CARMS 2007 match - Good or Bad news for IMG's

[firetown]

Currently IMG's are participating in the frist round iteration of Carms in a parrallel match. On the carms website, 160 positions are reserved for IMG's. I am not sure if this is good or bad news. In Ontario, 130 positions are reserved for IMG's. This is far less than the 200 positions that IMG Ontario was offering to IMG's. There is not much for IMG's in the other provinces too. Is this therfore good or bad news or I am missing something. Are the other provinces like Nova Scotia and NFLD still offering their assessments with practice opportunities in addition to the Carms match or it is like in Ontario where IMG Ontario is only providing assessments and not residency positions anymore.

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[JBA]

This is definitely bad news. The changes to Carms have without question hurt the chances of IMG's trying to get into Canada. And have definitely made the US a more attractive option for Canadians studying abroad. Take GS for example. In the past IMG - Ontario had been offering around 5-7 spots. Now they are offering 2. Add to that the return of service committment for 5 yrs and it looks like IMG's should have kept quiet and snuck into either 2nd round spots or left things as they were.

 

[pattycanuck]

This is definitely bad news. The changes to Carms have without question hurt the chances of IMG's trying to get into Canada. And have definitely made the US a more attractive option for Canadians studying abroad. Take GS for example. In the past IMG - Ontario had been offering around 5-7 spots. Now they are offering 2. Add to that the return of service committment for 5 yrs and it looks like IMG's should have kept quiet and snuck into either 2nd round spots or left things as they were.

I would reckon that it depends on what type of IMG you are - if you HAVE to go through IMG-O (ie Canadian immigrant who ahs been here for a while and hasn't been practicing medicine), it may not be so good. However, as Canadians who have gone abroad from more noted schools represented in Canada such as the UK, Ireland and Australia), this news is soo much better - the program directors in these schools know that there are a large amount of graduates from these countries in the system and generally respect their training. With the suspected demise of the old IMG-O regimen, opening up CaRMS in the first iteration, and especially the HUGE amount of Canadian born-IMGs now wanting to come home, it will be easier for those "Canadian born" group versus those in the "not-born" in Canada group.

Also remember, whatever spots are left after the first round will still be available in the second for IMGs ... so there are "more opportunities" again if you don't match the first time guaranteeing "2 cracks" at the system as IMGs compared to many years of only one crack and that crack coming with the "leftover" spots

 

[peacefuljourney]

Hi,

I met with the policy wonk this summer who helped create this program (in Ontario) and she was genuinely concerned that we weren't all so superexcited about the Canadian option versus the States. You must still do the 5 year return of service up north (for the specilaties); south for family medicine. This is also true if you only do a 3 year or 4 year specialty training.

Still, I went to the carms site and just see the main chart where parallel and competitive is listed. Where are you guys getting the specific, by specialty information about how many spots available? Could you post the link here. When I last spoke with the lady, she said the spots by specialty would be posted but I can't seem to find it (silly me).

Thx. S-

 

[Methodnike]

Hi,

I met with the policy wonk this summer who helped create this program (in Ontario) and she was genuinely concerned that we weren't all so superexcited about the Canadian option versus the States. You must still do the 5 year return of service up north (for the specilaties); south for family medicine. This is also true if you only do a 3 year or 4 year specialty training.

Isnt that only in Ontario? If yes, then whats the problem?

 

[pattycanuck]

Could you post the link here. When I last spoke with the lady, she said the spots by specialty would be posted but I can't seem to find it (silly me).

http://carms.ca/jsp/program.jsp

Go to any of the descriptors under "by specialty" or "by university" and it will breakdown the quotas by both university and program into Canadian/US spots and IMG spots.

 

[pattycanuck]

Isnt that only in Ontario? If yes, then whats the problem?

According to my contract and those who are in other specialties here at Queen's who signed on to the 5 year return of service, it looks like that it is 5 years for all specialties (CCFP and RCPSC programs) and all over the province (north and south).

