Thoughts on this article?

[yup]

http://www.cbc.ca/amp/1.4223028

[Bambi]

If you wish to practice med in Canada, persevere in applying to Canadian medical schools only, or be prepared to suffer the consequences. 

[TARS]

Don't know enough to comment on the whole CaRMS IMG CMG situation, but damn she gave up on Canadian medical school applications at the age of 21 because she didn't get interviews and decided to go to the Caribbeans? If she wanted to practice back in Canada, she should've done the proper research on IMGs coming back, and realized she should've worked on her app for a few more years and kept applying to Canadian schools instead.

Also, could someone please clarify - what was stopping her from coming back to Canada to practice seeing as she already completed her residency in the states? Was it just the fact that Ontario didn't give her the fellowship? Or was she not able to be board certified for her residency for some reason?

[moonlitocean]

Those students chose to go to the Carribeans, they should have known the risks and hurdles. Nobody in Canada has to cater to them.

Why should anybody entertain the idea of making Carribean students' paths easier when we already have CMGs like Robert Chu not being able to match for two years??

 

There's a reason that the Carribean schools take so many incompetent students, because they are for-profit degree mills. 

 

Here's what US hospital program directors have to say about these students (taken from SDN): "bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior."

I say keep them the hell away from our healthcare system.

[moonlitocean]

9 hours ago, TARS said:

Don't know enough to comment on the whole CaRMS IMG CMG situation, but damn she gave up on Canadian medical school applications at the age of 21 because she didn't get interviews and decided to go to the Caribbeans? If she wanted to practice back in Canada, she should've done the proper research on IMGs coming back, and realized she should've worked on her app for a few more years and kept applying to Canadian schools instead.

Also, could someone please clarify - what was stopping her from coming back to Canada to practice seeing as she already completed her residency in the states? Was it just the fact that Ontario didn't give her the fellowship? Or was she not able to be board certified for her residency for some reason?

Giving up on her Canadian application at 21: classic example of someone who wants to be in the medical field but doesn't wanna put in the efforts.

[la marzocco]

The article is not balanced. 

16 minutes ago, moonlitocean said:

Those students chose to go to the Carribeans, they should have known the risks and hurdles. Nobody in Canada has to cater to them.

Why should anybody entertain the idea of making Carribean students' paths easier when we already have CMGs like Robert Chu not being able to match for two years??

 

There's a reason that the Carribean schools take so many incompetent students, because they are for-profit degree mills. 

I agree. The article is very unbalanced in this respect. It highlights the difficulty of foreign-trained Canadians (i.e., IMGs), but they barely mentioned the hurdles of CMGs, as if to pass off CMGs as having minimal hurdles. Robert Chu, as you mentioned, is a very recent case. The growing number of unmatched CMGs is the primary concern.

Also, there are 338 dedicated spots for IMGs in the first iteration. Arguably, they should resolve the CMG unmatched situation first and some of these 338 spots should be shuttled to CMGs to prevent cases like Robert Chu. 

IMGs should fill in remaining spots that CMGs cannot fill. The article does not shed light on the CMGs who have struggled numerous times and continued to preserver round around round to get into a Canadian medical school.

[moonlitocean]

2 minutes ago, qnzjlo said:

The article is not balanced. 

I agree. The article is very unbalanced in this respect. It highlights the difficulty of foreign-trained Canadians (i.e., IMGs), but they barely mentioned the hurdles of CMGs, as if to pass off CMGs as having minimal hurdles. Robert Chu, as you mentioned, is a very recent case. The growing number of unmatched CMGs is the primary concern.

Also, there are 338 dedicated spots for IMGs in the first iteration. Arguably, they should resolve the CMG unmatched situation first and some of these 338 spots should be shuttled to CMGs to prevent cases like Robert Chu. 

IMGs should fill in remaining spots that CMGs cannot fill.

The fact that there are even spots reserved for IMGs when some CMGs can't match is simply ridiculous. 

