I've had a bit of time to digest the CaRMS results from this year, so let's dig into the numbers a bit more deeply.
1) I made some predictions... few were right.
So, back in December, I took an educated guess as to what the match rates to a person's first-choice discipline would be by specialty, restricting myself to the larger specialties where statistically-insignificant variation doesn't play to much of a role. I even set myself some conditions for success. Those predictions can be found here.
How'd I do? Eh... Let's look at the list
Exactly Right
Orthopedic Surgery
Psychiatry
Within Margin of Error
Family Medicine
Ophthalmology
Wrong
Anesthesiology
Dermatology
Diagnostic Radiology
Emergency Medicine
General Surgery
Neurology
Obstetrics & Gynecology
Otolaryngology
Pediatrics
Plastic Surgery
Crazy Wrong
Internal Medicine
Physical Medicine & Rehabilitation
Urology
I missed my guess by 3 times my margin of error (Crazy Wrong) by almost the same number of specialties I got exactly right or within my margin of error. Wow. So, Don't trust what I say on upcoming specialty competitiveness!
Ok, the real take-away here is that even in larger specialties, there's a lot of variability. I set myself some fairy narrow margins of error, but even expanding those out a fair bit wouldn't have helped all that much. I was just flat-out wrong most of the time. Predictions are hard and competitiveness in specialties are far from being consistent.
2) This year's match was competitive
No question, this year was a tougher match than previous years. Fewer people got their first choice specialty than for any match stretching back over a decade. With a few exceptions (Radiology, ENT), my guesses on specialty competitiveness were underestimates - most specialties ended up being tougher to match to than I predicted.
Some of this likely has to do with Ontario's cuts to residency programs. While the announced 25 CMG spots aren't a huge number in the grand scheme of things, especially since the final number was less than 25, there are some non-linear effects when decreasing the buffer between number of applicants and number of positions. One person missing their first choice and ending up in a lower-ranked program can displace someone else from their first choice, and so on.
A lot of the competition this year, however, has to do with specialty preferences. Surgery was popular this year, with more people selecting it as their top choice. Family Medicine was less sought-after. When applicants shift their preferences from less competitive to more competitive specialties, overall outcomes are pretty much guaranteed to decline. They did.
3) Income and job markets matter - don't they?
I'm a firm believer that when it comes to specialty choice, incentives matter. Job market, working conditions, income - all of these affect what specialties students prefer. These aren't generally definitive considerations, as few people would pick a specialty they hate over a specialty they love simply because of these extrinsic factors. However, when faced with a roughly similar appreciation for multiple specialties, which is a fairly common situation, students tend to prefer careers that give them a reliable job with decent pay and their preferred work-life balance.
On that front this year... confused me. Surgery has declined in popularity recently due to a terrible job market and generally poor working conditions, offset only by a generally good income. It got more competitive this year - not that much more competitive, but an increase nonetheless, above and beyond any loss in surgical residency spots.
Yet, PM&R - a sleeper specialty with a decent mix of pay, working conditions, and job market, saw a huge jump in interest. Derm and Emerg continue to grow in popularity, for similar reasons. Psych has maintained its gains in medical student interest.
In the middle, Family Medicine and Radiology both took some decent hits to their income in Ontario as a result of the on-going feud between the OMA and the Ontario government. Interest in those specialties declined. Yet, the decline in interest wasn't exactly confined to Ontario schools. That makes some sense for Radiology, but doesn't quite fit the trend in Family Medicine.
Basically, I'm lost. There's always some year-to-year variability in specialty interest, but we've seen some rather stable trends lately. Specialties with poor working conditions and job prospects have dropped in student interest, while more lifestyle-friendly specialties have seen their level of interest improve. That didn't exactly happen this year, but it also didn't exactly not happen - it was very much a mixed picture. Could we be seeing the limit of lifestyle effects on student specialty preferences?
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The overarching lesson here is that CaRMS matches are pretty chaotic. My year, starting the match process in really only a few months, are really at the mercy of chance and the random preferences of the rest of our cohort. Some people are going to get lucky and shoot for a specialty that is unexpectedly uncompetitive this year. Some are going to draw the short straw and will have to fight for a surprisingly in-demand position. There's no point trying to play the guessing game and picking a specialty based on competitiveness though, as I know some students would prefer to, because we mostly find this information out after-the-fact.
The recommended match strategy for everyone remains the same - pick a specialty you like, pick a back-up specialty if feasible, work hard for good LORs, apply broadly, and rank every program you would prefer matching to over going unmatched. That doesn't change if you're going for Family Medicine or Dermatology.
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