Of course, you have to weigh your options if you want to go to the US - get into Canada/Ontario and work in virtually any place in Ontario outside of downtown Toronto, Kingston and downtown Ottawa (yes, even London and Hamilton are on the underserviced list) OR trying to get back to Canada with an American residency (many threads on this if you search this forum so I wont comment on this here!). Just remember also that the LADAU list from the MOHLTC changes every 3 months - at this point in time, Kingston has applied for underserviced status, but I doubt they'll get it.

ROS agreements: http://www.health.gov.on.ca/english/providers/project/img/serv_agreem.html
LADAU lists: http://www.health.gov.on.ca/english/providers/program/uap/desiglist_mn.html

Another reminder of the MOHLTC free tuition grant - it doesn't apply to IMGs old or recent grads - the recent grads who had their proof of tuition ready to submit who graduated this past June were flatly denied (especially for one guy has signed up already with a community as of June and he's not finishing FM till Oct 2008)!

 

[JBA]

I guess the changes to carms are a good thing if you are interested only in FM or a less competitive specialty. But to be honest, Canadians who were training abroad were matching into FM before this year so I doubt the changes will see any drastic increase in the number of Canadian born IMG's getting spots. The major reason I think this is a bad situation is that last year IMG-Ontario had 200 spots for IMG's. Now it seems like there are about 130 or so. So for the right to say we can match in the first round, we just lost 70 places. Where they went I am not sure. Likely some have been passed into the pool for Canadian grads.
As well the return of service agreement is a pain, regardless of how you look at it. Fair enough you might get into a southern ontario city but you're still not free to pick the city you want entirely. And when it comes to specialty training your choices would be even less.
I think it's important that people stop and really look at the situation before they abandon all plans to head to the US or stay in Australia just because IMG's are in the "first round".

 

[firetown]

As much as some positions have been lost to IMG's, I do agree that it is a plus for Canadian IMG's in Australia, UK or Ireland. They are most likely to be preffered over other IMG's from the carribeans or elsewhere as it use to happen in the 2nd round previously. I read in the UK forum that reps from MOHLTC are touring the Irish schools to encourage people to apply to carms. In addition, I am sure they will not neccessarily have to go through the pain of assessment through the Ontario IMG to be considered by programs. It will really be almost impossble for any other IMG who have not passed through the assessment program at Ontario IMG to get a position in Ontario. Does anybody have any idea if provinces like Nova Scotia and NFLD will still organise their assessment programs.

 

[Arb]

When they visited Dublin, they said ALL return-of-service locations for specialists are north of the French River (ie. Northern Ontario). It will be 5 years for everyone but there is an option to buy out of it: Return all the money you earned through residency PLUS the cost of training.

The director of HFO even said that if you do your residency in the USA and want to come back to Canada, THEY WILL TAKE YOU. Hell, you're probably more desirable coming from the USA since they put in absolutely no money in training you. Then you can probably work anywhere.

This is really indicative of how they view IMGs. They feel like they are doing us a favour and pulling on our heart-strings, which will work for many DO want to return to Canada. If you ask the Malaysian students in Ireland, those who are sponsored will have to do a 10 year return-of-service while those that pay their way do not. They don't understand Canada's rationale for having a return of service clause for IMGs. Again, it's all about taking advantage of our emotions....for now.

 

[UofTGradStudent]

Hey Guys,

I was told that these ROS agreements can be swayed somehow legally, as it levies on our constitutional right, as Canadians and as guaranteed under the charter, to work where we want. I think if you can get a lawyer to argue a case where such an agreement could potentially cause some kind of harm - emotionally, psychologically, or otherwise (caring for an ill parent, children's needs, staying close to family, etc.), you might be able to reduce those years on 'compassionate grounds' (as they mentioned on their websit) or get rid of them altogether. This is conjecture at this point, however.

I'm heading for USyd for med this year and hope that within 4 years, things will be streamlined, as program directors will actually take a liking to IMGs over the years, and as more spots become available, Canada will be a REAL option for Canadian-born IMGs, and not just in paper.

