Medical students at the University of Calgary are alarmed by a continued decline in the number of post-graduate positions available in Canada. This year, the Canadian Resident Matching Service projects 1,321 medical students will graduate in 2004, and 1,334 post-graduate positions will be available, a 1-to-1.01 ratio.
The small excess in the number of available residency positions troubles the Canadian Federation of Medical Students.
"In past years, there have been surpluses of 1.02 to 1.11 positions to one [graduate]," said CFMS Western Regional Representative and U of C medical student Lanette Prediger. "This year, there's a projected one to one match."
According to U of C Post-Graduate Medical Education Director Dr. Alexandra Harrison, every U of C medical school graduate who applied to CaRMS last year received a first or second iteration placement. This year, some students are concerned that a deficit of 10 positions in Quebec may impact the rest of Canada.
"There's usually some excess capacity, but I think it's much tighter than it has been in other years," said Dr. Harrison. "In Alberta, the government has indicated it will make sure that there are at least the same number of post-graduate positions as graduating students. The trick is that the Alberta government puts them in the national pool."
All Canadian graduates who wish to receive residency training at Canadian medical schools in 2004 must apply for post-graduate or residency positions. Students are then interviewed in early 2004 and matched in two rounds with available positions by CaRMS. This year, with fewer available positions, more students may receive lower-ranked placements.
"I think it's a detriment to medical students," said third-year U of C medical student Lara Knebel. "By decreasing the number of positions, they're increasing competition and driving people to the United States."
Prediger is also concerned about graduating students who may leave for the United States. Due to the Toronto SARS outbreak, the course schedules of some medical students were delayed this summer and the CaRMS match date will be after that for the U.S. Therefore, this year's graduates cannot fall back on an American placement if they are not matched in Canada since they are removed from the CaRMS system if they matched to an American placement first.
Both Knebel and Panich are frustrated that they were not informed earlier in the year about the low ratio. Panich said students were not told of the situation two weeks ago during a clerkship meeting when other changes to CaRMS were being discussed.
"Right now, we're in the process of applying for residency next year," said Knebel. "It would have been nice to have some heads up."
According to Dr. Harrison, precise information relating to the actual number of placements has only recently become available. She encouraged student representatives on the U of C's Post-Graduate Medical Education Committee to bring forward student concerns.
"Next year, you'll have more cutthroat competition and more difficulty getting into programs than in the past," cautioned Knebel. "It would not be a good learning environment."
Prediger is concerned some students who do not get their placements will leave the medical education system.
"Resources will be wasted training medical students who do not practice," she said. "The provincial government is paying for students to get trained, but not to get licensed."
According to Dr. Harrison, it is extremely unlikely students would not get post-graduate placements if they use both rounds of CaRMS. She said students are counseled from their first year on how to realistically structure their education and CaRMS application to avoid non-placement.
"It's really, really unlikely if they are thoughtful in the way they apply to CaRMS," she said. "Last year, ninety-five per cent of Canadian students were matched. At the U of C, more than 85 per cent were matched to their first choice of residency and 100 per cent obtained their first or second choice of medical disipline."
Dr. Harrison notes that some students seeking very competitive placements will reapply after increasing their competitiveness with a year of research. She added a handful of students will leave the profession if they perform poorly or do not receive their desired placements after repeated attempts.
"That's why it's important to have a surplus," Prediger said. "We can't expect students to be forced into a discipline they don't want to do."
Dr. Harrison agreed provincial funding for a larger surplus of positions would benefit both current students as well as those who may wish to retrain in another medical specialty n the future.