I fully agree that IMGs should only be used to fill remaining spots 

[la marzocco]

29 minutes ago, moonlitocean said:

The fact that there are even spots reserved for IMGs when some CMGs can't match is simply ridiculous. 

I fully agree that IMGs should only be used to fill remaining spots 

In case anyone wants more details on the "dedicated" IMG spots. http://carms.ca/wp-content/uploads/2017/05/Table_14_Dedicated_Quota_offered_to_IMG_Applicants_by_Discipline_English.pdf

The point of contention is that Canadian taxpayers pay significant dollars to support Canadian medical schools. 

"Based on the above figures, the start-up cost per new seat in medicine will be about 1.5 million for Laurentian University and one million for the University of British Columbia. By way of comparison, the University of Washington announced a medical school expansion project in July 2006, based on a distributed campus model, and gave the following figures, in American dollars, when it expanded its medical program by 20 seats: $5.5 million to cover annual operating costs, $4.9 million in start-up costs and $7.5. million in capital costs. In Canadian dollars, the figures are $6,132,500 for annual operating costs, $5,463,500 for start-up costs and $8,362,500 for capital costs. Since 20 new seats are to be created, the start-up costs per new seat are estimated at $273,175.23." (http://publications.gc.ca/collections/collection_2009/sc-hc/H29-1-2009E.pdf)

These are significant public monies - the cases where CMGs are unmatched, that's potentially millions of public money gone to waste or at least inefficient if they are force to defer a year of training to match in the second year. From this perspective alone, CMGs should be given preference in matching and all CMGs should be matched before IMGs even begin matching. 

[Pippa756]

On 7/31/2017 at 9:22 PM, qnzjlo said:

In case anyone wants more details on the "dedicated" IMG spots. http://carms.ca/wp-content/uploads/2017/05/Table_14_Dedicated_Quota_offered_to_IMG_Applicants_by_Discipline_English.pdf

The point of contention is that Canadian taxpayers pay significant dollars to support Canadian medical schools. 

"Based on the above figures, the start-up cost per new seat in medicine will be about 1.5 million for Laurentian University and one million for the University of British Columbia. By way of comparison, the University of Washington announced a medical school expansion project in July 2006, based on a distributed campus model, and gave the following figures, in American dollars, when it expanded its medical program by 20 seats: $5.5 million to cover annual operating costs, $4.9 million in start-up costs and $7.5. million in capital costs. In Canadian dollars, the figures are $6,132,500 for annual operating costs, $5,463,500 for start-up costs and $8,362,500 for capital costs. Since 20 new seats are to be created, the start-up costs per new seat are estimated at $273,175.23." (http://publications.gc.ca/collections/collection_2009/sc-hc/H29-1-2009E.pdf)

These are significant public monies - the cases where CMGs are unmatched, that's potentially millions of public money gone to waste or at least inefficient if they are force to defer a year of training to match in the second year. From this perspective alone, CMGs should be given preference in matching and all CMGs should be matched before IMGs even begin matching. 

Couldn't agree more with the above.

[mcater2006]

Having finished a 5-year residency and seen the boom/bust cycles, pains of having residents defecting/switching out of own program (and needing to pick up calls and other slack), and of course the tragic case of Robert Chu, I propose the following system:

Let me first list the three primary issues that my proposed system is trying to minimize:

1. residents defecting/switching out of program

2. programs (esp ones in northern Ontario) who will simply dangle their hands and refuse to accept residents and leave those spots empty rather than risk matching inferior (as in loyalty) residents (the "not mo money, not mo problem" attitude)

3. the IMG reserved spots

My proposed system:

1. residents are not allowed to defect/switch from their programs, furthermore residencies in northern Ontario should additionally mandate minimum 5-year ROS for BOTH CMGs and IMGs

2. IMG reserved spots should be totally abolished, IMGs should only be used to fill remaining spots

3. programs will not be allowed to leave residency spots empty

4. after first round, and BEFORE IMGs are allowed in, I propose the addition of a CMG-ONLY SECOND ROUND: no interviews during this round, it happens almost entirely automatically, what happens is the computer takes the list of unmatched CMGs from the first round, enters them into a random lottery algorithm that assigns them to unfilled residency spots across the country, once assigned, becomes binding on both parties: i.e. school not allowed to toss CMG (rule number 3-ish), and CMG not allowed to toss school (rule number 1)

What are your thoughts on this? Can point #4 of my proposed system be further improved?

