Reflections on CARMs presentation

Its daunting every time to read those statistics, even thought they havent changed much. That 44% number will probably get lower every year, as more CSAs will be applying from Carribeans, Australia, Ireland and other countries -- meanwhile, # of residencies will stay the same (based on CARMs CEO).

Its a lot easier, if you plan on doing GP. However, if you would like to try for a specialty residency, US is a better option by a lot. Just make sure its ACGME accredited.

I have some experience with IMGs who finally make it Canada and some don't. These individuals are brilliant people who go through enormous hardship to become certified. As a fully trained doctor in their home country, they might drive a cab or become a janitor in the hospital. They usually leave home at the peak of their career to find themselves doing these kind of jobs. It's tremendously sad.

If you are a Canadian studying abroad (CSA) you are doing so because you did not have the right GPA, MCAT or interview scores. There might be a few individuals who actually might have a legitimate reason, but for the most part CSAs are not brilliant students. They are mediocre students who are stubborn. (Mediocre student does not mean you are not intelligent)

These IMG quota residencies were made to alleviate the struggle of these IMGs. Not for CSAs. Yes, not for CSAs. Its important to set things straight in my opinion.

And even with our (overall) weaker MCCEE scores, we tend to have a higher chance of getting a residency. The residency, that was made for that middle aged frustrated cardiologist who has been picking up trash in the morning to pay bills for his/her family. Why?

1) It could be because CSAs tend to be younger. Resident directors prefer a clean slate

2) It could be because we talk, act and walk like Canadians. No language barrier issues, no clash of cultures etc.

Canada is supposed to a country for immigrants. In terms of job security, we treat our immigrants like crap. I've seen successful professionals get discriminated simply because of their accents or cultural differences, give up on their goals and settle for a menial job. This is wrong because a country which is made for immigrants should embrace accents and cultural differences in the work force. As a Canadian, I see that the government of Canada does embrace the cultural differences, but not employers. Employers tend to discriminate. Especially if you are a from a 3rd world country.

I believe, we CSAs are a part of that problem.

With our lower MCCEE scores, weaker GPAs/interview scores/MCAT scores (you could even argue weaker work ethic)................we take residencies from the IMG who worked extremely hard to get into medical school and worked hard to get that residency spot.............the IMG who is struggling to keep his/her family afloat in Canada...............simply because we're younger and we are Canadian.

Rather than integrating immigrants into Canadian society, these IMG quota residencies are being misused by Canadians for their own gains. That is un-Canadian. And I am a part of the problem.

Summarization of CARMs presentation today (2009 match)

The numbers look ok for us "Canadians studying abroad". Remember, by law, CARMs cannot discriminate between CSA and IMG. It is really important to understand that CSAs and IMG are treated excatly the same by CARMS and all medical bodies in Canada on the surface/legally.

However, you can gauge how well CSAs do specifically based on the year they graduate. In the 2009 match, most CSAs will have graduated in 2009 or 2008. Meanwhile IMGs tend to graduate a lot earlier since they have to do their training in their home country and then they migrate to Canada. Also note, these IMGs tend to be from India, Pakistan or China etc. IMGs from Australia or US tend to walk into Canada and work (they might have to do a few things here or there).

The numbers aren't pretty but here they are:

1) Overall, 1812 IMGs applied and 492 IMGs got residencies. Thats about 25%. This is a record high, and apparently funding for IMG residencies will not be increasing. Now its a matter of maintainence at this level. Infact, this % might even drop next year. So, as an IMG you have a 25% chance of getting a spot.

2) Now, 44% of CSA managed to get residencies. And out of that 44%.....84% had done an elective in Canada.
Two important points here:
This doesnt mean that if you are a CSA and you do an elective in Canada, there is an 84% chance you`ll get a residency.
This doesnt mean that those CSA who matched, got their 1st, 2nd or even 3rd preference.


3) Since its so important to get electives and they are in high demand, it matters who gets these electives. Ireland and Australian graduates tend to get most of the electives. But candidates will probably not get elective in the area they plan on doing their residency in (especially if its not FM or IM). These electives are the leftovers after Canadian medical students have their picks. But, you can arrange electives through contacts, so make those contacts!

