Jennifer Smith* was hoping to see the words “general surgery” on her computer screen when she logged into the Canadian Residency Matching Service (CaRMS) website on March 1 of this year. She had applied to every general surgery program across the country. Instead, it said: “We regret to inform you that you have not matched to a program. Please click here for more information.” That was at noon. An hour later, Smith had to attend a meeting set up by her medical school for all the fourth-year students who hadn’t matched with a residency program. “I didn’t have time to cry or react,” she says. “The deadline for the second iteration match was in one week. I had to get myself together emotionally and figure out what to do next.”
What Smith is going through is the nightmare scenario of graduating medical students across Canada, and an increasingly real one as “match day” becomes more and more about not only where but also whether they will do their residency training. Medical school graduates need to complete 2–5 years of residency in a specialty—like family medicine, general surgery or neurology—to be able to practise medicine in Canada. Students apply for spots through a process administered by CaRMS that includes written applications, interviews and completing a ranked list of the programs they want to attend. The programs similarly rank student applicants, and an algorithm matches programs with students. There are two rounds of matching, with the majority of students matching in the first round and many of the remaining matching in the second.
However, in 2017, a record 68 out of 2,813 students did not match with any program after both rounds. This year’s number will not be known until April 11, when the second iteration is complete, but it’s expected to be even higher—anecdotal reports have it that as many as 222 students are unmatched after the first round. A report released this past January by the Association of Faculties of Medicine of Canada (AFMC) suggests that Canada is on pace to leave 82 students without a residency this year; by 2020, the number of unmatched is predicted to be 118. This is more than an entire class of students at most medical schools.
Why are more students going unmatched?
Myriad factors are in play here, not least the competing interests of the multiple stakeholders: provinces, which fund the residency positions and are concerned with the health needs of their populations (and thus want to fund more or less of certain types of specialties); residency programs, which want the best possible candidates and may only be able to offer a certain number of positions based on teaching capacity; and students, who are pursuing closely held career and life goals.
The overarching issue is pure numbers—more applicants every year versus a static or diminishing number of residency training positions. (Ontario cut 25 resident positions in 2016 and has been poised to cut 25 more, though this has been delayed.) There are two key dynamics contributing to this growing applicant pool. The first is that unmatched students from one year often re-enter the competition the following year. According to the AFMC’s calculations, if the first iteration was comprised only of current-year graduates of Canadian medical schools, the ratio between applicants and jobs would stay steady at roughly 1:1.056. But when you add in the unmatched graduates from prior years, “that ratio starts plummeting down,” says Genevieve Moineau, president and CEO of the AFMC, such that it is currently about 1:1.026, and is forecasted to dip to 1:0.99 by 2021. In other words, in 2021, for every applicant, there will be less than one training position available.
The second is that, as of 2007, most provinces have been allowing graduates of international programs to compete in the second iteration, greatly increasing the amount of competition. International graduates applying to the match are typically physicians who completed their training in other countries and may have already had significant careers before coming to Canada. They have also have completed a series of Canadian exams. In the past four years, international graduates have filled up to 50 percent of spots in the second iteration.
How does the system need to change?
There is consensus among groups like the AFMC, the Canadian Federation of Medical Students (CFMS) and the Ontario Medical Students Association (OMSA) that the provinces must add more residency positions, “to help us get back to a more reasonable ratio,” says Moineau. The AFMC has its eye on 1:1.1 as the target—meaning about 110 jobs for every hundred graduates—while the CFMS prefers 1:1.2, allowing even more room for students to match with programs they’re interested in. Moineau recognizes that this is a “big request” of governments which are “struggling to maintain the costs of their delivery of health care.”
Nevertheless, it’s the key thing that needs to change, say Andy Ng, who graduated from the University of Ottawa’s MD/Ph.D. program in 2017. In his fourth year of med school, Ng applied to neurology programs across the country and received interviews at almost all of them. “I had a pretty good CV, I did really well in my clinical rotations, and I got very good references,” he says. He believes that most schools were speaking to 40 to 50 students—for two or three positions. Still, he was shocked when he didn’t match. In the second round, Ng applied for family medicine which seemed to him a likely match—there were several positions in Ottawa and Calgary (there were more in Quebec, but to meet the needs of French-speaking communities it was expected that physicians in those programs would speak French, which Ng did not). In the end, only seven of the 14 U of O students who went unmatched in the first iteration found a spot in the second, and Ng was not one of them.
The second iteration is another focus of the AFMC’s recommendations. They are asking governments to revert back to a system in which only Canadian graduates are eligible to compete for the majority of spots left vacant after the first round. International medical graduates, by contrast, feel they deserve greater access to a medical career in Canada by being able to compete for the residual positions in the second round.
How do medical schools need to change?
After Ng went unmatched in the second iteration, he enrolled in the University of Ottawa’s fifth year of medical school, which allowed him to do 30 weeks of electives. “The first time around at U of O, we only got 10 weeks, pre-application (to CaRMS), and so most people spread themselves really thin, did two-week electives at many different places,” says Ng. In his fifth year, Ng spent up to six weeks in programs he was interested in, getting to know the residents and staff physicians, working to distinguish himself. In the process, he discovered a love for pediatric neurology—a different specialty than the one he’d applied for the previous year—and on March 1 of this year, he matched to that program at the University of Alberta.
The option to do a fifth year is an example of what the AFMC had in mind when recommending that faculties create “appropriate structures, policies and procedures” to help unmatched graduates find success. “Not only is it the medical schools’ responsibility to look after their students, it’s also their responsibility to support their graduates,” says Moineau.
There is work to do at the front end of medical school, as well. Primary care and generalist specialities are often where doctors are most needed, but some faculties appear to perpetuate the idea of family medicine as a “fallback” specialty, the thing you do if you can’t do anything else. “You get your lectures and education from specialists in big academic hospitals, and so you get a very skewed view of the appeal of primary care,” says Michael Herman, who graduated from McMaster in 2012. “They come in with their biases and their perspectives, the trope of the surgeon or the internist deriding the job the primary care doctor has done prior to the patient seeing the specialist.”
AFMC president and CEO Moineau says that medical schools are increasingly trying to prepare students for the fact that up to 50 percent of them will be matched into family medicine. “We’re trying to explain to students from the first week they come into medical school, ‘You have to realize that you are going to be supported now by society, by taxpayers, and what’s going to happen to you is in part going to be dictated by societal needs,” she says. Students must be flexible about their goals and apply more broadly to the match. Moineau says that the AFMC is trying to get a similar message to the residency programs, encouraging them to rank more students. “You may have your two top preferred candidates, but maybe there are 10 candidates who you say, yes, these people would be OK,” she says. “Well, then make sure that you put all 10 in the list of candidates you’re willing to accept.”
Smith, the student who is currently unmatched after this year’s first round, says she didn’t receive enough encouragement to adapt and make herself more competitive. “I heard the first-years received a scary email about backing up with family medicine after this year’s match results,” she says. “But going through, I was pretty set on not backing up. I didn’t get too much pushback. I met with our school career counsellor throughout and when I told them I’m only applying to general surgery, they told me based on my CV, they don’t seem too concerned.”
How can we better support unmatched graduates?
