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To the Editor:
The Canadian residency match is high stakes for Canadian medical students as it is the only in-country route into clinical practice for Canadian Medical Graduates (CMGs). There is an increasing number of unmatched CMGs in Canada. This trend is of grave concern to the Canadian Federation of Medical Students (CFMS), which represents over 8,000 medical students across Canada. The article by Wilson and Bordman entitled “What to do about the Canadian Residency Matching Service” provides only a glimpse into the complexity of the residency matching system, and we fear that it may lead some readers astray.
We are concerned with the claim that CMGs face direct competition from international medical graduates (IMGs). In most provinces, CMGs and IMGs apply for separate seats during the first iteration of the match, and direct competition only arises in the second iteration. What is left unclear in the available data is the number of CMGs who applied for each second round seat. Some CMGs in the second iteration might not apply to (or rank) seats, as a result of specialty availability, location of seats, or other factors. One cannot simply look at the numbers of IMG vs. CMG matches, and draw an accurate conclusion.
The CFMS supports increasing the ratio of 120/100 which facilitates greater student choice, greater flexibility in the system and will lead to less unmatched students. Even a number like this requires nuance; for example, one must consider seat-specific language requirements. In 2017, 1.026 residency positions were available for every 1 graduate, but the ratio of anglophone positions to anglophone-only applicants drops to 0.986 spots for every one student. The ratio of the numbers of medical students studying in each province to the number of residency seats also varies across the country, with not all provinces having adequate postgraduate seats. According to data from CaRMS, Saskatchewan had the lowest ratio at 0.879 in the 2017 match, and Nova Scotia was the only province to approach the recommended ratio of 1.20, having the highest provincial ratio at 1.157. The competitiveness of the system due to tight and non-dynamic ratios is a significant cause of distress to medical students, and largely responsible for our currently increasing numbers of unmatched students.
Furthermore, we are cautious of the comparison to European medical schools, many of which do not require previous university degrees for medical school admission. They exist within the context of primary university education with students often entering directly from high school, experience different pressures and norms in university than Canadians, and have different residency requirements. The accumulation of student debt, as well as the different role of medical schools within Canadian society, must be considered in comparison to the European model.
Finally, it is vitally important to consider the breadth of student motivations and circumstances in their match strategy; steps toward limiting the number of programs to which a student may apply may have significant consequences. For students intending to enter a “couples match” with a fellow colleague, for students hoping for a residency for which each program may only have a few seats, for students interested in more than one career path, or for students who need to apply prior to completing all core rotations, a limitation of applications could significantly harm the student’s chance at a successful match.
The CFMS is advocating for greater financial support from all organizations, including individual medical schools and postgraduate programs to reduce the burden of the match. To better address the financial burden associated with the final year of medical school, efforts should be made to reduce cost per application, increase interview flexibility to minimize travel costs, and a more objective selection process in which electives are valued less as auditions, and more as opportunities for learning and broadening skills.
The CFMS is working tirelessly with stakeholders and medical students across the country to address the “unmatched medical graduate crisis” in Canada.