Well, I just finished up my first block of residency. Starting on my home rotation of Family Medicine, I got a chance to dive right into what I hope to be doing for the rest of my career. It's been a very busy transition (hence the complete lack of posting), but in a mostly good way. Here are my first impressions.
1) Increased Responsibility
This hit harder than I expected, and faster. I see my own patients. I review most of them with my preceptor, but not all of them. My preceptor sees my patients usually only when I ask them to. I can write my own prescriptions now - I even have a stamp with my name on it for those! It's a wonderful freedom in many respects, as I don't have to couch every single encounter based on what I think my preceptor wants. Instead, I can give my own impression and hedge only when I'm uncertain about the best answer.
Yet, that means when I mess up, it's all on me. And I've definitely messed up. No big screw-ups - life-or-limb cases are fortunately not that common in Family Medicine and I know enough to at least confirm my thoughts with my preceptor in these cases - but certainly less-than-optimal actions that could have been handled better. I recognize that's part of the learning process and that in my first rotation is very much expected, but it still hits a bit harder now than it did in medical school. As a student, if a patient's treatment was sub-optimal because of my mistake, outside of a clearly negligent decision, much of the fault would lie with the educational system that either failed to properly train or supervise my actions. Now those factors still matter, as I'm still a trainee, but as an employee, I share far more in that responsibility.
2) Rush, Rush, Rush
When I started my rotation, I got a slow introduction. Lots of time for patient appointments. Arguably too much time. I was getting bored going into my second week, and started asking to see more patients. Then I got ramped up to a full schedule in my third week. It. Was. Crazy. I managed to keep up with my schedule, yet only at the expense of my note-writing. On the busier days, I was at the clinic hours afterwards finishing my notes and completing other paperwork.
Nevertheless, I mostly kept my head above water and I'm fairly proud of that fact. At the end of my block, I was handling a workload roughly what I can expect as an early PGY-2 and while I wasn't nearly as consistent or efficient as the PGY-2's in the office (who were nothing short of amazing), I at least did the job. As I gain some more experience and familiarity, I'm hoping the late nights of note-writing well decrease.
That said, even my current "full schedule" pace is about half what it will be in full practice. Even with the advantages of a shorter lunch (currently I get over an hour, which I don't really need), lighter note requirements (my notes are detailed now, especially compared to the 2-3 lines most of my preceptors write), an extra exam room (I get a single room now), and no delays caused by checking with a preceptor, I'm nowhere near being able to operate at full speed. Yet, I've got 25 more blocks, including many family medicine blocks, to get up to that pace, so there's still plenty of time.
3) Home Call is Not Like In-House Call
One of the interesting quirks to my residency program is that we do a full home call on our Family Medicine blocks. It's not particularly frequent (about one weeknight every 2 weeks and one weekend every 2 months) and in many Family Medicine centres, it wouldn't be too busy. Except at my centre. Our weekend call is Friday night through until Monday morning. I got at least two dozen calls during that time, some of which were simple and straight-forward, others which took a fair bit of time to sort out. Ended up having to do a fair bit of driving, either to see patients in clinic over the weekend or to visit patients in the nursing home we cover.
The main advantage of home call is that you can still do life-stuff when you're not actively working. That's pretty great, since you can get a lot done if you don't get called often. It's way better than in-house call in that respect, where you're basically working a 24-hr shift that may involve some long breaks if you're lucky, but which doesn't allow you to do anything outside of the hospital. Yet, since my home call was over 60 hours long and was reasonably busy - during the day, I rarely got more than an hour off - I didn't get much opportunity to get anything done and developed some rather intense pager anxiety. It's surprisingly hard to "switch off" on the third day of being page-able at any time!
4) Conclusions
Overall, I'm enjoying residency more than I did medical school. There's a bit more independence and some clear ways to progress forward over time. Getting paid rather than paying insane amounts of tuition is a significant benefit, as finances are now slowly moving in the right direction. Month-long blocks rather than two week rotations provides a bit of stability, and the ability to take vacations provides some much-needed flexibility, though the schedule remains fairly hectic.
Life still isn't yet where I'd like it to be - I spend too much time at work or on work and don't have enough consistency or control over my own schedule to prioritize other aspects of living. I'll be glad to finally finish up in two years' time and to experience the supposed wonder of full, independent practice. Nevertheless, residency feels closer to my ultimate lifestyle goals than medical school did and what sacrifices are necessary feel more like they're in the service of meaningful progress than they did as a medical student.
Showing posts with label residency. Show all posts
Showing posts with label residency. Show all posts
Thursday, 10 August 2017
Saturday, 3 June 2017
The Worst Part of Medical Training
While working on another post, I found the following paragraphs saved as a draft post. I'm not sure if I'm the author of these words and suspect that I'm not, yet can't find who wrote them originally. I have a feeling this was a forum post that ended up getting deleted, that I copied because I felt the words were worth saving.