I agree with previous comments - Canadian born IMGs in UK/Australia/Ireland may have the upper hand over other international (e.g., India, Egypt) and Caribbean schools. I think the most important thing is to go to a well-established, English-speaking country/school for your MD/MBBS training. We'll see how this year matches. It's going to be a VERY important determinant for how this new policy pans out.

UofTGradStudent

 

[pattycanuck]

I am not sure if the reducing of the time amount in the ROS will work or not - there are approx (really rough estimate) of 200 IMGs (?) currently in this ROS and I think no one has mounted a serious threat to change the ROS legally.

There is one IMG at Queen's that is on the PAIRO exec this year and her main goal is to get this ROS changed to if anything a year-for-year repayment of services rendered - she also believes from what she has seen to date over this academic year that it will be a long a roungh ride in getting that done

 

[markdc]

When they visited Dublin, they said ALL return-of-service locations for specialists are north of the French River (ie. Northern Ontario). It will be 5 years for everyone but there is an option to buy out of it: Return all the money you earned through residency PLUS the cost of training.

The director of HFO even said that if you do your residency in the USA and want to come back to Canada, THEY WILL TAKE YOU. Hell, you're probably more desirable coming from the USA since they put in absolutely no money in training you. Then you can probably work anywhere.

This is really indicative of how they view IMGs. They feel like they are doing us a favour and pulling on our heart-strings, which will work for many DO want to return to Canada. If you ask the Malaysian students in Ireland, those who are sponsored will have to do a 10 year return-of-service while those that pay their way do not. They don't understand Canada's rationale for having a return of service clause for IMGs. Again, it's all about taking advantage of our emotions....for now.

I agree with the return of service clause being a little ridiculous. The Canadian students studying in Australia, UK etc can likely stay there if they desire and will be lost if there are too many negative aspects with returning. Those that are desparate to return home will definantly be taken advantage of. I can't really see it improving much in the future given the past history.

It is ironic that Canadian citizens that have trained abroad are competing with all FMGs. This is done to ensure that the process is ethical and fair supposedly. However both the British Medical Association and WHO slam the practice of taking foreign trained docs from developing nations that have critical shortages of their own. Just a little food for thought since the UK has recently changed their policies regarding FMGs.

 

[pattycanuck]

As people don't want to admit - all of those people that went overseas to pursue their medical education CHOSE to go overseas and become IMGs. When they signed on to those schools, the willingly knew that the chance to get back into Canada during that time was a a crap shoot. They knew both the benefits AND CONSEQUENCES of this choice!

They chose to go over knowing fully that the chance of getting back home was dismal (during some years especially).

I don't think I've b*tched too much on this topic myself - I think it is natural to think animosity. However, there are some of those here who have just blown it all out of proportion. Just get on with it and be glad what you are given - it is probably better than the circumstances of being allowed to return to a Canadian residency compared to when you signed on to a foreign medical school and officially became an international medical student

Remember - you knew exactly what you were getting into when you signed on the dotted line in accepting a position overseas.

 

[avenirv]

...Remember - you knew exactly what you were getting into when you signed on the dotted line in accepting a position overseas.

correct and many will hate you.
they tried to find the easy way.
maybe it is easier but for sure longer.

 

[MeowMix]

As people don't want to admit - all of those people that went overseas to pursue their medical education CHOSE to go overseas and become IMGs.

Please note that this is not always a choice. I would have been happy to go to med school in Canada, but I got turned down without interview, and I would not have qualified at many other schools. I was a strong candidate in the US and had multiple acceptances. This situation is somewhat specific to older non-trads with dual citizenship, but it's also a problem for a lot of non-trads with coursework completed part-time over multiple years.

Meanwhile, my mother is asking me to find her a specialist in the US because she can't get a non-emergency appointment in Ottawa for 6-9 months; my sister can't find a GP in her area who's taking new patients. It's hard to believe that the Canadian system is working well.

 

[pattycanuck]

True, many may hate the situation and even me for saying that ... but the fact still does state true (and regardless, the truth may hurt) - one makes a choice in pursuing medical school and one makes a choice in going overseas to do so. It is still a contract and one that has to take all bad and good things considered. You can't expect the world to change overnight just because you demand it.

