2017 Carms Applicants

[rmorelan]

7 hours ago, LittleDaisy said:

Hey guys, the official 2017 CaRMS stats reports are out: http://www.carms.ca/en/data-and-reports/r-1/r-1-match-reports-2017/

It might be interesting for those applying to CaRMS next year 2018 :)!

awesome - thanks for letting us know. Time for some analysis

[ralk]

Alright, finally get to dive into some real numbers. Last couple years I've done a full rundown of all specialties looking at match rates and back-up rates of people ranking each individual specialty first. However, I'm out of the country and working off a phone, so the pen-and-paper version of the larger specialties will have to do for now!

 

The following is the percent matching to the listed specialty of those who ranked that specialty first:

Family Medicine - 96.6%

Anatomic Pathology - 90.9%

Psychiatry - 88.3%

Public Health - 84.2%

Internal Medicine - 84.1%

Orthopedics - 82.5%

Physical Medicine and Rehab - 80.6%

Diagnostic Radiology - 78.7%

General Surgery - 72.2%

Pediatrics - 70.8%

Anesthesiology - 70.3%

Ophtho - 69.4%

ENT - 69.2%

Neurology - 67.2%

OBGYN - 62.8%

Urology - 59.6%

Neurosurgery - 57.7%

Emergency Medicine - 53.4%

Dermatology - 49.2%

Plastic Surgery - 49.0%

 

Apologies for any formatting errors, I'm doing this on mobile and have never seen how things look on the new site's full version. Because this was done the old-fashioned way, there is a higher chance of calculation or transcription errors on my part, though I've tried to be as accurate as I can. Will follow-up with comments on the data when I can!

[ralk]

Ok, some quick comments on the match stats.

1) Rough year for surgical specialties. Gen Sx, Ortho, Plastics, ENT and Ophtho had rather typical years, but Urology was more competitive than usual and Neurosurgery had a very rough year. OBGYN, as a semi-surgical specialty, also had a rather tough match.

2) Internal. Yeah. It got more competitive. Interestingly, it was still a reasonable option for people to back-up into, with over 50 people doing so. I'm going to infer from this that while volumes of applications to IM are up, programs haven't changed their selection criteria all that much. That is, they don't currently insist on IM gunners and IM gunners alone.

3) Speaking of backing up, that is still very much a thing. A lot of people going for competitive specialties seemed to have had no trouble getting a 1st round spot in an alternative discipline. FM seems to be the obvious outlet, as there was a drop in FM interest this year, meaning more opportunity for those using it as their second or third option.

[R<Py]

...

[ArchEnemy]

11 hours ago, ralk said:

Alright, finally get to dive into some real numbers. Last couple years I've done a full rundown of all specialties looking at match rates and back-up rates of people ranking each individual specialty first. However, I'm out of the country and working off a phone, so the pen-and-paper version of the larger specialties will have to do for now!

 

The following is the percent matching to the listed specialty of those who ranked that specialty first:

Family Medicine - 96.6%

Anatomic Pathology - 90.9%

Psychiatry - 88.3%

Public Health - 84.2%

Internal Medicine - 84.1%

Orthopedics - 82.5%

Physical Medicine and Rehab - 80.6%

Diagnostic Radiology - 78.7%

General Surgery - 72.2%

Pediatrics - 70.8%

Anesthesiology - 70.3%

Ophtho - 69.4%

ENT - 69.2%

Neurology - 67.2%

OBGYN - 62.8%

Urology - 59.6%

Neurosurgery - 57.7%

Emergency Medicine - 53.4%

Dermatology - 49.2%

Plastic Surgery - 49.0%

 

Apologies for any formatting errors, I'm doing this on mobile and have never seen how things look on the new site's full version. Because this was done the old-fashioned way, there is a higher chance of calculation or transcription errors on my part, though I've tried to be as accurate as I can. Will follow-up with comments on the data when I can!

Could you direct me to which tables in the R1 Match reports you used to calculate these? I am getting different numbers...

[ralk]

22 minutes ago, ArchEnemy said:

Could you direct me to which tables in the R1 Match reports you used to calculate these? I am getting different numbers...

Tables 19 through 22. Again, did this on my phone, so might have made an error or two, but most of the numbers should be right, at least according to the definition of the "match rate" I described above (the are of course alternative definitions and metrics of competitiveness to look at).

