Carms 2016 Match Data Out

[btdubs]

This is going to be a somewhat strange question, but how do people manage to match to alternative disciplines? For eg. 43.8% of people who had Dermatology as their 1st choice discipline matched to an alternative one. Now, I am probably making a big assumption, but these people probably did majority of their electives in Dermatology. How does the other program still take those people despite knowing it isn't their #1 choice? These days, people talk about how FM doesn't want you if they see 6 weeks of electives in one specialty.

 

TL;DR: how do you manage to be competitive for your "back-up" option while competing with people who have it as their #1? I guess it isn't that bad. One of the biggest dilemmas is how much backing up should one do, or go all-in for one specialty.

Would love to know this, too.

[Doc_911_doc]

Would love to know this, too

 

This is going to be a somewhat strange question, but how do people manage to match to alternative disciplines? For eg. 43.8% of people who had Dermatology as their 1st choice discipline matched to an alternative one. Now, I am probably making a big assumption, but these people probably did majority of their electives in Dermatology. How does the other program still take those people despite knowing it isn't their #1 choice? These days, people talk about how FM doesn't want you if they see 6 weeks of electives in one specialty.

 

TL;DR: how do you manage to be competitive for your "back-up" option while competing with people who have it as their #1? I guess it isn't that bad. One of the biggest dilemmas is how much backing up should one do, or go all-in for one specialty. 

 

 

I think this is really the new wave of CaRMS - backing up is becoming very hard when every specialty is getting tighter for seats. Internal used to be a sure fire backup - now with an 88% match rate it's looking much more like it's not a done deal. For surgery - many of the competitive subspecialties (ENT, Plastics) would back up with gen surg - but now with a 74% match rate for those who rank it first choice it's really making it clear that this isn't a great backup.

 

With spots being so tight I think we're going to trend into an "all in" kind of application, with backing up being more location wide rather than multiple specialties. The elective people at my school have even mentionned how this seems to be the case in surgery these days but its trickling down to even family to some extent - super appealing family locations are way out of reach as a back up! 

 

Backing up is really a double edged sword - you don't want to weaken the primary application but you also don't want to go unmatched. I think it's a risk vs benefit analysis these days. 

[Anythingradiation]

Re:Backing Up

 

It's all about the spin.

 

For derm, there is the option to have a derm focused practice in family. It's all about your personal approach to it.

 

I would also argue that people who are going for competitive specialties tend to be more competitive overall. I.e. More leadership research etc.

 

Programs don't loose anything if they rank someone high and that applicant doesn't match. This encourages ranking on merit and strength. Just because isomeones primary interest is in derm doesn't mean they wouldn't make a great resident for the program.

[ooo]

Of course, I'm exploring multiple practice types and locations. I've been asking preceptors as much as I can about the business side of things - how much administrative work they do, impacts on free time and family life, ability to adjust practice, as well as compensation for various activities. I've had a chance to work at several different clinics and while all seem busy, none seem particularly rushed seeing ~25 patients a day and I can see myself - with a fair bit more knowledge and familiarity - being able to keep up. Most other specialties seem to move at an even faster pace when considering severity and acuity of the conditions involved. I agree that there are FPs who churn through far too many patients, but from what I've seen, that's not a necessity for FPs that bill appropriately, work efficiently, and put a higher priority on good patient care than maximizing income.

 

----

 

I think I'm still missing something when it comes to Pathologists. Being salaried does provide some bad incentives for employers, but that's not unique to pathologists (public health is also often salaried) and I'm not seeing evidence of those bad incentives in play. Pathologists on the Sunshine List (which I generally agree shouldn't be publicizing salaries the way it does) are clustered around the same level of compensation, particularly within individual institutions, so undercutting does not appear to be having much of an effect. Compensation appears have declined marginally, but no more than what other physicians have experienced in Ontario. I'm also failing to see how this is leading to overworked pathologists considering the fairly reasonable hours pathologists themselves are reporting and the near-lack of call requirements. I really fail to see how the salaries reported will fall below the FM standard pre-tax amount of around $180k - with just RRSP deductions, total take-home income will fall near or above $180k. Incorporating helps, but it doesn't come close to eliminating tax burdens entirely!

