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What to do about CaRMS and matching in Canada


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We have quite a few different threads going on relating to this, so just wanted to put things in one place. With the CBC article out today and the CMAJ editorial out this week on the topic of CaRMS and what to do, the media, the public and physicians are looking for possible solutions - the UofT Dean tweeted today as well about looking for solutions. So, I figured, a dedicated thread with proposals to share ideas could be useful.

My own opinions on guiding principles of CaRMS/the Match: 

- Every graduating CMG deserves a fair opportunity to a residency position, and should be given priority over candidates trying to re-enter, IMGs, or last year's unmatched. Basically it should be such that if the student wants a spot, there will be a spot available in their graduating year, and they only become fully unmatched needing to go again the next year if they decline the available spot on their own terms. This would mean that (a) programs are not legally allowed to leave spots unfilled, and (b) there should be options to default into FM at your home school if nothing else is available. 

 

- For those that do go unmatched, there should be enough residency spots left over for a "round 3" of CaRMS. This would basically be a gamble to see if a spot is available in some other specialty, and if not then they should still have the option of defaulting to FM at their home program. Ideally, there would be very few people in this category based on point #1 above. These people would take priority over IMGs, with IMGs being able to pick up whatever is leftover - Canadian taxpayers have no obligations to take IMGs. 

 

- All MDs who have passed LMCC part 1 should be able to work as a physician extender/moonlight in certain clinical settings. This will allow students who do go unmatched the opportunity to pick up a shift or two and help cover costs of the unmatched year.


- No student is or should be guaranteed the residency specialty of their desire. No, not everyone who wants to be a plastic surgeon will or should be a plastic surgeon. This should be made extremely clear even when starting med school, and setting people up to have backup careers in mind. In med school, it's often thought that it's an "even playing field" on day 1, but that is 100% not true. There are people in my class who were destined to be pediatricians before med school even started that no late comer to the specialty would have any chance of displacing from a position in peds. Same for plastics, derm, ophtho etc - the entry CV of people in med school is incredibly broad and it can't be expected that your chances on day one of matching into a certain specialty is just as good as anyone elses. At the end of the day, while medicine is our job, we are doing it to provide a service to the community and so there needs to be a proper distribution of students going into specialties in need rather than the specialty the absolutely want (and I'm sure most people day before med school acceptance offers came out would have been happy to do anything so long as they got accepted). 


- The subjective aspect of CaRMS is a good thing and should remain as such. In basically every other job, selection of the right candidate comes down to a combination between on paper performance, and who the person actually is. There is probably no rigidly defined weighting to each of those, and that weighting could change year to year depending on the needs of the company. Moreover, this weighting probably differs company to company as they have different needs. Same for residency - the needs of a rural FM program are different from an academic neurosurgery program, which may be different even within themselves across the country. So instituting standardized exam scores, publication counts, grades etc as standardized measures to form rank lists of candidates would not be appropriate - it should be the individual program's discretion to decide what their priority is for their program and the community they serve, and then accept candidates accordingly. This is just how employment works. Within this freedom, however, refer to my first point that they still should not be allowed to leave a position unfilled if there are candidates interested in taking the spot.

 

- There should be an adjustment to med school admissions, residency positions (mostly FM) or both.

 

Feel free to add, comment, tear apart etc. 

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Practically my advice to M1-M4s: don't wait for the government to come up with solutions. Stay open minded, do the Step 1 regardless of your personal preference or ideology towards USA. Better to be d

You are more optimistic about the utility of family med training than me.  From what Ive seen that extra (2nd) year adds fairly little.  Make it so the intern year requires some time in walk in clinic

Nah, I'm really glad I went to a three year school with a family. I started med school after my third year of undergrad, and I'm going into family med. Because of that, my total length of education wi

I agree with these tenets, but my thoughts are.. legislative changes take time.. and whilst lobbying efforts must continue.. these medium-term solutions are not going to address the immediate concerns. The cascading effect is already taking a big toll and will continue to cascade. I think the deans of medicine across Canada can show leadership and curtail enrolment at the medical school level until more concrete actions from the provincial governments are made. 

I am not sure whose jurisdiction enrolment # falls under in other provinces, but the government has a lot of say in enrolment in Quebec with recent curtailments across the 4 Quebec medical schools. If anything, each school themselves should preserve the minimum 1:1.1 ratio. Let's say, school A has 110 residency spots allocated by the province, then they should produce only 100 graduates. Again, this is an immediate solution until a more sustainable or longer-term solution can be thought out across all stakeholders.

