2019 CaRMS Forum – English

2019 CaRMS Forum – English


We’re gonna go through a bit of a flow
here we’re gonna start with subspecialty matches we’re gonna get into a bit of an
overview on the match outcomes, some details around the opportunities are
available participation and some of the choices that have been made primarily
around applicants who make a variety of choices as they’re going through their selection process some detailed outcomes look about a little
bit and some new elective information that’s been made available last fall and
then a deeper dive into unmatched any amount of Canadian medical grads and on
field positions. So subspecialty matches we have three subspecialty matches which
I’m sure many of you will know and the first one in largest of the three is the
Medicine Subspecialty Match and I think what I’ll draw your attention to here is
that over time the last three years there been an increase of 12% between
2016 and 2019 and the number of matched applicants and the number of positions
available in that same period has gone from 489 to 538 so a pretty considerable
increase in the number of positions available so that’s the MSM match. And
the next match we’ll turn to is the the Family Medicine to Emergency Medicine
Match and that is for those who have been finishing their second year of a
Penta medicine program they’d like to go into a third year deeper into a
particular enhanced skill in this case Emergency Medicine so that’s what that
match has typically been this year in 2019 for the first time we’ve added
additional enhanced skills programs particularly the province of Quebec so
that’s why you’ll see the numbers have grown a little bit and shifted from what
they had been pretty consistent over the last three years. Then finally but
not leastly the Pediatric Subspecialty Match and it’s the smallest of the three
subspecialty matches but very important for those those colleagues that are
looking to advance their training and a pretty consistent trend over
time with a bit of growth in available positions. So now we’ll jump into the
R-1 Match the jumelage R-1. So four key themes emerged as we looked at the data and there’s going to be other things
that will emerge for you and that you’ll be interested in but for for us these
are the four themes that’s kind of popped up. Number one is that the
increases and opportunities nationally and that’s after some number of years of
pretty flat and maybe even some declining in opportunities nationally
even with that the fill rates so the percentage of positions filled across
the country increase, so more opportunities and a higher fill rate and
in addition a continuing trend is that Canadian medical graduates are having
increased concentration of interest as measured by first-choice discipline in
what are already high demand disciplines. So think plastic surgery, dermatology, urology more interest is in those high demands that’s a bit of a continuing
concentration of interest and then finally fewer unmatched Canadian medical
graduates now we released a bit of a high-level overview of the match so
some of these numbers will not be a surprise to you you will have seen those
on Wednesday so we’re gonna review some of those more but again some more
layers lower into some of those some of those facets. So this is an
overview so I’ll orient you a little bit to what you’re seeing here this is
the applicant pool and we break down our applicant pool into three main groupings,
Canadian medical graduates so those are graduates of one of the 17 faculties in
Canada, U.S. medical graduates either allopathic or osteopathic graduates and
International Medical Graduates so those who have graduated from a medical school
outside of Canada or the U.S. A registrant is somebody who simply
indicates their initial intent to participate in the match, they register
and then for whatever reason folks decided withdraw and not continue on to
actually apply to a program. Active applicants or those who apply to at
least one program for some reason folks do not submit a rank order list
indicating their their intent to train somewhere that they’ve applied and so
you have a few relatively few number of those.
Then finally the final participants are 4746 applicants who submitted at least
one rank on a rank order list So that’s the applicant pool for this
year. Now this is a very busy slide so we’ll take a little bit of time to
unpack it. We have two iterations as I’m sure everybody here knows and the first
iteration is typically other than in Quebec it’s it’s broken into two primary
streams a Canadian medical graduate stream and an International medical
graduates dream in Quebec they’re competitive so both IMG’s and CMG’s
compete on equal footing so first iteration you’ll see the number
matched, the match rate, the number unmatched for both current year
graduates and previous year’s graduates. A current year graduates at least from a
Canadian medical graduate perspective are those that we actually get on lists from
the undergraduate schools and for some of these folks that are considered
current your graduates this may not be their first time participating in the
match. They may have participated in a prior year they go back and
they are still part of the faculty so they’re still on a class list
so they’re considered a current year graduate from a data perspective as
opposed to previous year graduates who they may have
participated in the match before, they may not have matched but they’re not on
a current year list so there’s a bit of nuancing and we often get questions
about is this cohort in here as this cohort in here, how do you
measure all that so that’s essentially the breakdown so the
results of first iteration I can tell you that the match percentage for both
Canadian grads and international grads was considerably higher than in
previous years. The last couple of years IMG’s were at 46% so 50% is an
uptick and then so going into second iteration then those who do not
match in first iteration or those who didn’t participate in first iteration
and only participated in second iteration that can happen particularly for a
international graduates where there may not be programs of opportunity for them so some
only participate in second iteration for IMG’s. So again the same kind of break
down here and I’ll the one thing I’ll draw your attention to for second
iteration is that there was a change in eligibility in Alberta and Ontario where
as in previous years what had been Canadian graduate streams, International
graduate streams were blended and then both groups were able to compete on an
equal footing in the second iteration. This year those streams were it
maintained separate in the second iteration so that’s one pretty
substantial difference in how the eligibility of work in the second
iteration. So the number here and we called out the number of
unmatched graduates being quite low. So 31 is the lowest number since 2011 when
there were 23 so we measure unmatched current year graduates as those who
participated in both first and second iteration and are in the current year so
that’s our definition. There’s lots of different conversations
about unmatched and people use a variety of different kind of definitions of
what’s in what’s out so that’s the definition that we use here that you’ll
see. So 3346 available positions 98.4% fill rate. Last year 78 unfilled this year 52 so a considerable change
not only in the numbers but in the fill rate. So moving on to a bit more
of a focus on the on the program view so you’ll see this is broken down by region
and I mentioned 3346 positions last year 3309 in 2018 and Quebec had
the most dramatic reduction in fill positions there were 69 last year 69 in
Quebec 29 this year so less than half on fill positions and there’s a bit of a
storyline around that that we’ll get to in the coming slides.
