Diane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open
Yesterday was Match Day for CaRMS (the Canadian Resident Matching Service). The results were available at noon, and Twitter came alive with jubilant tweets from candidates who matched successfully.
“I JUST WANT TO HUG EVERYBODY!!!!!! SOOOOO HAPPPY!!!”
“Survived D-Day #CARMS #matchday results, excited to join @UofTFamilyMed for the next phase in my medical journey!”
For some, of course, the day was much less happy. They weren’t matched and now have to wait until the second round on April 14 to see if they will have a residency position beginning in July, or need to find something else to do for a year. Or perhaps they were matched, but to a program they were less interested in.
There was another group of Canadian medical students for whom being matched (or not) yesterday was likely met with mixed emotions. These students were interested in residency training in Canada, but were also considering studying at some of the great hospitals in the US.
Match week for American training programs through the National Residency Matching Program (NRMP) begins later this month on March 16. It should be simple then for these students:
1. Apply for a Canadian program through CaRMS.
2. If you are matched but not to the specialty program you want, you have a chance to get into the right program in the US in a few weeks.
But that isn’t how it works. CaRMS and NRMP have a special arrangement. If a medical student is matched to any residency position through CaRMs’ first iteration, he is “automatically and without any notification” withdrawn from the NRMP match. The same holds true for the second CaRMS match and its US equivalent.
So, a medical student who dreams of being an ophthalmologist, but is matched to another type of specialty in the CaRMS match, will never have the opportunity to find out if she would have matched to ophthalmology in the US. All the preparation, travel and expense for interviews in the US? For naught.
Students do have the option to gamble and participate only in the US match—but there remains the distinct possibility that they will be unmatched. That’s it then until next year—there are no “backsies” in the residency matching business.
What benefit is there for CaRMS and NRMP to cooperate in this way? Well, administratively it’s simpler, of course. Knowing who is in and who is out makes for a cleaner match. Some will probably argue that it’s fairer too, as students can’t play different programs against each other. Others may suspect that this is a plot to keep Canadian-trained medical students in Canada. It makes sense for the residency programs too, as they can more or less be assured that their quota of students matched in March will arrive on July 1.
Although CaRMS only has this arrangement with the US, Canadian students considering doing their postgraduate training anywhere else in the world are still restricted. If they are matched through CaRMS and choose not sign the program contract, they break a legal agreement with CaRMS. The penalties for this are clearly outlined on the CaRMS website and include temporary or permanent barring from future matches and notification of the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada and the provincial regulatory bodies.
So Canadian medical students have to abide by the rules. I wonder though whether all this is in their best interests. Perhaps it works for most of them.
But for others who dream of training at some of the great hospitals elsewhere in the world or practising in one particular specialty, this bureaucracy comes at a large cost. By considering doing their residency training in Canada, they are risking losing the freedom to choose what and where they would like to study.
It is a bit of a stretch to blame IMGs for the inability of anyone to match or other shortcomings of CaRMS. The IMG slot, which is in most specialties around 5-10% of total spots, is actually not being used for it’s intended targets, Doctors who move to Canada through various immigration programs, rather being used by faculties to sneak in their relatives who went to Caribbean schools. I don’t know why it was surprising that IMGs can compete for desirable specialties and locations. IMGs are equally equipped, if not better in some conditions, to join a residency training.
My advice to IMGs is the same though- do USMLE steps, go to America where the spots are plenty and your matching chances are higher than the rigged system of matching in Canada. I learned this the hard way and I am glad I came to America.
The whole Carms system is corrupt.
Let’s say a student is applying to a competitive field like emergency medicine. In Canada the match rate for such is something like 50% – not good odds. The likelihood that a Canadian student will end up matching to a personally undesired program in Canada for EM is quite high given the paucity of positions. Some students would much rather go to certain programs in the US for training that provide better experiences and resources than some of our schools, yet are prohibited from doing this by the arbitrary, unfair policies you outlined above.
Another topic is the shutting out of any residents applying to any first round positions if they have already attended a post-graduate training program. Should they desire a career change, they’re out of luck. The answer given by carms is always “you can apply to the second iteration” but the second iteration has limited choices that are not particularly attractive to anyone. Meanwhile, there are IMG positions in the first round, in competitive specialties in desired locations like Toronto and Ottawa, that CANNOT be applied to by any Canadian medical graduates, instead being held for foreign medical graduates. If that doesn’t spell corruption, I don’t know what does.
As an educator of medical students, I always encourage my students to sit for the USMLE exams and apply concurrently, or dare I say exclusively, to the USA. Carms clearly disrespects the achievement of our Canadian medical students by providing backdoor positions exclusive to foreign medical graduates and limiting their opportunities to re-train.