I present them here as I found them in my draft folder - if the original author comes across this and wants them removed, I will happily do so. However, I think these paragraphs provide an important context to medical training which should be shared.
I present them here as I found them in my draft folder - if the original author comes across this and wants them removed, I will happily do so. However, I think these paragraphs provide an important context to medical training which should be shared.
"I have to highlight this for those considering or early in their medical training, because it's a part of medical training no one appreciates until they're in it.
As a trainee, there will be times where a patient's treatment is below what you consider acceptable. The worst is when there's a preceptor acting completely inappropriately. All you can do is sit back and watch the carnage unfold. If you're lucky, you'll be able to debrief the patient and provide some more appropriate guidance, as well as a bit of simple human empathy.
More often you're simply a cog in a system failing patients that, because you're new to that system, you don't understand and are ill-equipped to navigate. You act the way you think you're supposed to act, even the way others expect you to act, and it causes harm to patients in one way or another. Everyone goes along like it's normal or, worse, thanks you for your part in it. Yet, you have to continue with your role as that cog, because as a trainee, you have no alternative short of quitting. As you gain experience, becoming more knowledgeable about medicine as well as the healthcare system you're now a part of, you start to see opportunities to work around the system to avoid causing harm, to lessen it, or at least to warn patients of what's coming so they aren't blindsided.
This is the worst part of medical training - not the long hours, not the pressure to perform, not the vast amount of knowledge you need to acquire, not even the (fortunately uncommon in my experience) instances where you're personally treated poorly by preceptors - but the time where you're made to be complicit in bad care or outright mistreatment of patients. You don't have the power to change it, and so ultimately you aren't responsible for it, but it sure doesn't feel like it at the time."
I am now about a month away from starting my residency. This is definitely the part of my medical education thus far that I hated the most. It's the part of my upcoming residency I most fear. This is the dark side of medicine, the part that doesn't just challenge your ability, but compels you towards the corruption of your own ideals - ideals which the profession purports to share and uphold, yet frequently betrays.
Wednesday, 5 April 2017
CaRMS & Match Strategies
My class got a quick and by no means thorough breakdown of our overall match results, where the most notable highlight was a complimentary breakfast ten times better than anything I'd been served throughout the prior 4 years. The other notable point concerned how our class did in the match. I'll pump up my cohorts here a bit - we had a lot of people match to some rather competitive specialties, especially surgical specialties. Otherwise our results were fairly typical for our school in terms of the overall unmatched. There's some very good soon-to-be physicians in that cohort of unmatched people at my school, so I'm really hoping they land somewhere acceptable in the second round, or match to their intended residency next year if nothing suitable is left available this year.
Getting a chance to be a bit more up-close-and-personal to the match process has reinforced a few things I had been told, as well as a few I hadn't thought of, when it comes to match strategy.
First and foremost, a good match strategy - applying broadly, backing up where it makes sense to - is still absolutely the way to go. Beggars can't be choosers and when it comes to CaRMS, we're all beggars.
Second, and a perhaps slight caveat to the first, elective choices matter. Splitting electives between competitive specialties is a great way to get neither. The odd person may be able to pull it off, but it's a gamble, even for well-qualified individuals. Backing up should be done when possible, but if a candidate can't give themselves a desirable, viable back-up option without significantly hurting their chances with their first-choice specialty, then maybe a back-up no longer makes sense. Programs shouldn't care about a candidate's exclusive interest in their specialty - the CaRMS algorithm is meant precisely to avoid that kind of thinking - but they do and it shows. Even for less competitive specialties, not showing a reasonable commitment can be a detriment to matching. Any elective set-up should be purposefully created, with a logic to it that fits with a reasonable set of match goals, taking into consideration the timing of CaRMS, the specialty or specialties being applied to, and any geographical restrictions.
Third, networking and playing the social game absolutely have an impact, particularly in smaller fields. Moreover, that factor may be justified. While we often want people to get ahead based on ability than who likes them, few jobs are performed in isolation and medicine is definitely a social job. An ability to get along with others amicably makes a difference in terms of the functioning of the whole group. Networking and playing the social game are the ways to prove that you're easy enough to get along with. Building off the prior point, electives are the ultimate networking opportunity, which is part of the reason they're so important.
Lastly, chance is still a huge factor. In any CaRMS cycle, there seems to be a set of individuals who are phenomenal, clearly desired by programs, and are near-locks to match. That they land their first-choice programs is no surprise. On the opposite end, there are a very small number of individuals who are unsurprisingly left unmatched, or who in some cases never make it through medical school to the match. Yet, most of us fall into the vast middle ground, where we're good, competent candidates without standing head-and-shoulders above the rest. There are differences between candidates in this substantial middle-of-the-pack group, certainly, but the differences end up being more like a difference in flavour than in quality. As a result, when someone ends up on the outside looking in after the first iteration, luck plays a significant role. With the match overall being more competitive than it has been in the past, someone has to go unmatched and it very often is someone who really didn't do anything wrong. Unfortunately people who go unmatched in the first round, or their first year, face a stigma of inferiority, one which is not deserved in many cases. I think this is the part of the CaRMS match that really hit home this year - while the way we approach our residency match does involve some merit-based stratification, outside the extremes it's far less about merit than we like to believe.