[ralk]

7 hours ago, mcater2006 said:

Having finished a 5-year residency and seen the boom/bust cycles, pains of having residents defecting/switching out of own program (and needing to pick up calls and other slack), and of course the tragic case of Robert Chu, I propose the following system:

Let me first list the three primary issues that my proposed system is trying to minimize:

1. residents defecting/switching out of program

2. programs (esp ones in northern Ontario) who will simply dangle their hands and refuse to accept residents and leave those spots empty rather than risk matching inferior (as in loyalty) residents (the "not mo money, not mo problem" attitude)

3. the IMG reserved spots

My proposed system:

1. residents are not allowed to defect/switch from their programs, furthermore residencies in northern Ontario should additionally mandate minimum 5-year ROS for BOTH CMGs and IMGs

2. IMG reserved spots should be totally abolished, IMGs should only be used to fill remaining spots

3. programs will not be allowed to leave residency spots empty

4. after first round, and BEFORE IMGs are allowed in, I propose the addition of a CMG-ONLY SECOND ROUND: no interviews during this round, it happens almost entirely automatically, what happens is the computer takes the list of unmatched CMGs from the first round, enters them into a random lottery algorithm that assigns them to unfilled residency spots across the country, once assigned, becomes binding on both parties: i.e. school not allowed to toss CMG (rule number 3-ish), and CMG not allowed to toss school (rule number 1)

What are your thoughts on this? Can point #4 of my proposed system be further improved?

Interesting proposal, address some key areas of concern. However, I think it would fall apart in a few ways.

To start, points #2 and #4 are likely non-starters, as the system changed to dual streams (rather than CMGs first only) due to a legal challenge of discrimination by IMGs. I have a feeling if that's the case, your proposed system, being equally rigid to the old system pre-2007, would fail an inevitable further legal challenge.

Enforcing an ROS for all northern Ontario residencies I think would backfire. Northern residencies are intended as a way to bring practitioners to the north by way of exposure, making it so that residents get comfortable in the area and wanting to settle their long-term. It seems to work to an extent. An ROS would turn a lot of otherwise-interested parties away from northern residencies, since even people inclined to practice in northern Ontario aren't going to want to give up their flexibility of location. That leaves those positions getting filled by those who were either 100% going to stay anyway and those who have no better choices, who will finish their ROS and leave. Northern Ontario needs physicians, but it needs physicians long-term, not just a revolving door of physician who will leave at the first opportunity.

Lastly, making people lock into their program is going to be a non-starter from many parties in the residency system for good reason. People switch residencies for a lot of reasons, including some very serious ones. It's not uncommon for people to switch due to significant burnout in their fields, meaning forcing them to continue in their own residency could endanger their health, the health of their patients, or cause them to quit medicine entirely. It sucks, especially for small programs, when a resident leaves a hole in the call schedule, and residency programs need to have some contingency plan for this possibility (in some programs, likelihood) that isn't just "all residents work more". Yet, preventing residents from switching programs could result in the same holes in the schedule anyway, with additional harms to physicians and patients on top of it.

[mcater2006]

1 hour ago, ralk said:

Interesting proposal, address some key areas of concern. However, I think it would fall apart in a few ways.

To start, points #2 and #4 are likely non-starters, as the system changed to dual streams (rather than CMGs first only) due to a legal challenge of discrimination by IMGs. I have a feeling if that's the case, your proposed system, being equally rigid to the old system pre-2007, would fail an inevitable further legal challenge.

