So, a bit of a shocker - over the next two years, Ontario will reduce the number of residency spots in the first round of CaRMS for CMGs by 50 per year. This coming cycle will see 25 fewer spots than this year, with another 25 seat reduction in the subsequent cycle (my cycle) for a total of 50 fewer spots.
This has been done without a similar reduction in the number of graduating medical students, which will be more-or-less static for the next 4 cycles, as each one of those cohorts has started or been accepted to their MD program. This is also being done without much warning. In fact, the only information about this change has come from the organizations representing Ontario MD students on the provincial and national levels, the OMSA and the CFMS. The people in these organizations deserve full credit for publicizing this change as soon as they could.
Since we haven't been given an official release from the Ministry itself, many of the details are still unknown or unsettled. Some information has come out through back-channels, but these may not be final or entirely accurate. The information I've been told indicates that these cuts will hit all schools in Ontario proportionately and will fall primarily on primary care residencies. We also don't know why the Ministry believes this change is necessary or beneficial. The intent seems to be to reduce the ratio of Ontario MD grads to CMG spots in Ontario from it's historical target of 1:1.10 to 1:1.05.
If that was indeed the goal, then this change wouldn't be too harsh for Ontario CMGs. If the cuts were to residencies that were of lower value - either because the demand for physicians in that specialty has fallen or the need for physicians in the region served by that residency program is minimal - then this would be a sensible move. It would force Ontario CMGs to accept less desirable residency positions, but there would still be some slack in the system and Ontario CMGs would be better able to serve Ontario patients.
Yet, these cuts seem to be made without much regard for which residency positions get the ax, or their value to Ontario patients. Hopefully when details come out I will be proven wrong, but the indications coming out aren't encouraging.
In addition, while the target ratio may have been 1:1.10, the actual ratio last year, as far as I can tell, was lower, at only 1:1.06. Removing 50 spots lowers that ratio to just below 1:1.01, or less than 1% surplus of CMG spots in Ontario relative to new graduates. This change doesn't just reduce the slack in the system, it eliminates it entirely. The whole point to having some additional positions is to accommodate previous years' graduates who went unmatched, to provide some room for incoming USMGs, to allow for some movement across the country (CMGs can match anywhere in the country, not just their home province), and to provide some flexibility for CMGs based on their preferences. If the ratio falls to below 1:1.01, the number of unmatched CMGs will grow.
If they had reduced the number of medical students to retain a workable ratio (say, the goal of 1:1.05), then this would be a move that at least had some merit. It's expensive to train physicians, but training them halfway and them preventing them from going further for reasons unrelated to competence means a lot of wasted funding for their education.
I really hope that as details emerge, we'll be able to see the intent of this change and why this particular move was the best way to go. Still, based on what's come out so far, I don't see how this move is the optimal course of action for any party involved, including the Ontario healthcare system or Ontario government's bottom line.
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