Thoughts on this article?

[rmorelan]

1 minute ago, mcater2006 said:

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?

We track everything about it - we know their rematch rate later on, and what programs they end up in (if and when they do). Part of the problem though is there are still relatively few of them so there is always going to be a bit of individual circumstance into the mix that the statistics cannot easily show (mostly why exactly didn't they match - dumb luck, red flagged, geographically stuck, really gunning for something competitive to the exclusion of all else....)

It is around if I recall 70% first round match the follow year for unmatched people(?). If the unmatched numbers are rising we are going to have to see what impact that has on things. 

[mcater2006]

8 minutes ago, rmorelan said:

We track everything about it - we know their rematch rate later on, and what programs they end up in (if and when they do). Part of the problem though is there are still relatively few of them so there is always going to be a bit of individual circumstance into the mix that the statistics cannot easily show (mostly why exactly didn't they match - dumb luck, red flagged, geographically stuck, really gunning for something competitive to the exclusion of all else....)

It is around if I recall 70% first round match the follow year for unmatched people(?). If the unmatched numbers are rising we are going to have to see what impact that has on things. 

K that sounds more reasonable. I'm more relieved now.l

Yeah let's see what the long term impacts are with the rising unmatch rates.

[indefatigable]

1 hour ago, rmorelan said:

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).

 

With regards the US MLE scores, the closest analogy I can think of is the issues surrounding educational standardized testing in the US.  There is a very heavy reliance on those tests there, which creates incentives to "teach to the test", as there are significant rewards associated with higher test scores, as a way of proving better educational outcomes.  It's not to say that there isn't some validity to having objective standardized measurements, but when education becomes directed towards "test knowledge" then I think there could be issues.  The economic incentives to teach to the test would be very high for any school receiving a large number of CSAs.  

OTOH, Canadians I find are reluctant to address and find deficiencies within their own systems, and if there are problems then these should be more openly addressed.   I agree that there are probably brilliant IMG physicians in the world, just like in academia.  But in terms of matching, the CSA-IMGs are matching much more than immigrant IMGs.  To me, the CMG "raw material", in terms of academic ability, etc.., shouldn't be any worse than the CSA raw material - the difference would be at the educational level.  So if there is a problem, then it should be identified and remedied.

I agree with your accessibility points fully.  My understanding is that is Western instituted the Schulich scholarships for example, but I'm sure that this doesn't go far enough.  UofT I think has a bursary/scholarship system as well, but student debt is getting out of control.  This don't even tackle the extra challenges for a premed without a high SES background.  Unquestionably, they will have to work harder to get accepted to med school and probably have to take on more debt while in med school.  

 

[la marzocco]

1 hour ago, rmorelan said:

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).

The argument of quality leads us down to the path where there should not be spots earmarked for neither CMGs nor IMGs - it should just be the free for all then. If Canada were to adopt some sort of USMLE-esque standardized testing to evaluate all candidates entering residency and remove the streaming of CMGs and IMGs, then the quality argument would hold better for me. 

The cost argument is merely to underscore the economic inefficiencies of training someone on Canadian soil and to have them not match and not be added to the productive workforce in healthcare. Granted some CMGs should not be matched because of red-flags or real gaps in competency, but it is unlikely that the 120 CMGs that went unmatched last year were all like that. As you said, some didn't matched because of poor luck. If that is the case, then the cost argument would hold better for me. It is economically inefficient to train someone on Canadian soil and not have them be able to add productivity to the labour force. Whilst it is sunk cost, you are effectively stripping the individual's ability to provide returns to the healthcare sector. I am not talking about red-flagged individuals, but individuals who would have matched well if they were just luckier or was a bit smarter in how they did their electives.

As a side note, if we were to improve the current match rate for CMGs while maintaining the current matching format, they really need to pare down the Canadian medical school enrolment then. The slashing of residency spots across Canada (particularly Ontario) has made the ratio too tight. One remedy is to reduce seats to preserve the ratio, if we cannot move away from the current matching format.