Enforcing an ROS for all northern Ontario residencies I think would backfire. Northern residencies are intended as a way to bring practitioners to the north by way of exposure, making it so that residents get comfortable in the area and wanting to settle their long-term. It seems to work to an extent. An ROS would turn a lot of otherwise-interested parties away from northern residencies, since even people inclined to practice in northern Ontario aren't going to want to give up their flexibility of location. That leaves those positions getting filled by those who were either 100% going to stay anyway and those who have no better choices, who will finish their ROS and leave. Northern Ontario needs physicians, but it needs physicians long-term, not just a revolving door of physician who will leave at the first opportunity.

Lastly, making people lock into their program is going to be a non-starter from many parties in the residency system for good reason. People switch residencies for a lot of reasons, including some very serious ones. It's not uncommon for people to switch due to significant burnout in their fields, meaning forcing them to continue in their own residency could endanger their health, the health of their patients, or cause them to quit medicine entirely. It sucks, especially for small programs, when a resident leaves a hole in the call schedule, and residency programs need to have some contingency plan for this possibility (in some programs, likelihood) that isn't just "all residents work more". Yet, preventing residents from switching programs could result in the same holes in the schedule anyway, with additional harms to physicians and patients on top of it.

Thanks ralk for clearing up a lot of areas where I did not have a good understanding of the relevant background histories. It's ironic how I could finish the whole 16-year premed-med journey and still remain ignorant to so many key facts and histories that have shaped our medical landscape as it stands today.

Now I fully understand why the dual streams are set up the way it is, which, in retrospect, is yet another reflection of our great country with its inherent strength in diversity. I duly take back my point #2, having made it in complete ignorance of the history pre-2007 and the legal challenge of discrimination by IMGs.

As for "revolving door of physicians", if, let's say, the ROS is increased up from 5 years to 10 years, then even if it is still revolving door, the door revolves so slowly so as to bring some semblance of continuity of care? I am sure that there are counterpoints that you are going to raise to that.

With the ROS up to 10 years will bring the real aspect of burnout which altogether brings us to the last point: to this I again agree with your appraisal. And there does not seem to be any good solution to this. I have only two points: 1. arguably that would nevertheless still be a better outcome than Robert Chu 2. burnout will occur, too, under our current system.

[mcater2006]

1 hour ago, ralk said:

To start, points #2 and #4 are likely non-starters, as the system changed to dual streams (rather than CMGs first only) due to a legal challenge of discrimination by IMGs. I have a feeling if that's the case, your proposed system, being equally rigid to the old system pre-2007, would fail an inevitable further legal challenge.

Ralk I was also just talking to my mom about this. She said that the legal challenge was in all likelihood brought up by "Canadian IMGs" (variously referred to as CSAs and CMAs in other posts done by rmorelan and others), namely rich spoiled Canadian kids of prominent Canadian doctors or politicians, who took the easy way out by going to UK/Australia/Carribean, probably didn't even do pre-med, and then want to cash back into Canadian residencies. Since their families are rich and powerful, their voices are heard by the court and so resulted in the dual-streams system change in 2007. This is quite drastically different from my earlier stereotype of the legal challenge having been brought up by "taxi-driving broken-English international IMGs". In all fairness I think my mom's version makes much more sense. I wonder what are your thoughts.

[ralk]

1 hour ago, mcater2006 said:

Thanks ralk for clearing up a lot of areas where I did not have a good understanding of the relevant background histories. It's ironic how I could finish the whole 16-year premed-med journey and still remain ignorant to so many key facts and histories that have shaped our medical landscape as it stands today.

Now I fully understand why the dual streams are set up the way it is, which, in retrospect, is yet another reflection of our great country with its inherent strength in diversity. I duly take back my point #2, having made it in complete ignorance of the history pre-2007 and the legal challenge of discrimination by IMGs.