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13 minutes ago, la marzocco said:

I agree with these tenets, but my thoughts are.. legislative changes take time.. and whilst lobbying efforts must continue.. these medium-term solutions are not going to address the immediate concerns. The cascading effect is already taking a big toll and will continue to cascade. I think the deans of medicine across Canada can show leadership and curtail enrolment at the medical school level until more concrete actions from the provincial governments are made. 

I am not sure whose jurisdiction enrolment # falls under in other provinces, but the government has a lot of say in enrolment in Quebec with recent curtailments across the 4 Quebec medical schools. If anything, each school themselves should preserve the minimum 1:1.1 ratio. Let's say, school A has 110 residency spots allocated by the province, then they should produce only 100 graduates. Again, this is an immediate solution until a more sustainable or longer-term solution can be thought out across all stakeholders.

even if they cut enrollment - which is an option - it would still take 4 years to do anything at least. The numbers for the coming year are set and there are 3 more years coming through. They mentioned in the article 140 students unmatched by 2021 (close to an entire medical school) . We would need an even more immediate solution than that. Some form of one time only perhaps family medicine (only because politically it would sell) set of spots to fix what is already going on(?)

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9 minutes ago, rmorelan said:

even if they cut enrollment - which is an option - it would still take 4 years to do anything at least. The numbers for the coming year are set and there are 3 more years coming through. They mentioned in the article 140 students unmatched by 2021 (close to an entire medical school) . We would need an even more immediate solution than that. Some form of one time only perhaps family medicine (only because politically it would sell) set of spots to fix what is already going on(?)

I agree. Really, FM is the only specialty that is probably uniformly underemployed across Canada so I think a boost in FM numbers (especially to rural zones) makes sense as an immediate option. Logistically, FM training is probably the only one that is doable on a short term quick fix basis as well without creating more problems. For instance, it is not easy to find jobs in surgery as it is, and if IM is increased, that will do nothing but make more unmatched rates at the fellowship level without a subsequent increase in numbers for all the available fellowship options too. Then things like path, rads, anes, derm, pmr - these are things that usually need at least a bigger centre or reasonably large sized community and not as easy to boost resident numbers due to less available preceptors and resources to do so. Not to mention they are small programs (e.g. pmr and derm haves maybe 30 spots each across Canada?) so even doubling the number of residency positions for these types of specialties would do nothing other than make it more challenging for training and jobs without making a dent in the number of unmatched.

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25 minutes ago, rmorelan said:

even if they cut enrollment - which is an option - it would still take 4 years to do anything at least. The numbers for the coming year are set and there are 3 more years coming through. They mentioned in the article 140 students unmatched by 2021 (close to an entire medical school) . We would need an even more immediate solution than that. Some form of one time only perhaps family medicine (only because politically it would sell) set of spots to fix what is already going on(?)

Fair point. There has been some talks about creating supernumerary FM positions for CaRMS 2019 and a conversion of 1/2 of IMG-designated spots to CMG-designated for the first iteration. Both measures are slated for a time-limited basis - maybe 2-3 years. Hopefully these more immediate stopgaps come through.

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Just now, ZBL said:

I agree. Really, FM is the only specialty that is probably uniformly underemployed across Canada so I think a boost in FM numbers (especially to rural zones) makes sense as an immediate option. Logistically, FM training is probably the only one that is doable on a short term quick fix basis as well without creating more problems. For instance, it is not easy to find jobs in surgery as it is, and if IM is increased, that will do nothing but make more unmatched rates at the fellowship level without a subsequent increase in numbers for all the available fellowship options too. Then things like path, rads, anes, derm, pmr - these are things that usually need at least a bigger centre or reasonably large sized community and not as easy to boost resident numbers due to less available preceptors and resources to do so. Not to mention they are small programs (e.g. pmr and derm haves maybe 30 spots each across Canada?) so even doubling the number of residency positions for these types of specialties would do nothing other than make it more challenging for training and jobs without making a dent in the number of unmatched.

even with the under employment issue with family doctors - it is always so tricky. I mean just because 800K people in Ontario don't have a family doctor doesn't actually mean 800K don't have one and are actively seeking one. There are a lot of people that simply have never bothered to go get a family doctor ( I don't have one right now for instance - my old one retired a long while ago and I have never sought out another one as I move around). people are always throwing around all this facts without fully context for political reasons. Annoying. 