 

A number of your complaints just don't make sense to me as a way to single out Pathology as being in a uniquely bad situation. The OMA hasn't been effective in promoting any specialty's interests lately. The CPSO is the regulator for all specialties, not just Pathology - the Ontario Association of Pathologists has no legal authority and neither do any of the other provincial specialty associations. Salaried positions generally don't receive overtime pay in any field, and physicians of all backgrounds do a ton of uncompensated work.

 

I do understand the value of autonomy, since I'm choosing FM because it allows me an autonomy most other specialties won't. However, I feel like you're saying the sky is falling when it comes to Pathology, yet all I see are some dark-ish clouds. Aside from autonomy and the mediocre job market, there's a disconnect to me between what you're saying and what I'm seeing. I'd like to clarify where that disconnect lies, because right now I'm clearly not getting it.

A number of your complaints just don't make sense to me as a way to single out Pathology as being in a uniquely bad situation. The OMA hasn't been effective in promoting any specialty's interests lately. The CPSO is the regulator for all specialties, not just Pathology - the Ontario Association of Pathologists has no legal authority and neither do any of the other provincial specialty associations. Salaried positions generally don't receive overtime pay in any field, and physicians of all backgrounds do a ton of uncompensated work.

 

Yeah, there is disconnect as you repeated a few times. The sky isn't falling in pathology, nor is it in particularly uniquely bad. What Cain is trying to say (if I may) is that there are problems with how the specialty is run. As was iterated, money is an issue, but not the only one. I believe they are a path resident -- the pathology staff I have worked with in various sites would say the same, if not worse. I was told by a few staff that it's only recently that the path salaries have gone up - not long ago (around 5y ago) it was at the 150k range. As for the overworked/underpaid issue, I don't know what averages you are quoting, workload has been continuously increasing -- unlike other fee for service specialties, rate of remuneration by definition goes down. Because all they need are microscopes in an office, the administration can hire locums/part timers and dump a full time case load on them. People on specialty services often stay late and come in on weekends to sign out cases. This is on top of the expectation/requirement of "research". Many people started their careers wanting to have a heavier research component. Nowadays the 80/20 split is very rare. 50/50 split usually just means full time sign out and extra research. A lot of these projects are funded and driven by clinicians, who often see pathology as nothing more than a cog or a time consuming section they need to include on their papers. Staff have told me that their work was left out of the authors' list numerous times. Cain also touched on the overall lack of respect given to pathology. Pathologists often feel that they are squeezed in the middle by everyone involved. How demeaning is it to show up for an intraop consultation that probably wasn't indicated in the first place only to be told that the surgeon already closed up? People think it's an easy life style specialty, but there's more to it than meets the eye. It is one of the specialties that demand a ton of knowledge, liability insurance is very high, and yet it is poorly understood by other physicians, the government, and the public. 

[GrumpyMoriarty]

Looking at Emerg stats made me cry a little bit on the inside T_T

[GrouchoMarx]

Yeah, there is disconnect as you repeated a few times. The sky isn't falling in pathology, nor is it in particularly uniquely bad. What Cain is trying to say (if I may) is that there are problems with how the specialty is run. As was iterated, money is an issue, but not the only one. I believe they are a path resident -- the pathology staff I have worked with in various sites would say the same, if not worse. I was told by a few staff that it's only recently that the path salaries have gone up - not long ago (around 5y ago) it was at the 150k range. As for the overworked/underpaid issue, I don't know what averages you are quoting, workload has been continuously increasing -- unlike other fee for service specialties, rate of remuneration by definition goes down. Because all they need are microscopes in an office, the administration can hire locums/part timers and dump a full time case load on them. People on specialty services often stay late and come in on weekends to sign out cases. This is on top of the expectation/requirement of "research". Many people started their careers wanting to have a heavier research component. Nowadays the 80/20 split is very rare. 50/50 split usually just means full time sign out and extra research. A lot of these projects are funded and driven by clinicians, who often see pathology as nothing more than a cog or a time consuming section they need to include on their papers. Staff have told me that their work was left out of the authors' list numerous times. Cain also touched on the overall lack of respect given to pathology. Pathologists often feel that they are squeezed in the middle by everyone involved. How demeaning is it to show up for an intraop consultation that probably wasn't indicated in the first place only to be told that the surgeon already closed up? People think it's an easy life style specialty, but there's more to it than meets the eye. It is one of the specialties that demand a ton of knowledge, liability insurance is very high, and yet it is poorly understood by other physicians, the government, and the public. 