So this unfilled decline that’s at the same time increasing positions in all regions so higher fill
rate and higher in large number positions. So here’s a breakdown of the
applicant though since is now a CMG oriented slide around at the regional
level so for pretty much every one of these kind of views
whether it’s the percent match by region almost every one of those views has
increased from last year in terms of match percentage almost every
region and whether its first iteration or second iteration so that’s a sign of
some very interesting things happening again which we’ll get into more detail.
So every region went down in terms of its percentage, so the national from 2.4 last year to 1.1. Eastern region stayed flat to last year
they were already at a relatively low rate so that certainly is a very good
news story for Canadian medical graduates and while the 31 who did
not match that is a difficult situation that certainly is
markedly low number. Here’s a view for the last three years of
international medical graduate results broken down by a region of medical
school, so again, this has got nothing to do with where somebody’s born or where
their citizenship is. This is about where they graduated from medical school.
Quite consistent rates over the last three years from all these
regions, with the exception of South America, which dropped from 24%
down to about 11%. Now those ends are relatively
small so it doesn’t take a lot of shift to to make a big
percentage decrease but, so by and large, you know pretty consistent results over
the last few years. So this view and I find this view quite interesting because
it tells you a lot about what’s been happening over time with who is filling
the positions in Canada so the burgundy and the far left hand side
or previous year Canadian medical graduates. The blue are current
year Canadian medical graduates. Green are
International graduates and then the 22 as on the 2019 is a United States
medical graduates. So you can see that you know the 3294 positions filled is
the most ever most we’ve ever filled through the R-1 match. So that is, I
think from a Canadian healthcare system perspective, that is a very good news
story. It’s also the most CMGs who will be entering post-grad training on July
1st than any single year so this is we talked about,
what is considered a current year graduate or a previous year
graduate, so this actually breaks down that number who previously
participated in first iteration. So, and one thing I’ll actually draw your
attention to is the significant decline in the returning current year graduates
slide and I, does have a little ability to point, no okay.
So, the third bar down you’ll see that the total of 44 returning current
year graduates this year 21. So, that’s a significant decline and you may recall
last year that there were supernumerary positions made available post second
iteration in Ontario and through the Department of National Defence in
Family Med it well Family Medicine programs with DND but there were other
positions available through Ontario. So, 38 positions were filled from the the
folks who did not match in second iteration last year. So, that took out
quite a considerable number of people to return to the match this year.
This is a, I have an interest in this, so you’ll have to kind of just bear with me.
This is the percentage of IMG’s who submitted a rank order list.
There is some school of thought that says if you submit a rank order list,
then you must have had an interview and there’s a bit of a kind of
logical thinking, that why would you submit a rank order list if you didn’t
if you didn’t submit an interview and that’s a sure that’s true in all
cases. Now the good news is we’re going to be introducing a system next year
that’s gonna track whether or not programs offer interviews. So there’s one of the
outcomes of the interview communication systems, we’re gonna have some data
that’ll be able to correlate with the ROLs just to see if that if that
hypothesis is true or not. But you can see this number is relatively flat over
over time. Pretty high rate. But I can tell you if I were in this system I would say what’s the cost? Why not submit a rank
order list whether you interview or not? That’s just me. So, we’re gonna get
some actual data as opposed to a hypothesis next year. So, now we’re gonna
do a deeper dive into the opportunities, participation, and choices. So, here’s a
picture, a big system picture view of the participation and quota available
in first iteration. So, the the column is the quota. Blue is for CMG. Pink or
fuchsia is IMG. And then the blue line, which you see increasing, and the IMG is
the burgundy line which is decreasing. So pretty flat quota across a
number of years. So, you can’t see much in the way of movement up and
down, but again, this year we know there’s a been some increase. CMG participation
has grown slightly every year. IMG’s, that inflection point of 2015 that’s when the
NACOSCE was introduced. So there’s a bit of a change and participation for IMG
group. Now this is a quite a… this particular slide gets a lot of attention
because it has some some important information on it and I’ll orient you. So, the
the blue column is the number of positions, the number of
applicants. CMG applicants, current year. The green little bar at the
top is the number of the previous year. The burgundy dash that’s quota available.
So, you can see in 2016, 2017, 2018, the top of the bar and the dash were real
close. So, that ratio was, we actually took it to three decimal
places because it was getting pretty tight, so, the 1.029
this year is the highest it’s been since 2015. So a lot of attention paid to
this ratio, and so that is the highest it’s been since
2015. Now this is a slide that breaks down the opportunities, positions
available, again for CMG’s by discipline group. This the first time you’re gonna
see this breakdown. We break it down into four major categories: Family Medicine,
Internal Medicine, Surgical Specialties, and Non-Surgical Specialties. So, the blue
is Family Medicine, the green is Internal Medicine, the Surgical is the burgundy,
and then, the orange or I guess that’s orange is Non-Surgical. So, you can see
that every one of the discipline groupings increased from last year. So
not only was there increase across the board nationally, but every one of the
discipline groupings increased from last year. So, 43.6.
