MD Students Need System-Wide Action
April 11 marks the second and final iteration of the 2018 Canadian Residency Matching Service (CaRMS) process that “matches” MD graduates with a residency program at sites across the country, allowing these new physicians to move forward with a compulsory next level of clinical training.
We’re very pleased that 92 per cent of graduating MD students at U of T successfully matched this year to a residency program, including most who enrolled in our fifth-year extended clerkship program in 2017/18. Congratulations to everyone taking this essential step forward toward independent practice.
But we have a systemic issue that requires focused and coordinated attention from all stakeholders. After relatively stable historic levels of 10-20 unmatched Canadian medical grads nationally, that number has risen sharply since 2011: to 46 in 2016 and 68 in 2017 (35 in Ontario). We don’t yet know the final 2018 provincial and national numbers of unmatched students, but the Association of Faculties of Medicine of Canada (AFMC) projects this number to reach 141 by 2021.
Without post-MD residency training, medical graduates cannot be certified to practise independently. For competent, dedicated MD students, going unmatched to a residency position can be a shocking setback. But I want to stress it is just that: a setback. At U of T, our MD Program team works diligently to support individual students both personally and professionally in planning for their future success.
However, for provincial governments that determine physician supply and have to answer to voters around physician shortages and wait times — not to mention all Canadian taxpayers who subsidize the cost of postsecondary education — this situation is simply unsustainable. At U of T, we are working hard to ensure our MD students are successful, and we’re actively advocating with a range of stakeholders for coordinated system-wide action.
From first year medical school onward, our faculty and staff introduce career options with specialized counselling around career choices and preparation, including selecting electives to optimize student success in matching to a residency position. If difficult conversations need to happen, we take those on: not every student can achieve their singularly personal goals in medicine without honest self-reflection and a realistic eye on societal needs and geographic realities.
But medical students make the point that to plan their careers wisely they need timely access to the most up-to-date provincial projections around residency position allocations and the projected need for specific medical specialties. In Ontario, regular updates to the needs-based physician forecasting model are essential. And that information needs not only to be available but also clearly communicated. (See Saskatchewan’s approach here.)
Fundamentally, however, we have an imbalance that needs to be corrected. According to the Canadian Federation of Medical Students (CMAJ, Jan. 19, 2018), in 2017 there were 1.026 residency positions available for every one medical graduate, but the ratio of anglophone positions to anglophone-only applicants dropped to 0.986 spots for every one student. This is clearly unsustainable over time.
As the voice of Canada’s 17 medical schools, the AFMC has recommended that provincial funders must work collectively to increase the number of residency positions to return to a minimum national ratio of 1.1 entry positions for every current year Canadian medical graduate, as aligns with the health needs of the population.
There are a number of ways to achieve that. We will work with our colleagues locally, at our sister medical schools, the Ministry of Health in Ontario, and with our learners to co-create solutions as we move forward. Simple fixes do not often address the shortcomings of what is a complex system of medical education, much of which is carried out on the frontlines of our decentralized healthcare system. All of us play a role — MD educators, hospital-based residency program leads, our provincial funders, and federal agencies — and the onus is on all of us to find viable solutions.
Dean, Faculty of Medicine
Vice Provost, Relations with Health Care Institutions
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