Jump to content
Premed 101 Forums

2017 Carms Applicants


Recommended Posts

I don't think it is just people not wanting to do family medicine just because they don't like family medicine - in Ontario the government has been playing a lot of games with family medicine lately - including consideration of some very big restrictions on new graduates (like not even really being able to set up a typical practice). A logical response would be less interest in family medicine and indirectly by making those changes (or even threatening to) the government sets out signals of now much it values family medicine and if it was being logical about (not that it always is) the current need for family doctors.  I have had a bunch of people tell they just shifted out of considering family medicine just because of that. 

Link to comment
Share on other sites

  • Replies 444
  • Created
  • Last Reply

I don't think it is just people not wanting to do family medicine just because they don't like family medicine - in Ontario the government has been playing a lot of games with family medicine lately - including consideration of some very big restrictions on new graduates (like not even really being able to set up a typical practice). A logical response would be less interest in family medicine and indirectly by making those changes (or even threatening to) the government sets out signals of now much it values family medicine and if it was being logical about (not that it always is) the current need for family doctors.  I have had a bunch of people tell they just shifted out of considering family medicine just because of that. 

 

I don't blame anyone in Ontario for choosing another primary care specialty such as internal medicine. I agree with you that provincial restrictions were likely a significant factor in staying away from family medicine. Is there a break down of how many Ontario medical students chose family medicine as their first choice? Slide 31 (http://www.carms.ca/wp-content/uploads/2017/04/2017-CaRMS-Forum-web-deck-EN.pdf)  shows an upward trend of quotas filled... which doesn't mean it was their first choice, given that 2017 was the highest number of applicants per program ratio in a while. 

 

Another overall trend is that family medicine residents prefer to have their focus of practice.

Gone are the days of the true generalist. Everyone wants a niche - either through CFPC or FRCPC. 

 

Link to comment
Share on other sites

I don't think I'm over it enough to articulately address these issues but I'll just say:

 

All this justifying of the unmatched rates by suggesting people should be less picky and downplaying the number unmatched - still hurts. Seems to reflect the general attitude among medical students of " this could never ever happen to ME". It's different when it's your life.

 

It may not be a public health crisis, but it's a personal one , and I wish people wouldn't downplay that.

Link to comment
Share on other sites

I don't think I'm over it enough to articulately address these issues but I'll just say:

 

All this justifying of the unmatched rates by suggesting people should be less picky and downplaying the number unmatched - still hurts. Seems to reflect the general attitude among medical students of " this could never ever happen to ME". It's different when it's your life.

 

It may not be a public health crisis, but it's a personal one , and I wish people wouldn't downplay that.

Sorry amichel for any disrespect you may feel. But in earnest, you are different. The above sentiment only applies to those who truly didn't apply broadly. Aka 2 upper year colleagues who only applied to residencies(3 different ones at that) in a very constrained geography.. And the other who only applied their speciality in 3 major cities for example. Not saying these are bad decisions at all, but personal ones that may be more risky.

 

I dont think anyone is disagreeing that there is a sizeable amount of the unmatched who did simply get unlucky or screwed and couldn't have done anything else(I.e. they did all the right things). But there are people who go unmatched who could've done more to decrease the odds of being unmatched- weather or not it would change the outcome is unknown.

 

Honestly, I wonder if the huge trend to applying broadly is actually apart of the problem here. I'd love to see hard stats on if programs have increased the # they interview proportional to the slow increase of # programs people apply to.

Link to comment
Share on other sites

The other caveat to the "Apply broadly" is the assumption that simply applying for the interview is enough. It's already fairly well known that one of the main determining factors for getting an interview is if you've done an elective at the school (ideally in the specialty as well). So it's not just "apply broadly" but also "Elective broadly", which is quite the costly venture, which ultimately boils down to a feeling of "Throw enough money at it to hopefully secure your future".

 

Due to financial stress I had a difficult time traveling much for my electives, and as such when I did "apply broadly" to Radiology (with backups, and extremely broad application in second iteration) I did not receive the favorable response I was hoping for when it came time to interview. Overall the system itself is a complex eldritch beast that swallows everything you put into it and may or may not yield the result you hope for. In similar fashion there isn't much you can do about it when it doesn't yield that result but rail at the system (quietly, as if you raise too much of a raucous you risk damaging your chances of matching in the future) and then getting lost in the veil of academia.

 

I can't speak to other unmatched students' experiences but at my program I basically received a placating head pat with "That sucks man, better luck next time", words of consolation, and no actual support put forth for the coming year. My program doesn't have a fifth year option, and the culmination of advise I got was "we'll have a look at your application with you to improve it if you want" (which I am grateful for as I appreciate all help towards the end goal at this point), "Maybe you should look at less competitive things, even though there's nothing that stands out wrong on your application" and "Well go hunt down some supervisors and apply for a masters, either via our school or another University".