One of the things that, you know, there’s a lot of attention to primary
care, and making sure people have a family doctor for them, so in 2013, the
number of Family Medicine positions as a proportion of the total, was 43.6% this year it’s 46. So not only has the absolute number gone up,
but the proportion has also gone up. And if anybody was wondering, there have been
some question from time to time as to where does obstetrics and gynecology fit? It’s in
the surgical specialty. So that’s consistent with Royal College and other
other groups that classify. This slide is a bit of a, you know, calling out some of
the big movement in disciplines over the last, over the last, what is it, 2014 to 2019. So, the upper right-hand quadrant are the disciplines that increased in the number of positions over that time. And these are disciplines that have more than 50 positions available. So the big, these are the big disciplines. So the upper right-hand quadrant are those that increased, and the vertical axis is the number of positions, the horizontal axis
is the percentage gain, and in the lower left-hand quadrant are those that actually had reductions disciplines. So I’m actually, this isn’t actually
in the script, so people will give me the evil eye. So I have a question. Anybody, any want to posit an opinion as to what are some of
the underlying factors that are driving some of these changes in disciplines? I
have my own theories, but they don’t matter very much. So
anybody have a want to talk a little bit about what’s going on here? That these
particular disciplines are changing. I know, yes. Population needs. Population needs, yeah, ok. Any particular aspect of population change that is? I guess I see psychiatry, so mental so the focus on mental health. Getting older, getting older, ok. So, yep. Sorry? So this is, this is something that I think there,
it’s kind of telling some stories here. For me, the mental health focus is one that comes through loud and clear. The aging population, not as many
kids, you know kind of comes through loud and clear. I think there’s some change in how babies are delivered. So midwives are doing work maybe that was done by obstetricians before. So that’s my own theory, so I’m interested in chatting again
over a glass of wine about some of your thoughts. This is, so here we have 4,700 applicants. We have 3,300 positions. And in order for those two groups to come together, there has to be a way in which they inform each other about a) interest, in the part of an applicant, I’m interested in that program and here are my qualifications. And hat’s what an application is. An
application is an applicant saying to a program I am interested in attending there, and training there, and here’s why I think you should be interested in me. And that’s an application! So, we operate a system that is open, that people are free to choose, and this application trend, if you will, I think is evidence of the fact that it is, it is an open market, you know, to coin the term. So, the number of applications across all disciplines has been going up and up and up. Not terribly surprising given that the number of applicants is going up, as well as the quota going up. So this is a bit of a view over time of that. And here’s that same view for Internal
Medicine. You’ll see that there was a bit of a dip in 2018 and we’re gonna get into the concept of supply and demand here shortly. But you’ll see that
the interest in some of these disciplines goes a bit up and down over time, and we have an interactive data worksheet on the carms.ca which shows some interesting patterns, a bit of a sawtooth sometimes. I think people kinda chase, chase positions if there is a lot of interest one year, then people don’t pursue it the next year. And then they go up, and it goes down,
so there’s a little bit of that that we see. And this is Family Medicine. And let’s just go back here to see Internal Medicine. So, you’ll see the very small column at the bottom there, that’s the number of sites, the number of sites where programs are delivered, where training is delivered. And Family Medicine, you can see it a little bit easier here. So the number has gone from 111 sites where Family Medicine
training is delivered to now 136 from 2013 to 2019. This is the
average number of program applications for CMGs and IMGs. You can see the big drop
from 2017 to 2018 for IMGs; that’s when there were some eligibility changes in British Columbia. So, the number of IMGs able to apply in
British Columbia went down, so, therefore, because BC has a lot of Family Medicine sites, and you’ll see in a minute that Family Medicine is a pretty popular choice for IMGs, that those two things taken together give you
a reduction in the average. So, a continuing bit of a climb though, certainly for CMGs. And here’s the breakdown by region. So, you can see that, you know, from a sheer numbers’ point of view,
it’s, so nationally, you can see the increase, and then the very top line, that’s Western Canada. Western Canada, we consider being BC to Alberta schools, Saskatchewan and Manitoba. And then, the blue line is Ontario. Quebec is the green line. And then, the orange line, is Eastern Can, MUN, DAL. So, interestingly though, the biggest percentage increase over time has been in Quebec. So, if you look at 2016 at 9.4 and 2019 at 13.5, that’s a 44% increase in the average number of applications submitted by Quebec applicants. That’s a big increase. So, while they’re the lowest number on average across
the country, they have the biggest increase. So now, here’s a breakdown of those, again, those same categories in terms of CMG discipline choices. So, 33% for Family Medicine. That’s held quite steady over the last number of years. Internal Medicine has kind of waxed and waned a bit over time and now it’s up to 15.7%. Surgical disciplines, you know, actually have come down from 20%, quite high in 2013, now to 17% in 2019. And an increase in the Non-surgical disciplines over time. And this complementary view for IMGs. And you will notice that family medicine is much higher as a percentage, followed by Non-surgical disciplines. And Surgical disciplines, there are relatively few
opportunities available to IMGs in those IMG streams, so that, I think, speaks to the fact that the opportunities and the interest pretty much match each other. And I should say that CMG, this is the first iteration only, but for IMGs, because of
the preponderance of second iteration participation for IMGs, we included both
iterations. So, this is the first time we’re going to look at this concept of
supply and demand. And supply in the context of this view, is the
number of available positions in a particular discipline. And demand is the number of applicants choosing that discipline as the first choice on their rank order
list. Not the applied, but what they ranked. So, interestingly here,
so you can see Family Medicine has increased. The blue bar increasing
means that there’s more supply available as against demand, and that
oversupply, if you will, this is not a judgment comment, that’s just kind
of an economic comment, that increase supply has happened over
time. Interestingly this year, there is a bit of convergence. All four regions seemed to have converged around the mean, if you will, and I mentioned that in
Quebec, the number of unfilled positions was quite a bit lower than last year,
where a lot of that reduction came into Family Medicine. So you can see Quebec, and Quebec is the green line, so that coming down means that there is actually more demand. More demand in Quebec for family medicine. So more demand in Quebec for family medicine Quebec for family medicine. So more
demand in Quebec for family medicine nice correlation there. That’s, I know
there has been some pretty strong work in Quebec to promote
and encourage folks to be open to Family medicine as an option, so there are some things happening here that have shifted those, that have shifted that trend.