 

excellent explanation.

 

the way things are in pathology would be equal to telling a surgeon that the more surgeries they do, the less each one is worth. 

 

why do you think the specialty has been so ineffective at fixing these issues?

[distressedpremed]

Re:Backing Up

 

It's all about the spin.

 

For derm, there is the option to have a derm focused practice in family. It's all about your personal approach to it.

 

I would also argue that people who are going for competitive specialties tend to be more competitive overall. I.e. More leadership research etc.

 

Programs don't loose anything if they rank someone high and that applicant doesn't match. This encourages ranking on merit and strength. Just because isomeones primary interest is in derm doesn't mean they wouldn't make a great resident for the program.

 

 

Hey there - could you expand on this a bit? I thought programs generally like people who are strong on paper, but elective performance (to my limited understanding) is more important.  

[Doc_911_doc]

Hey there - could you expand on this a bit? I thought programs generally like people who are strong on paper, but elective performance (to my limited understanding) is more important.  

 

Re:Backing Up

 

It's all about the spin.

 

For derm, there is the option to have a derm focused practice in family. It's all about your personal approach to it.

 

I would also argue that people who are going for competitive specialties tend to be more competitive overall. I.e. More leadership research etc.

 

Programs don't loose anything if they rank someone high and that applicant doesn't match. This encourages ranking on merit and strength. Just because isomeones primary interest is in derm doesn't mean they wouldn't make a great resident for the program.

 

I would say programs DO loose something - they want to rank the best applicant that is likely to come to their school. An amazing applicant on paper who interviews superbly BUT does all their electives in Derm in Ontario and then applies to Family med in Dal without ever going east, no connections to the east....will be ranked lower.  Even someone like that that applies to Fam Med in Ontario - they will be ranked much lower than the colossal amount of fam med applicants who are obviously all in for family. So if they do match - they'll get a less desirable location.

 

The schools don't want to go down their match list. They would all love to get their top 3-5 and never see anyone below that. There will be several applicants with similar levels of merit and strength - esp for programs like Derm or Plastics that are super competitive. What will make or break their rank: the person who appears to be all in versus the person clearly backing up. Schools are selfish - they want the best, most dedicated for themselves and will only move down to the rest if that list is exhausted. It leaves the backing up in less desirable locations much further down their rank list.

 

Not to say you can't back up - but spinning it isn't as easy as you think. Also there's many specialties that have no easy spin - what if you want to do plastics? What can you spin as your back up? Gen surg? Doesn't really connect - and is now getting competitive as the last standing employable surgical specialty. Family? No real relation to plastics so that is quite the settle for the plastics gunner!

 

Even something that isn't all that competitive as a primary match, like ortho. How do you spin that? There was only 1 spot left over in second round and its a program notorious for liking to see you go all in. PMR is a reasonable back up but is much more competitive than ortho. And most ortho gunners are not a fan of non-op MSK problems! Sports med +1 after family? Maybe....but again not exactly an orthopods dream.

 

Backing up is getting harder and harder - esp with the more specific programs where spinning it isn't an option. Backing up means excepting that you may not get your 2nd choice and that you may end up in a location you don't enjoy. It's the sad reality of an ever-increasingly competitive CaRMS. 