As for "revolving door of physicians", if, let's say, the ROS is increased up from 5 years to 10 years, then even if it is still revolving door, the door revolves so slowly so as to bring some semblance of continuity of care? I am sure that there are counterpoints that you are going to raise to that.

With the ROS up to 10 years will bring the real aspect of burnout which altogether brings us to the last point: to this I again agree with your appraisal. And there does not seem to be any good solution to this. I have only two points: 1. arguably that would nevertheless still be a better outcome than Robert Chu 2. burnout will occur, too, under our current system.

I'll admit that I'm not a fan of ROS approaches in general. They work well enough as a temporizing measure when nothing else is available, but they're on tenuous legal standing as freedom of movement is a fundamental right in Canada. That's why even the current 5 year ROS for IMGs aren't overly restrictive geographically, and they come with out clauses that carry financial penalties only. If all residencies in northern Ontario were made to be 10 years and restricted to practicing in northern Ontario, I suspect we'd see a combination of quality medical students avoiding northern Ontario residencies (and hence worsening physician quality in northern Ontario), many people buying out of their ROS early to work elsewhere (especially given the high salaries in northern Ontario), and legal challenges against the ROS or some of its conditions.

I agree though, there's no easy answer to the problem.

53 minutes ago, mcater2006 said:

Ralk I was also just talking to my mom about this. She said that the legal challenge was in all likelihood brought up by "Canadian IMGs" (variously referred to as CSAs and CMAs in other posts done by rmorelan and others), namely rich spoiled Canadian kids of prominent Canadian doctors or politicians, who took the easy way out by going to UK/Australia/Carribean, probably didn't even do pre-med, and then want to cash back into Canadian residencies. Since their families are rich and powerful, their voices are heard by the court and so resulted in the dual-streams system change in 2007. This is quite drastically different from my earlier stereotype of the legal challenge having been brought up by "taxi-driving broken-English international IMGs". In all fairness I think my mom's version makes much more sense. I wonder what are your thoughts.

Oh no doubt the main legal agitators in any change to the IMG system would be brought forth by CSAs who are much better connected and wealthier than other IMGs. That's a matter of public perception though, it wouldn't change the legality of any attempts at altering that system. They have the money to fight those changes and quite likely enough legal standing to prevent a complete exclusion from the first part of the matching process.

[indefatigable]

5 hours ago, ralk said:

To start, points #2 and #4 are likely non-starters, as the system changed to dual streams (rather than CMGs first only) due to a legal challenge of discrimination by IMGs. I have a feeling if that's the case, your proposed system, being equally rigid to the old system pre-2007, would fail an inevitable further legal challenge.

2 hours ago, ralk said:

Oh no doubt the main legal agitators in any change to the IMG system would be brought forth by CSAs who are much better connected and wealthier than other IMGs. That's a matter of public perception though, it wouldn't change the legality of any attempts at altering that system. They have the money to fight those changes and quite likely enough legal standing to prevent a complete exclusion from the first part of the matching process.

It's possible to get a sense of what was going on by looking at old premed 101 threads.  From what I gather there were charter of rights and freedoms challenges going through the courts, but aside from Manitoba (where there had been a successful challenge), it was sort a pre-emptive change by the AFMC.  Certain contextual factors have changed though: i) CSAs now make up the majority of successful IMG matches; ii) there doesn't seem to be an acute shortage of physicians, especially in Ontario and iii) there's a much higher number of CMGs going unmatched (with reduced resident/graduate margins).  In terms of i), I'd argue that CSAs are on much shakier legal ground.  It's one thing to argue being born and trained in Country X then coming to Canada and being unable to practice, while it's another to leave Canada for non-LCME education and then feel unfairly treated.

 I think a legally sound resolution, in light of iii) especially, is either reducing the number of IMG parallel stream positions OR allowing CMGs to apply to the parallel stream positions concurrently.  The second option would thus keep the ROS system going, which could satisfy the provinces and would also allow IMGs to apply to the first round.  The first option would reduce the number of ROS spots, but would otherwise function equivalently.  