Here’s internal medicine. A bit of a sawtooth thing. That’s a, Eastern region
has a relatively few, it’s small but mighty, but the numbers are relatively
small there. So small changes in numbers can mean big changes in percentages. Here are Surgical disciplines. So, a continuing
decline. So while there has been lower, and we talked, you know, looked earlier
at the interest in Surgical disciplines, so that has been coming
down over time. But in fact, the reduction in the number of positions available has
actually outpaced the reduction in interest. And we looked at that, you know, with the
four quadrants that said, you know, where are the reductions coming from, where three out of four of those disciplines were Surgical disciplines. So you get decreased interest, an even greater decrease in availability, so you get that tightening of the ratio. We will look at
Quebec: less than one position available for every two applicants who
want a surgical discipline as the first choice. So that’s a very, you know,
they are all competitive. Any discipline that has more than
one applicant is competitive, but that is a very difficult ratio. And then, this
is non-surgical. Six years of increasingly tighter national supply,
but not the national ratio of supply and demand. And the Eastern region, I guess, is kinda bucking that trend a little bit over the last three years. And now, here’s a slide that, I’ll just take a moment to orient you. So, there are each discipline has, and we’ll just go back here, and we’ll look at, so Non-surgical disciplines. That, if you were to look at that as a discipline, that would, that we would call that a high-demand discipline. There is more demand than supply. Contrast that with family medicine, where there’s more supply than demand. So every discipline can be categorized as either a high-supply discipline or a high-demand discipline. So now we go forward to this slide. And this tells you, of all the CMG first choice disciplines, how many chose a high-demand discipline or a high-supply discipline. And the thing I’ll draw your attention to is that increased volume on the bottom
of the column from 31% choosing a high-demand discipline to now 45% choosing a high- demand discipline. So that’s what I talked about, one of the themes, so the greater concentration in high-demand disciplines, that’s where you see that. So two things are happening. Number one, is the shift in the Non-surgical disciplines becoming more, more interest in those non-surgical disciplines by about 4.9%, and those are all, by and large, high demand. And then two large disciplines, Psychiatry, and Internal Medicine have shifted from being what once were high supply, so more than a 1 to 1 ratio of available positions due to first choice disciplines, to
more demand than supply. So, psychiatry and internal medicine, both have shifted to become a high-demand discipline. So that’s why those numbers have gone up so quite dramatically by 31 to 45. So, with that, and you know, we looked at some of those trends, at least, as particular across the region, I wanted to look at what’s the match rate? You know, can we look at what the impact of that, of those choices, are from a match success perspective? So, I wanted to look at the high demand disciplines against some other comparators. So, the blue column on the far right-hand side is the high-demand disciplines taken together and the match success for those with one of those disciplines as a first choice. So about 91%. And pretty consistent from 2013 to 2019, not much change. And if you look at everybody, the far left-hand side, 95%. Slight reduction, and we know that’s been happening. So, that’s where the unmatched comes from. And then, for Family Medicine as a first choice, you know, quite consistent of 97+% success rate for those with Family Medicine as a first choice. Now you would think that, given the increased concentration in high demand, so we looked at this slide here, that there’s more demand in those high-demand disciplines. So, you know, what’s happening that the match rate is
just as high. So, that is a question. And, so here’s one particular look at it. If you did choose one of those high-demand disciplines and only chose one of those high-demand disciplines, then you did see a lower success rate from 85% to 80%. So if you chose one, that’s stand to reason for both, if you chose first one discipline for Family Medicine, you actually, interestingly, you went, you know you pretty much stayed the same, and for all the applicants again, stayed pretty much the same. So why did that number stay the same and that number go down? Well, the reason is that fewer people are choosing one discipline and one discipline only. So, particularly, in those choosing high demand discipline, the number choosing only one discipline, ranking only one discipline, went from 33% to 24%. So, people are still pursuing their interest, pursuing their passion, but they are also mitigating with some additional disciplines that they’re open to. And that is certainly consistent with, you know, what we hear from undergrad student affairs, learner leaders, that there’s some encouragement to be open to other opportunities, particularly when you’re in a situation where there is a lot of demand on relatively few number of opportunities. So now we’re gonna go to sli.do. So the first question we have is: “Can you explain why interest in
surgery specialties is a reason for a high unmatched rates when the data shows
that CMG interest in it’s stayed steady over time?”
Well, I mentioned the number of available positions is lower. That’s, so, interest over time has stayed pretty much the same, but the number of positions available has been lower. “Can you speak to the consistently unfilled seats in Quebec? How are they affecting match rates across the country?” As I mentioned, the number of unfilled positions in Quebec declined dramatically this year. A lot of them were in family medicine. A lot of them, as I talk to people, are in, you know, parts of the province that are not necessarily places where folks want to live. It’s a rural community. So, they do have a bit of a, you know, have to make a lifestyle choice, so I think that some of those are factors. But different results this year. You know, quite a few. I think only 23, last year there was 60… 65… on… sorry? in family… 65 unfilled family medicine positions in Quebec last year, 23 this year. So I think that trend has been, has pivoted quite a bit. “Are match rates better this year than last year because people have responded by changing how they approach the match?” Well, they, as I said, the number of people using only one first only one discipline in their rank has gone down. So to me, that’s a, that is a pretty clear sign that that’s true, yeah. “How come there are unfilled positions for R3 programs?” I think the reason why is that there is not a match. You know, you might have positions that are available and people who want positions, but they are not in the same place. I think by and large how, why those things don’t match up. “What is a returning current year graduate?” Somebody who is, participated in the match previously, that was not successful and then came back within their faculty and are considered what is called a fifth year, a fifth-year current graduate. “Is there a relationship between the increased number of applications and the increased number of distributed sites that a student can apply?” I think there is.
That, and in fact, we’re going to talk about that in a minute here. I think there is a relationship. We saw 111 Family Medicine sites in 2013 and now there’s 136. So, if you have to apply to more places to access the same quota, then that’s going to increase the number of applications. I know a number of faculty have different strategies as to how they deal with that. They will do joint interviews, you know, so they’ll do a lot of things that help, you know, kind of reduce the amount of churn within the system, but certainly, for a sheer application point of view, that could be a driver, absolutely. “Differentiate rural Family Medicine from urban Family Medicine in erms of high supply or demand.” I think we could. I think we could. I see Jennifer. Jennifer, are you in the? Yeah, I think we could do that. I suspect we could do that with a bit of correlation with CFPC on what’s on the definition and use some geographic information to help do that, yeah. Yeah. I know we are capturing questions like this, so we’ll take this away and see what we can do about that. “In my expert opinion, where do you foresee the future of the demand for medical professionals heading? What specialties will be more in demand?” You know, I, my expert opinion in that would be of limited value, but there are lots of people who do, there are lots of, lots, and I have attended a couple of Royal College meetings where, you know, the place of AI and big data in the practice of medicine has been, you know, discussed with, you know, very knowledgeable people who have some vision about what this might look like and what is the role of doctor going to be, so, you know, you don’t have to go very far to find all kinds of thoughts about it. And I can share my opinion again over a glass of wine but, I think, things are going to change, no doubt. I think some of those things you see actually in the trends, you know, whether it’s, you know, Orthopedic Surgery where technology
and scope of practice, and how things are done, you know, it changes the demand for certain kinds of work. And it’s not just medicine. You know, this goes on around the world. So, I suspect the answer to that is yes. How can we explain… “Is there data on the success rate of a match to first choice discipline compared between CMGs applying to a single discipline or multiple disciplines?” Yes, there is. We will make it a point to get that on one of our next data cycles. I’ve seen it, we just haven’t produced it for this. So, we like to scrub things pretty clean before we bring it to the, bring it to you folks. But I’ve seen the numbers. So, we’ll do that for the next time, the next go around. “How can we explain the incredibly low supply to demand ratio for Surgical specialties in Quebec as opposed to a high ratio for family medicine?” Well, that’s a function of applicant choice. You know, essentially, as against the available opportunities. So, it’s a numbers thing. The number of people interested is first choice versus the availability. So, whether it’s the lower relative number of Surgical discipline available versus the norm across the country or whether it’s demand, I think, that is worthy of, I should reel myself back on that conclusion that it’s about applicants. It could be about the ratio as compared to what the national average is. So we will, that’s another thing we should take away and do a deeper dive on that, is that about demand or is it about supply. And that, you can ask that question about really any of these things; is that about demand changing or supply changing? So, how are we doing for time? Should go? Ok. So I may or may not be able to answer every question that we receive. We’ll do our very best, but I think our commitment has always been if we get a question we can’t answer, you know, we’ll make sure we answer it and get it up on carms.ca.