3) MCCEE scores matter a lot. Resident directors rank their applicants based on their MCCEE scores and could make distinctions between someone who got 10 points more than another individual. So its not a matter of just passing it.

4) On average, IMGs do better on MCCEE than CSAs.

5) Doing residency in US, getting fully licensed there and then moving back is apparently a high probable strategy. Perhaps, you might have even better chances than getting a Canadian residency

6) Australian graduates tend to be slightly behind their Canadian counterparts in managing patient care as residents. But, this distinction disappears after 6 months. However, resident directors are aware of these issue and apparently its more labor intensive to train us than a fellow Canadian/American graduate.

7) As someone from Ontario and BC you have a slightly better chance of getting a residency. You're screwed if your from Alberta.

Update after a looong break

Hey guys,

You get two updates because I've been away for so long. It's been terribly busy and I think im a bit slow when it comes to writing out my thoughts. I need time to reflect, and I havent had that time recently.

Classes have been going excellent. My uni streams all their lectures online. This is absolutely huge. Rather than actually going to classes, I tend to stream them from home, pause when I get lost and memorize the lecture as it happens.

This tends to slow the process down: an hour lecture will take me 1.5 hours. But, I'll not only understand, I'll also memorize 80% of the material on the first attempt. And for courses like immunology, its an absolutely amazing feature. Im reviewing the entire block's worth of immunology now, and its so complicated that it would have taken me forever to memorize everything if I hadn't done it my slow way the first time.

The anatomy is taught decently well here. The amount of resources they give to aid you with your anatomy learning is great. I would like to do dissections, but ive realized that its more efficient time-wise, to learn my anatomy from prosections and ask a retired or currently practicing surgeon for help when i dont understand something. Yes.....surgeons...my uni is awesome.

All other courses arent that bad for me. Most Canadians students will find that a lot of material is quite basic. You definitely need to study those courses in more detail for your USMLE.

Thats all for med life. Coming very soon: reflections on the recent CARMS talk.

The current situation regarding internships/residencies (an overview)

Today, NAMSA (North American Medical Students' Association) had their first meeting. They painted an overall picture for us Canadians. I dont remember all the details but here is what I got out of it:

The 3 options we have, as Canadians, after we graduate are: stay in Australia, match in the States and match in Canada. (Technically 4, if you include New Zealand and Singapore, but I have not researched that option properly)

1) Option 1 - Stay in Australia
Not likely unless you have connections, and even then its not likely. Internationals fight for the last couple of positions left over after all Australians and Newzealands have a go at them (in the same province). Last year, in the state of NSW, they were 17 intern positions short. Which basically means, 17 internationals who did their medicine in the state of NSW did not have internship positions. To save face, NSW created positions out of thin air. This will probably not happen anymore because from now on, when we get an offer from an NSW medicine school, we have to acknowledge that we are not gauranteed an internship position when we graduate.

We were also shown a trend for the next 4 years. 2 years from now, during the intership tsunami, it will get really ugly. As of now, there will not be enough positions for internationals for sure

2) Option 2 - Go to Canada
Depending on the choice of your residency, this might be easy or hard. GP and internal medicine is quite likely, although EM and other specialties are not likely at all. Please refer to the cARMS website

3) Option 3 - Go to the States
Canadians are more likely to match in the States than in Canada, even in strong specialties. Furthermore, if you do your training in the States, you will not have to do 'return of service' when you go back to Canada. And especially in Ontario, you will you literally just walk in and start practicing (you still have clear your licensing exams).

4) If you are choosing between Queensland and other Australian medical university. Strongly consider not going to Queensland. They are bulging with medical students, resourced are limited (it doesnt matter what their rep says, ask the students) and quality will suffer.

I will add more details to this post, with supporting evidence. This post was really for individuals who are looking for the big picture. Also, keep in mind that I will not able to do a proper report on this topic for a while, and you should really use my blog as a launching pad for your own research.