Overall, my feelings on a good approach to a match haven't changed much, but the overall importance of certain aspects has. I'm lucky to have had the outcome I did. If I had any new advice to give prospective residents, it'd be merely to emphasize the importance of being proactive with their electives and with developing contacts. Otherwise, stick to the tried-and-true strategies, they're standards for a reason.
Getting a chance to be a bit more up-close-and-personal to the match process has reinforced a few things I had been told, as well as a few I hadn't thought of, when it comes to match strategy.
First and foremost, a good match strategy - applying broadly, backing up where it makes sense to - is still absolutely the way to go. Beggars can't be choosers and when it comes to CaRMS, we're all beggars.
Second, and a perhaps slight caveat to the first, elective choices matter. Splitting electives between competitive specialties is a great way to get neither. The odd person may be able to pull it off, but it's a gamble, even for well-qualified individuals. Backing up should be done when possible, but if a candidate can't give themselves a desirable, viable back-up option without significantly hurting their chances with their first-choice specialty, then maybe a back-up no longer makes sense. Programs shouldn't care about a candidate's exclusive interest in their specialty - the CaRMS algorithm is meant precisely to avoid that kind of thinking - but they do and it shows. Even for less competitive specialties, not showing a reasonable commitment can be a detriment to matching. Any elective set-up should be purposefully created, with a logic to it that fits with a reasonable set of match goals, taking into consideration the timing of CaRMS, the specialty or specialties being applied to, and any geographical restrictions.
Third, networking and playing the social game absolutely have an impact, particularly in smaller fields. Moreover, that factor may be justified. While we often want people to get ahead based on ability than who likes them, few jobs are performed in isolation and medicine is definitely a social job. An ability to get along with others amicably makes a difference in terms of the functioning of the whole group. Networking and playing the social game are the ways to prove that you're easy enough to get along with. Building off the prior point, electives are the ultimate networking opportunity, which is part of the reason they're so important.
Lastly, chance is still a huge factor. In any CaRMS cycle, there seems to be a set of individuals who are phenomenal, clearly desired by programs, and are near-locks to match. That they land their first-choice programs is no surprise. On the opposite end, there are a very small number of individuals who are unsurprisingly left unmatched, or who in some cases never make it through medical school to the match. Yet, most of us fall into the vast middle ground, where we're good, competent candidates without standing head-and-shoulders above the rest. There are differences between candidates in this substantial middle-of-the-pack group, certainly, but the differences end up being more like a difference in flavour than in quality. As a result, when someone ends up on the outside looking in after the first iteration, luck plays a significant role. With the match overall being more competitive than it has been in the past, someone has to go unmatched and it very often is someone who really didn't do anything wrong. Unfortunately people who go unmatched in the first round, or their first year, face a stigma of inferiority, one which is not deserved in many cases. I think this is the part of the CaRMS match that really hit home this year - while the way we approach our residency match does involve some merit-based stratification, outside the extremes it's far less about merit than we like to believe.
Overall, my feelings on a good approach to a match haven't changed much, but the overall importance of certain aspects has. I'm lucky to have had the outcome I did. If I had any new advice to give prospective residents, it'd be merely to emphasize the importance of being proactive with their electives and with developing contacts. Otherwise, stick to the tried-and-true strategies, they're standards for a reason.
Saturday, 4 March 2017
Comments on the Match
With the match now over and my class now aware of their results, we've had a bit of time to decompress and look ahead to residency preparations. On that latter point, there is a lot to get done - forms to fill out, organizations to sign-up with, some certifications to arrange, figuring out how to get paid (but yay, money!).
While I know where most of my class is headed now, it's all been through voluntary disclosures, which means I pretty much only know about my classmates who are happy with their results (and all the classmates I'm closer to all matched). Seems like my school had a pretty good year, but I know I'm only getting a partial picture. We do get a debrief on the school's overall match results soon, so I'll know more then. Here's hoping my class did as well as I think they did, and those who didn't match are getting enough support for the next steps.
I wanted to comment quickly on the only match stats we have at this time - the list of spots left unfilled from the 1st iteration. Interpretation of these is always a bit hazardous, as these positions mix both the CMG and IMG unfilled positions together. You can make some inferences, but there's naturally a bit of guesswork.
Some of the results aren't terribly surprising. There's a handful of positions left in the smaller, more technical fields with poorer job prospects. There's a few positions in typically competitive fields (like Derm) that are most likely IMG spots that were intentionally left unfilled. And there's the crush of positions in Quebec that go habitually unfilled as Quebec oversupplies its residency positions.