Unmatched students often experience a great deal of emotional distress and a sense of isolation and stigma. For many, connecting with peers going through the same thing is critical. Ng says that the meeting organized by U of O to help unmatched students prepare them for the second iteration was as—if not more—important for the opportunity to see that he wasn’t alone. “There were 13 other people in the same situation,” he says. “And [for] a lot of them, there were no red flags in their applications, they would make very good clinicians.” This year, in anticipation of Match Day, the CFMS set up a mentoring network, connecting previously unmatched students with those who have just learned they did not match. Ng is part of this network, and so is Jillian Follett, a graduate of Memorial who is now working as a family and emergency medicine doctor in Havre-Saint-Pierre, Quebec, and who went unmatched in 2014. “It’s great that the CFMS is doing this, but it would be cool if the universities already had it set up,” she says.
Herman, who didn’t match to anesthesiology in the first round of CaRMS, likens the experience to a “scarlet letter” in the medical community. “It’s like a shameful secret, ‘Oh, so and so didn’t match, did you hear?’” Herman, who now works in emergency medicine in St. John’s Newfoundland, recently posted his own story on Facebook, and several people have reached out to thank him for telling his story. Talking openly about not matching, he says, “normalizes the process and takes it away from this big, scary colossal, terminal failure.”
With only one surgical spot left in this year’s second round, Smith has accepted that she will likely not be a surgeon. At this point she just wants to match somewhere and move on. “We see all of our friends posting their CaRMS match results on Facebook,” she says. “We see pictures taken at the ‘Match Party’ on our news feed. It feels like everyone else is excited to move on, and we are held back, not knowing what the future holds. The worst part is getting asked the dreaded question, ‘What are you doing next year?’”
*details changed for reasons of privacy
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With respect- I have only responded to the comments you and others have made on here about the superiority of Canadian medical schools, how people like my daughter have “paid their way in” to other “easier schools”, how she and others like her should have carried on applying to Canadian schools and how, because they did not, they must be inherently less intelligent. All of this has been said in complete ignorance of what school my daughter attends and her personal circumstances including financial situation, standing in medical school, what she had to do to secure a place in a UK medical school and what her studies have entailed.
I do not believe this discussion forum is intended for the personal remarks and name calling which have been expressed here.
There seems to be a fundamental difference in understanding between commenters here regarding whether or not the transition from medical school to residency represents an open competition for all available residency positions. The question is whether the CaRMS process is a competition for Canadian jobs or a part of the ongoing education of Canadian physicians. I would argue two points:
1) The incredibly high cost of medical education in Canada means that without a reasonable expectation of matching to post-graduate training, medical education is only available to individuals who either independently or with the support of their families are able to pay their tuition out-of-pocket or are able to service their substantial debt after graduation without working as a physician. This would inevitably mean that Canadian medical schools will draw their student populations almost exclusively from higher socio-economic backgrounds that can afford to bear this significant financial risk. increasing quality of care through the diversification of the medical community is an important and ongoing project of all Canadian medical school. Numerous studies show that medical students from marginalized and rural communities are significantly more likely to return to practice in these communities, and are more likely to specialize in Family Medicine. Given that these are the communities most in need of physicians, an open competition for residency positions will create a physician workforce that favours sub-specialized practice in urban and academic centres. This leads to my second point-
2) The CaRMS match is an important avenue for health care human resource planning. Whether you agree with it or not, the training of physicians in Canada is heavily subsidized by provincial governments at both the undergraduate and post-graduate level. The number of currently available residency positions closely match the number of graduating CMGs, who at the time of graduation from medical school represent a significant investment in health care human resources by the government. The expectation is that Canadian medical schools select students who will become competent Canadian physicians. Every year, there are many more qualified applicants who would become excellent physicians than there are spots available to train them. This does not change the fact that the admissions process is designed to select future physicians, not future CMGs who will be forced to compete against IMGs for extraordinarily limited residency positions. The point of divergence between commenters here is whether the point of entry to Canadian medical practice is upon admission to medical school or upon matching to a residency position. I would argue that, barring a clear demonstration that a medical student would be unable to practice medicine competently, safely, and professionally, not guaranteeing them the opportunity to continue their training as a resident is a waste of a significant investment of valuable tax dollars.
It truly is unfortunate that Canadian medical schools do not have the capacity to admit all of the applicants who would become excellent physicians, but this is the unarguable reality of a profession that is limited in size and opportunity by the government’s ability to reimburse billings. This bottleneck of opportunity is most apparent in the CaRMS process. The reality is that CMGs are not admitted to medical school alone; they are admitted to the full educational process that trains Canadian physicians. Knowing this, regardless of the quality of the international medical school chosen, the decision to train outside of the country is the decision to accept the risk of not returning to Canada as a resident.
And as I have said repeatedly- I understand all of that but do not agree that to exclude otherwise qualified Canadian citizens on the basis of where they took their medical degree is morally defensible if they otherwise qualify through the Canadian exams. As you sat it’s a political decision and it may even be legally not open to attack- however that does not make it morally appropriate. Arguments about differences in cars in the UK- well I’m sorry I don’t follow that at all. Obviously those on the other side of the argument have much to lose if the situation were to change so it’s no surprise to see the points that are made. I have to say I find the attitudes displayed here quite alarming. If it’s all about graduating only Canadian doctors why do Canadian medical schools accept international students thus depriving Canadian students of places?
I acknowledge I am not going to change any invested attitudes here. I know that my daughter will return home to practice medicine. She has been accepted to a Canadian elective program so that at least there are some broadminded physicians out there. She may go into family practice which seems to be an area of disdain for many Canadian graduates, and she will be happy and proud to serve the Canadian public which assisted in funding her primary, secondary and undergraduate education. Thank you.
I’m sorry concerning my lack of clarity. You had an earlier example of BMW vs Volkswagen. I merely wished to point out that cars in the UK having steering wheels on the other side as compared to cars in US/Canada, as an analogy. I also apologize for misquoting you – you mentioned “high” rather than “rigorous” which I mentioned regarding CACMS/LCME standards.
Getting an elective and getting in residency is not the same. And no, family med is actually more sout after than is in US. 40% of students rank it first in CaRMs. So i have no idea where you get that idea from. No matter how many angry comments you post here the truth doesnt change. your daughter couldnt get into canadian med school, didnt want to take the hard way and take extra years to better herself and paid her way into an easier UK school that has curriculum thats NOT IN LINE with canadian standards. I am glad we have barriers in place to protect our residency spots from those who paid their way in
The allegation that someone has “paid their way in” supports your narrative that only those who are accepted into canadian medical schools are fit to practice medicine in Canada and now also that any other medical schools in other countries are “easier”. Oh, and I am arrogant.
Yes, those who choose to study abroad could try again to be admitted to school in Canada- those are all personal choices for which people take responsibility, including the increased debt load. Interestingly there are other excellent medical schools in the world and I don’t believe assessors are first checking a student’s international status before grading them.
There are many excellent schools and we have many. In fact we have more than enough seen by the increasing unmatched rates. So why do we need to take international students who took the easy path and paid their way in? Guess what, your daughter made the personal choice to take a risk with going to an easier international school so your daughter is the one who has to deal with the consequences.
I’m not sure where you get off on the idea that an international school is “easier”. I cannot even begin to refute that point because it’s so obviously flawed.