As well, some individuals could have stopped thinking about medical school as an option once they didn't get accepted in Canada or the US; to choose then to go outside to go to medical school came with inheirant risk - thus one potentially pays a higher price and faces more conditions coming home, right?

People who do go over knew initially that coming back would be hard before they left I am sure for most of the students abroad now, they came in at that time with the understanding that they would still only be accepted into the second round of CaRMS and to mainly FM spots as well. Not only that, but that they would be competing with many of those IMGs already present here, some who were consultants in former lives, from areas such as the UK, Ireland, Australia, but more noteably from other countries like India, Russia, Egypt and Pakistan.

Be happy that at least IMGs are at least considered even for some of the specialties like ER, radiology, etc compared to the situation just even last year! It is moving forward, yes, but maybe not in the way and pace that some individuals may want it.

And also with due respect, the state of the Canadian system can be considered to be a separate issue - if the government wanted to solve one of the big related problems (doctor shortage), one solution could have been to hire the hundreds/thousands of IMGs already present here in Canada. They don't have to even consider all of us Canadian-born IMGs for that problem at all.

 

[Arb]

It's not the return-of-service issue. It's the hypocrisy of their policies. They say they genuinely want you to return to Canada for residency, and yet they will tell you the US is the best way to go. They tell you they are desperate still for doctors, yet they have policies that discourage you to return to Canada. They say that they recognize the great education and training that you receive in Ireland and they see how many have moved up nicely in the Canadian system. Yet, you have a 4 month assessment period before you can start residency even though they recognize the compatibility of the Irish and Canadian system.

Now it is a choice for those that want to return to Canada for residency and I personally don't think you can/should lawyer up and break your contract. Progress is being made too however, I feel that they should be honest and transparent with their motives and also realize the mistakes they are making. I can't see how going to Ontario for residency would be better than going to the U.S.A and those at MFO will agree with me. I know people in my year and in the upper years at UCD are more than willing to go to the US for residency as am I. The reality though, some will not return to Canada afterwards.

Edit: I also don't think we should feel grateful for allowing to return to Canada and thus, let them take advantage of us. Seriously, it makes no sense.

 

[pattycanuck]

With all sincere respect to you Arb as I agree with your point, but again, the issue comes down to this: we (yes me, you and all others who have been accepted to an overseas school) made the conscious decision (meaning we "understood and appreciated") of going over and still accepting what ever repercussions along the way. There was never any issue about the possibility of us potentially getting back with full equal rights to access as a Canadian graduate ... and that is what we again signed onto. Additionally, if the government bodies are hypocrites, we signed on knowing that there was a possibility dealing with hypocrites could happen ... and yes it has happened to me as well and most if not all others here as well.

I remember a day when I used to feel like many on this board - I am not saying it is wrong, but we have to live by the choices we make and if it means knowingly that we could have a hard time coming home and realizing that it is hard coming home ... we have to live with it.

Another quote reference: the "shoot first (ie go to med school overseas) and ask questions later" (ie "hey Canada, why wont you let us back in as doctors?") doesn't work here.

And I don't give Canada or Ontario any credit either for allowing me back into Canada as a physician ... I had to do all that work by myself and with other graduates and students from Ireland like yourself over the past few years (all the time having the MCC and Canadian MOH spit as us while we try to get things in order).

 

[Arb]

I actually never thought of going back to Canada until all this. It was always, the US for me and it still is but now, I'm paying more attention to the dealings back home. Seeing what one has to go through, pattycanuck has all of my admiration. Man, you're in and going through it all and that's awesome. I just never thought they (Ontario) would view doctors in such a way. For instance, they said that they will do a much better job of labeling you as an IMG for the duration of your training in Canada ESPECIALLY when you are searching for fellowships. Maybe I'm missing the point but, how is this a good thing?

Again, none of this should be a bother if you don't choose to go to Ontario for residency.

