the tale of CaRMS

So,
There has been a very surprising development in the canadian residency matching system in the past day. It's got so many pairs of panties in so many knots I can't even begin to count them. So this is the story:

International medical graduates (IMGs) used to match only in the second round of CaRMS so that gave Canadian graduates first pick at residency spots. There history have been a few provinces that have set aside parallel match spots just for IMGs but this was by far the minority. To qualify the term IMG, these are usually people who are Canadian born but went to medical school in other countries because they could not get one of the very limited spots here and now wish to practice in Canada. There are also a handful of people who are landed immigrants in Canada and wish to convert their training in another country over to be a doctor here but they are in the minority.

What has happened now is that a bill was passed without anyone knowing about it stating that IMGs will now be able to participate in the first round of the CaRMS match. The reason everyone is in a snit about it is that the CaRMS ratio for spots to Canadian medical students will now be reduced to 1:1. This means that there will be one spot allocated for each graduating medical student.

A majority of these spots will be family spots. Traditionally family medicine spots go unmatched because there are far more family spots than people who want to do family. This is by in large because they are the cheapest spots for the government to fund, being only 2 year programs, and so all of the "new" spots they've created over the past few years have been family spots. If the residency match goes to a 1:1 it means that there will be a lot of people matched to family spots who do NOT want to do family medicine as a specialty. It also means that once you're in a residency there will be no way to switch programs unless it's within the same institution and you can convince the program directors to re-direct your funding. You may be saying to yourself "well, there's a doctor shortage, people should be forced to do family". Yes, there is a doctor shortage, that isn't limited to family doctors. There is also a specialist shortage in Canada. And the reality is, people who do not want to do primary care don't make good primary care physicians. These people will not do justice to a specialty that takes lots of time, effort and dedication.

Furthermore, there is a rumor that it's going to be a parallel match. This means that we will not be directly competing with IMGs for spots but there will be a certain number of residency spots allocated to the IMG CaRMS match and a certain number allocated to the Canadian grad carms match. There has been no strategy reveiled for how these spots will be allocated. If there's only one derm spot at a school, which stream will it be allocated to? If there are 2 ob/gyn spots, will one go to IMGs and one to Cangrads eventhough there are going to be way more cangrads than IMGs accepted into spots? Or will it be proportional? These are questions that need to be answered in the days to come.

From what I see this is really going to fuel resentment on the part of Canadian grads against foreign grads. I have no problem with foreign grads being funnelled back into the Canadian system. What I do have a problem with is the 1:1 ratio. I think the ratio should be atleast 1.2:1 which is approximately what it is now. Just adding IMGs into the additional .2 of the ratio to make the cangrad match 1:1 does NOT make sense. The biggest problem I feel is that the general public doesn't understand how residency works so the 1:1 ratio probably makes total sense in their minds. I mean, we all get to be doctors, right? It's going to be a hard task to explain adequately to the public what this new system will mean for the quality of their health care in the future.

Oh, and why did this all come about? A class action lawsuit! of course. A group of IMGs are threatening to sue every medical school in Canada because only letting IMGs match in the second round is, in their opinion, against the charters of rights and freedoms.