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

[3change]

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[ralk]

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.

As was pointed out, the "second entry" carries with in some significant unfariness and costs.

 

In terms of unfairness, wealth is the major one. Going abroad costs money, which means wealthy students do it in much greater numbers. It's great to advocate for a meritocracy based on feature more directly relevant to medicine, but a meritocracy that first filters out applicants based on wealth is no meritocracy.

 

Keep in mind that GPA and the MCAT, while highly imperfect predictors, have been correlated with performance in medical school and beyond. All things being equal, higher GPAs and MCAT scores are preferable. Things are rarely equal, which is why it is likely worth lowering the GPA/MCAT requirements in some Canadian schools in favour of other qualification, but we get no such trade-off with CSAs - there's no evidence they're better communicators or have better clinical judgement - the schools they often attend have no better evaluations for those competencies than Canadian schools (in some cases, evaluations of those metrics may be much worse than Canadian schools). Individual CSAs may be more competent than individual CMGs, but on the whole there's good reason to believe the average CSA is less competent than the average CMG. By permitting more CSAs at the expense of more CMGs, we trade an indication of competency for nothing.

 

Now, as you point out, some schools in Canada have lower entry stats and those doctors seem to do fine. Yet in these cases, we get something for the trade-off of lower stats: regional connections. Students with regional connections are more likely to stay in those areas, the bulk of which are strongly underserved by physicians. And, because of cultural competencies related to growing up in that area as well as simply being happier living there (relative to physicians not from the area), there's weak evidence they may be more effective physicians as well. CSAs are the opposite - by and large, they come from overserved areas, particularly Toronto and Vancouver. In general, they don't want to be in those underserved communities, even if ROS agreements force that situation temporarily. Ultimately, fairness is the main consideration here again, not for students, but for patients. The medical system's first duty is to Canadia patients, not aspiring physicians, and patients' rights to adequate access to medical services are paramount.

 

Lastly, the cost. Evans explained this area in good detail, but to summarize: as the CSA population grows, we send more Canadian money overseas to train largely intelligent, hardworking Canadians in a field some are ill-suited for and that others will never get the chance to practice. There are direct monetary costs (tuition/living expenses spent out of the country), human capital costs (skilled Canadians being productive outside the country either temporarily or permanently), and opportunity costs (the time spent overseas studying medicine when many do not get to practice). We focus on the marginal savings of not covering these students' med school subsidies, but we lose a lot when they go overseas. Economically, having the CSA route available likely costs Canada more than it saves. It's a penny-wise, pound-foolish approach to supplying Canada with physicians.

[JohnGrisham]

As was pointed out, the "second entry" carries with in some significant unfariness and costs.

 

In terms of unfairness, wealth is the major one. Going abroad costs money, which means wealthy students do it in much greater numbers. It's great to advocate for a meritocracy based on feature more directly relevant to medicine, but a meritocracy that first filters out applicants based on wealth is no meritocracy.

 

Keep in mind that GPA and the MCAT, while highly imperfect predictors, have been correlated with performance in medical school and beyond. All things being equal, higher GPAs and MCAT scores are preferable. Things are rarely equal, which is why it is likely worth lowering the GPA/MCAT requirements in some Canadian schools in favour of other qualification, but we get no such trade-off with CSAs - there's no evidence they're better communicators or have better clinical judgement - the schools they often attend have no better evaluations for those competencies than Canadian schools (in some cases, evaluations of those metrics may be much worse than Canadian schools). Individual CSAs may be more competent than individual CMGs, but on the whole there's good reason to believe the average CSA is less competent than the average CMG. By permitting more CSAs at the expense of more CMGs, we trade an indication of competency for nothing.

 

Now, as you point out, some schools in Canada have lower entry stats and those doctors seem to do fine. Yet in these cases, we get something for the trade-off of lower stats: regional connections. Students with regional connections are more likely to stay in those areas, the bulk of which are strongly underserved by physicians. And, because of cultural competencies related to growing up in that area as well as simply being happier living there (relative to physicians not from the area), there's weak evidence they may be more effective physicians as well. CSAs are the opposite - by and large, they come from overserved areas, particularly Toronto and Vancouver. In general, they don't want to be in those underserved communities, even if ROS agreements force that situation temporarily. Ultimately, fairness is the main consideration here again, not for students, but for patients. The medical system's first duty is to Canadia patients, not aspiring physicians, and patients' rights to adequate access to medical services are paramount.