Each time you miss the point. It does not matter what personal choices were made. My daughter and others like her will deal with that because it is the current reality. The point is that it is morally wrong that a Canadian citizen is denied the same employment opportunities as other Canadian citizens once they have demonstrated competency on the sole basis they took their education abroad. All arguments around taxpayer money and North American standards are just smoke screens for a protectionist practice in favour of Canadian medical school graduates.
I must admit your arrogance combined with ignorance makes for a particularly distasteful commenter. I never saw how privilege could make someone so underdeveloped in so many ways. You repeat the same things over and over without ever seeing any other point of view.
But, yes, obviously all IMG schools are better than Canadian med schools, since they accept CSAs, who usually weren’t accepted by Canadian med schools. It’s not that IMG schools saw a new source of revenue, it’s because the IMGs are in fact better than CMGs.
And yes, we should stop graduating CMGs, but rather take in only IMGs because going abroad show their true worth – how dare standard bodies potentially deny them opportunity for employment based on concerns concerning the healthcare profession and patients? What is Canada but a UK colony – obviously second class? What does it matter what Canadian values are input into Canadian med student selection, when it’s obvious that IMG schools are so much better? Why did your daughter spend the time to apply to a Canadian med school, when she could have gone IMG straight out of high school? It’s so obvious that the school she attends is better, except for inconvenient bureaucratic barriers, which unfortunately denies opportunity to worthy IMGs. It’s true there’s much less space for residency positions, but Canadian med students should suffer the consequences, since going to an IMG school shows moral (and financial) superiority which should be the foremost factor in residency selection.
Unfortunately, I think this all too truly reflects your point of view.
Travis and K. Easier route? Seriously?
If you think getting into a medical program in Britain (much less staying in it – unlike here, they actually flunk people) is easy, I suggest you try it. Like here (where we also charge a premium), the spots for foreign students are limited and gaining entry is very challenging. It is true that the British schools tend to concentrate more on academic credentials rather than, say, how many sea turtles you saved on the trip to the Seychelles that your parents paid for, but that hardly suggests that it is some kind of easy degree that you just pay for. You can write all the cheques you want but you won’t as an international applicant get a sniff of an entry into a British medical school without a pretty sound academic background and a pretty amazing UKCAT. The reasons given to my own son for non-acceptance on his first try to an Alberta medical school was a lack of voluntary experience (even though he had a lot). This despite a first class degree in organic chemistry from McGill.
And surely you are not suggesting that Canadian medical schools are somehow superior to the ones in Britain. On what basis would you come to that conclusion? Of the top 25 medical schools in the world as rated by QS, 7 are British (only 2 are Canadian). The University of Alberta of ranks about the same as the University of Sheffield (51-100) which is still very good but hardly indicative of some kind of claim to superiority on the U of A’s part. The University of Saskatchewan ranks between 400 and 450. Now think about that. Someone in the bottom of the class at the U of S has more chance of getting residency in Canada than someone in the top of the class of top 10 University in Britain. That seriously makes sense to you?
And have you not met any British doctors practicing in Canada? Have they exhibited substandard abilities or knowledge to you? I sort of think not.
Look, paint this any way you want. The policy has zero to do with the quality of health care here. It is all about placement rates. Merely getting into a Canadian medical school (and lets’ be honest, in some cases because you chose the easier undergrad courses and saved a few sea turtles or you knew somebody) does not suggest that ultimately you will be any good at it. Doing well in a Canadian (or any comparable e.g. British) medical school, does. THAT is where the test is. Why on earth would we not give preference to the very best? Instead we reward mediocrity with a protectionist policy that is unsound in its underpinning logic. I suggest we have a policy that gets us the best doctors. The policy you are defending ensures we place doctors whose academic performance has demonstrated that they probably aren’t going to be very good at it.
Pretty much the argument is: i) Canadian med schools are a lottery; ii) some IMG schools are better than Canadian school; iii) daughter is doing well at such an IMG school therefore merits residency position in Canada over Canadian grad.
A few things aren’t addressed:
i) no IMG school is licensed by the CACMS/LCME to product Canadian doctors. This is a rigorous licensing procedure attested by the fact that one of Canada’s highly recognized/ranked med schools had recent issues. This accreditation ensures that high standards for med students and future doctors are maintained who will be working with patients and other health professional in health-care setting. If your daughter had attended a US MD school, she would have no issue being considered like a CMG. But perhaps your opinion is that US MD schools are a lottery as well. They do share one aspect with other IMG schools – they are beyond the reach of many Canadians in terms of cost. And despite your remarks, USask is currently licensed by CACMS/LCME unlike any UK school.
ii) there are actually more CSA IMGs than there are CMGs. Despite the lack of accessibility, since the cost is prohibitive to many Canadians, and lower selective admission standards compared to most Canadian/US schools, it’s simply not possible to accommodate IMGs preferences to match to Canada due to the sheer numbers. Moreover, it strikes me as hypocritical to feel there’s an option for your daughter to match in the UK, in the country of training, when this isn’t an option that is available to any CMGs, despite them going through a training procedure which is approved by the governing bodies in Canada to produce doctors.
iii) The pathway for CSA IMGs to CaRMS exists through a loophole that occurred due to immigrant IMGs demanding equality in terms of treatment, despite certain foreign origins. Some even went on a hunger strike to protest their situation. It strikes me as completely contrary to the intent of the rule to favour CSA IMGs in this process. At one point in the past, there was a need to bring in foreign physicians – currently there is no such need.
Correction: The number of CSA was last estimated to be 1/3 of Canadian students.
Not one of your points answers the central question as to why Canadian citizens who have taken a medical degree elsewhere and have demonstrated competency to Canadian standards – should be denied equal access to the residency job pool. The best students should get the residency positions – which may or may not be my daughter- but they should have equal access to the job pool.
My daughter will graduate from a UK school that has extremely high standards having undergone a rigorous five year education where students are being failed right to the fifth year. I dispute 100% that the entrance requirements are not as high as Canadian schools. She can work in the UK because she has dual citizenship by birth like many Canadians. She would prefer to work in the country where she was born, did her schooling and her first degree and where she has worked.
1. My daughter has dual citizenship by birth which enables her to work in the UK – however she has received no favours or special treatment in terms of education having paid fees as an international student. She would prefer to work in the country she was born in and lived in since birth. Many Canadian citizens have dual citizenship enabling them to live an work in other countries and I see nothing hypocritical in this.
2. I do not suggest Canadian IMG’s should be entitled to be considered for residencies on the same basis as Canadian graduates or before Canadian grads unless they have passed the Canadian qualification exams. I have no issue with being sure that someone is trained to the appropriate standard. Having reached that qualification their citizenship should mean they are considered on the same basis,, i.e.equal basis as any other Canadian citizen. My daughter did all of her education in Canada aside from her medical degree- she was born in Canada, and has worked in Canada. Her first degree is from a Canadian university. I do not see what difference it makes that she got a medical degree from elsewhere as long as she can demonstrate she has reached the required standard. She has cost the taxpayer nothing and has been willing to invest that amount herself in her education. She will be paying off loans for a long time.
3. She has been trained in the UK at an established medical school in a red brick university. Many physicians from the UK work in Canada – I do not think there is anything suspect about the standard of education and I have every reason to believe it is as high or higher than most Canadian medical schools- but as I said I have no problem with being tested to ensure Canadian standards are met.