Still if there is an area where they could be absorbed in some fashion in would be family medicine.  

and yeah - one of the effects of just having so many doctors graduating is there aren't a lot of jobs in many areas. Your completely right - giving residency positions to people in those fields - even if people want them - just defers the problem even further where it is even harder to fix (an unemployed graduating med student stucks, but I would argue an unemployable fully trained orthopedic surgeon is even worse).   

As OP mentioned I really think the deans do have to get together on this - this is really a major point and where leadership needs to come from. Part of the problem is their budgets are in many ways directly connected to the number of students they have. There are a lot of people in their particular positions at the school now after this long with our high enrollments that have based their careers in large part on the number of students currently there. All those satellite campuses for instance (which are more expensive to run, and are all highly political - closing them would not be fun in those terms). 

 

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Practically my advice to M1-M4s: don't wait for the government to come up with solutions. Stay open minded, do the Step 1 regardless of your personal preference or ideology towards USA. Better to be doing even just a transitional year in USA than go unmatched. Also remember a bad Step 1 score does not affect CaRMS. 

 

What will happen is there'll be another brain drain, and one day the electorate will wake up panicking (look at the brain drain of NHS), and politicians will suddenly scramble to find solution. When will this "Minsky Moment" happen? who knows.

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Bit hesitant to join in as I can't quite even call myself as being part of the community yet but I think there is one aspect that people could be overlooking in all this. I think it's important to consider why residency spots are being cut. From experience, I can't say it's because there is an oversupply of services, but from what I hear from many of my friends in policy, it's that physician compensation is too high. Government can't afford to keep up with paying for all these doctors so I think they are trying to cut from source -- the residency spots which they do have some way to control.

I think it's important for physicians to recognize also that although I personally know many who are in it to serve the patients/public, I also know many who are in it to fatten their wallets. For a lot of policy makers they encounter many hinderances to innovation because of issues with compensation, and some even go onto say that we won't see any meaningful innovation in healthcare until all physicians are salaried. Obviously there are a lot of interest groups within medicine that works to look out for their own specialty or demographic. For instance, perhaps heavy costs of physician compensation now is costing young med students from being able to match. Just an idea, not tested by any means, but I think it could be possible.

Basically, I think there should be some immediate actions that could take place to limit lack of matching as much as possible (many great ideas already being discussed here), but in the long run, I think physician as interest group have to look inwards and consider what's the cost they are incurring to the public. Scope of practice will vastly change as AI and modern computational technologies really take off in all fields including medicine, and with a universally funded system, you're only increasing the selection pressure for yourself to be phased out more quickly if you are costing the system heavily without much added value...

Just my 2 cents. My hearts go out to those unmatched facing a lot of hardships regardless. Really good to be talking openly about it to try to mitigate in the future.

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2 minutes ago, rmorelan said:

even with the under employment issue with family doctors - it is always so tricky. I mean just because 800K people in Ontario don't have a family doctor doesn't actually mean 800K don't have one and are actively seeking one. There are a lot of people that simply have never bothered to go get a family doctor ( I don't have one right now for instance - my old one retired a long while ago and I have never sought out another one as I move around). people are always throwing around all this facts without fully context for political reasons. Annoying. 

Still if there is an area where they could be absorbed in some fashion in would be family medicine.  

and yeah - one of the effects of just having so many doctors graduating is there aren't a lot of jobs in many areas. Your completely right - giving residency positions to people in those fields - even if people want them - just defers the problem even further where it is even harder to fix (an unemployed graduating med student stucks, but I would argue an unemployable fully trained orthopedic surgeon is even worse).   

As OP mentioned I really think the deans do have to get together on this - this is really a major point and where leadership needs to come from. Part of the problem is their budgets are in many ways directly connected to the number of students they have. There are a lot of people in their particular positions at the school now after this long with our high enrollments that have based their careers in large part on the number of students currently there. All those satellite campuses for instance (which are more expensive to run, and are all highly political - closing them would not be fun in those terms). 

 

8

For the deans part... AFMC has a committee on this issue, so the deans are trying to tackle this issue. I believe with the increased pressure exerted by UGME faculty and the public on PGME this year, PGME would be more inclined to use their funding to create spots on unmatched students than before.

I agree with above that whatever approach we take should be three-pronged - curtail medical school enrollment + increase residency positions + increase physician jobs in underserved areas. This might be associated with a pay cut for physicians in the future, especially for primary care, because money has to come from somewhere.