 

Lastly, the cost. Evans explained this area in good detail, but to summarize: as the CSA population grows, we send more Canadian money overseas to train largely intelligent, hardworking Canadians in a field some are ill-suited for and that others will never get the chance to practice. There are direct monetary costs (tuition/living expenses spent out of the country), human capital costs (skilled Canadians being productive outside the country either temporarily or permanently), and opportunity costs (the time spent overseas studying medicine when many do not get to practice). We focus on the marginal savings of not covering these students' med school subsidies, but we lose a lot when they go overseas. Economically, having the CSA route available likely costs Canada more than it saves. It's a penny-wise, pound-foolish approach to supplying Canada with physicians.

But the thing is, the "average CSA" isn't getting a residency in CaRMS. Only the high percentile CSA is getting in. Have you seen some of the cut-offs some provinces/residencies have in filtering IMG/CSA's based on their MCCEE and NAC OSCE Scores? If you aren't 1-2 S.D above the mean, you're out of luck a lot of times.

 

Agree with the rest of your commentary though, just wanted to be clear on that. Talking with some friends in 3rd year abroad/US, CaRMS requirements stack up, that it just ends up being an exercise in futility - when they can just stick with the tried and true NRMP. 

[older]

Here we go with the cost of training argument. If that's the case, then let's just get rid of all CMGs. This way we don't have to spend a single cent.

 

On a serious note, we pay money to train our own doctors because our MD training program is better, because our residency program is better, because the quality of CMGs are better than most IMGs on average. It's absurd to trade quality over money, especially when you are dealing with people's lives.

 

But we don't take "most IMG's", do we. What were the numbers, several IMGs out of 3500 or so got a spot? I would like to think we take the best.

 

About "our MD training program is better, our residency program is better, the quality of CMGs are better".  Better than where?

[uwopremed]

The following will sound a bit politically incorrect - but sometimes someone has to state the elephant in the room.

 

While I feel sorry for both of the guys in in the article to some degree - they only want to live in Toronto because they wanted to be close to a large Jewish community (that they both belong to).   The ENT's wife is not the breadwinner and has a healthcare job - there is NO reason why he can't take a job outside the GTA (and there are ENT jobs outside the GTA, even in academic centers).  He just feels incredibly entitled.

 

The same mentality is true of many east indian and Chinese newly minted MDs and other 'racialized' Canadians  - the thought of living outside the GTA repulses them - and they feel entitled to a Toronto area job and whine about it.  IT is also true for many of the new HIPSTER MD graduates that want to live the cool urban city lifestyle. 

 

Give me a break.  Specialists are going to earn 400K+, with much of the education subsidized on the taxpayer dime.  Don't complain about not getting a job in Toronto.  Or not matching to a Toronto area residency.  For most people - it's their own sense of entitlement (sadly my millennium generation is full of these types of whiners).

[武田信玄]

But we don't take "most IMG's", do we. What were the numbers, several IMGs out of 3500 or so got a spot? I would like to think we take the best.

 

About "our MD training program is better, our residency program is better, the quality of CMGs are better".  Better than where?

Better than 90% of other countries' system just by our selection criteria alone.

 

Of course, I've often heard many former doctors from my cultural community complaining and looking down on Canadian doctors about how incompetent Canadian doctors are, but what's a whole other story I'm not getting myself into.

[武田信玄]

The same mentality is true of many east indian and Chinese newly minted MDs and other 'racialized' Canadians  - the thought of living outside the GTA repulses them - and they feel entitled to a Toronto area job and whine about it.  IT is also true for many of the new HIPSTER MD graduates that want to live the slick big money, big city lifestyle.

Here we go with another "let's single out the Chinese community" post from the infamous "uwopremed". I'm quitting this thread. Enjoy your race talk.

[JohnGrisham]

But we don't take "most IMG's", do we. What were the numbers, several IMGs out of 3500 or so got a spot? I would like to think we take the best.

 

About "our MD training program is better, our residency program is better, the quality of CMGs are better".  Better than where?

Agreed... the line of thinking that we train our MDs is because we are better is completely wrong. Most places in the world have been training MDs far longer than us. We train our own MDs because we want local talent and people who understand our local customs and medical needs.