Some of the results aren't exactly shocking, but are notable. Internal filled almost every spot. Internal did see a jump in competitiveness last year, and the word is that trend continued in a big way this year. While this data doesn't confirm that perception on its own, it's certainly consistent with it. In the other direction, Psychiatry had a few more unfilled spots than I expected, given that it is also garnering a bit more attention. Psychiatry has been steadily gaining positions, however, and the remaining spots are generally in more remote locations - ironically, the places that are probably lacking the psychiatrists those extra positions were meant to train.
Lastly, Family Medicine had an absolute ton of unfilled spots this year. Family usually has a number, but the proportion of Family spots left open is greater than it has been in the recent past. Interest in Family, which took a bit of a dip last year, may be a bit low this year as well. That would fit with the notion that Internal has jumped in popularity - while overall competitiveness for CMGs in CaRMS has increased somewhat, Internal is a huge specialty and for it to become more competitive means other larger specialties have to get less competitive. It makes sense that a rise in interest in Internal would be coupled with a drop in interest in Family. We'll have to see when the full match stats eventually come out.
While I know where most of my class is headed now, it's all been through voluntary disclosures, which means I pretty much only know about my classmates who are happy with their results (and all the classmates I'm closer to all matched). Seems like my school had a pretty good year, but I know I'm only getting a partial picture. We do get a debrief on the school's overall match results soon, so I'll know more then. Here's hoping my class did as well as I think they did, and those who didn't match are getting enough support for the next steps.
I wanted to comment quickly on the only match stats we have at this time - the list of spots left unfilled from the 1st iteration. Interpretation of these is always a bit hazardous, as these positions mix both the CMG and IMG unfilled positions together. You can make some inferences, but there's naturally a bit of guesswork.
Some of the results aren't terribly surprising. There's a handful of positions left in the smaller, more technical fields with poorer job prospects. There's a few positions in typically competitive fields (like Derm) that are most likely IMG spots that were intentionally left unfilled. And there's the crush of positions in Quebec that go habitually unfilled as Quebec oversupplies its residency positions.
Some of the results aren't exactly shocking, but are notable. Internal filled almost every spot. Internal did see a jump in competitiveness last year, and the word is that trend continued in a big way this year. While this data doesn't confirm that perception on its own, it's certainly consistent with it. In the other direction, Psychiatry had a few more unfilled spots than I expected, given that it is also garnering a bit more attention. Psychiatry has been steadily gaining positions, however, and the remaining spots are generally in more remote locations - ironically, the places that are probably lacking the psychiatrists those extra positions were meant to train.
Lastly, Family Medicine had an absolute ton of unfilled spots this year. Family usually has a number, but the proportion of Family spots left open is greater than it has been in the recent past. Interest in Family, which took a bit of a dip last year, may be a bit low this year as well. That would fit with the notion that Internal has jumped in popularity - while overall competitiveness for CMGs in CaRMS has increased somewhat, Internal is a huge specialty and for it to become more competitive means other larger specialties have to get less competitive. It makes sense that a rise in interest in Internal would be coupled with a drop in interest in Family. We'll have to see when the full match stats eventually come out.
Wednesday, 1 March 2017
Matched
Quick update because I'm still processing the result - successfully matched today in Family Medicine to my top-choice program. Whew.
It's a huge sigh of relief, but I know it means that the real work is only just beginning. I now have a ticking clock of two short years to get myself practice-ready. It all feels very real now, but I'm pretty excited knowing that this is where the stakes get higher. Onwards and upwards and all that!
It's a huge sigh of relief, but I know it means that the real work is only just beginning. I now have a ticking clock of two short years to get myself practice-ready. It all feels very real now, but I'm pretty excited knowing that this is where the stakes get higher. Onwards and upwards and all that!
Tuesday, 28 February 2017
Match Day - Tomorrow
Ugh...
Argh...
Ahhh...
So, tomorrow's match day. I've been trying to distract myself from that fact for well over a week now and my level success is pretty low at this stage. At noon, I find out my fate moving forward. So does the rest of my class. For the record, communal anxiety is not helpful for personal anxiety!
My school has done the only thing that makes sense to me and gives us the whole day off. I think I could have tolerated morning classes, but having the afternoon off is a huge relief. Whether I'm happy, sad, or just confused, I'll have the time to handle it on my own terms, rather than have to deal with a bunch of lectures, tasks, or people I'd rather just avoid. Apparently years ago they used to hand out sealed envelopes to everyone in the same room and you were supposed to open them together. That sounds mortifying.
In any case, thumbs up to the home school for doing the right thing. Here's hoping I get to use that time to celebrate.
Argh...
Ahhh...
So, tomorrow's match day. I've been trying to distract myself from that fact for well over a week now and my level success is pretty low at this stage. At noon, I find out my fate moving forward. So does the rest of my class. For the record, communal anxiety is not helpful for personal anxiety!