I remember following the advocacy process when the IFHP got cut - physicians overwhelmingly spoke up about it on a national level and the issue was addressed within a year. If people can do that for those they have never met in their life, they would be willing to support their doctors. In Ontario at least, with the next election coming up so quickly, the most effective way to persuade the ministry to increase the residency positions as a short-term solution would be to make the issue political. Whether it is writing letters, townhalls, demonstrations - honestly, the bigger the better. Go out there, look your best, speak well, let people know about the problem. If the matter is known to the public, the current political climate would not allow them to turn a blind eye on this issue.

 

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1 hour ago, la marzocco said:

Fair point. There has been some talks about creating supernumerary FM positions for CaRMS 2019 and a conversion of 1/2 of IMG-designated spots to CMG-designated for the first iteration. Both measures are slated for a time-limited basis - maybe 2-3 years. Hopefully these more immediate stopgaps come through.

I'm not sure they could easily create enough FM or any other residency positions fast enough to have a significant impact.   The easiest thing is to change whatever's in place which is the designated IMG spots.  Everything else is more medium or long term - which needs to be addressed as well, but won't change much in the short-term.  I could be way-off base, but bureaucracy usually takes time.  
 

1 hour ago, plastics91 said:

Bit hesitant to join in as I can't quite even call myself as being part of the community yet but I think there is one aspect that people could be overlooking in all this. I think it's important to consider why residency spots are being cut. From experience, I can't say it's because there is an oversupply of services, but from what I hear from many of my friends in policy, it's that physician compensation is too high. Government can't afford to keep up with paying for all these doctors so I think they are trying to cut from source -- the residency spots which they do have some way to control.

I think it's important for physicians to recognize also that although I personally know many who are in it to serve the patients/public, I also know many who are in it to fatten their wallets. For a lot of policy makers they encounter many hinderances to innovation because of issues with compensation, and some even go onto say that we won't see any meaningful innovation in healthcare until all physicians are salaried. Obviously there are a lot of interest groups within medicine that works to look out for their own specialty or demographic. For instance, perhaps heavy costs of physician compensation now is costing young med students from being able to match. Just an idea, not tested by any means, but I think it could be possible.

Basically, I think there should be some immediate actions that could take place to limit lack of matching as much as possible (many great ideas already being discussed here), but in the long run, I think physician as interest group have to look inwards and consider what's the cost they are incurring to the public. Scope of practice will vastly change as AI and modern computational technologies really take off in all fields including medicine, and with a universally funded system, you're only increasing the selection pressure for yourself to be phased out more quickly if you are costing the system heavily without much added value...

Just my 2 cents. My hearts go out to those unmatched facing a lot of hardships regardless. Really good to be talking openly about it to try to mitigate in the future.

   It's an interesting point - but I wonder about the IMG impact to the Canadian physician workforce.  Not only do IMG match directly, many CSA-IMGs do training elsewhere (usually the US) and come back to Canada.  If they're looking at the total workforce, then I think this is something that needs to be considered.  Unfortunately it could mean leaving IMGs even further in the lurch.  Without getting into the whole IMG debate, I wonder how many IMGs ultimately come back and work in Canada.  

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3 minutes ago, la marzocco said:

Fair point. There has been some talks about creating supernumerary FM positions for CaRMS 2019 and a conversion of 1/2 of IMG-designated spots to CMG-designated for the first iteration. Both measures are slated for a time-limited basis - maybe 2-3 years. Hopefully these more immediate stopgaps come through.

complex problems usually require complex solutions after all :)

 I do think part of the problem is that no one in charge of the process benefits directly or indirectly by any of the obvious solutions. More spots? High costs to the government and they would have to agree to it, existing doctors might get less money/jobs if more people are on the seen and the downstream hospital costs go up. Cut spots? The university, the program lose money, all the students wanting to be doctors (and the premed programs for those) won't be happy, and all the politicians   from areas where there is or there is perceived to be at least a shortage would get bad press (and now to add political pressure doctor shortages are back in news).  

 

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14 minutes ago, rmorelan said:

complex problems usually require complex solutions after all :)

 I do think part of the problem is that no one in charge of the process benefits directly or indirectly by any of the obvious solutions. More spots? High costs to the government and they would have to agree to it, existing doctors might get less money/jobs if more people are on the seen and the downstream hospital costs go up. Cut spots? The university, the program lose money, all the students wanting to be doctors (and the premed programs for those) won't be happy, and all the politicians   from areas where there is or there is perceived to be at least a shortage would get bad press (and now to add political pressure doctor shortages are back in news).  