 

 

[JohnGrisham]

Better than 90% of other countries' system just by our selection criteria alone.

 

Of course, I've often heard many former doctors from my cultural community complaining and looking down on Canadian doctors about how incompetent Canadian doctors are, but what's a whole other story I'm not getting myself into.

The selection criteria is meaningless.

 

I'll say this time and time again. The only reason we have such high GPA averages cut off  is because of SUPPLY AND DEMAND. It has absolutely NOTHING to do with NEEDING to have those criteria to be a successful physician.

 

Broken record.

[uwopremed]

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.

So beautifully said.  In a world of 7 billion people; we could fill up all our residency spots with good quality IMGs from China, India, Russia, and so forth - even if IMGs in average are worse than CMGS, only because of the vast number of people in the rest of the world.  But why would we deprive Canadian born people from these lucrative jobs connected to treating the people within their own community.  Canada produces more than enough really smart people to basically create 95%+ of all future Canadian doctors.  We DON'T need IMGS - even if many of them are better than the average CMG.  There should be some exceptions of course (top level IMGs that bring a new research program or skill to Canada) - otherwise we don't need them (but their home country does).

 

And with CSAs- these guys couldn't hack in in Canada - so they used their mom/dad's money to buy a foreign degree and expect to come back to Canada??!?!?  Give me a break.  OF course there should be exceptions for US MD programs (Which are also very hard to get into), and people that got into programs in the UK with the same stats as local (ie Cambridge or Oxford competing at the same level as native brits).  As opposed to Ireland - which lets subpar Canadians get in if they pay a crap load of money.

[uwopremed]

Here we go with another "let's single out the Chinese community" post from the infamous "uwopremed". I'm quitting this thread. Enjoy your race talk.

 

I basically discussed every community - including hipsters (that are often white) - that only want to live in Toronto or Vancouver - and that this is a problem why the big cities are so saturated with MDs.  If you deny that a large segment of the Asian community does not prioritize Toronto as their spot of residency/work - then you are delusional. You have no problem attacking IMGs (who are usually also 'racialized' canadians, but get offended over this statement that most Chinese-Canadians would even agree with? 

[JohnGrisham]

So beautifully said.  In a world of 7 billion people; we could fill up all our residency spots with good quality IMGs from China, India, Russia, and so forth - even if IMGs in average are worse than CMGS, only because of the vast number of people in the rest of the world.  But why would we deprive Canadian born people from these lucrative jobs connected to treating the people within their own community.  Canada produces more than enough really smart people to basically create 95%+ of all future Canadian doctors.  We DON'T need IMGS - even if many of them are better than the average CMG.  There should be some exceptions of course (top level IMGs that bring a new research program or skill to Canada) - otherwise we don't need them (but their home country does).

 

And with CSAs- these guys couldn't hack in in Canada - so they used their mom/dad's money to buy a foreign degree and expect to come back to Canada??!?!?  Give me a break.  OF course there should be exceptions for US MD programs (Which are also very hard to get into), and people that got into programs in the UK with the same stats as local (ie Cambridge or Oxford competing at the same level as native brits).  As opposed to Ireland - which lets subpar Canadians get in if they pay a crap load of money.

Lol. Forever a premed.

[ralk]

But the thing is, the "average CSA" isn't getting a residency in CaRMS. Only the high percentile CSA is getting in. Have you seen some of the cut-offs some provinces/residencies have in filtering IMG/CSA's based on their MCCEE and NAC OSCE Scores? If you aren't 1-2 S.D above the mean, you're out of luck a lot of times.

 

Agree with the rest of your commentary though, just wanted to be clear on that. Talking with some friends in 3rd year abroad/US, CaRMS requirements stack up, that it just ends up being an exercise in futility - when they can just stick with the tried and true NRMP.

I agree, the average CSA getting into a Canadian residency is not the same as the average CSA period. However, I would disagree that they represent the top 1/3 of CSAs. CaRMS is far from being perfectly meritocratic and even with the recent emphasis on standardized tests, that goes double for the IMG match. As an IMG, CSA or otherwise, who you know seems to matter as much as who you are when it comes to successfully matching.