My school has done the only thing that makes sense to me and gives us the whole day off. I think I could have tolerated morning classes, but having the afternoon off is a huge relief. Whether I'm happy, sad, or just confused, I'll have the time to handle it on my own terms, rather than have to deal with a bunch of lectures, tasks, or people I'd rather just avoid. Apparently years ago they used to hand out sealed envelopes to everyone in the same room and you were supposed to open them together. That sounds mortifying.
In any case, thumbs up to the home school for doing the right thing. Here's hoping I get to use that time to celebrate.
Wednesday, 1 February 2017
Rank Order List Submitted
Ok. It's final. My Rank Order List is now submitted and I don't intend to change it, even though the deadline is still 2 weeks away. Plenty of last-minute deliberations went into the list to the point that I'm honestly a bit surprised with some of the end result. My top 3 are the same top 3 I've had for a long time, but they're now in an order I had never considered prior to my interviews. Of the remaining 10 (I ranked 13 programs total, you know, for luck), there are also some surprises, including a program I almost didn't apply to at all sitting fairly close to the top of my ROL. Some that I thought would be higher fell down pretty low.
Interviews are as much tryouts for programs as they are for students. Some programs definitely impressive, proving more attractive than they looked at first glance. Others were quite underwhelming. I changed my rankings accordingly.
In any case, now I get to play the waiting game. I have exactly 1 month before I find out my match results. There's nothing more I can do to improve my chances, nor any new information I could find to change my preferences. Time for some Netflix binging, I guess!
Interviews are as much tryouts for programs as they are for students. Some programs definitely impressive, proving more attractive than they looked at first glance. Others were quite underwhelming. I changed my rankings accordingly.
In any case, now I get to play the waiting game. I have exactly 1 month before I find out my match results. There's nothing more I can do to improve my chances, nor any new information I could find to change my preferences. Time for some Netflix binging, I guess!
Saturday, 28 January 2017
CaRMS Touring
So my CaRMS tour has begun and is actually nearing an end. I've only got a single interview left. The Rank Order Lists are available and I've submitted my tentative list. (Side note - submitting a preliminary list is very much worthwhile, as no ROL means no match at all, while a bad ROL still gives you a chance at something. ROLs can always be changed, as I suspect my tentative list will be after I finish my last interview).
I obviously can't say much about the interviews themselves, but I will note that the preparation offered by official groups (my school, the CMA, CFMS) have all been quite helpful. I would highly recommend accessing as many available resources from official sources as possible and sticking to that available prep material seemed to be sufficient.
I say seemed to be sufficient because obviously I have no idea how well I did in my interviews. They seemed to go fairly well. They've been universally relaxed and conversational, which may be a factor of being Family Medicine interviews more than anything else. In my case, they've also been unbelievably quick, and I'm not quite sure what to make of that. I answered all the questions I was given reasonably thoroughly, my interviewers seemed happy enough with my answers, but the interviews have all felt like whirlwinds once they were done. It's impossible to know how well interviews went, so I'm just going to hope my speed was not a detriment to my evaluation.
In any case, I've got one last interview to show what I can bring to a residency program, a few weeks to finalize my ROL, and then a month to sit around and stress about the match results! Fun times ahead...
I obviously can't say much about the interviews themselves, but I will note that the preparation offered by official groups (my school, the CMA, CFMS) have all been quite helpful. I would highly recommend accessing as many available resources from official sources as possible and sticking to that available prep material seemed to be sufficient.
I say seemed to be sufficient because obviously I have no idea how well I did in my interviews. They seemed to go fairly well. They've been universally relaxed and conversational, which may be a factor of being Family Medicine interviews more than anything else. In my case, they've also been unbelievably quick, and I'm not quite sure what to make of that. I answered all the questions I was given reasonably thoroughly, my interviewers seemed happy enough with my answers, but the interviews have all felt like whirlwinds once they were done. It's impossible to know how well interviews went, so I'm just going to hope my speed was not a detriment to my evaluation.
In any case, I've got one last interview to show what I can bring to a residency program, a few weeks to finalize my ROL, and then a month to sit around and stress about the match results! Fun times ahead...
Sunday, 15 January 2017
Predicting Specialty Competitiveness - 2017 Edition
Last year I tried to take a guess at the competitiveness of the larger specialties in Canada. I even went so far as to put numbers to my guesses. My accuracy was... not good. At least, it wasn't quantitatively good. It was a popular post nevertheless, so I suppose my random speculation has some minor value. This year, however, I'll be making my predictions a bit more qualitative, to spare myself the embarrassment of my quantitative imprecision!
I'll also avoid the specialty-by-specialty analysis. Unfortunately most specialties don't change much in a year, so when I started doing so, I just ended up repeating myself quite a bit. Instead, I'll lump specialties together by my expectations of changes in their competitiveness relative to the last couple years.