 

It's a good point.  For example - the QC health minister is an easy target for criticism for having cut medical school enrolment.  As long as there are people without family docs,  then cutting looks bad.  If there's one move which would be rather neutral to the status-quo of all the stakeholders it's changing the status of the IMG positions.  There'd be protest, but I doubt people would be marching to Queen's park nor getting media attention, etc..  The people who would most be upset are CSA-IMGs, but I don't think they'd get much public attention.

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3 minutes ago, marrakech said:

It's a good point.  For example - the QC health minister is an easy target for criticism for having cut medical school enrolment.  As long as there are people without family docs,  then cutting looks bad.  If there's one move which would be rather neutral to the status-quo of all the stakeholders it's changing the status of the IMG positions.  There'd be protest, but I doubt people would be marching to Queen's park nor getting media attention, etc..  The people who would most be upset are CSA-IMGs, but I don't think they'd get much public attention.

I would still say the problem of not having a family doctor often has less to do with the number of family doctors then where those family doctors live, and as long as you get paid exactly the same to work everywhere it will be hard to attract people to particular areas. That problem is hardly new and no one has figured out an easy way of dealing with it :)

Those CSA-IMG people have put up a lot of resistance in the past - I mean I wouldn't count them out quite so easily. The truth is no matter what you do you are going to get heat for it - someone, somewhere will not be happy. What ever the solution will be it will not be universally popular - which is part of why no one has done much.

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4 hours ago, rmorelan said:

I would still say the problem of not having a family doctor often has less to do with the number of family doctors then where those family doctors live, and as long as you get paid exactly the same to work everywhere it will be hard to attract people to particular areas. That problem is hardly new and no one has figured out an easy way of dealing with it :)

Those CSA-IMG people have put up a lot of resistance in the past - I mean I wouldn't count them out quite so easily. The truth is no matter what you do you are going to get heat for it - someone, somewhere will not be happy. What ever the solution will be it will not be universally popular - which is part of why no one has done much.

Sure - but cutting medical-school positions on the surface looks bad, whether it's truly affecting the nature of the problem or not.

Yeah - but I'd argue that unhappy faculty of medicine (students + administrators)  at UofT getting public attention are much more of a concern than unhappy CSA-IMGs.  I definitely agree they'd be unhappy - just think the magnitude of the unhappiness would be less than the current situation.  A public protest is a big deal.  

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13 minutes ago, Coby said:

Most Img spots come with return of service. If those spots are opened up to cmgs with no return of service, could that create more of an issue for patient care  in less desirable locations to practise?

In Ontario at least, the ROS is effectively meaningless.  I suspect the measures will be provincial  rather than pan-Canadian - I.e. no coordinated effort.  BC might do something different.

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2 hours ago, Coby said:

Most Img spots come with return of service. If those spots are opened up to cmgs with no return of service, could that create more of an issue for patient care  in less desirable locations to practise?

In Ontario, RoS means you can't practice in the city of Toronto and a few other municipalities and Ottawa, unless of course you practice academic medicine. Translation? You can practice anywhere you please. 

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1. Agree with the idea that a certain % of IMG spots should be converted to CMG spots until most of the backlog clears. It's a reasonable short term solution until schools are willing to cut medical school admissions (or the government is willing to add more residency spots back). I doubt the backlash would be severe as long as this was temporary.

With regards to the ROS they could just leave it tagged on for the new spots.

2. I don't think the 'physician extender' idea is realistic since it'd cost the government money. IMO better to use that money to fund more residency spots.

3. Agree that home schools should be forced to be take on adequate individuals they graduate as a FM residents (i.e. Should be open to anyone without red flags; should be open to those with academic red flags as long as they have had appropriate remediation). This would also place more pressure on schools to cut back on medical school enrollment.

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I think the way to go would be allow unmatched people to start a transitional year internship, and the home medical school would be obligated to provide this to any qualified graduate who goes unmatched. They're paid as an R1 resident, have full R1 responsibilities, then they do a year similar to a core clerkship year, i.e. 4-6 years of each core rotation, plus electives or additional core rotations based on the intern's interests.

Then they can reapply as R2 residents in their field of choice, or at the very least transition into R2 of family practice.

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6 minutes ago, shematoma said:

I think the way to go would be allow unmatched people to start a transitional year internship, and the home medical school would be obligated to provide this to any qualified graduate who goes unmatched. They're paid as an R1 resident, have full R1 responsibilities, then they do a year similar to a core clerkship year, i.e. 4-6 years of each core rotation, plus electives or additional core rotations based on the intern's interests.