4. I dispute 100% the point about Canadian schools having higher selection standards than UK ones. You quote nothing to support this statement because really there is no factual basis for it.
5. There is no loophole for Canadian IMG’s. You cannot legally completely exclude Canadians from the job pool.
6. All of your points fail to address the central point I am making that Canadian citizens should not be denied equal access to the job pool just because they took a medical degree elsewhere if they have demonstrated competency to Canadian standards. I would like to know that the best residents are being hired from all Canadian citizens. This may or may not be the Canadian IMG- but morally they are entitled to the same opportunity.
I’ll keep this simple:
i) red brick is irrelevant. What is relevant is whether a school is accredited or not to produce North American doctors. McGill is as red brick as they come and had recent difficulties, despite having a long history, and also being accredited within CACMS/LCME.
ii) There’s way too many IMGs (CSA + immigrant), especially considering there’s no surplus of residency positions, unlike in the past or in the US. CMGs are logically prioritized since they’re trained in accordance with standards and norms that are accepted in Canada
iii) Your daughter has an opportunity to match in the UK, her country of training because of her citizenship. You want her to have the opportunity to match in CaRMS as well, even at the expense of CMGs, despite the fact she went through training that isn’t approved in Canada. CMGs main option is CaRMS – they don’t have the opportunity to match to the UK. This strikes me as unfair in many ways (accessibility and opportunity to name a couple).
iv) CSA IMGs really only started because immigrant IMGs won the right to be considered in CaRMS and Canadian med school became more competitive. Your daughter in benefitting indirectly from the fact that immigrant IMGs went on hunger strikes to demand equality. CSA IMG now outmatch immigrant IMGs, despite the fact the CaRMS positions were created with immigrant IMGs in mind. This is the “loophole”.
v) As much as you repeat how great UK schools are, they’re not CACMS/LCME approved. The training is different and there’s no need to bring in foreign trained physicians who made the choice to go abroad, knowing there was no priority for them.
Again- many of your points are just distractions from the main question as to why a Canadian citizen is prevented from equal opportunity once competency to the required standard has been demonstrated.
I am sure that CACMS/LCME standards are high whatever they are- but they are also used to disqualify on an artificial basis. If UK or Australian physicians are so poor because they went to schools they adhere to standards with different names – why are there so many in the Canadian health system? Do you seriously think the training in the UK is not in tune with whatever these standards are? IMG’s have to take Canadian competency exams- if they pass that should be the end of the matter-particularly if you are also a Canadian citizen.
My daughter is as Canadian as the next Canadian. She lived in Canada all of her life apart from the last four years. This argument that she should stay in the UK as a basis for your argument only serves to demonstrate how weak the arguments are about Canadian IMG’s not having equal access to the residency job pool. I have another child who studied law in a different country. Once competency in Canadian law had been demonstrated there was no suggestion that she should only be able to apply for articles in the country where she took her degree. Only in medicine are artificial barriers raised to protect Canadian medical school graduates.
Yes, there are a limited number of residency places in Canada, but that is not sufficient reason to promote only graduates of Canadian medical schools to those spots if other Canadian citizens have demonstrated competency. Of course you are right to be fearful that your job pool would shrink if equal opportunity would be provided but welcome to reality and how life should work fairly.
Even as recently as a few decades ago, Canada needed to bring in foreign physicians because a lack of domestic supply. That is no longer the case – so CMGs are prioritized as their training conforms to CACMS/LCME norms. There’s no need to recruit IMGs from South Africa or the UK whose training is different enough that it’s not considered equivalent. In the past, many were recruited into underserved areas.
One thing you seem to overlook is that immigrant IMGs have the same rights as CSA IMGs as they are also Canadian citizens or Permanent Residents. As mentioned, CaRMS IMG positions were created for immigrant IMGs in mind to give them an opportunity to practice in their new country. These positions were created when there was surplus of residency spots compared to CMGs. This is no longer the case. They were not created as “reserved” positions for CSA IMGs.
In any case, you seem to be advocating for more than “equal opportunity” for CSA IMGs – to not only match in their host country, but also match back in Canada, because they have the means to go abroad, which most people don’t. Again, this is despite the lack of equivalent training, in contrast to US MD schools. Despite your assertion of a “lottery” of Canadian med admission, most schools have very clear criteria of what admission is based on. The fact that your daughter chose not to strengthen her application and reapply to Canada (or the US), but instead chose to go to the UK, when there are clear warnings about a surplus of CSA IMGs with an inability to accommodate them in Canada was her choice – fortunately for her, it looks like she has a good opportunity to match in the UK.
Sigh. Your protestations miss the basic point every time. A Canadian citizen is being denied an equal opportunity of employment in Canada based only on a distinction of where a medical degree was taken. Everything else you mention is just noise and distraction from that point. If you pass the Canadian entrance exams- which do exist so I’m assuming there must be a point to them- you have established you are qualified to practice in Canada. There is then no reason to discriminate based on where a person went to school and what protocols they learned under. Medicine as a science does not differ according to what country a person is in. Protocols may differ- perhaps even some standards- but nothing that cannot be learned.
Not all IMG’s are also Canadian citizens by birth. My daughter could practice in the UK purely as an accident of her birth to me as a British citizen. It is not her country. We have paid education taxes for her education (and yours) in Canada. We have paid taxes for you to attend a very highly subsidized medical school program in Canada. Not that it is at all relevant to the basic point stated above, but my daughter chose to take an opportunity abroad at a highly regarded school rather than take a chance on waiting as long as three or more years to be accepted into a Canadian school. I could discuss how the north american system of requiring degrees before medicine favours men rather than women but again that’s a distraction and a discussion for another day. Anyway that was her choice including the expense involved and living away from Canada for five years. Yes she know about the admission issues back to Canada- but again that does not make the argument that it is a protectionist and flawed process invalid.
You fail to see the relevance of CACMS/LCME accreditation in the CMG debate. While you acknowledge it may be rigorous procedure, it’s very purpose is to uphold certain standards of quality with regard to the educational program and both the experience and preparation of the graduates within Canada/US. It’s not a rubber stamp as indicated by the recent struggles of various medical faculties to obtain accreditation. The LMCC Part 1 is only part of this educational experience – and for most CMGs, simply a box to be checked. There would be no issue with accreditation if passing the test were the essential component of the accreditation as CMGs have a far higher pass rate than IMGs on that exam. It goes much further than this.
To continue your use of analogies, the UK is different. People drive on the other side of the road and electrical appliances need to be adapted to work there. A UK car could technically drive on the road in the Canada or US, but wouldn’t be necessarily well-adapted to do so. So by accident of geography partly, US/Canada vehicles are actually much more interchangeable than Canada/UK. A luxury vehicle from the UK could in fact be treacherous on Canadian roads.
In terms of medicine, since the UK schools are not accredited by CACMS/LCME, it makes sense to prioritise CMGs whose educational experience is a known and approved by these accreditation bodies. To not do so would defeat the point of having such bodies, which even you acknowledge as “rigorous”.