 

[pattycanuck]

The funny thing is that as a Canadian born graduate from Ireland once you are a resident, the staff and Canadian graduating residents say (literally), "WTF did you need to do that stupid 'clerk' period for? You trained in Ireland for God's sake? (sarcastic tone obviously)"

Even had a few of the GPs (including the Queen's PD) have said, "Irish clinical training is SUPERIOR to Canadian clinical skills training" - yes they used that bolded word.

It maybe that once they hear the Canadian accent (and kinda feels good and bad about this at the same time), that it really becomes a non issue if you are an "IMG", because in their eyes, if you are satisfactory at what you do in your job, you really aren't an "IMG". You can communicate like a "Canadian" and that is 50% of the medicine, being able to communicate/interpret Canadianisms, ideas, body language, "Canadian" intonations, and sad to say, but even accents for some, etc. Medicine is not only a science, but also an art in which communication is key for effective process of care to patients and other caregivers. I don't know if it is, but it is a possibility that this is true

Anyway and overall, our discussion has purely been on the administrative/bureaucraitc mechanism of how to get home. Do not let it get in the way of the knowledge that your Irish medical education is by all means one of the best in the world ... some of you may beg to diifer while standing around waiting for an SHO/registrar for tutorials, but when you come come back home and see yourself against your American/Canadian counterpart, you'll understand. And if you are purely a Type A personality, coming back to NA, you'll be exposed to the some of the best management and technology in the world and you can combine the two and be awesome at both; the cool part about that is that it takes a few weeks to learn management, but it takes a lot longer to learn clinical skills.

Oh and BTW Arb, thanks for that, but there are many more before me who had worse and really got the "kick in the teeth" sort of speak.

 

[avenirv]

ask in ireland what happens with an irish guy that graduated from a canadian/american medical school ?
you have the surprise to see that...ooops, just like in canada !

as about canadian medical system: they need doctors far north, not in north bay but much far north. they need doctors not in the cities.
is anybody willing to go there when you just go, take usmles and compete in the most open residency competition: USA ! the majority of residencies are accepted in canada.

 

[pattycanuck]

the majority of residencies are accepted in canada.

yes, they are accepted ... but, with added conditions before you come back - ie making the residencies of equal length (most Canadians are not at liberty to do that as they can only get J1s and not H1Bs and only with the stupid Canadian MOH form to get the J1). Canadians cannot on the other hand go straight south for the most part as they have to do the 3 steps of the USMLEs before being allowed to practice after their Canadian residencies.

 

[eirosome]

pattycanuck, if you had postgraduate training in Ireland, as a GP for example, would that have have made the move home any easier?

 

[avenirv]

yes, they are accepted ... but, with added conditions before you come back - ie making the residencies of equal length (most Canadians are not at liberty to do that as they can only get J1s and not H1Bs and only with the stupid Canadian MOH form to get the J1). Canadians cannot on the other hand go straight south for the most part as they have to do the 3 steps of the USMLEs before being allowed to practice after their Canadian residencies.

the american boards, at least in 43 states, do not require from canadians the USMLEs. but dhs requires ALL 3 USMLEs for H1B.

 

[Arb]

I think you're missing the point. It's not about the policies, it's the why and motives behind them.

 

[Who M.D.]

Yet, you have a 4 month assessment period before you can start residency even though they recognize the compatibility of the Irish and Canadian system.

Sorry for being a bit late to this and a bit off topic:

When does one do this assessment period? Before applying for residency? Or after applying (and possibly being accepted?) but before actually commencing the residency?

 

[pattycanuck]

Sorry for being a bit late to this and a bit off topic:

When does one do this assessment period? Before applying for residency? Or after applying (and possibly being accepted?) but before actually commencing the residency?

The AVP is a period of 8-12 weeks at the START of the residency where one is observed/tested and if they fail ... they are booted out of the residency with no recourse - no appeal. No joke about that as well - no appeal. You cannot continue the residency and will find it hard to reapply to ANY program because of this failure.

The chance of you failing it are pretty small, but not impossible. They have checks on certain weeks with pretty lengthy (on paper) evaluations which can include from how you work around the office to videotaping your interviews.

Again, no recourse, no appeal. That is a fact so don't even try to go and argue this one!