Increased Interest, Mild-to-Moderately Increased Competitiveness
In this category: Internal Medicine, Physical Medicine and Rehabilitation, Diagnostic Radiology, Radiation Oncology.
Diagnostic Radiology has had a few years of being relatively uncompetitive, but interest in the field appears to be back up a bit this year. Radiation Oncology has suffered with a terrible job market, but it seems to be improving somewhat, driving some interest back into this relatively well-paying, good lifestyle specialty. Internal Medicine saw a large jump in interest last year relative to its medium-term average and that seems to have been maintained this year, benefiting from decreased interest both in surgical specialties as well as Family Medicine. PM&R shockingly became one of the most competitive specialties last year and I do not expect that to change at all. Good lifestyle, alright pay, unique and interesting work makes it very attractive and so it was long regarded as a hidden gem of specialties. It's no longer hidden and so I expect a competitive match to PM&R this year, likely comparable to last year.
Similar Interest, Decreased Positions, Mildly Increased Competitiveness
In this category: Anesthesiology, OBGYN, most surgical specialties.
Pretty much every specialty involving being in the operating room is seeing a small reduction in residency spots this year, with Plastic Surgery (slight increase) and Urology (no change) being the exceptions. Overall interest in surgical specialties has been steadily declining over the past decade, but seems to be plateauing. In response to a weak job market, positions in these fields have been cut. The sum of this is that even with the new nadir of interest, overall competitiveness may, if anything, increase. Would-be surgeons, OBGYNs and anesthesiologists look to continue to have their work cut out for them to match.
Top-Tier of Competitiveness, Unlikely to Change
In this category: Dermatology, Plastic Surgery, Emergency Medicine.
These three specialties have solidified themselves as being uniquely competitive and that doesn't look to change much this year. ENT or Ophthalmology are competitive enough at baseline that in an odd year they might squeeze ahead of one of the three, but it'd be a temporary (and unexpected) blip for that to occur this year. PM&R also has an outside shot at being more competitive than these three given its huge increase in popularity last year, but I'm expecting these three to stay clustered at the top this cycle.
Similar Interest, Small Increase in Positions, Similar Competitiveness
In this category: Family Medicine, Psychiatry
When one specialty loses residency positions, another tends to gain them. Family Medicine and Psychiatry are those specialties, reflecting the higher demand for physicians in these fields. For Family Medicine, this comes on the heels of a successful decades-long push to get more medical students into family practice, combined with slowly increasing numbers of residency spots. Last year was the first year in a decade where interest in Family Medicine declined. Family Medicine has never been competitive by any metric, and I don't expect this year to be much different. Psychiatry, in contrast, has become a little more competitive in recent years and is no longer the near-guaranteed match it used to be. It's a unique field, however, and continues to have low pay despite a stellar job market. There's a limit to how much interest the field can generate for itself, so I would expect the additional positions to make Psychiatry a bit less competitive this year than last year.
For the most part, specialty competitiveness will stay roughly where it was last year. Large, dramatic swings in competitiveness tend to be statistical anomalies in smaller specialties. More often, changes in specialty competitiveness take place over the course of several years with slow, incremental adjustments, reflecting change job markets, working conditions, or pay, each of which change fairly slowly as well. I have not heard any word of any particular specialties being dramatically different from previous years beyond the normal year-to-year variations. I've been surprised in the past, however... we'll see how well it turns out this year!
I'll also avoid the specialty-by-specialty analysis. Unfortunately most specialties don't change much in a year, so when I started doing so, I just ended up repeating myself quite a bit. Instead, I'll lump specialties together by my expectations of changes in their competitiveness relative to the last couple years.
Increased Interest, Mild-to-Moderately Increased Competitiveness
In this category: Internal Medicine, Physical Medicine and Rehabilitation, Diagnostic Radiology, Radiation Oncology.
Diagnostic Radiology has had a few years of being relatively uncompetitive, but interest in the field appears to be back up a bit this year. Radiation Oncology has suffered with a terrible job market, but it seems to be improving somewhat, driving some interest back into this relatively well-paying, good lifestyle specialty. Internal Medicine saw a large jump in interest last year relative to its medium-term average and that seems to have been maintained this year, benefiting from decreased interest both in surgical specialties as well as Family Medicine. PM&R shockingly became one of the most competitive specialties last year and I do not expect that to change at all. Good lifestyle, alright pay, unique and interesting work makes it very attractive and so it was long regarded as a hidden gem of specialties. It's no longer hidden and so I expect a competitive match to PM&R this year, likely comparable to last year.
Similar Interest, Decreased Positions, Mildly Increased Competitiveness
In this category: Anesthesiology, OBGYN, most surgical specialties.
Pretty much every specialty involving being in the operating room is seeing a small reduction in residency spots this year, with Plastic Surgery (slight increase) and Urology (no change) being the exceptions. Overall interest in surgical specialties has been steadily declining over the past decade, but seems to be plateauing. In response to a weak job market, positions in these fields have been cut. The sum of this is that even with the new nadir of interest, overall competitiveness may, if anything, increase. Would-be surgeons, OBGYNs and anesthesiologists look to continue to have their work cut out for them to match.