In terms of your daughter, I’m not sure why you felt it would take multiple years to gain admission. There are many med schools in Canada and some don’t even consider ECs – if the rest of the components of her application were strong, there would be no need to go abroad. Moreover, ECs can usually be improved significantly quite rapidly. It’s not uncommon for med students to apply more than one cycle or that rare to be accepted before completion of a degree.
As a point of fact, despite your assertion, women now make up the majority of medical students in Canada (and in the US), and also young physicians within Canada.
most UK schools are easier to get in than Canadian ones. Lets not kid ourselves. Students who cant get in canada go to UK ireland carribean or austrailia. Nothing to do with quality of school, its all numbers. Canada has few schools and tuition cost less. UK has more schools and cost more. You and delusional if u think otherwise. If not just go look up entrance avgs in UK and in Canada
This is how it should be! If you attend medical school/ pass medical school/get a diploma stating your have a medical degree, then you should automatically get a residency. 1st/2nd/3rd. They should only take the number of student that they can offer a residency seat
Absolutely not! Some people are just not cut out for it and will not be good doctors. Getting into medical school should not be a guarantee you will get a residency and a job.
I don’t think it is a bad thing that people go unmatched. Often they are not cut out for the specialty and there are simply better applicants. It is ridiculous to think that every medical student should match to their specialty of choice. In my opinion, every good medical student that has rotated with me has got the spot that they deserved with VERY few exceptions.
We need to stop coddling medical students and properly counsel them with regards to career choice. Maybe this begins with who we are letting into medical school.
Maybe an objective standard could be utilized, as it is in the USA with USMLE.
The smartest person in my class didn’t go into a competitive specialty.
One of the “dumber” ones matched very well based on luck, charm, and connections.
Your assessment is shallow and dismissive.
My assessment of medical students may be dismissive but is far from shallow.
It doesn’t have to do with ‘smarts’ it has to do with the whole package. Being a good medical student and doctor is far from just having the best marks. Almost everyone in medicine is smart. Hard work, conscientiousness, being a team player, sense of duty and pride in your work are just some of the things that I characterize as being characteristics of a good medical student and doctor. Good marks are often a side effect of these traits. And luck comes to those who are prepared.
And this should include canadian students who have graduated outside of Canada. They should be given equal opportunity.
Think carms is stressful? Wait till you try to get a specialist staff job. 7 out of the 25 people that completed training in the year I graduated in my specialty across Canada are practicing in the USA.
Agree that this is important but, since it’s downstream from the CaRMS process, isn’t getting the same thought and attention in these discussions. It’s easy to say that the solution–as suggested above my medical student organizations–is to add more residency spots but if there aren’t jobs for all of those graduating specialists, you’ve actually made the problem much worse. At the medical student-resident junction, these individuals are in a better position to course correct and choose careers that are in demand than 5-8 years later when they’re done their clinical training and find that there are no positions for them.
Those of us who are further along the process sympathize with those who aren’t matching but also understand that adding more spots is probably the easy-but-wrong thing to do.
And even if extra spots are not added allow canadian IMG’s to compete on an equal footing. I have not read one argument yet that wasn’t based on solely protecting the positions of Canadian graduates.
Thank you Jon for bringing this up. What are we teaching these people about competition and real life? There are no other professions where you are just given a position because you did a degree. In general, good people get good positions. If you are applying to something that is competitive then you shouldn’t be surprised when you don’t get the spot. This is magnified when you finish your training. There are multiple specialties now where you need two fellowships to be competitive in even a non-academic setting.
Maybe we should teach CMGs how to be more competitive by leaving the country and do their residencies in the US, where there are plenty of competitive residency spots for them, higher pay and much better job opportunities. The reality is that these CMGs spent a lot of money and effort getting into med schools and therefore, unless there is a serious flaw in the candidate, the government should provide adequate residency spots for them to become physicians. Plus Canada does not even have an objective method of evaluating medical students, so these less competitive candidates you speak of might suddenly become extremely competitive candidates at US residencies. Very few professions require this much sacrifice in terms of effort, time and money and after all this hard work, there is not even a career left for them is simply inhumane. This is NOT like law or other professions, in which the career can be extremely flexible. Plus the bar to get into medicine is extremely high, which is also not the case with other professions as well.
confused as I submitted a comment today hoping to see some discussion??? I do not see it..Please advise
The real issue is that medical students are forced to make career choice when they are inexperienced and lacking in knowledge. In reality, students are making specialty decisions in the first 2 years of medical school, by picking electives and making personal connections with the key players, that they hope, will be on their side in the match.
The public and the profession ( and in that order) would make meaningful progress if general practice competence was the goal before licensure. This would allow students to make more informed choices. This would lessen the prejudicial attitude of the specialist toward the generalist. General practice before specialty training does not have to be compulsory but it should be an option and should be encouraged. Enlightened cooperation from medical schools, family medicine departments, speciality departments and licensing authorities will be required. Amazingly. everyone seems to agree that the present system is unfair. Regrettably, almost everyone thinks the system can not be changed.
In Alberta just recently the medical association considered equalizing remuneration between family doctors and specialties. Reportedly one specialty is considering legal action. I agree that raising the profile of family physicians should be a priority.
This will never happen.
A pipe dream.
An ophthalmologist makes in 1 day what a family doctor makes in 3.
lol family doctors get paid less because they work less and do easier work. What a communist mindset to think all doctors should get paid the same. I think surgeons should be paid more because I could never live that lifestyle.
You are correct that I am a parent of a child studying abroad- however she has other options because she is also a UK citizen by birth and can work there. My concern is the basic unfairness at work here for people who are Canadian citizens. It’s simply morally wrong to deny them the same opportunity as their fellow citizens if they have passed the canadian entrance exams. You mention the stats which show higher problems with international graduates. I have spoken to many British physicians in Canada who feel that while the Canadian residency program is superior, by and large UK university training is superior to programs here. I don’t know about that personally but I believe that international education comes in many varieties and that in general a medical degree from an established UK university is going to be at least equal to a Canadian degree. The rules in place are simply protectionist in favour of canadian medical grads. There is no way to defend it on any other basis and that basis is unfair and wrong.
No its not. its morally wrong to think you can pay your way into easier school and expect to have same opportunity. I couldnt afford to pay my way into foreign schools. Line of credit for foreign schools require cosigner and i cant afford that. Dont think you can buy your daughters way into canadian residency. your daughter should have done what other canadian med students did and take extra years and improve. you wanted an easier shortcut and now you are paying the price
Having been a part of the admissions process for a Canadian medical school and a Canadian residency program, I agree that the process is far from perfect and that selection committees are faced with a very difficult task of differentiating whom would make the best physicians, and there is a fair degree of luck and of “who you know” that can dictate the success of your application. I don’t think we can ever create a perfect system that picks the best candidates, but we do know from analyzing data between CMG residents and IMG residents that more IMG residents require remediation, more IMG residents receive professionalism lapses, and more IMG graduates receive complaints to the provincial governing bodies and the federal medical insurance association (CMPA).
I see that the push back from further disadvantaging IMGs seems to be from parents of current Canadian-born international medical students, who are in a very stressful situation of hoping their children can return to Canada. While it is not right to abandon Canadians currently investing their time and money abroad, I think we need to set a new expectation to those thinking of going abroad that they will essentially not be able to obtain residency back in Canada. A fair bit of this expectation already exists, but in trying to balance the high unmatched rate of Canadian grads, we need to remove variables that allow the system to plan and allocate finances and resources with less uncertainty.
