusive supply and demand concept i mentioned earlier...) - can still make great docs. 

 

Different people have different reasons. Not everyone can rock the MCAT enough to squeek by, or want to wait around for years to get lucky enough to get into a Canadian school. 

 

Take a slice of humble pie and maybe tone down that IMG hate, as when you hit clerkship or residency - surprise, some of your superiors will 100% be IMGs. Once you leave the pre-med rat race, where science kids think their 4.0 is the end all to be all, you realize there is a whole lot more to it then that. 

[indefatigable]

Except many IMGs who are studying abroad are 3.5+ or at times near 4.0.

Don't kid yourself into thinking that you or I are any more special than many of those who have to go abroad. Getting into a Canadian school, is a lot of luck more than anything. Basic supply and demand - there are way too many qualified applicants for seats. And sometimes those who don't make it into a Canadian school, still have the desire to be a doctor - and take a harder route elsewhere to reach it.

But yes, it is a conscious decision and they should know the current political climate and restrictions they may or may not face in wanting to return. Thats why I always tell people to look at USMD and USDO schools first before elsewhere, based purely on the politics of it all in ultimately securing a residency slot.

I certainly realize I am fortunate to be accepted and agree with this to some extent. I will be breaking for a little while from this forum, altough I am glad to have learned such a great deal regarding med and medical residency selection.

[武田信玄]

ok true...but in the end we don't accept the "average" IMG in our system do we?

 

the truth is we seek out the best we can find from around the world for much of it. So to be fair how does the "average" CMG compare to the top IMGs we can attract - and I mean objectively top with top of the line test scores, often people that already have completed residency in that field and even practised in it, published 20+ high end journal articles in the field, have very high end advanced degrees...... These people are smart, motivated (a level of motivation that borders on desperation almost), and extremely hard working.

 

They are often embarrassingly good at what they do is my point. Not always, not in all areas, but in enough that I have to point that out. They make me work harder because I feel so stupid in comparison that it makes me wonder why we are in the same program. I am deadly serious about that.

 

As an example of the top of my head for radiology I know of 3 resident IMGs that completed Canadian fellowship training in radiology who then became IMG residents (so one week I am reporting to them, having them teach us in rounds, and then the following week I am more senior to them). That is the kind of thing we are talking about here.

 

So why do we take them? Simply because they are extremely good - quite often arguably better than the average CMG and on top of that they don't cost us anything to train, and often we can get them to work where we don't want to.

I think we are discussing several different IMG programs at the same time so it's confusing. At least I believe that our use-IMG-to-serve-rural-areas program is failing. But back to what you were discussing:

 

I'll concede that if the IMG accomplished something that's at the world level, then sure we should take the IMG. I also know an IMG from Germany who was the head of his department and who did some extraordanary things there. He then came to Canada and has been continuing doing wonders. In his case I would even argue that we should waive the residency requirement altogether.

 

However, the problem here is that we are both using personal anecdotes and we both are speculating based on our own experiences. At least from my experience, I am not convinced that the IMGs who fill our residency spots are as qualified as our own CMGs. If we had some systematic stats and numbers, maybe we'd be able to reach some concensus.

 

Another point I want to make is the cultural factors. Just because some foreign doctors practiced in another country for a number of years as practicing physicians, it doen't mean that this person is a necessarily good fit for Canada as a doctor. The culture is different, the medical system is different, the language is different, etc. And it's very hard to understand another culture if you come to another country after the age of 30, which is probably the case for most IMGs. Heck, I'll honestly admit that I don't fully understand the Canadian culture, even though I am a Canadian citizen (moved here after 10 years old). A CMG who did all the trainings in Canada, who grew up in Canada, who are familiar with our culture and belief, is significantly better to serve Canadians in my humble opinions. This single advantange cannot be compensated by how many years of foreign experiences an IMG has, or how many papers an IMG has published, etc. I believe this is another reason why every country, not just Canada, needs to have its own medical training programs.