[ArchEnemy]

1 minute ago, ralk said:

Tables 19 through 22. Again, did this on my phone, so might have made an error or two, but most of the numbers should be right, at least according to the definition of the "match rate" I described above (the are of course alternative definitions and metrics of competitiveness to look at).

Thanks. I used Tables 9, 11 & 12 to measure competitiveness, hence the differences in numbers.

[ralk]

3 minutes ago, ArchEnemy said:

Thanks. I used Tables 9, 11 & 12 to measure competitiveness, hence the differences in numbers.

Yeah, quotas are a common way to look at it. I find quota ratios difficult to interpret and apply to individual decision-making though, especially for fields that have a lot of people backing up into them (FM, IM). Matter of preference, I suppose.

Regardless, Table 9 provides some excellent contextualizing data, really emphasizes that most people apply to multiple specialties.

[R<Py]

 

Someone at my school posted this @ralk

First choice discipline	Percent matched to first choice discipline	Percent matched to alternate discipline	Percent unmatched
anat pathology	90.9%	3.0%	6.1%
anesthe	70.3%	20.3%	9.4%
cardiac surg	70.0%	10.0%	20.0%
dermato	49.2%	44.3%	6.6%
diagnostic rad	78.7%	11.2%	10.1%
emerg	53.4%	40.7%	5.9%
family	96.6%	0.9%	2.4%
gen path	100.0%	0.0%	0.0%
gen surg	72.2%	15.7%	12.0%
hemato path	100.0%	0.0%	0.0%
interna med	84.1%	10.6%	5.4%
medical genetics	100.0%	0.0%	0.0%
medical microbio	100.0%	0.0%	0.0%
neurology	67.2%	21.3%	11.5%
peds neurology	66.7%	22.2%	11.1%
neuropathology	100.0%	0.0%	0.0%
neurosurgery	57.7%	11.5%	30.8%
nuclear med	100.0%	0.0%	0.0%
obsgyn	62.8%	25.7%	11.5%
ophtalmology	69.4%	18.4%	12.2%
orthopedic	82.5%	8.8%	8.8%
ENT	69.2%	12.8%	17.9%
peds	70.8%	25.1%	4.1%
PMR	80.6%	16.1%	3.2%
plastics	49.0%	18.4%	32.7%
psych	88.3%	8.3%	3.3%
Public health	84.2%	15.8%	0.0%
rad onc	100.0%	0.0%	0.0%
uro	59.6%	15.4%	25.0%
vascular surg	87.5%	12.5%	0.0%

[ArchEnemy]

59 minutes ago, ralk said:

Yeah, quotas are a common way to look at it. I find quota ratios difficult to interpret and apply to individual decision-making though, especially for fields that have a lot of people backing up into them (FM, IM). Matter of preference, I suppose.

Regardless, Table 9 provides some excellent contextualizing data, really emphasizes that most people apply to multiple specialties.

Agreed.

Using First Choice Disciplines tend to underestimate the competitiveness of the smaller, more competitive disciplines since not every applicant to a discipline gets an interview. Those who do not get an interview will rank a different discipline first, hence reducing/underestimating this number.

Using Total Applicants tend to overestimate the competitiveness of larger, less competitive disciplines. Many applicants tend to back up with larger, less competitive disciplines, hence increasing/overestimating this number.

It is of course a lot more complicated than the above two paragraphs. The true "values" of measuring competitiveness likely lies in between the two.

I think Quotas work better to estimate the competitiveness of the smaller, more competitive disciplines, whereas the Percentage Matched (posted by Ralk & R<Py) work better to estimate the competitiveness of the larger, less competitive disciplines.

PS. I hope no readers takes offence at these discussions of "more competitive" and "less competitive" disciplines. All disciplines are equally respectable regardless of how "competitive" it is. This is not a pissing contest.

