A while back, word came out that the Ontario government was cutting funding for 50 residency positions in Ontario designated for Canadian Medical Graduates in the first round of CaRMS. Details were sparse, because many of them were apparently still up in the air with discussions still underway. There was a lot of back-channel information coming out, but all of it hard to verify. Even the announcement itself came from student organizations - a reliable source, but not the ones making these decisions, so there was no guarantee even the information from them was representative of the final policy.
My school recently sent out a memo with a few additional details. It's still not from the Ministry, so the information is potentially subject to change, but it's as reliable as could be possibly expected at this stage. Two main pieces of information came out of that memo.
1) Rather than 50 CMG positions cut over the next two years, it will be 25 CMG positions in 2016 then 25 IMG positions in the 2017.
2) While the specialties losing positions are still undecided, the cuts will be proportionally split across all Ontario schools, meaning schools with large residency programs (like U of T) will lose more spots than schools with small residency programs.
The change from 50 CMG positions to 25 CMG & 25 IMG positions is fairly significant. The main difference is that we get to keep a slight buffer of excess CMG positions relative to graduating students, with about 3% more positions than students. That's important to maintain because while most CMGs match to a residency the year they graduate, a few do not. Those excess spots provide some flexibility for those previous years' graduates to find a residency, which most do. Indeed, of the cohort that graduated in 2013, all but about 10 people have found a residency, which is how the system is intended to work.
When a CMG fails to match, it means their education - which is heavily taxpayer subsidized - goes to waste. If these CMGs are truly unfit to practice, that would be an acceptable loss, but there's little indication that's the case for most CMGs who don't match their first year. As an aside, CMGs who are not residency-worthy probably shouldn't be getting their MD in the first place, but completely failing out of medical school in Canada is a relatively rare. Cutting 50 CMG spots would have effectively eliminated the buffer. Without that buffer, the number of people permanently failing to find a residency would almost certainly have grown from the current ~10 per year, adding unnecessary waste - waste of both dollars and people - to our medical education system. With a smaller buffer, the number of CMGs failing to match in the first round of CaRMS the year they graduate will go up and the number who fail to match in their graduating year after the second round will probably rise, but the number of people who never find a residency shouldn't jump by much, if at all.
It's still not my preferred approach to cutting 50 residency positions - I'd rather see all 50 positions cut be IMG spots - but it's an improvement.
Here's the thing - because unfilled CMG spots open up to everyone in the second round, IMGs ate up whatever excesses were built into the system for CMGs. Cutting IMG spots therefore becomes a more efficient and direct means to achieve the same ends. The sense I get is that the Ontario government was worried about the optics of cutting only IMG spots and so split things between CMG and IMG positions.
More cynically, I'm worried the Ministry representatives making these decisions may not fully understand the effects of these cuts and are making changes on the fly. What little information that has come out about the Ministry's goals or intentions when making these cuts doesn't always square with the impact of their decision. I also trust the CFMS and OMSA. Perhaps they were mistaken in their initial report that all 50 positions cut would be CMG spots, but I'm inclined to believe that was the Ministry's original intention. There are fewer IMG positions which mostly exist in larger programs, so it'd be easier to cut 25 IMG spots on short notice than 25 CMG spots. Fewer programs to coordinate with and evaluated. Yet the CMG spots are getting cut first. It's pure speculation, I will fully admit, but I suspect the Ministry decided to switch the cuts in 2017 from CMG spots to IMG spots after the CFMS/OMSA statement.
In any case, the full impact of these cuts won't be known until all the details are out, which are at least a month away. With any luck, the positions lost will be in specialties with low patient demand and/or mediocre job markets. We'll know soon enough.
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