 

 

[SunAndMoon]

I'm having difficulty understanding the "I can't give up on my dream therefore I have no choice" argument given that you can always try again the year after. 

[indefatigable]

43 minutes ago, SunAndMoon said:

I'm having difficulty understanding the "I can't give up on my dream therefore I have no choice" argument given that you can always try again the year after. 

How about to start there’s a huge stigma attached and rarely really works out - think Robert Chu.  The biggest risk of going unmatched is having been unmatched.  Not to mention personal or financial cost especially for someone with a family.  There's very little support for unmatched students (can't usually do electives) which makes matching the next year even more difficult.  So it's pretty much, the "end of dreams".

[rmorelan]

1 hour ago, calcan said:

How about to start there’s a huge stigma attached and rarely really works out - think Robert Chu.  The biggest risk of going unmatched is having been unmatched.  Not to mention personal or financial cost especially for someone with a family.  There's very little support for unmatched students (can't usually do electives) which makes matching the next year even more difficult.  So it's pretty much, the "end of dreams".

It certainly a big challenge. The unmatched rate of subsequent matching in their target field (or for that matter any field) is comparatively very low. It also seems to get lower if you go unmatched again and go into yet another round. 

If doing electives, more research, developing contacts is useful then you would think someone unmatched would start to gain advantages - they don't. Part of this is that some people by shear randomly luck - mostly too many applicants in a particular area in a particular year - get squeezed out. Those people you would think should in a perfect world become better applicants over time. However some of it are that some people really do have red flags, and just aren't that good at medicine, or at least good at the fields they are interested in,  but are stuck with massive debit - something that seems to be getting worse for following years - are still going for medicine. 

 

 

[SunAndMoon]

2 hours ago, calcan said:

How about to start there’s a huge stigma attached and rarely really works out - think Robert Chu.  The biggest risk of going unmatched is having been unmatched.  Not to mention personal or financial cost especially for someone with a family.  There's very little support for unmatched students (can't usually do electives) which makes matching the next year even more difficult.  So it's pretty much, the "end of dreams".

I was commenting on the article, which discusses carib med students who had to leave because they couldn't "give up on their dreams".

Hard to comment on matching and the failure to match, it's a much more complex process and a lot more factors involved.

[rmorelan]

11 hours ago, ralk said:

Interesting proposal, address some key areas of concern. However, I think it would fall apart in a few ways.

To start, points #2 and #4 are likely non-starters, as the system changed to dual streams (rather than CMGs first only) due to a legal challenge of discrimination by IMGs. I have a feeling if that's the case, your proposed system, being equally rigid to the old system pre-2007, would fail an inevitable further legal challenge.

Enforcing an ROS for all northern Ontario residencies I think would backfire. Northern residencies are intended as a way to bring practitioners to the north by way of exposure, making it so that residents get comfortable in the area and wanting to settle their long-term. It seems to work to an extent. An ROS would turn a lot of otherwise-interested parties away from northern residencies, since even people inclined to practice in northern Ontario aren't going to want to give up their flexibility of location. That leaves those positions getting filled by those who were either 100% going to stay anyway and those who have no better choices, who will finish their ROS and leave. Northern Ontario needs physicians, but it needs physicians long-term, not just a revolving door of physician who will leave at the first opportunity.

Lastly, making people lock into their program is going to be a non-starter from many parties in the residency system for good reason. People switch residencies for a lot of reasons, including some very serious ones. It's not uncommon for people to switch due to significant burnout in their fields, meaning forcing them to continue in their own residency could endanger their health, the health of their patients, or cause them to quit medicine entirely. It sucks, especially for small programs, when a resident leaves a hole in the call schedule, and residency programs need to have some contingency plan for this possibility (in some programs, likelihood) that isn't just "all residents work more". Yet, preventing residents from switching programs could result in the same holes in the schedule anyway, with additional harms to physicians and patients on top of it.