 

Lastly I want to clarify something here. I was commenting only on non-Canadian IMGs, not CSA. CSA is a completely different issue.

[evans]

Okay so there's a few discussion going on, and it's helpful to break them down.

1. IMGs who are extremely competent (ex: went to Oxbridge)
2. IMGs born outside of Canada, did their medical school internationally, and wants to come to Canada
3. CSAs, mostly comprised of Canadians who could not get into a school nationally or in the US and decided to study abroad

 

For:

1. I agree, having some residency spots open to these extremely qualified candidates is great. But these make up the vast minority of IMGs.
2. IMGs who are competent and come from an international medical schools could potentially be good for filling in residency spots that are left over (ie: family med in an indesirably place to live) but we need a very good screening program in place if do this. It won't be good for anyone if an IMG ends up hating the part of Canada they're living in. These IMGs have to be sure about what they are getting into.
3. CSAs which I will not discuss in respect to Gohan's comment.

 

 

Right, but the only reason the average acceptance is 3.9(which it is definitely not, if you account for all schools in Canada across the board) is because of SUPPLY/DEMAND and NOT because that is what is needed to be successful in medical school and residency/beyond. People need to understand that.
 

 

 

 

Ironically, this is where I agree with you the most.

 

At the end of the day, there are more qualified candidates than there are places. There are many people, like you friends, who would make amazing and caring doctors. But the fact is, there are more qualified applicants than spots.

 

Thus, at the end of the day, we do need some screening methodology. That methodology, in order to cut down on the candidates, will likely have things that are arbitrary to becoming a good doctor.  Things like having a GPA past, 3.8, as high as possible. Things like BS/PS score. Things like being an olympic medalist. Is this the best way? Obviously not, but a meritocracy is better than having a random draw for whoever makes the cutoffs.

 

Now, where you and I disagree is what paths to a MD should there be, for candidates who do not gain entry into a North American school. Perhaps take candidate X, who did not do that well in undergraduate, but will do literally anything to get into medical school. Moreover, let's assume candidate X will make a great doctor, if selected.

 

• Correct me if I'm wrong, but you would be okay with letting candidate X, go to a medical school in Ireland, if he could not gain entry at a North American school. You would be unopposed to having residency spots left open for people like candidate X.
• I however, am opposed to this. I believe competition between Canadians for becoming a doctor should stay on the level of getting into medical school. I am opposed to having "two streams" of becoming a doctor.

The reasons for that are the following:

 

Equity

• It is unfair that those who have the means to travel abroad, have an exclusive path to medical doctor
• Even if they didn't have the means to travel  abroad, and took on the huge debt and risk personally, it is unwise to create a pathway to med where students are expected to take on this much risk and debt. 

Economy

• In terms of the economic argument everyone's putting out, looking on a wider perspective. Yes we save money on training the doctors, but that has to be measured against the loss of productivity of the thousands of CSAs, and the loss in their economic spending
• Only around 13% of IMGs get residency every year. With the thousands of CSAs, all of those Canadians who did not find a residency represents a huge financial loss in: the $300,000 in tuition/living spent internationally and the 4-5 year opportunity cost of a university-educated Canadian

Incentivizing more Canadians to go abroad

• There are 3500 Canadians studying med abroad. 90% want to return. The number is growing exponentially (http://www.carms.ca/en/applicants/csa/)
• 1500 IMGs apply every year. Only 200 are accepted. (http://healthydebate.ca/2014/06/topic/international-medical-graduates-canada)
• Right now, by having a "de facto" route where Canadians can do med internationally and have some return, incentivizes the growing number of Canadians who take this route. -- This is obviously bad because we are just increasing the number of Canadians med students who can't practice but have huge debts.

 

It is for the above reasons why I think it is a bad practice to continue to allow CSAs residency positions. I think this route should be phased out by having CaRMS discourage any more new CSAs, with the warning that new CSAs will not be eligible for matching.

[evans]

double post

[JohnGrisham]

Except many CSAs also end up in the US for residency.