I have to say I am finding this all rather disturbing.
I think we can all agree that UK medical schools (and Australian ones for that matter) are quite credible institutions that are every bit as good, and in some cases better, than Canadian ones. Yet apparently we have a policy under which someone graduating in, say, the top quarter of their class in a UK medical school and having thus demonstrated an admirable level of skill and competence in the area will be denied an opportunity for residency in Canada in favour of someone who graduated in the bottom quarter (or even the bottom 5%) of their class in a Canadian school, who did not.
If we are looking for the best doctors surely the proof is in the pudding. Admission to medical school is one thing. You pick the ones you THINK will do well. Some of them will but some of them will not. The real test is going to be medical school itself and the admission exams. To deny ourselves the best professionals because we have paid for the worst ones is reasoning that is beyond my comprehension. We should be realizing that we are lucky to getting the good ones for free.
I am sure that I am over simplifying this but I think the public can be forgiven for thinking that this is more about medical schools artificially maintaining high placement rates than good health policy. I can’ think of any other profession where we would deny ourselves good people just because we didn’t fund them.
It’s easy to say bottom 5% of the class, but class ranking doesn’t exist in Canada because our selection process is based on luck and connections.
Lol no it isnt. I was one of the interviewers and there is absolutely no way for me to push someone into the school. Dont talk as if you have the slightest idea lf what you are talking about.
How they do in medical school exams dont tell you how good of a doctor they will be. What is a good doctor? Someone that was able to remember an obscure disease treatment for few questions over another one? Do you even comprehend the soft skills and other communication skills which are NOT examined and graded? Dont talk as if bottom 5% student in canadian school is worse than top 25% of a UK school based on meaningless numbers. What if they received 100% on general surgery and 50% in rest but wants to be a general surgeon? You cant use numbers here to differentiate who is better. Truth is there are so many schools in the world and their curriculum is NOT the same as ours. Our schools CONSTANTLY get reviewed and restructured so that its in line with what Canadian government needs. We cant know if Oxford meets our criteria. Its naive to think because they are a famous school that it automatically has satisfactory curriculum FOR Canadian system. If you want to get in residency then do the training here. Stop crying about it because you couldnt get in and had to pay your way into easier schools.
Let me summarize it this way. If the gold medal student from Oxford was Canadian they would have less chance of getting a residency than the lowest student from Saskatchewan. As for the tax argument- what you are saying is if someone offers you a free BMW you should turn it down if someone offers you a Volkswagen. When a qualified Canadian citizen has trained on their own $ why should they be penalized on that basis? It’s a ridiculous argument and serves only to protect Canadian medical school graduates. As for getting into canadian medical school being a lottery – all Canadian medical schools are oversubscribed for applications. Not everyone can get in so decisions are made on the slimmest of margins. I’m sure you are very smart. Are you smarter than everyone who didn’t get in when you did? I doubt it. My daughter was told she did not have enough volunteer work even though marks and MCAT were above average. She has spent five years in medical school now including two academic years and three clinical. If she passes the canadian exams she should have the same opportunities as her fellow citizens. My only point is that we should be choosing the best doctors from all Canadian citizens- not excluding citizens on a basis that does not stand up to scrutiny.
The problem with your argument Lynn is that since your daughter has in fact used her own money instead of the government’s, after not gaining admission into Canadian medical programs, she has paid her way through the tough system. As you said there are many more applicants than seats for medical school in Canada so only the best get in every year, and many that are qualified do not. Unfortunately, your daughter that year was not. There are many students who could not afford to do what your daughter did so they were forced to increase their amount of volunteering or do a masters degree and then reapply, or else pursue another career. What would be unfair would be if your daughter and many other CIMGs could go around the system and get themselves ahead by paying 50000 a year tuition which would only be feasible for the upper class to do and then attempt to match in the first match with students who performed better and were more competitive 4 years prior, or students who went through the extra hoops of doing more schooling because they too did not gain admission their first few application cycles, but worked hard to get into Canadian medical schools in future years because they could not afford to do what your daughter did.
Sophie, my daughter has a medical school loan from a Canadian bank because the bank knows that sooner or later Canada needs more doctors than it can afford to train. That’s another piece of the hypocracy going on when it comes to kids who go abroad to get training. As was acknowledged by another person who commented on here and who has sat on admissions committees people are accepted or not into medical school by the slimmest of distinctions and even on the basis of who you know- which is truly troubling. So I think it unwise to go down the road of we got into medical school in Canada because we truly are the smartest. That’s an extremely arrogant position. That’s not even my point though- you are distracting from the main point which is that all canadian citizens should have equal access to the residency matching program once they have established they are qualified. There is no justifiable basis to limit it to canadian medical school grads only. Here’s a thought- perhaps those canadian grads who didn’t get matches were simply not good enough. There should be no artificial barriers to ensuring we get the best doctors of all of our citizens.
Hi, Lynn. When you said that “Canada needs more doctors than it can afford to train” I was reminded that we have long been accustomed to accepting that medical training is prohibitively expensive. Funding concerns seem to cast a long shadow over not only medical training but also practice. It is of course terribly important that doctors are as well trained as possible, that research and infrastructure be properly funded, etc. I would dare to question, however, whether all of the associated costs are in every case entirely justified. I wonder, for example, to what degree excessive profit-taking drives up the cost of training doctors or running a hospital.
I agree it’s something to look at. Also the high subsidy given to medical students who train in Canada. I don’t believe enough if them appreciate the true cost of their education.
I have sat on admissions committees as well. The poster earlier was referring to residency admissions when they said it is sometimes who you know. Medical school admission in Canada has largely transferred to a multiple mini/panel interview. There are restrictions in place stating that you cannot interview/file review a person you know due to conflict of interest, and even when someone tries to cheat the system admission scores are so spread out that one person cannot significantly influence whether a candidate gets in. Small residency programs however do not have the luxury to do this, and this is where the who you know kicks in. If there are only 3 opthalmologists at a school for example, there is limited choice in who sits on admissions. Furthermore, if you are an opthalmology candidate interested in this school, you will have likely worked with the 3 opthalmologists.
I did not get into a Canadian medical school on my first try either. At first I also had difficulty processing why I was not selected with my high grades and tons of volunteering. I continued to work hard on my application to finally get in. Once there, I truly realized how accomplished my class is. I am not saying I/we are the smartest, but sometimes it is easy to think that you are more accomplished than you are from the rest of the applicant pool. I was guilty of that myself.
Sophie I must also comment on the inference that my daughter has bought herself a medical degree. She had to apply for admission to her UK university just like anyone else. Instruction has been rigorous over 5 years with exams on a marks basis. Every year students don’t make it to the next year. She has consistently been in the top of the year and I’m sure works every bit as hard as anyone in Canada. Only in fifth year do they go to a pass / fail system which I understand is contrary to most Canadian schools where it’s almost impossible to fail once you get in. She will be paying back her loan over many years. All that I can live with. Those are the breaks you get in life and you make choices accordingly. What I cannot live with is that she is denied an equal opportunity to gain employment in Canada with graduates from canadian schools.
Lynn, the fact that you chose to illustrate your point by denigrating USask’s medical program shows exactly where the arrogance lies.