 

[rmorelan]

3 hours ago, qnzjlo said:

The argument of quality leads us down to the path where there should not be spots earmarked for neither CMGs nor IMGs - it should just be the free for all then. If Canada were to adopt some sort of USMLE-esque standardized testing to evaluate all candidates entering residency and remove the streaming of CMGs and IMGs, then the quality argument would hold better for me. 

The cost argument is merely to underscore the economic inefficiencies of training someone on Canadian soil and to have them not match and not be added to the productive workforce in healthcare. Granted some CMGs should not be matched because of red-flags or real gaps in competency, but it is unlikely that the 120 CMGs that went unmatched last year were all like that. As you said, some didn't matched because of poor luck. If that is the case, then the cost argument would hold better for me. It is economically inefficient to train someone on Canadian soil and not have them be able to add productivity to the labour force. Whilst it is sunk cost, you are effectively stripping the individual's ability to provide returns to the healthcare sector. I am not talking about red-flagged individuals, but individuals who would have matched well if they were just luckier or was a bit smarter in how they did their electives.

As a side note, if we were to improve the current match rate for CMGs while maintaining the current matching format, they really need to pare down the Canadian medical school enrolment then. The slashing of residency spots across Canada (particularly Ontario) has made the ratio too tight. One remedy is to reduce seats to preserve the ratio, if we cannot move away from the current matching format.

 

ha - don't tempt them There are program directors that would want to do exactly that (remove all CMG vs IMG classifications and go for it). From there perspective why not - they just want to maximize the caliber of people in their program to make the next 2-5 years as easy as possible on themselves etc. 

There are some good arguments for reducing spots right now - we have major hiring backlogs in many fields and just too many people coming out to make it work. That is part of the problem 

I completely understand what you are saying about economic inefficiencies  . It feels wrong not to use someone you have training, and trained at a high cost no less. There are technicalities with the terms we are throwing around my economics professor would get mad at me for doing (unless you enjoy pain I don't recommend doing an economics degree, ha, I am glad I have one but their way of thinking at times is a bit warped)

 

[la marzocco]

31 minutes ago, rmorelan said:

ha - don't tempt them There are program directors that would want to do exactly that (remove all CMG vs IMG classifications and go for it). From there perspective why not - they just want to maximize the caliber of people in their program to make the next 2-5 years as easy as possible on themselves etc. 

There are some good arguments for reducing spots right now - we have major hiring backlogs in many fields and just too many people coming out to make it work. That is part of the problem 

I completely understand what you are saying about economic inefficiencies  . It feels wrong not to use someone you have training, and trained at a high cost no less. There are technicalities with the terms we are throwing around my economics professor would get mad at me for doing (unless you enjoy pain I don't recommend doing an economics degree, ha, I am glad I have one but their way of thinking at times is a bit warped)

Are you referring to marginal social costs and benefits and how the current system is inadequate in clearing market failure  

[ralk]

9 hours ago, rmorelan said:

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. 

 

Absolutely agree here, I already see some of these issues pop up in FM, since that's what weaker applicants and those who had the misfortune of going umatched get pushed towards. With suggestions going around that all schools should be guaranteeing their graduates an FM residency if they fail to match - a suggestion with some merit given how things tend to work out anyway - I do worry about primary care suffering further from less capable or poorly suited physicians.

[mcater2006]

12 hours ago, ralk said:

Absolutely agree here, I already see some of these issues pop up in FM, since that's what weaker applicants and those who had the misfortune of going umatched get pushed towards. With suggestions going around that all schools should be guaranteeing their graduates an FM residency if they fail to match - a suggestion with some merit given how things tend to work out anyway - I do worry about primary care suffering further from less capable or poorly suited physicians.

I have to say I like the "guaranteeing their graduates an FM residency if they fail to match" bit.

[rmorelan]

15 minutes ago, mcater2006 said:

I have to say I like the "guaranteeing their graduates an FM residency if they fail to match" bit.