 

Within the CSA category, there are those whom are strong and were just unlucky with Canada, those that couldn't make it into Canada but still are competent and do well in medical school, and those who shouldn't be there at all-and are accounted for by failing out and not even making it to residency stage.

[Fresh fry]

I think every med student should have a guaranteed family position at their home school if they want it. If the school accepted them and "screened" them for undergrad than they should back up their selection criteria by creating the spots if necessary.

[evans]

Except many CSAs also end up in the US for residency.

 

 

Do you know the %? I doubt it's most. But say it was, then these CSAs are fine and doesn't need Canada to open up more residency spots.

 

Within the CSA category, there are those whom are strong and were just unlucky with Canada, those that couldn't make it into Canada but still are competent and do well in medical school, and those who shouldn't be there at all-and are accounted for by failing out and not even making it to residency stage.

 

This doesn't refute directly any of my arguments. And, yes, obviously the cohort of students that don't get into med are on a gradient of competencies. The ones closest (that you call unlucky) probably have the stats to just apply again and get in. So it doesn't make sense that they would go to an IMG.

 

The rest of them who may very well make great doctors. But the thing you are ignoring is your own point: supply and demand. There is a limit to how many medical students we can take. A student may be terrific, but s/he may simply be less terrific than his/her fellow colleagues. If a student wants to badly get in, they should work on their application and reapply to a Canadian or American medical school. 

 

Your points did not directly address my Equity and Economic points. Moreover, it did not address the main thrust of my incentivizing points, which is: this alternate path is creating an unsustainable number of CSAs. Sure, some may find residency in the States or elsewhere. But there is a growing number of CSAs with NO residency options. 

[NLengr]

I think every med student should have a guaranteed family position at their home school if they want it. If the school accepted them and "screened" them for undergrad than they should back up their selection criteria by creating the spots if necessary.

If that's the case, we could just bring back the 1 year internship and general license. That would greatly increase the number of family docs available because many people would do a couple years of GPing prior to entering the specialty match.

 

The few studies that looked at GP's and residency trained family docs showed no difference in practice patterns.

 

If people are concerned that you would become rusty with GPing after x number of years in specialty practice, it could be set up so that if you don't do x # of GP hours for x number of years, you lose your GP license. If you wanted to go back to GP practice, you could get some kind of retraining or sit another exam etc.

[Birdy]

If that's the case, we could just bring back the 1 year internship and general license. That would greatly increase the number of family docs available because many people would do a couple years of GPing prior to entering the specialty match.

 

The few studies that looked at GP's and residency trained family docs showed no difference in practice patterns.

 

If people are concerned that you would become rusty with GPing after x number of years in specialty practice, it could be set up so that if you don't do x # of GP hours for x number of years, you lose your GP license. If you wanted to go back to GP practice, you could get some kind of retraining or sit another exam etc.

I rather like that idea, and have seen it suggested a few times. I have, basically, two years from right now to decide what I want to do for the rest of my life. It'd be nice if it were the norm to finish school, do an internship year, work general practise for a few years, and then decide whether to specialise or not. As I hear it, if I decide to do family med, it will prove very difficult to go back and pursue something else.

[A-Stark]

That's how things used to work. It has never been clear to me what sort of quality or labour force flexibility benchmarks were achieved by doing away with general licensure and rotating internships. 

[Edict]

Personally, I don't care if IMG's are better/more experienced than Canadian med graduates - following this logic, I'm pretty sure we could fill out all the residency/jobs positions in Canada with IMG's from other first, second or third world countries, since a lot of them would be willing to live here and are much more experience than our recent med graduates.

 

As for CSA's (Canadians studying abroad) - sorry fellah, if you didn't make it to medical school in Canada and think you can be a ''MD'' with your 3.2 gpa or whatever just because you churned out a ridiculous amount of money to go elsewhere, I think you're wrong. We read about the ''hardships'' of Canadians who study abroad and want to come back - Hey, nobody forced you go to elsewhere, and nobody should take you back just because you have a diploma from an institution many thousands of miles away that is in NO way affiliated with the Canadian medical school system.