An example only. Not meant to be personal. The point is it could be the bottom student from any Canadian school.
I did not read Lynn to be denigrating USask. Her point is that there is a range of quality of graduates coming from each and every school. Nor are all schools able to consistently deliver the highest level of education. Things happen. Saskatchewan is a fine medical school but it was not that long ago that it was on accreditation probation. Dalhousie has also been on probation. Most recently McGill was placed on accreditation probation. In 2015 McGill was found to be lacking in 24 out of 132 accreditation criteria. The range of failures ranged from administrative matters to curriculum and clinical experience. For example, it was found that McGill was not ensuring that the curriculum was carefully monitored so that students were receiving the education experience required. Whether or not students received the requisite clinical experience depended on the hospital or clinic they were assigned. Some faculty were unclear about the objectives of the program and students on rotation were not receiving sufficient supervision. The probation was lifted June 2017 but with some continuing concerns expressed by the LCME.
Most Canadian medical students dont fail because weeding out already happened during getting IN medical school. For example my school (UBC) had entrance average of 87% when I was accepted which is roughly top 5% of entire Science faculty at UBC. That means your average UBC medical student was on average a top 5% student out of thousands of UBC students, of course they are not going to fail. I love how someone who hasnt written the exams say things like “its almost imppssible to fail” as if our exam is easy to pass. It seems easy when 99% pass because that 99% is studying their ass off and was already mostly succesful students. Schools in UK have higher attrition rate because less stellar students get in tha in Canada. Your daughter should NOT have equal opportunity to residency spots over Canadian students trained in Canadian school subsidized by Canadian government. If we dont protect our own students first then its a downward slippery slope with students paying their way to get in medicine and we will soon have only rich families getting in medicine. You talk as if you think your daughter was just as qualified because of her grades and MCAT. Do you even know how much harder it is to maintain grades WHILE volunteering 10-20hrs a week? Your daughter did no do as much volunteering which means she had more time to study. Your daughter MAY be just as qualified but it doesnt matter because we have a mandate to support our own students in our own country first.
I am appalled that not allowing international graduates into even the second round is being considered- which I assume includes Canadian international graduates. Morally it is indefensible that the Canadians who studied abroad cannot go in the first round- to take away the second round is ridiculous. Canadians who have gone abroad have cost the taxpayer nothing. My daughter has studied for 5 years at a uk school ranked above many Canadian schools. Just because you are not successful on the lottery of Canadian medical school admission is no reason why you should be penalized in getting a residency. I would hope we are selecting applicants based on merit and not primarily because they went to a Canadian medical school.
They are selecting based on merit – those that attend international medical schools have lower requirements at cut-off. Plus, if you look at the licensing examination pass-rates, canada graduates pass on average 97% compared to 60% for international graduates.
A few things to add. Higher cut offs doesn’t necessarily mean a higher caliber physician. It’s what you do DURING medical school that matters. I’ve met US, Caribbean, Australian, UK students with “lower” cutt offs than Canadian programs but they did exceptionally well not only on a standardardized test but more importantly clinically. The point is people have the idea that once you get in you’re garenteed something, which is not the case. Your performance in medical school matters. Schools should consider making sure that poor performing students don’t get through. At our institution it’s very obvious if the rotating student is good or not, once you spend over a week with them you can tell if they will be a fit with our speciality or otherwise. Merit doesn’t just mean if you can pass some MCQ exam. It has to be more encompassing including all the CANMED criterias. Again anyone who is qualified should be able to compete for residency spot regardless of their origin. IMGs only compete during the second iteration and have their own stream (smaller number of spots) during the first.
No kidding. I’m a Irish grad myself. Sure, the cutoffs to get in are lower over there, but medical school itself had a significant washout rate. I know a number of very capable individuals who failed exams and were held back a year. I also knew several less capable individuals who dropped out entirely. Medicine isn’t easy, and the idea that everyone passes once they get in always seemed a little strange to me.
You have to remember that a lot of medical students that train outside of Canada are FROM Canada and in my experience are more competitive applicants because they have gone thru a lot more struggle in their process of getting a medical school spot and then applying back to Canadian residencies.
While you do make many valid points, there is also the argument that since taxpayer money was used to train a Canadian medical graduate, they should be prioritized in the match. If a CMG is trained and then unmatched, taxpayer money is essentially wasted.
Medical school ranking is a poor indicator of quality of education since a significant part of the ranking relates to funding. Also, the medical school system in Canada varies from that of many countries. Even if someone truly does come from a “superior” school, there is a chance they may not be up to par to residency standards here simply due to learning things at different times. Example: many European schools focus on medical knowledge in medical school and clinical skills in residency. Coming to Canada, they would be behind residency standards due to their lack of clinical skills despite having superior knowledge. I cannot comment if this is true of the UK.
Lastly, if you think Canadian medical school admission is a lottery, you have not met carms.
You have brought out a gruesome stress that medical students today have endured. What you have not addressed is the global stresses that have developed on students in Britain, Germany, or France. Socialized medicine has limits but much of its manpower planning and administration is challenged by speciality programs. THese programs want fast tracked graduates focussed on special needs. NOw Quebec does not have enough generalists to provide family based practice for its population but we still produce more specialists. There is work to be done by government, colleges, and universities to provide better general healthcare. POlitical, commercial, and social forces appear to be pressing on new graduates to move away from their helping narrative towards exclusive or limited care models that have become the status quo. Medical students cannot be made to feel failed because the present model has failed to embrace them.
I CHANGED MY MIND, I WILL NOT LEAVE A COMMENT.
I’m sure it’s very stressful for the medical students. Unfortunately, we don’t always get what we want. I went to law school and we too had a match process at the time. Routinely every year people didn’t match, or they matched with places they didn’t really want to go to so they couldn’t practice in the area or location they really wanted to. And we all knew this going into the profession. Lots of other people in Canada don’t always get work in their chosen field.
Seriously Adam it’s not the same. If you don’t get articling position in Ontario you can use alternate course and be admitted to the bar. Medical students have no other route to practice than residency.
Yes it is different, but it is comparable. Those law students who don’t get an articling job have great difficulty and are very disadvantaged at getting into the profession. They simply don’t have the range of options of those who do “match” and many of them don’t become lawyers. I had several friends in law school in this position and, over my decades of practice, I have been a mentor to several such students (including right now!) trying to help them find a place in practice or something else that might work. My point simply is that many people graduate from university and are not able to find work of their choice (e.g. all the trained teachers we are training who don’t have jobs).
The whole process will have to change. Medical school class sizes have to reflect the available residency spots. The mentality of the students have to change as well. Just because you went to a Canadian medical school should not guarantee a residency, it has to be based on the qualification of the candidate; maturity, intellect and ability to practice that specific specialty. It’s the same story in the United States the number of residency spots are below the applicants. In terms of IMG, again if they are qualified then they should have a fair chance at competing for those spots. At the end of the day we want physician who are capable of serving the population of Canada. There are many of Canadian students who go abroad to study medicine in the hopes of coming back, and if they have the qualifications they should compete with their Canadian counterparts. Getting into medical school is tough but doesn’t mean once you get in you decrease your standards.
TL;DR version: Med school class size should reflect available Residency spots. Competition is good, we want the best doctor to serve the Canadian population regardless of where they come from.