 

In any case, there is some data on the quality of accepted CSAs and they still appear to be, on average, less capable than CMGs. That data is far from definitive - mostly consisting of credentialling test pass rates - but what data there is out there has been consistent. Even skimming the best of the best from the applicant pool, IMGs az a whole, including CSAs, do not appear to be matching CMGs.

 

In any case, while CSA competency is a concern, it's not the major one I have with the current IMG/CSA system. Even if IMGs/CSAs were equal to CMGs in all academic and clinical metrics, I would still prefer to see the system fundamentally altered.

[JohnGrisham]

I agree, the average CSA getting into a Canadian residency is not the same as the average CSA period. However, I would disagree that they represent the top 1/3 of CSAs. CaRMS is far from being perfectly meritocratic and even with the recent emphasis on standardized tests, that goes double for the IMG match. As an IMG, CSA or otherwise, who you know seems to matter as much as who you are when it comes to successfully matching.

 

In any case, there is some data on the quality of accepted CSAs and they still appear to be, on average, less capable than CMGs. That data is far from definitive - mostly consisting of credentialling test pass rates - but what data there is out there has been consistent. Even skimming the best of the best from the applicant pool, IMGs az a whole, including CSAs, do not appear to be matching CMGs.

 

In any case, while CSA competency is a concern, it's not the major one I have with the current IMG/CSA system. Even if IMGs/CSAs were equal to CMGs in all academic and clinical metrics, I would still prefer to see the system fundamentally altered.

For sure, I just meant that if you don't already have high standardized test scores - the rest of your app isn't even being looked at. This would be regardless of who you know. ON-FM does it as a group, so they wouldn't just make an exception for someone, as it would be computer screened.

 

As for the rest, i'm not sure I've read studies or presented data that indicates that - can you provide some links for reading?

 

I find it hard to believe that at face value, since I don't even know how they would make the comparison? Would they base it one MCCQE1 scores? Subjective clinical evaluations in residency? Licensing exams during residency?

[ralk]

For sure, I just meant that if you don't already have high standardized test scores - the rest of your app isn't even being looked at. This would be regardless of who you know. ON-FM does it as a group, so they wouldn't just make an exception for someone, as it would be computer screened.

 

As for the rest, i'm not sure I've read studies or presented data that indicates that - can you provide some links for reading?

 

I find it hard to believe that at face value, since I don't even know how they would make the comparison? Would they base it one MCCQE1 scores? Subjective clinical evaluations in residency? Licensing exams during residency?

MCCQE pass rates are the ones that come to mind - they don't separate out CSAs but the numbers are so divergent that given the high proportion of CSAs among IMGs, their numbers have to be lower. I'm working off a phone from Europe, so I can't provide a link, but it's easy enough to Google. There are a few other minor stats that I've seen, but I'm having trouble pulling them up with my poor connection.

 

Again, nothing definitive as measures of quality, but enough to lend some credibility to the viewpoints of some clinicians (including some residents on this forum) that a reasonable subset of IMGs are not quite up to par with the typical CMG.

[older]

 

And with CSAs- these guys couldn't hack in in Canada - so they used their mom/dad's money to buy a foreign degree and expect to come back to Canada??!?!?  Give me a break.  OF course there should be exceptions for US MD programs (Which are also very hard to get into), and people that got into programs in the UK with the same stats as local (ie Cambridge or Oxford competing at the same level as native brits).  As opposed to Ireland - which lets subpar Canadians get in if they pay a crap load of money.

 

 

 

And where did you get the idea that Irish schools sell degrees to rich Canadians, at UWO? Med schools in Ireland are just as competitive as in UK. And in UK, all med schools are subject to the same standard - it doesn't count at all in your application for post-grad training in UK whether you graduated for Oxbridge or any other med school. 

 

It's incredible how smug and dismissive some people are - on pre-med level! You must be very sure you are not one of these subpar Canadians that end up without a spot in med school.

[NLengr]

Agreed... the line of thinking that we train our MDs is because we are better is completely wrong. Most places in the world have been training MDs far longer than us. We train our own MDs because we want local talent and people who understand our local customs and medical needs.

 

 

Oops, misread what you said. Disregard this post.

[uwopremed]

And where did you get the idea that Irish schools sell degrees to rich Canadians, at UWO? Med schools in Ireland are just as competitive as in UK. And in UK, all med schools are subject to the same standard - it doesn't count at all in your application for post-grad training in UK whether you graduated for Oxbridge or any other med school. 