So, some detailed outcomes here. This is a match success for IMGs based on the number of attempts at the match. So the blue line is those who are in the first match participation. The burgundy line is those with two or three attempts. And the green line is for three or more. So, not surprisingly, as you continue, if you are not successful the first time, then your likelihood of success somewhat diminishes over time. This is a view, of the frequency distribution of where Canadian medical graduates match on their rank order list. So 1,444 out of of 2,700 and some odd matched to their very first choice. So that’s about a 55% rate. Drops off considerably after that. The top five, so 88% of all CMGs match in one of their top five ranks. And then the line is actually the number of average applications for all those people who ranked at that point. So 100 and somebody, there was an average and this one person, so somebody had 101 applications. That’s not, that is not… it is uncommon but it’s not extraordinarily rare. 52, 45. So, you know, there are some who do match at the 35th rank.This is the view for couples. You know, because it’s a lower number, it’s a bit more of a ragged curve. And what I’ll say about this is, this is actually for the individuals within the couples’ match. So, when you are a couple, you have a joint rank role, but you each have your own individual preference list. So, what this is, is an indication of where each individual ranked on their own individual preference list. Because some people, in fact, this year there were six couples, who, as part of what an acceptable “match” was, that one of the partners would be unmatched. So, we say, when we say all the couples matched, that actually means that the joint rank order list we found is successful, successful outcome, but one of those partners chose that “hey, I’d be okay if I didn’t match”. And that happens. And that happens. So this is a CMG first choice discipline success rate. And pretty steady around 86 some odd percent for the last three years. That’s, I think it’s a geometric we use just to see how people are doing with their choices. And then, this is that same view but by region. And you can see Quebec, you know, and we saw from the supply-demand ratio of the various categories, how much lower, how tight the ratio was for some of those disciplines for Quebec, and so you can see that that is indicative in this slide. However, on the contrary of that, is that because of the increased application to Family Medicine, it’s actually gone up this last year. So this is the CMGs matched to first choice discipline by discipline group. So, family medicine has stayed very consistent over time with above a 99% rate. Internal Medicine has gone up in the last couple of years, and Non-surgical disciplines, again, not surprising, given the availability against the demand, Non-surgical disciplines have gone down. And surgical also gone down, but a bit of an uptake this year. So, this is what percentage of applicants, CMG applicants matched to one of their top three program choices. Again, a decline. And which brings us to a poll. And the poll is, the question for you is: Which discipline group, so we have four discipline groups, Family Medicine, Internal Medicine, surgical and non-surgical, which discipline group has the lowest rate of CMGs matching to one of their top three program choices? Ok. Let’s see what the survey says. Surgical disciplines, so that would be the intuitive thinking. So, let’s see what data actually says. Family medicine. Family medicine has the lowest number of applicants who match to their top three program choices. So you say “What the devil is going on there?” With a first choice, there’s been a success rate of 99%. So, let’s come back to what’s happening with the number of program sites, the number of training sites. If you have more sites you have to apply to access the same quota, you have to have more on your rank order list, the likelihood of actually matching to one of those top three is somewhat diminished, because, I can tell you that the number of disciplines, people who choose family medicine as a first choice, has not declined any. The number of schools they applied to hasn’t changed any. And that really only leaves the number of sites that are available. And I know that a very good reason why the number of sites has increased is because people want, the programs wanted to give applicants the choice to be more precise about where it is exactly they want to train. So there’s some thinking
behind why that is but I, that’s it just gives you a bit of a rationale. You know, I think there’s some more data we can bring to that, to put a bit more of a pinpoint to it. But there’s, there are some good cause and effect there. Mobility. This is a national system and we are, we are a national system that encourages and makes available mobility. You can go and train anywhere you are interested in and you are qualified for. So you can express your interest in that and you can see the mobility is pretty strong. So the blue is people who stay at their home school. The green is staying or leave your school but stay in the province, and your burgundy is your leaving the province. So, pretty consistent over time. And this is a breakdown of what that looks like at the regional level. So, to orient you, the colour within the column is the same as the colour of the name of the region, if you will. So, Quebec is the biggest, the province where people tend to stay at their, in the province. I was actually talking to Ramona Kearney, many of you will know, post-grad dean at U of A, who’s a Newfoundlander, and I’m from PEI, so we said, you know, when you are in Atlantic Canada, you are open to opportunities, and open to moving and going someplace else, and Alberta is peppered with people from the East Coast
and so we’re open to, but there’s different kind of cultural things, and also the opportunities, where the opportunities are, but this just gives you a bit of a pattern of how folks are thinking about where they attend their post- graduate training. So just turning your attention to some of the outcomes from the second iteration in particular. So what this tells you is for those who filled positions in the second iteration, of the various cohorts, which category did they match to. So, you’ll see for current year CMGs, so predominantly Family Medicine, but you know, quite a good selection of opportunities available in other disciplines. So that’s the breakdown by cohort. And this is a breakdown over time of the cohorts who filled positions in the second iteration. And there are some pretty interesting trends there, and I suspect you can draw some correlation to changes in eligibility this year and some of those outcomes. Now I mentioned CMG elective. So, for the first time this year, we published data around electives and various profiles of numbers of electives, whether they you know, whether people matched or were ranked with various profiles of electives. So, all that’s on carms.ca. Just so we thought we’d share a bit of a sampling of that. And the first one we’ll see is… The number of elective disciplines CMGs took their electives in. So now, remember this is self-reported, and you know, we are quite confident