I would also have to point out that sometimes it seemly is not appropriate for some people to be in some fields - we are not all universally transportable in to any field in medicine - and forcing someone to do that will just end up with a resident that is effectively being tortured being stuck in a career they don't want - there are definitely fields of medicine I know I would simply be terrible at. Put me in those fields and I would simply leave medicine all together. 

Programs will never accept a scenario where they are forced to take some if they feel that person is not "cut out" for that field. Even if that person really, really wants that field. It isn't good for the program, not good for patients in the end, and even not good at all for the resident. They shouldn't be hoarding spots either but both sides have to be able to say no that isn't going to work. 

 

[indefatigable]

9 minutes ago, SunAndMoon said:

I was commenting on the article, which discusses carib med students who had to leave because they couldn't "give up on their dreams".

Hard to comment on matching and the failure to match, it's a much more complex process and a lot more factors involved.

Sorry - all the unmatched discussion.  You're absolutely right!  

[rmorelan]

On 7/31/2017 at 9:22 PM, qnzjlo said:

In case anyone wants more details on the "dedicated" IMG spots. http://carms.ca/wp-content/uploads/2017/05/Table_14_Dedicated_Quota_offered_to_IMG_Applicants_by_Discipline_English.pdf

The point of contention is that Canadian taxpayers pay significant dollars to support Canadian medical schools. 

"Based on the above figures, the start-up cost per new seat in medicine will be about 1.5 million for Laurentian University and one million for the University of British Columbia. By way of comparison, the University of Washington announced a medical school expansion project in July 2006, based on a distributed campus model, and gave the following figures, in American dollars, when it expanded its medical program by 20 seats: $5.5 million to cover annual operating costs, $4.9 million in start-up costs and $7.5. million in capital costs. In Canadian dollars, the figures are $6,132,500 for annual operating costs, $5,463,500 for start-up costs and $8,362,500 for capital costs. Since 20 new seats are to be created, the start-up costs per new seat are estimated at $273,175.23." (http://publications.gc.ca/collections/collection_2009/sc-hc/H29-1-2009E.pdf)

These are significant public monies - the cases where CMGs are unmatched, that's potentially millions of public money gone to waste or at least inefficient if they are force to defer a year of training to match in the second year. From this perspective alone, CMGs should be given preference in matching and all CMGs should be matched before IMGs even begin matching. 

There are arguments I think for CMG advantages and placements.  The economic ones I find aren't for me at least that compelling though. Ok so you have invested X in a person to become a doctor. Then you get an IMG instead also invested in somehow by someone else or some other government with what you feel is a higher level of skill - a better doctor. You cannot change the money you put into the CMG - that is a sunk cost and sunk costs shouldn't be used to make the decision - no matter what that money is gone. The question is (using ha cold probably inhuman logic) is what will create the best outcome for society, and the best health care system? Take the "better" IMG (lets for argument sake say they really are better) with their free medical training prior and often a ROS that serves some other public policy objective? Or stick with the CMG just because you already invested in them ? 

If people start think IMGs can be better and use economics then they would be tempted to decrease CMG spots and take on more IMG. That is the opposite probably of what most people on the forum want - which is why purely throwing around costs is dangerous. The real question is our training system putting out better doctors than those we can get with IMGs? If we are paying so much are we getting value in return? 

[indefatigable]

18 minutes ago, rmorelan said:

There are arguments I think for CMG advantages and placements.  The economic ones I find aren't for me at least that compelling though. Ok so you have invested X in a person to become a doctor. Then you get an IMG instead also invested in somehow by someone else or some other government with what you feel is a higher level of skill - a better doctor. You cannot change the money you put into the CMG - that is a sunk cost and sunk costs shouldn't be used to make the decision - no matter what that money is gone. The question is (using ha cold probably inhuman logic) is what will create the best outcome for society, and the best health care system? Take the "better" IMG (lets for argument sake say they really are better) with their free medical training prior and often a ROS that serves some other public policy objective? Or stick with the CMG just because you already invested in them ? 