[rmorelan]

1 hour ago, R<Py said:

 

Someone at my school posted this @ralk

First choice discipline	Percent matched to first choice discipline	Percent matched to alternate discipline	Percent unmatched
anat pathology	90.9%	3.0%	6.1%
anesthe	70.3%	20.3%	9.4%
cardiac surg	70.0%	10.0%	20.0%
dermato	49.2%	44.3%	6.6%
diagnostic rad	78.7%	11.2%	10.1%
emerg	53.4%	40.7%	5.9%
family	96.6%	0.9%	2.4%
gen path	100.0%	0.0%	0.0%
gen surg	72.2%	15.7%	12.0%
hemato path	100.0%	0.0%	0.0%
interna med	84.1%	10.6%	5.4%
medical genetics	100.0%	0.0%	0.0%
medical microbio	100.0%	0.0%	0.0%
neurology	67.2%	21.3%	11.5%
peds neurology	66.7%	22.2%	11.1%
neuropathology	100.0%	0.0%	0.0%
neurosurgery	57.7%	11.5%	30.8%
nuclear med	100.0%	0.0%	0.0%
obsgyn	62.8%	25.7%	11.5%
ophtalmology	69.4%	18.4%	12.2%
orthopedic	82.5%	8.8%	8.8%
ENT	69.2%	12.8%	17.9%
peds	70.8%	25.1%	4.1%
PMR	80.6%	16.1%	3.2%
plastics	49.0%	18.4%	32.7%
psych	88.3%	8.3%	3.3%
Public health	84.2%	15.8%	0.0%
rad onc	100.0%	0.0%	0.0%
uro	59.6%	15.4%	25.0%
vascular surg	87.5%	12.5%	0.0%

well - that took some work!

[GrouchoMarx]

2 hours ago, rmorelan said:

well - that took some work!

Subspecialty surgery applicants are dedicated.

 

 

[shikimate]

With >10% of IM applicant match to alternative discipline and >5% unmatched, I think the notion that IM is an easy, safe field is clearly antiquated. This should be noted by future applicants.

[collegedude22]

1 hour ago, shikimate said:

With >10% of IM applicant match to alternative discipline and >5% unmatched, I think the notion that IM is an easy, safe field is clearly antiquated. This should be noted by future applicants.

Exactly. And those are only the stats for people who 1) got internal interviews, and 2) ranked internal first. I'm sure the numbers are worse for people who backed up with internal and didn't match to their speciality of choice. I also heard of a few internal gunners this cycle who got very few or zero interviews. The game is changing for internal medicine, which is not surprising. 

[LittleDaisy]

I found this on my daily newspaper: https://www.thestar.com/news/canada/2017/06/17/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads.html

My truly condolences to Robert Chu's family..Perhaps something needs to be done by the Canadian Medical schools to prevent this from happening again? or how the entire process of CaRMS is set up? Decreasing the number of medicals school spots versus residency spots? Allotting more spots to CMGs??

Giving the CaRMS match talk at the beginning of med school, and makes the competitive process brutally realistic to med-1s???

[GrouchoMarx]

53 minutes ago, LittleDaisy said:

I found this on my daily newspaper: https://www.thestar.com/news/canada/2017/06/17/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads.html

My truly condolences to Robert Chu's family..Perhaps something needs to be done by the Canadian Medical schools to prevent this from happening again? or how the entire process of CaRMS is set up? Decreasing the number of medicals school spots versus residency spots? Allotting more spots to CMGs??

Giving the CaRMS match talk at the beginning of med school, and makes the competitive process brutally realistic to med-1s???

this is the system we accept. if someone doesn't match, it's reflexively assumed that there is something inherently wrong with the applicant. Maybe because it is an easier conclusion to grasp. Rarely is any scrutiny given to the lack of accountability in the match system. The protected spots for IMGs who by definition are less qualified than their Canadian-trained counterparts further compounds the injustice. This guy killed himself, which is in my opinion a selfish and indefensible act but I bet most of us will be quick to judge him as having some sort of mental illness. Maybe he just couldn't live with the shame - he tried twice, and aimed very low the second time, and was still summarily rejected. Being rejected by radiology programs could be chalked up to a numbers game, no big deal. Being rejected by all the family and psych programs would cause me to strongly doubt myself, as this guy probably had. I know had I been rejected by pathology programs - programs that anyone with a pulse can enter - I'd feel lower than dirt. 

 

A possible solution would be to open up the first round to all Canadian MD holders even if they have prior post-graduate training. But waiting for government-run organizations to do anything takes too long and can't be depended upon. 

