It’ almost a week later and the pain of disappointment stings less now. However, there is still plenty of anger and frustration to go around. I’m not talking about just me.
For anyone who does not know what CaRMS is, I will give a brief description. The Canadian Resident Matching Service (CaRMS) is a national, centralized, online service that manages all the applications to Canadian residency positions. Each applicant submits an application online to any training program in a given specialty that they are interested in pursuing. These are sent to the programs for review to decide which candidates they would like to interview. Applicants then embark on the “CaRMS Tour”, which often takes most people across the country to attend interviews at various sites. After the interview period, each applicant submits a Rank Order List, basically a list of all the programs they would consider attending in descending preference. Programs also send in a ranking of all applicants the same way. The computer algorithm that CaRMS utilizes attempts to “match” each applicant to their most desired possible program.
The key here is that it is supposed to prioritize applicant choice over the preference of the programs. Given the results this year, it sure doesn’t seem that way. On paper my class matched well; many matched into a competitive specialty (if we pretend that is some indicator of success). However, most people say the results were bittersweet for them. It is hard, also, to look at people who matched to programs higher on your list that you did not match to, and not compare yourself to them. And wonder how program’s made their ranking decisions. What a shot at your self-confidence.
To have worked as hard as we have for the past four years and not be able to obtain anything close to your top choice raises questions about the dysfunctionality of this system. If nothing else, as someone once said to me, “the government has spent too much money training you for you not to be happy.” A minority matched to their number 1 choice. I am really happy for them! It’s just really depressing how few people that applies to. What a horrible way to start the most important chapter of our training.
One key problem is that the Canadian government has been steadily increasing medical school spots. This would be great except there is not a proportional increase in specialty residency positions. All that has increased are family medicine spots because that is where shortages are most severe. Let’s be honest, family medicine as it is practiced and presented to medical students today is less than appealing to most. This may be due to a combination of the type of people selected for by medical schools, how family medicine is represented in the curriculum, and the realities of practice. A lot of people in medicine really like studying and understanding concepts in-depth, and the sheer breadth of knowledge that a good GP must cover is intimidating. What you gain in variety, you lose in depth. Unfortunately, a common complaint from specialists across many services is that GP’s don’t do appropriate or adequate work-ups of their patients before referral. In the medical field in general, there is unfortunately less respect afforded for family physicians, an attitude that no-doubt hurts its appeal. Public opinion for medicine has been dwindling, and nowhere is it felt more than on the front lines in GP offices. The scariest, hardest specialty to practice in, to me, would be family medicine. I worked with an excellent family doctor in a rural location for my clerkship rotation and she was wonderful. Kudos to her; I couldn’t do it!
The reality then is that given these changes in medical school admissions, any specialty spots will become more and more competitive. Yes, the system might produce more family doctors, but do you really want unhappy physicians treating you and your loved ones? After being in rotations I know I loved, I can see the difference easily. I just love being in the OR, long hours are nothing because those hours are spent doing one of the fun-nest things in the world to me. When the focus shifts and all you want to do is stuff after-work, how do you get the same quality and motivation?
Of course when we entered medical school most of us said we would definitely consider family medicine. If you told me I could be a family doctor, I would have been thrilled because I’d get to be a physician and you know…help people. Funny how fast that perspective changes. Now I selfishly just want to practice something that I enjoy and would make me happy – which really would be the best for both myself and my patients. We just want to be happy!