 

That mentality is wrong, mainly because if you start judging people by their "medical pedigree" or GPA you will realize that the Canadian medical system is by no means perfect or fair. It is much harder to get into medical school in Ontario and BC than in other provinces for example, so many of those who go abroad are only doing so because of the competitive nature of Ontario/BC medical schools rather than actually not being qualified. I do agree that some people are probably not qualified to become physicians, but I also believe that Canada has a huge talent pool, we honestly have attracted some of the smartest people in the world over the past 40 years and as a result there are plenty of intelligent people who could become great doctors (and would do so if they were just born in other countries/provinces), but can't because the system here is just so competitive.

 

I wouldn't think anyone would criticize American doctors as being "uncompetitive", and yet without 3 of either a 3.9 GPA, a 33+ MCAT, good interview skills or great ECs you basically have no chance in Ontario. In the US for example, the talent pool will dip down to 3.6 GPAs and 27/28 MCAT for medical school. And yet doctors in the US do perfectly fine.

 

Judge people on their individual merits, not by which school they went to because that is a very inaccurate indicator of competency.

[Edict]

Okay so there's a few discussion going on, and it's helpful to break them down.

1. IMGs who are extremely competent (ex: went to Oxbridge)
2. IMGs born outside of Canada, did their medical school internationally, and wants to come to Canada
3. CSAs, mostly comprised of Canadians who could not get into a school nationally or in the US and decided to study abroad

 

For:

1. I agree, having some residency spots open to these extremely qualified candidates is great. But these make up the vast minority of IMGs.
2. IMGs who are competent and come from an international medical schools could potentially be good for filling in residency spots that are left over (ie: family med in an indesirably place to live) but we need a very good screening program in place if do this. It won't be good for anyone if an IMG ends up hating the part of Canada they're living in. These IMGs have to be sure about what they are getting into.
3. CSAs which I will now discuss in respect to Gohan's comment.

 

 

 

Ironically, this is where I agree with you the most.

 

At the end of the day, there are more qualified candidates than there are places. There are many people, like your friends, who would make amazing and caring doctors. But the fact is, there are more qualified applicants than spots.

 

Thus, at the end of the day, we do need some screening methodology. That methodology, in order to cut down on the candidates, will likely have things that are arbitrary to becoming a good doctor.  Things like having a GPA past, 3.8, as high as possible. Things like BS/PS score. Things like being an olympic medalist. Is this the best way? Obviously not, but a meritocracy is better than having a random draw for whoever makes the cutoffs.

 

Now, where you and I disagree is what paths to a MD should there be, for candidates who do not gain entry into a North American school. Perhaps take candidate X, who did not do that well in undergraduate, but will do literally anything to get into medical school. Moreover, let's assume candidate X will make a great doctor, if selected.

 

• Correct me if I'm wrong, but you would be okay with letting candidate X, go to a medical school in Ireland, if he could not gain entry at a North American school. You would be unopposed to having residency spots left open for people like candidate X.
• I however, am opposed to this. I believe competition between Canadians for becoming a doctor should stay on the level of getting into medical school. I am opposed to having "two streams" of becoming a doctor.

The reasons for that are the following:

 

Equity

• It is unfair that those who have the means to travel abroad, have an exclusive path to medical doctor
• Even if they didn't have the means to travel  abroad, and took on the huge debt and risk personally, it is unwise to create a pathway to med where students are expected to take on this much risk and debt. 

Economy

• In terms of the economic argument everyone's putting out, we do need to look on a wider perspective. Yes we save money on training the doctors, but that has to be measured against the loss of productivity of the thousands of CSAs, and the loss in their economic spending
• Only around 13% of IMGs get residency every year. With the thousands of CSAs, all of those Canadians who did not find a residency represents a huge financial loss in: the $300,000 in tuition/living spent internationally and the 4-5 year opportunity cost of a university-educated Canadian

Incentivizing more Canadians to go abroad

• There are 3500 Canadians studying med abroad. 90% want to return. The number is growing exponentially (http://www.carms.ca/en/applicants/csa/)
• 1500 IMGs apply every year. Only 200 are accepted. (http://healthydebate.ca/2014/06/topic/international-medical-graduates-canada)
• Right now, by having a "de facto" route where Canadians can do med internationally and have some return, incentivizes the growing number of Canadians who take this route. -- This is obviously bad because we are just increasing the number of Canadians med students who can't practice but have huge debts.