[ralk]

Yeah, there is disconnect as you repeated a few times. The sky isn't falling in pathology, nor is it in particularly uniquely bad. What Cain is trying to say (if I may) is that there are problems with how the specialty is run. As was iterated, money is an issue, but not the only one. I believe they are a path resident -- the pathology staff I have worked with in various sites would say the same, if not worse. I was told by a few staff that it's only recently that the path salaries have gone up - not long ago (around 5y ago) it was at the 150k range. As for the overworked/underpaid issue, I don't know what averages you are quoting, workload has been continuously increasing -- unlike other fee for service specialties, rate of remuneration by definition goes down. Because all they need are microscopes in an office, the administration can hire locums/part timers and dump a full time case load on them. People on specialty services often stay late and come in on weekends to sign out cases. This is on top of the expectation/requirement of "research". Many people started their careers wanting to have a heavier research component. Nowadays the 80/20 split is very rare. 50/50 split usually just means full time sign out and extra research. A lot of these projects are funded and driven by clinicians, who often see pathology as nothing more than a cog or a time consuming section they need to include on their papers. Staff have told me that their work was left out of the authors' list numerous times. Cain also touched on the overall lack of respect given to pathology. Pathologists often feel that they are squeezed in the middle by everyone involved. How demeaning is it to show up for an intraop consultation that probably wasn't indicated in the first place only to be told that the surgeon already closed up? People think it's an easy life style specialty, but there's more to it than meets the eye. It is one of the specialties that demand a ton of knowledge, liability insurance is very high, and yet it is poorly understood by other physicians, the government, and the public. 

 

Thanks for the explanation. Lack of respect - while sadly common in medicine in general - is something I definitely sympathize with. We treat each other terribly for pretty superficial reasons.

 

I guess I want to emphasize that the grass isn't all that greener in other specialties. Unpaid work on evenings and weekends is pretty much par for the course in medicine. Expectations for research - with insufficient support - are common for academic specialties, though acknowledgment for efforts is less of a problem. Liability insurance is a bit higher for Pathologists, but not that much higher - the fee schedule for Path is comparable to Radiology and well below that for surgeons, EM, and especially OBGYN.

 

The work hours stats I'm referring to come from the CMA specialty profiles (which I believe get their numbers from the National Physician Survey). It's not perfect, but it's the best data available. I really have trouble calling money a concern if, as you say, there was a near-doubling of salary recently. Considering the number of specialties who still have <$200k in average after-overhead income and are seeing a net reduction in their incomes, that's not a bad deal. It also speaks to the power that does exist for Pathologists. Hospitals don't give that kind of money to a group of people who have absolutely no power or respect, particularly during a time when other physicians' salaries are steady or down.

[ralk]

I would say programs DO loose something - they want to rank the best applicant that is likely to come to their school. An amazing applicant on paper who interviews superbly BUT does all their electives in Derm in Ontario and then applies to Family med in Dal without ever going east, no connections to the east....will be ranked lower.  Even someone like that that applies to Fam Med in Ontario - they will be ranked much lower than the colossal amount of fam med applicants who are obviously all in for family. So if they do match - they'll get a less desirable location.

 

The schools don't want to go down their match list. They would all love to get their top 3-5 and never see anyone below that. There will be several applicants with similar levels of merit and strength - esp for programs like Derm or Plastics that are super competitive. What will make or break their rank: the person who appears to be all in versus the person clearly backing up. Schools are selfish - they want the best, most dedicated for themselves and will only move down to the rest if that list is exhausted. It leaves the backing up in less desirable locations much further down their rank list.

 

Not to say you can't back up - but spinning it isn't as easy as you think. Also there's many specialties that have no easy spin - what if you want to do plastics? What can you spin as your back up? Gen surg? Doesn't really connect - and is now getting competitive as the last standing employable surgical specialty. Family? No real relation to plastics so that is quite the settle for the plastics gunner!

 

Even something that isn't all that competitive as a primary match, like ortho. How do you spin that? There was only 1 spot left over in second round and its a program notorious for liking to see you go all in. PMR is a reasonable back up but is much more competitive than ortho. And most ortho gunners are not a fan of non-op MSK problems! Sports med +1 after family? Maybe....but again not exactly an orthopods dream.

 

Backing up is getting harder and harder - esp with the more specific programs where spinning it isn't an option. Backing up means excepting that you may not get your 2nd choice and that you may end up in a location you don't enjoy. It's the sad reality of an ever-increasingly competitive CaRMS. 