that applicants are self-reporting accurately, but it is self-reported and we’d have no particular way of validating, but we are pretty confident. So, this is unmatched, this is matched and unmatched, so, the matched is the blue line and unmatched is the burgundy line. So, actually, unmatched applicants have a higher, and this is I wouldn’t call it statistically significant necessarily, but it is on average higher, but quite a significant drop this year, and I’m pretty curious about that and we haven’t dug too deep into that, but that’s, you know, a drop from 6.2 to 5. Now that may again be because the N is so much smaller. So now we have 31 unmatched applicants. So that may be it. Maybe it’s just a small sample size. But we’ll dig a bit more into that. Now, this is the next poll just to see what your thoughts are on a particular aspect of this. So we just saw the number of disciplines where the people were taking electives. The question here is “What’s the average number of electives, total number of electives, that CMGs who matched in the first iteration this year reported?” And those are your choices: 4.1, 6.3 9.5, 12.5 and 18.7. Ok. Let’s see what we say. Okay. So pretty interesting. So, let’s have a look at the actual number. So 9.5. The average number of electives. Which again, the unmatched, you know, declined quite a bit. I’m pretty curious about what the sample size there and how much of that plays into it. So, an increase, pretty steady increase for the matched applicants over time. Now at 9.5 on average. So now, we’re going to turn our attention to….
Unmatched Canadian grads and unfilled positions. So this is a graph we’ve been showing every year and it was a bit of a troubling, is a troubling graph, particularly when you put the human face on what that means for those who were not successful in the match. This year, that blue line dropped considerably as you can see, so down from 69 to 31. So again, the definition of unmatched that this is measuring is those who participated in the second iteration and did not match. Current year grads who participated in the second iteration and did not match. So it went from 69 to 31. The other thing we have reported, started reporting on last year are the number of people who did not match in the first iteration and did not participate in the second iteration. And people do that for different reasons. One thing I can tell you of the 36 who didn’t participate in the second iteration is that for 23 of them, there were no positions available in their first choice discipline from the first iteration. So that may simply have been a choice of well, what I am interested in is not available, that’s a statement of fact, whether that’s cause and effect, hard to say, but that’s a, and that is a pretty consistent, you know picture from year to year, that the numbers of people who don’t participate often are those where there are no positions available. And this is a categorization based on the ranking profile for each one of the applicants who did not match. So, 31 this year. The number of, so the blue are the, are how many applicants were ranked by at least one program on their rank order list. The bottom right-hand, so at about four o’clock there, 16%, those that were ranked by every program that they applied to. The far right-hand side at sort of three o’clock is not ranked by any program, and the green is people who would have matched, but they didn’t rank the program. But That’s five people, five people. And, it happens. We know it happens, is that people apply, they attend an interview, they have a conversation, and then, it turns out “no, not going to, not interested in that” and that’s, so, that we’ve always had at least one person, this is the highest percentage and the highest number of people that that situation is related to. And, so we tracked not only, you know, current year match results, match success, but also over the long haul. And we have seen that if you take the year people graduate and the next, you know, two subsequent years of participation in the match, that the match success rate is in around 99.5%. So, you know, one cycle, two cycles, three cycles. Now, in 2018, you see us at 98.2%. Remember that of the 44, and we call them an unknown journey, because we don’t actually have any data on them, but these are the folks who took advantage of the supernumerary positions, the 38. So if you adjust that 44 by that 38, you’ll get back up to 99.5%. So we’re pretty much at that same level, which to me is reflective of a system that, while, you know, it’s hard work and it’s anxiety producing, and I can tell you as somebody who’s looked for a job and hired people, that is hard work. But, you know, 99.5% is, I think, is a testament to a system that actually does what it’s supposed to do. And here’s a map, and I can tell you, when we looked at this map last year, it was hard stuff. You know, unmatched applicants, unfilled positions, you know, things were not really jiving the way they should. Well, this is a very different map. You know, so 52 unfilled positions as against 78. 31 unmatched graduates versus 69. That unmatched previous year CMG, that 31, that includes 15 who have prior postgrad training. So, notionally, folks who are looking to use the second iteration as a transfer mechanism, and we do include those applicants in that 31, but I just wanted to give you that context. So, coming back to our themes. Increased opportunities across the country this year as against last year. With that still, higher fill rates, more interest in CMG for CMGs in those high demand disciplines and fewer unmatched CMGs. So, those are the themes, lots of data. Now, we have lots of time, and so I will go back and ask questions. Answer questions. I could ask questions too, you never know. “Can you please share the match rates for both the first and second iteration by school rather than just by region?” Sure. I think we can. We’ll see if we can do that for next year. We usually talk to the schools about their individual match results, and we actually do, with the schools. We share with the faculty deans their individual school match results. So we’ll do a bit of a consultation to see what people’s openness is to share those things. Usually, they are, but out of respect for their data, we’ll ask them. “Can you speak about specific stats
for Non-surgical and Surgical disciplines?” Specific stats in terms of, I’m not sure who asked this, so in terms of the ratios is that we’re talking about? Nobody here. So, I can tell you that there’s what we call the pre-rolls, so as you were arriving, there was a whole series of data, sort of flowing on the screens, and that particular data will also be shared with the CARMs forum deck, and there’s a lot more data at a discipline level in those slides. So, if you don’t find what you are looking for there, you know, go under carms.ca, go to the data request portal and ask the question. We are happy to answer. “What’s