 

It is for the above reasons why I think it is a bad practice to continue to allow CSAs residency positions. I think this route should be phased out by having CaRMS discourage any more new CSAs, with the warning that new CSAs will not be eligible for matching.

 

I read the CSA rate is close to 33%. The rate for Ireland has been close to 50-60% in the past few years.

 

Also keep in mind that most of these CSAs if they can't return will go to the US for residency or in some cases stay in the country (like in the UK for example) so not as many end up jobless like you think. If you think about it, people aren't stupid, they usually do their research before forking over 300,000 for school. If the rate of return was 10-15%, not many would go abroad.

 

The Canadian medical school system is already a pretty unfair process, with different provinces having essentially different entrance requirements so it makes sense that there is a second chance system.

 

Also keep in mind that for many people, they find it difficult to post up the high GPA and the high MCAT which lets face it are just "predictors" of medical school performance rather than medical school performance. Some people might go abroad and do a lot better studying actual medicine and are better with patient care. Going abroad will make them study actual medicine and allow them to show their medical skills which are much more relevant to their career as a doctor than their GPA and MCAT.

[Edict]

US also has 10x more med schools no? And they admit even more IMGs than Canada.

 

They have also increased med school admission spots without increasing too many residency spots in recent years.

 

Yes but they'll take a CMG over an IMG in most cases.

[Edict]

I'm not at all sad that the guy who only applied to FM in GTA, didn't match. Sorry, but that is something you need to think and plan ahead as being an eventuality - doing your residency at any point in the country. Does it suck? Yeah, but that is nothing new that was easily missed in planning.

 

So true, when he said "when i got into medical school I thought all my problems were over", that made me just shake my head, that is mistake #1. Medicine is continous learning, it never ends and it shouldn't. Sure its a shock, but he completely exaggerates his predicament, he makes it seem like his future as a doctor is over, when more than likely he'll match next year.

[武田信玄]

Yes but they'll take a CMG over an IMG in most cases.

Yes...so what's your point? How is this relevant to US market being potentially saturated too in the future?

[Edict]

Yes...so what's your point? How is this relevant to US market being potentially saturated too in the future?

My point is that Canadian medical graduates should have no problem finding jobs in the US.

[Edict]

Btw, what is your link in your signature about? Is that you ranting and what are you ranting about?

[武田信玄]

My point is that Canadian medical graduates should have no problem finding jobs in the US.

They have their own graduates to take care of too...

[武田信玄]

Btw, what is your link in your signature about? Is that you ranting and what are you ranting about?

He was... I mean I was ranting about some nazi admin who shut off my gaming channel because I asked my fans to spam another user. I was so angry that day I actually cried near the end of the video.

[Edict]

He was... I mean I was ranting about some nazi admin who shut off my gaming channel because I asked my fans to spam another user. I was so angry that day I actually cried near the end of the video.

 

Oh i see, but it isn't bad to ask your fans to spam another user? Like I understand it sucks but its not something you should be doing. Was it restored?

 

So that was your channel, so you had 790k views, thats a lot congrats!

[Edict]

They have their own graduates to take care of too...

 

True but the number of CMGs heading south probably isn't enough to really saturate their system like someone else had originally said. Even if 10% of our physicians went down south that would only mean a 1% increase in the US.

 

We definitely wouldn't saturate the system as in the worst case we would likely just displace IMGs, there is a huge shortage of physicians in the mid-west currently.

[武田信玄]

So that was your channel, so you had 790k views, thats a lot congrats!

I know rit? I'm a super star.