Yes if you’re not guaranteed a residency spot, then Canadian medical students should feel no pressure to practice here. I URGE Dr. Jennifer Smith to consider pursuing general surgery south of the border. Investments are bidirectional. The government can’t underfund its students and expect them to stick around.
Agreed Canadian students should definitely apply to residency in the states. Unfortunately they also make the visa process a headache. Canadian students match at great programs in the states. Since the Canadian match is first they can apply to both.
Unfortunately, with the way the current match system. Canadian students are discouraged from applying to the US. Because the Canadian match happens first, if they match in Canada, they are withdrawn from the US match. This means all US choices must be lower than Canadian choices. Considering how much money and time is required to do electives in the US and how little time Canadian medical students already have to do electives and not only that, to fly to interviews in the US, it is nearly impossible for Canadians to apply to the US and Canada at the same time and remain competitive in both. Not only that, the way the system works, it discourages Canadians from applying. Why reduce your competitiveness in Canada by doing US electives when you have to rank every program in Canada over Harvard or Hopkins?
I disagree, IT IS NOT the same story in the United States since the number of residency spots FAR exceeds US medical graduates (MD and DO included). On top of that, they have USMLEs, clinical grades and research to tease out applicants, so those with poor scores or skills will not match well while CMGs have pretty much nothing to distinguish themselves except forming “connections” with people in the program. There should be objective standards not “maturity, intellect and ability” (Whatever that even means….). Also, more importantly, US MD graduates get competitive specialist spots while 40-50% of CMGs, despite being highly qualified, has to practice family medicine. In the US, most MD graduate consider family med to be reserved for those who are at bottom of the class . The government has to restrict the visas given for CMGs because if they do not, the CMGs will leave in US in droves looking for better opportunities. USMDs despite having a lower match rate of 94%, can stay for a fifth year and do research (common in US) and match into a competitive speciality next year as well because some would rather go unmatched than go into IM or family med….. This in combination with the fact that Canadian med schools are significantly harder to get into than US MD schools, makes it even more questionable about the lack of opportunities for medical professionals in this country.
You hit the nail on the head about how Canadian trained grads are evaluated. Do not assume the unmatched ones are the ‘weakest’ – the evaluation is subjective. There is favoritism. It is luck, who you know and a bit of strategy. Everyone from the class president, to the most clinically competent (ie/ Smith from this story!) can not match because of the system, the lack of spots, the subjective evaluation criteria where students can’t stand out and the favoritism that exists. Until we fix this and make it more truly merit based rather than pretending to be merit based, putting IMGs into this mix muddy’s the water. In other words, don’t assume the 70ish unmatched are bottom of the class. They likely are not.
That is no reason not to allow canadian IMG’s to participate. Every argument that is raised is a thin veil to protect Canadian graduate jobs. What does “muddy the waters” even mean?
The quality of medical education abroad cannot be ascertained with certainty as these schools have not been evaluated by our accrediting body, the LCME.
This is a reason to prohibit the wide adoption of IMG acceptance, as it would be rolling the dice on quality, and who would want to be the patient of a doctor whose medical education was obtained at a substandard school?
It means that when we don’t have a robust, reliable way of evaluating Canadian medical students for residency, why would we open our doors to CIMGs? What if when your daughter was applying to medical school, an IMG undergraduate took the Canadian medical school spot that your daughter was supposed to get? You would have said that IMG took your daughter’s spot…
We need to get our own house in order first. Your daughter may be the top of her class, according to you, but there is no clear comparison standard to Canadian students. Unmatched students are not the bottom of the class and just because your daughter is in the top wherever she is training doesn’t mean she would be better in a head to head comparison with an unmatched Canadian student. The process is subjective.
And your daughter made to choice to train elsewhere – there is no obligation for the training system here to adopt her. It was her risk to take. Having the expectation that the Canadian system should not only repatriate her back, but having her be at no disadvantage to her Canadian colleagues is self-serving. No one is saying she can’t be a doctor- but she can always practice where she trained if she wants.
I know what your response will be to this – to undermine the medical and residency application process and defend your daughter’s choice and reiterate how great she is. While this may be partially true, I think many would disagree with you. Your daughter will need to get back into the medical system and change policy herself — it’s hard for you to make this point as a parent with skin in the game.
would you recommend that Canadians do USMLEs as part of their preparation in the new CARMS reality?
That’s my point, I think it’s time you add more exams like the USMLE, clinical cores and research into that equation then. Perhaps then there will be no issue, strongest strudents will match and others will have to apply to the states; unless there is a reform for more residency spots or lower medical school class size.
Hello, Annon. You mentioned that “In the US, most MD graduate consider family med to be reserved for those who are at bottom of the class .” I wonder to what extent such thinking might adversely affect the public’s perception of the health care system. Family medicine is certainly the main, and sometimes the only, point of contact between a member of the public and the health care system. Good GP’s can reduce the pressure on the hospitals. Family Medicine needs to be given more respect relative to the specialties, as it plays a more important (though perhaps less glamorous) role in health care.
Hi Paul. I did not mean family medicine is bad in a derogatory matter, they are certainly crucial. The key here is that in the US, since their healthcare system is more specialist-focused, and therefore has a lot less family physicians. I was being too honest, but the reality is that with 400K loan, unless you are a saint, you would not go to FM in the US if you had other options. FM is definitely a great option for those in Canada, as they are more respected and more well compensated as well. My problem is perhaps that those who did not match the first time will try FM the 2nd time, which is not good since that is not what those medical student want and otherwise competitive applicants will conservatively choose FM instead of surgery not due to interest but due to fear of not matching and poor job prospects.
I appreciated reading this article. The article gives examples of Andy and other students eventually finding a residency placement for themselves after taking extra courses etc. For my curiosity’s sake, are there cases where Canadian-trained students do no find a match at all, not even eventually (especially as their chances of matching get more grim year-after-year)? If so, what are their statistics, and what do they end up doing with themselves after 4-5 years of medical training under their belts?
One committed suicide last year
Thanks for highlighting this extremely important issue in postgraduate medicine.
In my opinion, the Ministry of Health of each province in Canada should ensure there is a family medicine residency position available for every Canadian graduate who is unsuccessful in the first round of the CaRMS match. Trainees could choose to accept it, potentially transfer if positions become available later, or decline in view of a fifth year.
In addition to assuaging the understandable anxieties of trainees in the match, this will have the ancillary benefit of increasing the number of Canadian family physicians over time, as invariably some/most trainees will stay in family medicine.
Samir, I actually disagree with you on this point. I don’t think it’s fair to assume that a medical student who doesn’t get into a particular specialty will automatically be a good family physician. If anything, the opposite will likely happen — someone who was really motivated to be a surgeon or a dermatologist or a gynecologist might go into family medicine and either (1) abandon comprehensive family medicine for a focused practice practice, which will only exacerbate existing shortages of comprehensive family docs or (2) stay with comprehensive family medicine but not have their heart in it, which will manifest in due course as poor performance, poor patient interactions, college complaints, etc.
My suggestion is not to obligate family practice for the unmatched, but rather to make a family medicine residency position available to them. Individuals still motivated to pursue specialties despite going unmatched would retain the option of more medical school for a fifth year or pursuing training outside of Canada.