 

I bear no ill will towards my program as a whole, but it does seem like there could be a lot better support measures in place for -IF- this happens (instead of the attitude of "oh it doesn't happen often enough for us to worry about it").

 

As to a constructive response to address the problem, the government's repeated meddling with primary care physicians and how they practice is definitely a major turn off for primary care (all around and personally). In NB they have been speaking for the past few years about setting a hard limit on how much family docs can bill for (regardless of how much work you actually do. You hit limit and then keep seeing patients for free or close up shop for the rest of the year {Obviously not the ethical response}). Another issue being from what I've heard, is that they're roping more and more family docs into having to do call and be associated with the hospitalist services here because in order to obtain a billing number you as a new family doc you have to be associated with the hospital (that one I'm a bit less 100% on, but I know there were some recent issues with our psychiatry department regarding that issue). So, for my suggestion it'd be lobbying for limitations on how much government can manipulate family doc practices (acquiescing that this is a much harder thing to achieve in practice, and that there may or may not be valid reasons for some of the government involvement).

Link to comment
Share on other sites

Also your program seems reflective of at least my program, as they seemingly provide even less than yours. (They'll post a listing on their website saying "student x chose to not apply and is looking for a masters supervisor" and "better luck next year". This is the experience of my colleague and another who went unmatched last year.)

 

That makes 2 programs at least who are poorly handling things. Its always the " oh well everyone passes so we dont spend much time thinking of this" or "everyone matches by it out so make sure to have multiple back up specialities"

Link to comment
Share on other sites

I don't think it is just people not wanting to do family medicine just because they don't like family medicine - in Ontario the government has been playing a lot of games with family medicine lately - including consideration of some very big restrictions on new graduates (like not even really being able to set up a typical practice). A logical response would be less interest in family medicine and indirectly by making those changes (or even threatening to) the government sets out signals of now much it values family medicine and if it was being logical about (not that it always is) the current need for family doctors.  I have had a bunch of people tell they just shifted out of considering family medicine just because of that. 

The key is to get your certification...but don't practice family....alota the +1s allow you to focus just in that area, and you're not facing the cuts that normal fam clinics face or overhead concerns. 

Link to comment
Share on other sites

The key is to get your certification...but don't practice family....alota the +1s allow you to focus just in that area, and you're not facing the cuts that normal fam clinics face or overhead concerns. 

 

That would help :) of course you would have to want to do the +1 area. I mean not everyone interested in family medicine for instance like emerg or .... - some just want to be family doctors, ha. Some of those +1s aren't exactly easy to get either. 

Link to comment
Share on other sites

The key is to get your certification...but don't practice family....alota the +1s allow you to focus just in that area, and you're not facing the cuts that normal fam clinics face or overhead concerns. 

 

And then you wonder why no one has a family doctor! 

Link to comment
Share on other sites

Something about billion dollar outdated fighter jets ;)

 

ha - more federal transfers (all though I know why originally they set it up this way, the idea that we can have a Canadian Health Act but still individual provincial control of health care seems so strange to me). 

 

Sure you can pick things like that to say my word why are are doing that? (why ARE we doing that, ha?). Still on a bigger picture the Canadian military is also not flush with cash to say the least. 

 

Provincially the budget for health care is so large that there really isn't any way to increase it further I think. They are stuck with a system with raising costs more than inflation and ever more need. Not exactly ideal. 

 

This isn't to excuse the government for some of its policies of course - but you can see where the pressure is coming from. 

Link to comment
Share on other sites

The 2017 combined round 1 and 2 match rate was 96.5% (slide 9). The 2016/15/14/13 rates were 97.2%/97.7%/97.4%/97.5% (slide 47) respectively. There was a slight dip in 2017, but I wouldn't call that a "clear downward trend." It's actually been VERY steady since 2013 with max variability being only 1.2%!

 

Source: http://www.carms.ca/wp-content/uploads/2017/04/2017-CaRMS-Forum-web-deck-EN.pdf

 

Going back only until 2013 doesn't capture the full trend. Slide 43 goes back to 2007 and shows a clear rise in the unmatched rate, albeit with a less reliable statistic. Fortunately, the presentation gives enough stats to get similar numbers for 2012 and 2011 - 2012 is also around the mid-97% (at 97.3%), but 2011 is at 98.4%, a much better rate. From what I can see, the total unmatched rate started going up when the ratio of spots to applicants started narrowing from 1.10 pre-2012, to its current level below 1.03. Just because there was a pause in the 2012-2016 period shouldn't be used to obscure the broader trend.