 

the best bet for students today is to take their american steps and prepare residency applications for the USA. I don't know if this guy did that.

[LittleDaisy]

Yeah I personally find the stigma of unmatched applicants applying next cycle is terrible.

Not matched this year to a competitive program??..There must be something wrong with you, as thought by the selection committee...While backing up the following year, being rejected by primary care specialties while there are open spots after first iteration is heart-wrenching...

[goleafsgochris]

Ya I just read about Robert Chu.  With regards to his story specifically I doubt that will change anything TBH...you cant really say its the systems "fault" that he killed himself.  Presumably most of the other people who didn't match didn't kill themselves.  Even in his position, he still was not doing terribly.  If he managed to do some research/electives in family med, maybe got to know a program director or 2, I bet he could have been successful.  I would WAY rather be in his position at age 25 or so than to be older and still be applying to medical school...he may have simply lost that perspective.

It sounds harsh to bring it back to this, but stories like that really highlight the importance of applying broadly.  For most people it would be a lot better to do family med somewhere undesirable than to have nothing to do at all and to worry that your MD is useless.

I agree that the unmatched stigma is a terrible thing, but its hard to imagine a way that that could be changed. 

[ralk]

Chu's case has a terrible end and highlights some of the worst parts of the way our system is designed, particularly how little support students get through the matching process. Yet it's impossible to draw meaningful conclusions from his story - there's too much that is unknown about his particular situation. The Star articles don't help contextualize things much and I'm concerned about the quality of their fact-checking, as they make at least one factual error about the process that should have been easy to catch on editing (the number of residency spots reduced).

There are good reasons to consider adjustments to the CaRMS process, and I agree with the some of the positions Chu seems to have taken. We definitely need to get back to a higher ratio of residency spots to medical students, either by increasing residency positions or decreasing the number of graduating medical students (or both). I also agree that the current way our system treats IMGs is not fair to aspiring Canadian physicians or ideal for patients in Canada (while not being particularly great for IMGs either). We should be exploring ways to de-stigmatize unmatched 1st round applicants, though as many overcome that stigma, I'm not sure exactly how strong it is or what addressing it would entail. Likewise, while I strongly believe the current system over-emphasizes "commitment" to a specialty in applications, I'm not sure what steps could possibly be taken to reduce that on a system-wide level.

Yet, I'd be very wary of arguing changes to the CaRMS match or residency preparation in general based on the reactions of rejected applicants, even dramatic ones. People don't like setbacks, especially ones who have seen almost nothing but success in life up to that point, yet we shouldn't have a system where failure isn't an option. To the extent there is a connection between Chu's residency rejections and him taking his life, I'm hesitant to do as the Star articles imply and lay blame on the CaRMS system in general. Where I might direct a bit more scorn is on his school depending what kind of supports he was given before and after his CaRMS cycles, but again, this is hard to do with the details provided. We don't support students well at all, yet pile on the pressure at every stage.

On a much broader level, we need a medical system, education system, and society that is more comfortable with failure. goleafsgochris is absolutely right - he was not in a bad position, given the information provided. At 25 he had an MD and was finishing an MBA - even blunted by the lack of a residency, there's a lot he could have done with his life. He hit a set-back, a big one to be sure, but not one that couldn't be overcome. By the sounds of it, this was his first real taste of failure and may not have known how to deal with that failure effectively - that's the main take-away I get from this story.

[doc_doc_doc]

As ralk said, there are too many unknowns here to drawn general conclusions. Dr. Chu's passing is tragic and is if anything a highlight of the stress that medicine takes, how we define ourselves by it and that there needs to be support for all students, but especially those at risk of greater mental and emotional burden, such as unmatched students facing a new, unknown journey. 

[mononoke]

Schools do emphasize the 'apply broadly' and 'take your USMLEs' approach but unfortunately it may not be feasible for everyone. Coming from a 3yr program, Dr. Chu may not have had the time to take this exam. As well, more mature students who have partners and children may not have the luxury of packing up and moving anywhere in the country. Others might also not have the financial means to apply to 18+ programs (as was told to us by the CaRMS reps). It's easier said than done.

[hamham]

And yet we still continue to admit so many IMGs to our residency programs. I've said it before and I shall say it again: there is absolutely no valid reason for an IMG to match at the expense of a CMG, especially in less competitive fields like FM. Period. 