number of people that ranked Family medicine second? Has that gone up?” That’s a good question. The second discipline choice has certainly been, that’s where a lot of the opportunity is, is in Family medicine. So, certainly, there has been an increase there. “Is there data comparing the number of graduating medical students from each province and the number of residency spots available in that province?” Yes, there is. Yes, there is. We’ve actually done some analysis on that. I’m not sure if we find it on the website, but we’ll take that away. We have done that analysis before. “How do you think the new electives diversification policy from AFMC will affect match rates? I do not think about whether it will or won’t. So, to be quite honest with you, I suspect it’ll create all kinds of different, you know, pressures and changes in thinking both from applicants and programs. So, I think it’ll be interesting to see how that actually unfolds. I mean, as I looked at it, it seemed that there was a pretty good diversification in electives. You know, six disciplines where electives were taken, 10 electives. So, I’m not sure what the measure of diversification is. I’m not sure whether there is or isn’t a target of diversification, but, you know, I guess we’ll see. “Why is the percent position fill rate so low when there are so many going unmatched in the subspecialty match? Again, I suspect it’s because of the alignment of interest and availability at the program level. So, if you are interested in, you know, pediatric what, nephrology, is that… I’m not looking at a pediatrician. So, I suspect it’s about an issue of alignment of opportunity, specifically at the program level, with peoples’ interest. “Why are match rates higher this year?” Well, the factors that come to mind are the ratio, so more opportunities, and in Quebec, I think the increased interest in Family Medicine has evidence by the higher fill rate of Family Medicine, that’s another part. The fact that the 38 who were unmatched in second iteration last year had opportunities to fill one of those supernumerary positions, which meant that there were 38 fewer folks coming back into the match. I think that’s a factor. So, I think it’s a lot of things kind of taken together. The fact that there are, you know, fewer people ranking one discipline and one discipline only in those high-demand disciplines, I think that’s a factor. So there are lots of things taken together that have, and I know, I’m looking out for my student affairs and undergrad colleagues who advise and, you know, give folks, you know, “consider this, consider this”. I think that had a bearing. So, lots of factors which have led to that result.
“How has the de-blending of the streams in the second iteration impacted the match? Any data on this for Ontario and Alberta?” We have not, we have not produced data for this. I suspect we will be, I think we have to ask the right questions in order to get data that’s meaningful. So, I do not know, I cannot give you an answer as to how that has impacted the match. My guess is it has, but it also has had an impact on being able to fill positions. So there’s a couple of things that have occurred and I am quite certain that the policy makers and they’ll ask us for data, we’ll take a step back and actually access this and consider, you know, for the next cycle.
“Yeah. Hi, I wonder if you could reinterpret your key themes with a view to IMG positions. They seem very CMG centric. They are, they are. Yeah. So, I… so reinterpret. So, the opportunities nationally: pretty flat for IMGs. Fill rates: they are always strong. They are always strong for IMGs. Match rates: IMGs went from 46% in the first iteration to 50%. So, a bit of an uptick from that perspective. And IMGs, you know, from what I have seen, they will pursue the opportunities. And there is much higher demand than there is availability, and that is, that is just simply a true statement of the opportunities. Was their opportunity in the second iteration decreased this year with the change in streaming? So the question would be “Have the number of positions available to IMGs decreased in the second iteration?” Is that the question? Yes. Yeah. I don’t have that number of the top of my head. We can get that though, for sure. Okay, thank you. Yeah. “Have you considered having students rank programs before and after they interview? This could allow the analysis of the algorithm for matching to minimize unmatched.” I haven’t considered that. I’ll have to chew on that for a To what extent did the temporary increase in residency spots due to “Spots for Docs” influence this year’s lower unmatched. “Spots for Docs”. What is that? I’m not familiar with that. It says, it’s in quotes due to “Spots for Docs”. “It’s a student rally.” Oh, sorry. Tell us about it. It was a student rally around this time before the specialty spots were added. but ah. Oh, so like last year. Yes, last year. Gotcha. Gotcha. Ok Well, as I mentioned, I think the fact that there were 38, took advantage of those positions, did have an influence on the pressure, on the system this year. So, to the extent that “Spots for Docs” allowed for some of those things to happen, then it had some desired effect. “Should we be worried of the high unmatched rates for the subspecialty matches?” I haven’t really put my mind to it. I’m not… I think the people I would look to if they’re worried are the people who are trying to fill positions. I don’t hear a lot of angst from folks about those rates. As I said, the opportunities are there. The applicants certainly know where the opportunities are. So, I haven’t heard any great amount of angst about the outcomes, but I’m certainly open to hearing about it.
“Do the regions refer to where students match or where students are from?” It’s where students are from. So, if it’s about applicant interest, it’s about where they are from. If it’s about where they fill, it’s about where the positions are. “Will you show the applicant to spot ratio per discipline? Sure. You can actually, you can actually go to carms.ca in the interactive graph and actually see that data. And we’ll have that updated, I’m looking to Rob, now. So, that data is up to date now, for 2019, by discipline. “Do you track trends on applicants who do not match?” No. Once we, once they’re matched, we don’t really track things longitudinally. I know CAPER does. I suspect them, but I don’t think we don’t correlate whether people match or don’t match in the first or second time around. “Can we reach out to people who go unmatched because they didn’t rank a program that ranked them before results are released to give them the option to add it?” We could. If… yeah, we could, although people ask me what advice I give them, you know, when they are doing their application or rank order list, and I say “Eyes wide open”. So, if you choose not to rank something you applied to, then you are making an informed decision. That’s my expectation. So, the fact that a program, you know, we always tell people if you are interested in something, rank it. And that’s the end of the story. Don’t try to outguess whether the program will or won’t rank you. Just express your true… the part that is so great about this process is you’re free and safe to express your true preference. Whether you want to rank something or don’t want to rank something, nobody will ever know. So, there’s no downside to ranking something if you, but only do that if you are prepared to go there. So, you didn’t rank something because you didn’t want to go there? That’s a good choice.