I worry about a few things about it - would it  skew the selection process in somehow (now we have to make sure they are 100% going to be happy with FM because we have to potentially take them), and would people then be forced to do FM if they go unmatched (maybe not officially but will other resources be forth coming if they don't take it - I want more resources for the unmatched not less )

[mcater2006]

21 hours ago, rmorelan said:

I worry about a few things about it - would it  skew the selection process in somehow (now we have to make sure they are 100% going to be happy with FM because we have to potentially take them), and would people then be forced to do FM if they go unmatched (maybe not officially but will other resources be forth coming if they don't take it - I want more resources for the unmatched not less )

But that's the thing right? If FMs are kind enough to extend their olive branches (or rather life-saving buoys) to those struggling with matching, then by definition of equal reciprocal exchange those struggling with matching would have to take the opportunity (beggars can't be choosers), I mean this is infinitely better than throwing their 3/4 years of MD down the drain right? That's my viewpoint.

But as you rightly said a few posts ago, the real landscape is more complex, some people are stuck in geographic areas, some are obsessed with one specialty, etc. There is no one solution or resource that works with them all.

[rmorelan]

7 hours ago, mcater2006 said:

But that's the thing right? If FMs are kind enough to extend their olive branches (or rather life-saving buoys) to those struggling with matching, then by definition of equal reciprocal exchange those struggling with matching would have to take the opportunity (beggars can't be choosers), I mean this is infinitely better than throwing their 3/4 years of MD down the drain right? That's my viewpoint.

But as you rightly said a few posts ago, the real landscape is more complex, some people are stuck in geographic areas, some are obsessed with one specialty, etc. There is no one solution or resource that works with them all.

and yet a ton of people don't back up in our current system with family medicine - which by following your not unreasonable logic would simply be a "no brainer".  If getting family medicine is so much better than going unmatched then they should take every opportunity to ensure avoid it (they may not get accepted into their backup but that isn't really the point - you have some chance vs no chance if you don't ) 

but they don't back up with it - acting in part on the believe it is better to go unmatched than to do something you don't want to do. Part of that I think is just medical students are used to succeeding by this point - overcoming long odds is what got them there in the first place so I have to think that logic aside often on some level they don't think they will go unmatched regardless of the odds.   

[rmorelan]

On 12/3/2017 at 0:27 AM, la marzocco said:

Are you referring to marginal social costs and benefits and how the current system is inadequate in clearing market failure  

don't get me started

[mcater2006]

19 hours ago, rmorelan said:

and yet a ton of people don't back up in our current system with family medicine - which by following your not unreasonable logic would simply be a "no brainer".  If getting family medicine is so much better than going unmatched then they should take every opportunity to ensure avoid it (they may not get accepted into their backup but that isn't really the point - you have some chance vs no chance if you don't ) 

but they don't back up with it - acting in part on the believe it is better to go unmatched than to do something you don't want to do. Part of that I think is just medical students are used to succeeding by this point - overcoming long odds is what got them there in the first place so I have to think that logic aside often on some level they don't think they will go unmatched regardless of the odds.   

Couldn't agree with you more! This is now starting to remind me eerily of the "gambler's fallacy" or "gambler's streak". It's striking the similarities between the two!

[rmorelan]

3 hours ago, mcater2006 said:

Couldn't agree with you more! This is now starting to remind me eerily of the "gambler's fallacy" or "gambler's streak". It's striking the similarities between the two!

yeah I think it is the same thing I think at least in part. Bottom line is if you would then pick family medicine in the second round as an option there is no logical reason not to pick it and rank it after your first choice specialty in the first round (or basically rank it last ). You have to make that decision up front - would I rather go unmatched than do X. That question can swing both ways and that is fine, but it does focus the issue at hand

Also the idea of not matching is so stressful people don't even want to think about it. That doesn't encourage rational thought about it ha. 

[mcater2006]

On 12/6/2017 at 3:04 PM, rmorelan said:

yeah I think it is the same thing I think at least in part. Bottom line is if you would then pick family medicine in the second round as an option there is no logical reason not to pick it and rank it after your first choice specialty in the first round (or basically rank it last ). You have to make that decision up front - would I rather go unmatched than do X. That question can swing both ways and that is fine, but it does focus the issue at hand

Also the idea of not matching is so stressful people don't even want to think about it. That doesn't encourage rational thought about it ha. 

Fear induces irrationality. There is no arena where this statement is more true than that of CaRMS. Esp when talking about competitive specialties matching.