If people start think IMGs can be better and use economics then they would be tempted to decrease CMG spots and take on more IMG. That is the opposite probably of what most people on the forum want - which is why purely throwing around costs is dangerous. The real question is our training system putting out better doctors than those we can get with IMGs? If we are paying so much are we getting value in return? 

This kind of situation crops up all the time in scientific academic positions.  Essentially, Canadian PhDs are often deemed uncompetitive in favour of foreign hires (or even Canadians with usually US PhDs).  There are some contextual differences, though: i) communication is even more important in medicine - and often non-CSA IMGs struggle ; ii) health-care is a huge priority at all levels of government and Canadians in general; and iii) the level of investment is significantly higher.  If CSA-IMGs are prioritized there's an accessibility question - many pre-meds are not able to attend foreign schools, which even if of great quality, would essentially mean putting the path to being a physician out of reach from a number of premeds and more or less stating that Canadian training is inferior.  I'd argue that taking a look at what a foreign school might be doing "better" could be a place to start - is it a higher level of investment? different processes? educational techniques? then what exactly is causing the problem?  In theory, the Ontario CMGs say, should have been at least as strong candidates as the CSAs at the beginning of med school.

[mcater2006]

2 hours ago, calcan said:

How about to start there’s a huge stigma attached and rarely really works out - think Robert Chu.  The biggest risk of going unmatched is having been unmatched.  Not to mention personal or financial cost especially for someone with a family.  There's very little support for unmatched students (can't usually do electives) which makes matching the next year even more difficult.  So it's pretty much, the "end of dreams".

This makes me soooooooooooo scared!!!!!!! I remember my CaRMS days was like...medical tourism. That attitude definitely won't fly these days.

But this also makes me curious, with unmatching rates climbing up by the year, I've only heard of Robert Chu. The other CMGs that go unmatched, do they eventually match, or something else happens? Does anyone know?

[rmorelan]

1 minute ago, calcan said:

This kind of situation crops up all the time in scientific academic positions.  Essentially, Canadian PhDs are often deemed uncompetitive in favour of foreign hires (or even Canadians with usually US PhDs).  There are some contextual differences, though: i) communication is even more important in medicine - and often non-CSA IMGs struggle ; ii) health-care is a huge priority at all levels of government and Canadians in general; and iii) the level of investment is significantly higher.  If CSA-IMGs are prioritized there's an accessibility question - many pre-meds are not able to attend foreign schools, which even if of great quality, would essentially mean putting the path to being a physician out of reach from a number of premeds and more or less stating that Canadian training is inferior.  I'd argue that taking a look at what a foreign school might be doing "better" could be a place to start - is it a higher level of investment? different processes? educational techniques? then what exactly is causing the problem?    

Sure I agree with all of that  Kind of is the point - economics are less important than quality (particularly as you are always just trading spots from a CMG to someone that had their education paid for with no cost to you). 

We already have a huge accessibility problem. In 2007, a decade ago, the average income of the family of a Western medical student was 140K (median not mean so not skewed by high earners as much). Since then tuition has already jumped by about 100%. My point is they aren't paying too much attention to inaccessibility overall - or at least not doing anything about it. In fact it is getting I suspect worse. What they are looking at is cost containment. They are like a broken record with that. 

Some IMGs do definitely struggle on language - but of course not all and many are CSAs as well so not really a problem there. Ha, they often come with objective grades to show their abilities - USMLE scores usually so it is kind of hard to argue sometimes with their skills in that regard. One issue at the policy level it is hard for us to "prove" we are better than anyone else since we don't really standardize things in a way that would help with that. 

Our most powerful argument for CMG will always be quality over cost I suspect, and we do have to continuously attempt to become better. 

Though you do through all of the competitive forces, and the shear fact that Canada is small relative to the world market of potential IMGs, that it might ultimately end up that there isn't much difference between IMGs and CMGs (IMGs may overall be worse but the 0.1% of them probably are academically more gift just by shear numbers).