[GrouchoMarx]

1 hour ago, hamham said:

And yet we still continue to admit so many IMGs to our residency programs. I've said it before and I shall say it again: there is absolutely no valid reason for an IMG to match at the expense of a CMG, especially in less competitive fields like FM. Period. 

THATS RACEST!

No. I agree. You should see some of the path programs' residents. Some of the IMGs are numbskulls, yet we keep bringing them in for the government funding.

[GrouchoMarx]

6 hours ago, ralk said:

Chu's case has a terrible end and highlights some of the worst parts of the way our system is designed, particularly how little support students get through the matching process. Yet it's impossible to draw meaningful conclusions from his story - there's too much that is unknown about his particular situation. The Star articles don't help contextualize things much and I'm concerned about the quality of their fact-checking, as they make at least one factual error about the process that should have been easy to catch on editing (the number of residency spots reduced).

There are good reasons to consider adjustments to the CaRMS process, and I agree with the some of the positions Chu seems to have taken. We definitely need to get back to a higher ratio of residency spots to medical students, either by increasing residency positions or decreasing the number of graduating medical students (or both). I also agree that the current way our system treats IMGs is not fair to aspiring Canadian physicians or ideal for patients in Canada (while not being particularly great for IMGs either). We should be exploring ways to de-stigmatize unmatched 1st round applicants, though as many overcome that stigma, I'm not sure exactly how strong it is or what addressing it would entail. Likewise, while I strongly believe the current system over-emphasizes "commitment" to a specialty in applications, I'm not sure what steps could possibly be taken to reduce that on a system-wide level.

Yet, I'd be very wary of arguing changes to the CaRMS match or residency preparation in general based on the reactions of rejected applicants, even dramatic ones. People don't like setbacks, especially ones who have seen almost nothing but success in life up to that point, yet we shouldn't have a system where failure isn't an option. To the extent there is a connection between Chu's residency rejections and him taking his life, I'm hesitant to do as the Star articles imply and lay blame on the CaRMS system in general. Where I might direct a bit more scorn is on his school depending what kind of supports he was given before and after his CaRMS cycles, but again, this is hard to do with the details provided. We don't support students well at all, yet pile on the pressure at every stage.

On a much broader level, we need a medical system, education system, and society that is more comfortable with failure. goleafsgochris is absolutely right - he was not in a bad position, given the information provided. At 25 he had an MD and was finishing an MBA - even blunted by the lack of a residency, there's a lot he could have done with his life. He hit a set-back, a big one to be sure, but not one that couldn't be overcome. By the sounds of it, this was his first real taste of failure and may not have known how to deal with that failure effectively - that's the main take-away I get from this story.

Fucking up the match is a needlessly public and needlessly permanent failure.

[ralk]

12 hours ago, mononoke said:

Schools do emphasize the 'apply broadly' and 'take your USMLEs' approach but unfortunately it may not be feasible for everyone. Coming from a 3yr program, Dr. Chu may not have had the time to take this exam. As well, more mature students who have partners and children may not have the luxury of packing up and moving anywhere in the country. Others might also not have the financial means to apply to 18+ programs (as was told to us by the CaRMS reps). It's easier said than done.

I think once you're into the 2nd round, and particularly the 2nd cycle, geographical preferences and a desire for a cheap application fee lose their merits. It's by no means fun to move children around the country or uproot a significant other. Yet is that worth the professional, economic, and emotional difficulties experienced going unmatched? Likewise, CaRMS applications can get pretty expensive, but even in a worst-case scenario, we're talking a few thousands of dollars. Contrast that against the $100k+ required to get to CaRMS applications in the first place. More importantly, a single year lost to a missed CaRMS application costs no less than $150k in lost income over the long term. This can't be the time to be frugal.

9 hours ago, Cain said:

Fucking up the match is a needlessly public and needlessly permanent failure.

How do you suggest this be addressed? Getting programs to change their viewpoints on unmatched candidates is far easier said than done, particularly when they have sufficient current-year grads to choose from. Likewise, the only way I know about unmatched applicants is largely either through their own words, or through omission in steps that really can't be avoided. I'm at a bit of a loss as how to make going unmatched less public, since I can't think of ways anyone besides the candidate went out of their way to make it public.