Then they can reapply as R2 residents in their field of choice, or at the very least transition into R2 of family practice.

In theory that is a good idea - only issue each every specialty out there has a different R1 year all according to the particular specialty. We have moved quite far away at this point from a common first year. Often now for instance when you transfer from one specialty to another - even as a R1 - you end up repeating a year. The idea they can apply though still even directly into R1 again into the program of their choice might work - now with better clinical experience/letters perhaps(?) 

That would still cost more - and that raises another point. To fix this and keep it fixed there has to be some form of punishment/negative consequence to the government for having someone go unmatched. Right now there really isn't. All the spots are still filled for the hospitals, it is cost neutral for them.....and in fact the entire system currently forces people to go to places they otherwise may not which is to the governments advantage. If you want to a fix the problem you have to make sure there is some motivation permanently for them to do so.

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10 minutes ago, rmorelan said:

In theory that is a good idea - only issue each every specialty out there has a different R1 year all according to the particular specialty. We have moved quite far away at this point from a common first year. Often now for instance when you transfer from one specialty to another - even as a R1 - you end up repeating a year. The idea they can apply though still even directly into R1 again into the program of their choice might work - now with better clinical experience/letters perhaps(?) 

That would still cost more - and that raises another point. To fix this and keep it fixed there has to be some form of punishment/negative consequence to the government for having someone go unmatched. Right now there really isn't. All the spots are still filled for the hospitals, it is cost neutral for them.....and in fact the entire system currently forces people to go to places they otherwise may not which is to the governments advantage. If you want to a fix the problem you have to make sure there is some motivation permanently for them to do so.

Ya, the transitional/intern year might not entirely line up with the first year of a residency although I don't know why they can't "catch up" later so to speak, and even now some programs still say their first year is a rotating "general clinical" year. At worst, perhaps people need to repeat a few rotations or add some remediation - but we're supposedly now moving to a competency based system that should be less rigid in its timing?

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1 minute ago, shematoma said:

Ya, the transitional/intern year might not entirely line up with the first year of a residency although I don't know why they can't "catch up" later so to speak, and even now some programs still say their first year is a rotating "general clinical" year. At worst, perhaps people need to repeat a few rotations or add some remediation - but we're supposedly now moving to a competency based system that should be less rigid in its timing?

under competency based education it might work better when it is fully integrated. Right now the main issue would be the shear massive amount of rules and regulations about what a program must do to meet college requirements - set numbers of blocks in set things etc. 

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http://healthydebate.ca/opinions/should-we-embrace-a-return-of-the-rotating-internship 

In the words of the infamous Brooksbane, wherever he is now: 

"The return of the rotating internship will be meaningless unless general licensure is awarded with it.

The entire problem with the system now is that in order to practice general medicine, one has to “specialize” in family medicine. To do so is a career dead end, so students opt to specialize instead.

In the time before CaRMS, all graduating MDs were awarded a general license after completing a rotating internship. These doctors were then free to apply as many times as possible for specialty positions if they desired. Most did not want to re-train, and so the public’s access to primary care was better"

 

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34 minutes ago, distressedpremed said:

http://healthydebate.ca/opinions/should-we-embrace-a-return-of-the-rotating-internship 

In the words of the infamous Brooksbane, wherever he is now: 

"The return of the rotating internship will be meaningless unless general licensure is awarded with it.

The entire problem with the system now is that in order to practice general medicine, one has to “specialize” in family medicine. To do so is a career dead end, so students opt to specialize instead.

In the time before CaRMS, all graduating MDs were awarded a general license after completing a rotating internship. These doctors were then free to apply as many times as possible for specialty positions if they desired. Most did not want to re-train, and so the public’s access to primary care was better"

 

To be perfectly honest, I don't think we should be giving a license to practice to those with only 1 year of internship. 

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Without getting into the IMG debate, touching IMG spots might be a hard sell politically this year. Since 2016,  Canada decreased the statement of needs for J1 Visa for most specialties but FM and Canadian IMGs are now only allowed to pursue 1 year subspecialties in the USA. This year, many IMGs who matched to the US found themselves unable to get a statement of need. Their effectively walking around with 200k to 400k debt. People are super angry as their livelihoods are ripped from them. Think you can imagine the backlash :( from families, and IMG who have nothing to lose. I could be wrong and overestimating the power of IMGs?? Maybe no one cares?? I just know IMGs are fighting hard this year to shef light on this issue to policy makers.

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