“John we have a question.” Yes? “Hi, it’s related to that last point. So, the 16% that went unmatched that you said could have gone, could have matched, yeah, with those, did the programs later match somebody else? So, that wasn’t clear to me as we were going through. So, I was just wondering like, did those programs match somebody else or were those unmatched programs after the second iteration?” It could have been both. It could have been both. So, they, the person who didn’t rank the program may have been higher on the program rank order list, but because they didn’t rank, them, then somebody on the program rank
order list, you know, below it, did match. Or it may have been an unfilled position. So both things, either one of those things could have happened, yeah. Good question, that’s a great question. “When was the last time the match algorithm changed? Will it be changed anytime in the near future?” So, the last time the algorithm changed was in 93. Sandra, are you still here? 93? 94? Yeah. And when it was changed for the couples. “It was changed after proposing instead of programs…” So that was in 93? Okay, okay. So, that’s the last time it was changed to become, from program proposing to applicant proposing, which simply means that applicants get their preference and that’s what initiates the algorithm. So, anybody who’s interested, you know, the basic algorithm is called the deferred acceptance algorithm. It’s a public source. You can actually go on the Web and find a little bit about the math. “How many CMGs enter the USA match? Does a rise in this account for the improved Canadian match rates at all?” A relatively small number. So, last year, I think 10 matched to the US. So, relatively small numbers. Ok. I’m a med student. How should I use this data to help me inform my CaRMS application? Or should I? How much of it is just noise? Yeah. You can, you can get twisted around in the data. And I think the one caution I would have is, don’t be looking for a silver bullet here. You know, there’s no magic recipe. There’s no, you know, if you “If I do this, I do that, I do that, I do that, then this is going to happen.” It just doesn’t work that way, so, you know, the data is helpful, I think, in some ways. It can tell you where some trends are, but you know, your best bet is to have a great application. You know, to be clear on what you want, to be clear on what you are open to, and pursue what you are keen on.
“How long after graduation are CMGs eligible to enter the match?” Really anytime. There’s no sunset clause on when people can no longer participate. So no, there’s no deadline.
“Could you comment more on the trend of IM and psych having more demand now than supply? So, both Internal Medicine and Psychiatry had an increased number of positions available over time. But, in fact, the number of applicants who chose one of those disciplines as a first choice went up faster than the increase in available positions. So, those are the facts. That’s nationally. I think if you were to want to tease that out, we actually, we actually show for each discipline what the ratio is. And that, I mentioned the pre-roll slides, so if you go in to the detailed slides, it will be part of the deck that gets sent out, each discipline kind of has its own ratio, and you can see this year and prior years. “How is the Family Medicine match rate less than 20%?”
By match rate, do you mean people who choose it as a first choice discipline? Is that? I guess I’m not sure. So, let me go at it from both angles. So, match rates, so the people who applied to Family medicine first choice. Well, just because they applied at first choice, it doesn’t mean that there will be a necessary program that they applied to who is interested in them as a trainee, or that they, those programs all filled before their place in the rank order list. They may have been ranked by every program, but others rank matched ahead of them. “Congratulations on working with partners to let medical students…” Yeah, well, I hope hat worked well. And in fact, we talked to our undergrad and student affairs colleagues today about that, about that early information being made available, so we’re gonna do some fine tuning on that, so I’m glad it worked well. “This year, Ontario is not planning to offer supernumerary positions. Without these, what’s stopping match rates from going up again in the next year? Well, 31 current year means that there’s a lot less pressure for next year. So, I think that’s one thing. And that ratio, just about 1.03, you know, it just gives it that bit more of a breathing space in terms of the opportunities as against the demand on it. A particular province added a lot of spots, it was well distributed across the country? Most provinces added some, some more than others. I know Nova-Scotia added quite a few. “Can you additionally report the match rate to family medicine overall as opposed to just the first choice match rate? The match rate. And by match rate, so does that mean how many CMGs matched to Family Medicine? I wonder if that’s the question. And if that’s the question, the number is 40%. And that number has been very consistent over time. “Is there data on the average number of interviews accepted by applicants? Data on the average number of interviews.” There is not, but we will have the other side of that equation when the interview communication system is implemented next year. So, we’ll know how many of, how many interviews are offered. And then, one of the next rounds would be “Ok, now let’s do the response to that. Is that invitation accepted or is that invitation declined?” So, we don’t have that data, but it could be something that happens within the next couple of cycles. “How many people transfer between specialties after the match?” There is, I think Jeff, CAPER has that, the transfer information? Yeah. Yeah, so CAPER. Section K of the census. So, section K of the census. There you go, so Jeff Barnum from CAPER. Thanks, Jeff. “If a CMG goes unmatched, what are the chances that they will still be unmatched five years later? Well, I can tell you after three years, it’s about half of one percent. At 5five years, you know, we… it’s down lower, it’s getting down to like ones and twos in the years after that. And you know, for some, we don’t really ever know because they perhaps go off and do something else. So we kind of lose sight of them and they are what we call the unknown journey. So, it’s a pretty small number though in percentage terms. “How does CaRMS handle MOTP match?” MOTP is part of the match. It’s… they are designated positions. We work with our DND colleagues to sort all that out and manage that process. “Do CMGs that go unmatched in the first round, who have no family practice electives, successfully match in the second round in family practice spots?” That’s a great question. We can get an answer to that question. I don’t have the answer in my head right now. “Quebec: low ratio of supply/demand for surgical specialties. Does this mean Quebec applicants leave Quebec?” Sure. Sure it does. On the CaRMS website, there are stats about the number of electives that students did in the specialty they matched in. Does each elective represent 1 or 2 weeks? It’s whatever they answer.” Sorry? It’s whatever they answer. Whatever they answer. It’s self-reported. Okay, I can see we are getting a little sparse in the room, so I think we’ll take, is there anything in particular here that… gone. Ok, gone. So, moving on, moving on, moving on. So, with that, I really want to thank you all for attending. So that’s our Q&A. And just to remind you, if you are free and interested, join us Sunday for a deep dive into the two big initiatives, BPas and Interview Communications. That will be Sunday morning at Marriott on the Falls. And outside this room, we’re gonna have a drink together if you are interested in staying with us and a bite to eat. So, if you haven’t already registered on one of the iPads to get the CaRMS deck sent to you directly, please do so. Again, thanks very very much. It’s always fun to interact and chat with folks, so thanks again and have a terrific rest of your conference.

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