Top-Tier of Competitiveness, Unlikely to Change
In this category: Dermatology, Plastic Surgery, Emergency Medicine.
These three specialties have solidified themselves as being uniquely competitive and that doesn't look to change much this year. ENT or Ophthalmology are competitive enough at baseline that in an odd year they might squeeze ahead of one of the three, but it'd be a temporary (and unexpected) blip for that to occur this year. PM&R also has an outside shot at being more competitive than these three given its huge increase in popularity last year, but I'm expecting these three to stay clustered at the top this cycle.
Similar Interest, Small Increase in Positions, Similar Competitiveness
In this category: Family Medicine, Psychiatry
When one specialty loses residency positions, another tends to gain them. Family Medicine and Psychiatry are those specialties, reflecting the higher demand for physicians in these fields. For Family Medicine, this comes on the heels of a successful decades-long push to get more medical students into family practice, combined with slowly increasing numbers of residency spots. Last year was the first year in a decade where interest in Family Medicine declined. Family Medicine has never been competitive by any metric, and I don't expect this year to be much different. Psychiatry, in contrast, has become a little more competitive in recent years and is no longer the near-guaranteed match it used to be. It's a unique field, however, and continues to have low pay despite a stellar job market. There's a limit to how much interest the field can generate for itself, so I would expect the additional positions to make Psychiatry a bit less competitive this year than last year.
For the most part, specialty competitiveness will stay roughly where it was last year. Large, dramatic swings in competitiveness tend to be statistical anomalies in smaller specialties. More often, changes in specialty competitiveness take place over the course of several years with slow, incremental adjustments, reflecting change job markets, working conditions, or pay, each of which change fairly slowly as well. I have not heard any word of any particular specialties being dramatically different from previous years beyond the normal year-to-year variations. I've been surprised in the past, however... we'll see how well it turns out this year!
Tuesday, 10 January 2017
Last-Minute Decisions
With clinical electives done, my entire class is back in the school and catching up after a long period more or less off on our own. We're also all now finalized into our specialty choices. Some people are applying to multiple specialties with some degree of uncertainty, some are backing up, but there's no longer any room for being coy about specialty preferences - everyone's had to make a commitment one way or another.
So, we're finding out a lot about each other's final choices. After over 3 years with my classmates, it is interesting to see what people are ending up with. Most weren't huge surprises, with people either applying to what they had already expressed interest in or committing to one of the two or three options they were considering. There were a few last-minute surprises though, where a classmate did a hard switch to a completely unrelated specialty either near the end of 3rd year or even after doing some/all of their electives.
So, this post is mostly just a reminder for those still early on in medical school that while it's worth exploring specialties early as well as having a game plan for your clerkship and elective rotations, last-minute changes do happen, regularly.
So, we're finding out a lot about each other's final choices. After over 3 years with my classmates, it is interesting to see what people are ending up with. Most weren't huge surprises, with people either applying to what they had already expressed interest in or committing to one of the two or three options they were considering. There were a few last-minute surprises though, where a classmate did a hard switch to a completely unrelated specialty either near the end of 3rd year or even after doing some/all of their electives.
So, this post is mostly just a reminder for those still early on in medical school that while it's worth exploring specialties early as well as having a game plan for your clerkship and elective rotations, last-minute changes do happen, regularly.
Wednesday, 21 December 2016
CaRMS Update - Interviews
My CaRMS cycle is in full swing, so I thought I'd post a quick update. After significant waffling, I applied to Family Medicine and only Family Medicine.
I was considering applying to Pediatrics as well, and set up a number of electives in the field to keep that option open. I enjoyed them thoroughly and was encouraged to consider applying by my preceptors, but ultimately decided against it. I love working with kids and the people in pediatrics I found to be particularly caring and compassionate, but the extra years of training, the high focus on inpatient care, and the comparatively worse job market (it's not bad in pediatrics, but not nearly as favourable as Family Medicine) was enough to dissuade me. I spent weeks going back and forth on whether I would apply, and if I did, how highly I would rank Pediatrics programs - this was not an easy decision.
I had a somewhat smaller conundrum after a Psychiatry elective which was similarly enjoyable and also resulted in a preceptor encouraging me to apply to the specialty. I wasn't really set up to do that - not enough elective experience, no real opportunities to get enough good LORs in the field, a CV that wasn't particularly well-tailored to Psychiatry. Still, similar to Pediatrics, I could envision a happy career in Psychiatry. It's hard not to wonder what opportunities would have been in store if I followed these preceptors' advice to enter a field beside Family Medicine.
