More than many Canadian medical schools, the Rady Faculty of Health Sciences at the University of Manitoba seems to understand the current plight of the country’s medical students.
With around 115 medical-school graduates across the country without residency positions this year – up from 99 in 2017, and 77 the year prior – the school acknowledges the state of limbo that these students face.
Quite simply, without those two-to-seven years of required training in their fields following graduation from faculties of medicine, they are unable to practise.
“It’s not a degree that you can move into the work force without residency training, so it really does strand you,” says Dr. Brian Postl, dean of the Max Rady College of Medicine and the university’s Rady Faculty of Health Sciences.
Residency positions are allocated through a process known as matching, in which students rank their preferred specialties and residency locations and the medical schools do the same, with a system of algorithms determining a match. If students are passed over in the first round of selection, they can try again in the second round of matching. However, if they are unable to find a match at that point, they have to wait a year.
The number of unmatched students is increasing on a yearly basis; this year, there were 101 positions available for every 100 graduates, compared with a ratio of 110:100 in 2009. But many of those left over are francophone positions in Quebec, and/or in locations or specialties which students didn’t rank among their preferences.
To help address the problem, the University of Manitoba has devised something of a solution, offering positions for any of its unmatched students.
“We, for a very long time, have felt that there was an inherent crap-shoot effect to the match [process] that we were uncomfortable with ,” Dr. Postl says of the policy, which was approved by the faculty council six or seven years ago.
According to the Association of Faculties of Medicine of Canada (AFMC), which represents the country’s medical faculties, the University of Manitoba’s ability to find matches for unmatched graduates is unparalleled at other schools. “It is the ideal [solution] of course,” Marie-Hélène Urro, the communications co-ordinator at AFMC, said in an e-mail.
It’s not a degree that you can move into the work force without residency training, so it really does strand you.— Dr. Brian Postl
To help alleviate the problem, the AFMC is asking the provinces to increase the number of positions. Some have responded, with Ontario recently announcing up to another 53 residencies to help match graduates from the province’s school of medicines.
The other recommendation from the AFMC is to favour Canadian graduates in second-round matches. Currently second-round spots are available equally to both graduates of Canadian and international medical schools.
Dr. Geneviève Moineau, president and chief executive officer of AFMC, says that under the current system, many Canadian graduates are perfectly qualified for placements for which they are being denied.
“In fact 30 to 50 per cent of those residual spots are actually filled by [medical graduates from international schools],” she says. “Yet, of the Canadian medical graduates who are unmatched, the vast majority were actually ranked by a program, meaning they were deemed to be a competent candidate for whatever specialty they were applying to.”
The AFMC says that putting a stop to this pooling of Canadian and international placements would help alleviate the situation, and ensure that the graduates, who cost taxpayers around $250,000 apiece to put through medical school, can actually be matched.
One of the other criticisms of the current system is the number of residencies that remained unfulfilled in Quebec. Many of those positions are only open to graduates who can speak French, and in 2018, 69 positions remained unfulfilled after the second iteration, according to Dr. Hélène Boisjoly, dean of the faculty of medicine at the University of Montreal and chair of the conference of deans of faculties of medicine in Quebec.
Henry Annan, president of the Canadian Federation of Medical Students, says the matching system works in principle. However, like the AFMC, the CFMS is advocating for a greater number of residency positions to clear the logjam.
The fourth-year medical student at Dalhousie University in Halifax also says that more can be done to ensure that positions in less popular disciplines, such as family medicine, and those situated in more rural locales are filled.
At the University of British Columbia, 44 per cent of its matched students are pursuing family medicine. Dr. Roger Wong, executive associate dean at the UBC faculty of medicine, says the university emphasizes the concept of social accountability to encourage students to pursue disciplines that correspond with societal needs.
“From that social contract point of view, family doctors are absolutely needed,” he says. “People’s choices, people may choose family medicine or may choose other things.”