 

It's incredible how smug and dismissive some people are - on pre-med level! You must be very sure you are not one of these subpar Canadians that end up without a spot in med school.

Are you kidding me??  Almost all the Irish schools let in Canadians, with pretty low standards, in an effort to make money.  That is totally obvious.  The Irish kids themselves are very competitive for the Irish stream.  I'm talking about the foreigners that they let in. 

 

Most UK schools are the same as the Irish schools; I'm talking about the few exceptions (Imperial, Cambridge, Oxford) that are super competitive for anyone.  They do not have low standards for foreigners (ie - they don't let in a bunch of Canadians that have the money to buy a medical degree).

[JohnGrisham]

Uwopremed, classic pm101 CMG arrogance.

[sleeping_sickness]

The following will sound a bit politically incorrect - but sometimes someone has to state the elephant in the room.

 

While I feel sorry for both of the guys in in the article to some degree - they only want to live in Toronto because they wanted to be close to a large Jewish community (that they both belong to).   The ENT's wife is not the breadwinner and has a healthcare job - there is NO reason why he can't take a job outside the GTA (and there are ENT jobs outside the GTA, even in academic centers).  He just feels incredibly entitled.

 

The same mentality is true of many east indian and Chinese newly minted MDs and other 'racialized' Canadians  - the thought of living outside the GTA repulses them - and they feel entitled to a Toronto area job and whine about it.  IT is also true for many of the new HIPSTER MD graduates that want to live the cool urban city lifestyle. 

 

Give me a break.  Specialists are going to earn 400K+, with much of the education subsidized on the taxpayer dime.  Don't complain about not getting a job in Toronto.  Or not matching to a Toronto area residency.  For most people - it's their own sense of entitlement (sadly my millennium generation is full of these types of whiners).

As an aforementioned hispter jew, I take offense to this and I don't even live in toronto

[116E118]

And where did you get the idea that Irish schools sell degrees to rich Canadians, at UWO? Med schools in Ireland are just as competitive as in UK. And in UK, all med schools are subject to the same standard - it doesn't count at all in your application for post-grad training in UK whether you graduated for Oxbridge or any other med school. 

 

It's incredible how smug and dismissive some people are - on pre-med level! You must be very sure you are not one of these subpar Canadians that end up without a spot in med school.

Probably stems from the fact that Irish and American med schools tend to be back ups for Canadian premeds. I've heard of and known several people that had interviews at mid and high tier American med schools but none/only one in Canada (due to hard cutoffs used in many of our schools).

 

http://forums.studentdoctor.net/threads/stats-of-applicants-to-irish-schools-and-acceptance-waitlist-or-rejection.268232/page-49

 

There are plenty people in that thread with stats that would have had no chance at Canadian schools because of their GPA.

 

Although UWOpremed worded it arrogantly/badly (I don't think anyone seriously thinks Irish or American mid tier USMD schools are "selling degrees"), I think most people agree that if you're just missing the mark to get into a Canadian med school you have a decent chance outside of Canada (mid tier USMD schools/Ireland).

[JohnGrisham]

That has absolutely nothing to do with quality of education though.

[uwopremed]

Uwopremed, classic pm101 CMG arrogance.

 

It is you that exudes arrogance and elitism.  Let me explain.

 

Going to Ireland, or Autralia, or the Caribean (because one could not get into Canada), skirts the basic system of fairness.  Most middle class or poor Canadians, if they did not make the cutoffs to get into a Canadian school, cannot afford to go overseas to buy themselves a degree that will eventually earn them a lot of money.  These Canadians that go abroad defeat the very system of fairness we have in medical admissions.  They usually belong to well off families.  And then these kids, who could not get into a Canadian school, feel entitled to work in Canada and make huge money of our taxpayer funded system.

 

IT is VILE and appalling.  And people like you, in support of these IMGS, help prop up the major social imbalances we have in our society.  Your support of these purchased degrees allows the upper middle class and upper class to allow their children access to high paying secure jobs with a backdoor access. 

 

And that appalls me.

[LeBronto2019]

It is you that exudes arrogance and elitism.  

 

oh the irony...i'm sure if we polled the pm101 community, they'd definitely consider you to the one of, if not, the MOST arrogant users! 

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