 

In fairness, programs really don't lose out by ranking candidates they'd like highly, even if they believe the candidate would prefer another program or specialty. Programs shouldn't consider perceived applicant preferences just like applicants shouldn't consider perceived program preferences when forming their rank order lists - the CaRMS algorithm is brilliantly designed to prevent the need to do that.

 

Unfortunately, many programs (like many candidates) don't always rank rationally. I know some PDs don't fully grasp how the algorithm works. As a result, we do see programs ranking down candidates - or ignoring them entirely - because of a perceived lack of commitment to a location or specialty. It does nothing but limit these programs' ability to get the absolute best candidates, whiling forcing applicants to limit their options in order to project the "right" level of interest. That's not a great approach for anyone involved, but it's the one we have...

 

I suppose there is an argument to be made that commitment to a specialty or location is in itself a qualification. Certainly in Family, where there's an effort to get people to stay in underserviced locations, applicants who demonstrate zero interest in a location aren't likely to match there and programs have some justification for excluding them if there are more interested alternative candidates. However, for the plethora of specialties that have no interest in keeping their residents around (such as the surgical specialties with limited job opportunities), there's not much sense in ignoring a good candidate just because that candidate wanted to keep their options open. Likewise, I can understand a program rejecting a candidate because that candidate would clearly be unhappy in their program. Yet, programs also tend to infer a lack of interest when candidates respond to their own incentives - an applicant who would be perfectly happy in either of two specialties now often has to commit to one and destroy their chances for the other specialty. Similarly, programs insisting candidates do an elective at their site are forcing students to eliminate themselves from contention prematurely - my school only allows 6 electives maximum in any particular specialty, so candidates willing to go anywhere are finding themselves having to gamble on location, knowing any program they don't do an elective at might take that as a sign of disinterest. It's leading to a rather inefficient matching process.

 

I'll also point out that this year, more people successfully backed up than in 2015. It's a balancing act, no doubt, and it wouldn't surprise me if having a solid back-up reduces an applicant's chances at matching to their preferred specialty. However, 309 individuals matched to one of their back-up specialties this year, so it's not that uncommon.

[Lactic Folly]

In fairness to programs, incoming residents who are unhappy with their matched location or specialty may seek to soon transfer out, and this can create issues. A less rational reason for ranking according to candidates' perceived preferences is that programs like to feel good about being a desirable program that doesn't have to go far down its rank list to fill. 

[Bones13]

PMR is a reasonable back up but is much more competitive than ortho. 

 

 

 

Can you elaborate on this?  Is this based on ratio of applicants to spots or caliber of applicants (obviously there is some overlap).  

[NeuroD]

 

PMR is a reasonable back up but is much more competitive than ortho. 

 

 

 

Can you elaborate on this?  Is this based on ratio of applicants to spots or caliber of applicants (obviously there is some overlap).  

 

Its the ratio (plus the fact that its decent specialty). Traditionally PMR has had great match rates, but lately the trend has switched. Part of the reason is there are only 25 spots nation wide. It has only increased by ~2 spots in the last 10 years because its never been a very "hot" field.

[Doc_911_doc]

 

PMR is a reasonable back up but is much more competitive than ortho. 

 

 

 

Can you elaborate on this?  Is this based on ratio of applicants to spots or caliber of applicants (obviously there is some overlap).  

 

 

As PhD2MD mentioned, its the ratio of spots. 

 

Also - ortho (like many surgical specialties) has plummeted in popularity as the job market issues become more known to at the medical student level. Meanwhile PMR is picking up in the job market (or maybe has always been great!) and as a result students are noticing.

 

Ortho has an 87% match rate - down slightly from 90% last year. Not at all unreasobale.

[Letsdothisthing]

3 people had emerge as a 2nd choice and matched to it!

which table did you use to calculate?

[Fresh fry]

which table did you use to calculate?

http://www.carms.ca/wp-content/uploads/2016/05/Table_17_Match_Results_for_CMGs_by_Discipline_Preference_English.pdf