Link to comment
Share on other sites

 

Eh, this only captures a minor part of the issue, which is FPs not wanting to work as outpatient care providers. Even then, that's a small issue, since the FPs working as hospitalists are generally filling a needed role. If they all went out to start outpatient practices, there'd just be a lack of hospitalists. BC's also a particularly confusing situation because the rhetoric isn't exactly backed up by the data. BC's FP-to-population ratio is fairly average for Canada as a whole and is, if anything, slightly better than average. Every other large province is doing worse on that metric, Ontario especially.

 

As much as I would love for provincial governments to start throwing more money and supports at FPs - and I still believe there are good reasons to consider increasing the relative distribution of healthcare resources towards primary care - doing so won't change much to get more patients an available FP. If demand from medical students to be an FP shot through the roof, it wouldn't change the number of FPs coming out because every English-language FP position fills, one way or another. If we want more FPs, we need more training spots for FPs. That's where the main logjam is. Changing anything but that, including fees, allied health support, or hours requirements, won't make too much of a difference.

Link to comment
Share on other sites

Eh, this only captures a minor part of the issue, which is FPs not wanting to work as outpatient care providers. Even then, that's a small issue, since the FPs working as hospitalists are generally filling a needed role. If they all went out to start outpatient practices, there'd just be a lack of hospitalists. BC's also a particularly confusing situation because the rhetoric isn't exactly backed up by the data. BC's FP-to-population ratio is fairly average for Canada as a whole and is, if anything, slightly better than average. Every other large province is doing worse on that metric, Ontario especially.

 

As much as I would love for provincial governments to start throwing more money and supports at FPs - and I still believe there are good reasons to consider increasing the relative distribution of healthcare resources towards primary care - doing so won't change much to get more patients an available FP. If demand from medical students to be an FP shot through the roof, it wouldn't change the number of FPs coming out because every English-language FP position fills, one way or another. If we want more FPs, we need more training spots for FPs. That's where the main logjam is. Changing anything but that, including fees, allied health support, or hours requirements, won't make too much of a difference.

 

I hate it when they quote ABC percentage of the population doesn't have a family doctor. It assumes absolutely everyone is trying to get one. 

 

For instance I don't have a family doctor. I haven't bothered to get one - I move relatively a lot all over the province and potentially country wide so keeping one is annoying from that aspect, have no current chronic health conditions, and no particular need otherwise for a family doctor.  I am not alone - for similar reasons a not insignificant fraction of the population will never have a family doctor in any given year. 

 

The real question is what fraction wants a family doctor and doesn't have one. Quote that number :)

Link to comment
Share on other sites

 

Agree entirely. Family medicine is hugely underappreciated and underpaid. Why do family medicine when you can have just as good hours in many other specialties and punt any issues that aren't yours back to the family doc? IMO, it's a lot easier to have depth of knowledge in single topic versus the breadth of knowledge required for FM.

 

Even if you do family medicine, "regular" family medicine is a slog and difficult to do well and make any money (try squeezing a 73 y/o multiple medical comorbidities with a history of cancer, CHF, diabetes on 15 different medications into a 10-15 minute time slot - the expectation of patients and their GP's is to address multiple issues at one visit, but you barely get premiums for providing good quality care). I had fantastic GP preceptors during my core rotations who were angels for their patients, but nearly totally burnt out in ~15 years of practice. Glad I'm not in family medicine, but I have the utmost respect for them and think we should be placing far more focus (and money) on primary care versus specialists.

Link to comment
Share on other sites

True. It is sad I've worked with various doctors in FHOs and FFS. The FHO docs typically take their time with the complex pts and help deal with them. The FFS see them quickly and refer to GIM typically. Keep in mind the FHO docs are making a killing, the average FHO physician was bringing around 400k, and working less hours. Although fam docs do have to work more hours to reach specialist money, it can be argued the work is a lot easier and not as complex. 

Link to comment
Share on other sites

True. It is sad I've worked with various doctors in FHOs and FFS. The FHO docs typically take their time with the complex pts and help deal with them. The FFS see them quickly and refer to GIM typically. Keep in mind the FHO docs are making a killing, the average FHO physician was bringing around 400k, and working less hours. Although fam docs do have to work more hours to reach specialist money, it can be argued the work is a lot easier and not as complex. 

 

although as I understand it that is not an accident at least in Ontario - the government wanted to push people to do a particular model - they do that by forcing fee changes on people. 

Link to comment
Share on other sites

  • 4 weeks later...

Archived

This topic is now archived and is closed to further replies.


×
×
  • Create New...