A crisis appears to be brewing in Canada's postgraduate medical training system.
According to the Canadian Resident Matching Service (CaRMS), the 2004 match will provide no more than a 1-to-1 ratio between the number of graduates of Canadian schools and the number of residency positions. “We are expecting the lowest ratio ever,” says Sandra Banner, executive director of CaRMS.
This is bad news not only for graduates of the Canadian schools, who can expect intense competition in the 2004 match, but also for Canadian and other graduates of foreign schools who have traditionally applied for unfilled positions in the second round of the CaRMS match. This year, they can expect slim pickings.
According to CaRMS, there were 143 more residency slots than participants in the 2002 match, but only 65 last year. It expects 2004 will provide the tightest match ever. The problem has developed because the impact of increased undergraduate enrolment at Canada's medical schools is now filtering through to the postgraduate system, which has not received enough new positions to deal with the influx.
Banner says the main concern of program directors is that Canadian students may be lost to the US match, which in 2004 is being held earlier than Canada's for the first time. This means that Canadian students who used to use the US match only as a back-up plan may instead make it their first choice.
In October, the CMA, the Canadian Federation of Medical Students and the Canadian Association of Internes and Residents asked the country's ministers of health to move immediately toward a 1.2-to-1 ratio of residency positions to graduates of Canadian schools. Without this breathing space, says CMA President Sunil Patel, graduates of foreign schools and practising Canadian doctors seeking retraining would have “virtually no chance” of obtaining a match.
“We're shocked at the lack of foresight,” says CFMS President Sayeh Minoosepehr. “Why would they increase undergraduate enrolment without looking at the postgraduate level?”
Although Banner isn't sure what Match Day will bring next March, she remains “cautiously optimistic that the situation will resolve itself because health ministries will realize the wisdom of funding more positions.”
Minoosepehr, who hopes to become a cardiologist, says enrolment in her Class of 2005 at the University of Ottawa is 124 students, compared with 84 in the Class of 2004. She says this points to tough competition for almost all residency positions when she graduates. “I'm scared,” she says. “And as medical students, we really don't need the stress.” — Patrick Sullivan, CMAJ