Overall, although the mood of the meeting was sort of gloomy, there was a hint of optimism. Canada is opening more, especially to us Australian graduates. However, if I was not under pressure to start a medical program as soon as possible, id take doing an extra year (heck even 2 years) of undergrad to increase my GPA.....over coming to Australia. But I guess, crap is always less unbearable on the other side.

The whys

Why blog at all?

For the general public:
Whether we like it or not, a Caucasian's perspective is completely different from an Indian's perspective which will be entirely different from an African-America's perspective. My blog will, hopefully, give an Indo-Canadian perspective on living in Australia. This includes dealing with worried parents, subtle prejudices, being homesick and all that goes with being Indian on the outside, Canadian on the inside and Indian, even more inside!

For my sanity:
Rather than playing video games or finding another hobby to do during my studying breaks, id rather write out my thoughts and reflect -- so I dont lose sight of the big picture. Also, some days will get quite tough, and Ill need to lighten the load by typing my heart out to sleep easy.


Why Australia?
Simple reason:
Short sightedness + easy way out + family convenience

More complex reason:
My grades werent strong, but they werent weak either. I was in the "upgrade GPA another year and apply" pool. However, the anxiety caused by the perceived "lack of direction" my life was going in, was enough to insist that I look for more certain options. Perhaps anxiety is the wrong word. The mood was more along the lines frustration, disappointment, anger etc. I went from "he'll get in to med 2 years" to "he is wasting his life". I could have told them to deal with these emotions, but I wanted the easy way out too.

Those options were the Carribeans, Australia and UK.

I cancelled out Carribeans because my worse case scenario plan sucked. Same with UK. The amount of difficulty my American friends (Carib graduates) had with getting a decent residency in the states with a Carib MD and a decent USMLE score was quite scary. Now add in the fact that these hospitals will look at me say "what? H1B visa!? What are we? Rich?" was also really worrisome. Furthermore, I tried to gauge where the overall direction the American residency situation was going. Which is...steady amount of residencies but more and more applicants.
The Carib stigma was also a factor in my decision, but it was not a huge factor. I will never look down on a Carib graduate, neither should anyone else as they have to do much better than local graduates to get the same residency. Furthermore, I really liked SABA's program

Australia stuck. Yes, its next to impossible to come back to Canada and yes getting an internship in Australia is not easy. However, i have more connections in Australia than in States. And yes, Canadian residency directors look upon Australian students more favorably.

My evidence? Nothing substantial. I have weak supporting arguments like the CARMS presentation to University of Queensland students, to anecdotal evidence from IMGs who recently finished their residency. However, the worst case scenario with the Australia option is that I end up in Australia. Given the direction of NSW policies, in 4 years, it seems that getting an internship here might actually be quite reasonable.

Does my reasoning sound wish washy...uncertain...weak? It is. When i was knee deep in charts, policies and commentaries I realized that I have to just make a decision and there isnt a piece of information out there that will make any of the 3 options I had stand out. One option was just as likely or unlikely as another. In the end, I knew i wanted to go in medicine and I knew i had to do it soon. I simply chose my uni based on something as ridiculous as rankings.

So here I am.

Setting the structure

I'll update the structure of this blog as I go.

I still havent decided how personal ill let it get. The more personal I get (the more I elaborate my emotions/feelings) the less factual details i'll give to make sure this blog is not traced back to me and vice versa. Furthermore, Australia is a country of red-tape, so im not sure how much factual details I can give about the university I am at.

I'll give you a big hint though, its in Sydney.

I plan on keeping this blog throughout medicine school and during the struggles that will come with post-graduation. For those who are new to this world, international Canadian medicine students tend to be in a very tough spot after they graduate. After taking on tremendous debt (more than 300K)and getting through a tough program -- they have to fight to get a residency back home, in the States or where their local medicine school is. Managing to get any one of those goals is very difficult. This problem will be a recurring theme in the blog.

My ideas and thoughts will most likely get more sophisticated as time goes on. However, I dont plan on doing a whole lot of proofreading....i want to keep this blog as natural as possible. Hopefully, I dont succumb to my objective-science-paper writing ways.