On the otherside of things, you really have to F&^K up to flunk the AVP. It may cause stress, but remember that they've invested 4 months in the PRP program IN YOU (ie loads of money) to get you through this already - anyone that says they will be dropping thousands of dollars for those 4 months now lost ...

 

[Unch]

I'm pretty sure the bottom line on all this is protective politics, not standards or even communication styles per se. Yes, as Canadian IMGs in Oz, Ireland etc, we have these hurdles on returning but the reverse is also true. There is a first med here at UCC who is married to a pediatrician. They're both Americans and he has been practicing for six years in the US (after completing US residency/fellowship etc). He's relegated to being a registrar here in Ireland (essentially repeating his residency) with low pay, on call hours etc. And this from the country that sends it's top consultants to the US for fellowships as the final feather in their training. The restrictions are all about politics in all the "developed" countries and that's all there is!

 

[pattycanuck]

I'm pretty sure the bottom line on all this is protective politics, not standards or even communication styles per se. Yes, as Canadian IMGs in Oz, Ireland etc, we have these hurdles on returning but the reverse is also true. There is a first med here at UCC who is married to a pediatrician. They're both Americans and he has been practicing for six years in the US (after completing US residency/fellowship etc). He's relegated to being a registrar here in Ireland (essentially repeating his residency) with low pay, on call hours etc. And this from the country that sends it's top consultants to the US for fellowships as the final feather in their training. The restrictions are all about politics in all the "developed" countries and that's all there is!

Is it because his "internship equivalent year" in the US is not seen as equal to that in Ireland? As I recall from the residency descriptions in the US, one practically "specializes into their program ASAP".

I've been told that that is the case for those that do come over - many of my NA classmates inquired about coming back to Ireland after they've done their residencies in NA and not doing an internship year; the response from the official body (Medical Council) was that if your intern year in NA was deemed as satisfactory AND your training was deemed acceptable by the relevant college/Medical Council/governing specialty body in Ireland, then and only then can you transfer on "equal footing" into a spot in Ireland.

 

[peacefuljourney]

Hi.

It's been a while since I've been here. Firstly, thanks for the links to the actual numbers for this year. So, 16 internal medicine spots for all of Canada for this year. I don't recall how many in Ontario. How many applicants? I think it was just over a thousand. hmmm...

Re: knowing what we got into. Yes, of course. At the time we just assumed that we would be heading Stateside. The recent changes did make us seriously look at the Canadian process once again. And there were some good points made here - change takes time.

I think the key thing that bothers me is the hypocrisy - mostly because the average joe - i.e. mom and dad and aunts and uncles etc. just hear how desparate we are for doctors and then don't understand why my husband and I just can't set up practise in Ontario in one of the many many underserviced areas.

I worked in healthcare in Ontario (business side) for about 8 years in a number of capacities and what it all boils down to is this:

healthcare = politics as we are a social system.

What this means is that things/decisions don't necessary have to make good common sense (or financial, or logical or any other criteria) - they DO have to make good political sense. So, if you can deliver an MD to the North (with all of the attendant fanfare and publicity) every now and then, that is good political sense.

Re: ROS. You can buy this out, or the hospital can buy this out, or you can argue that the specfic communities don't meet your training needs - i.e. so many operations of different types are needed to be a 'complete' xyz doc.

Re: heading back to Canada from the States. This process is dependent upon the whim of the credentialling bodies in Canada AND each specialization board.

Re: crazy. One lady I spoke to is Canadian and lives in Niagara Falls, Canada and has practised as a family doc in the States for 11 years. She wants to practise in Canada (Welland area is underserviced) and the ruling was she would have to take a year to be a 'resident' under the care and supervision of a fully fledged Canadain FP before being allowed a full license. I don't get that. Sorry.

AND I can't allow my future and the future of my family to rest on these government folks' whims. That's what it really comes down to.

If I pass my usmle's - I mean pass not 'stellar pass' - just a pass - then I can get a job/residency position somewhere in something in the States. The same can't be said for Canada.

As one of our colleagues mentioned earlier, the match numbers this year will be very revealing; can't wait.

S-