Still, I'm quite happy with my decision. Family Medicine offers a rather quick path to a good job, with flexibility in opportunities, and a wide variety of patients to take care of. Having a relatively stress-free CaRMS application cycle doesn't hurt either. The match rate to Family Medicine is over 95% and I'm not banking on overly competitive locations. I don't feel nearly the same pressure a lot of my classmates are feeling.
Nevertheless, I'm not taking anything for granted. Family Medicine is what I want to match to and I'm not taking it anymore lightly than those in my class going for super-competitive specialties like Dermatology, Plastics, or Emergency Medicine. It's been reassuring to start getting interviews. I only applied to 5 schools, though there are 14 programs on my list between those 5 schools. I've been lucky enough to receive invites for interviews at 4 of these schools so far and am waiting to hear back from the fifth school. I'm fairly confident in my interviewing abilities, but have still been casually going over some questions and have set up some interview prep sessions offered by my school as well as the CMA. I didn't apply all that broadly, so I need to make each application and each interview count.
On the plus side, my smaller number of interviews means I'm going to have a lot of time off during the CaRMS interview period. My school gives those three weeks entirely off - an amazing and welcome decision on their part - and I'll likely only need a week or so of that time. Gives me both plenty of time to do some last-minute preparation, as well as time to recover afterwards!
Sunday, 11 December 2016
Depression in Medicine
JAMA recently published a meta-analysis of studies on depression in resident physicians, and it's understandably getting a fair bit of attention. The headlining number approximately 28.8% of residents report depression or depressive symptoms. This is almost certainly a bit of an over-estimate as depressive symptoms aren't necessarily equal to depression itself - particularly when it comes to the somatic symptoms of depression (fatigue, poor sleep, appetite changes), there can be multiple explanations aside from depression.
Still, it's likely not a gross over-estimation. A rate around 20% or so, with approximately half of that being only moderate depression, fits with what the more granular data in the study suggests as well as with my own personal experience. The challenge with depression in medical school is that there is a strong incentive not to let on that you're going through it. The stigma against physicians with mental health problems is lessening, but there are still risks to opening up about it, especially as so much in medical training is subjective. Admitting to dealing with depression wouldn't be met with scorn, but might lose a student or resident the benefit of the doubt when mistakes or misses happen - which they inevitably do for all learners. Showing outward signs of depression can be equally harmful to a trainee's prospects - fatigue, irritability, and disinterest are all significantly frowned upon, even in situations where it might be completely reasonable to feel all three. The outward appearance of strength and tranquility is demanded in trainees, despite having minimal opportunities to get away from medicine and drop their guard. Lastly, taking actual steps to address mental health issues like depression can be very difficult. I have enough trouble finding time to get to see my family physician, I can't imagine what it would be like to get the time to see a mental health professional, especially for the kinds of regular visits that are often optimal for dealing with these issues. Medicine simply doesn't permit that kind of flexibility for trainees.
As a result, many mental health issues are driven underground, which can give the appearance that it is far less common than reported in the JAMA study as well as similar reports. I've seen a degree of hostility towards even addressing these issues by students or residents who may not recognize the extent of the problem - in some cases, even by those who have trouble recognizing that they themselves are struggling with poor mental health.
There's also an unfortunate notion to dismiss cases of poor mental health in medical trainees as a problem with the trainees themselves. A lack of mental toughness or fear of adversity is often thrown around. Yet I've seen exceptionally strong medical students struggle. They might be doing amazingly well on evaluations or in clinical performance, but be unable to keep up with their social lives, personal interests, or even basic hygiene. Overall, medical students are already being carefully selected to be the most capable, resilient individuals available - if significant groups of trainees are having difficulty with depression, even if we had an outstanding admissions system, I doubt we're likely to get more resilient individuals who are also equally capable.
Addressing this problem is challenging. There are no simple answers as the depression is multi-factorial and any potential solutions to depression in medicine would encounter numerous barriers and trade-offs. I don't believe small changes are going to cut it, however. I think the stats seen in this study will continue until some fundamental changes are made to the way we train our physicians and, likely, the way we organize our healthcare system in general.
Wednesday, 23 November 2016
CaRMS In
After much scrambling, managed to complete my CaRMS applications on time. Personal letters got done at the last minute and I submitted everything far later than I'd like, but it's all in. My letters of reference were received in good time and all assigned already, so I don't even have that second reference letter deadline to worry about. It's all in, complete and done.
Posting has been a little bit delayed and will likely stay that way as I catch up on missed sleep, but it feels great to have a bit of extra time to get back to blogging. Expect to have some meatier posts in the near future.
Saturday, 19 November 2016
CaRMS - Deadlines Approach
Ok, so I have to finish my CaRMS applications by this Tuesday. I've picked my programs, my letters of reference are all arranged, and most of my documents are uploaded. I've still got quite a bit to do this weekend, however. I have one personal letter that still needs some final edits and another three that need to be written.
I'm starting to over-analyze those personal letters a bit, and it's getting to the point where I really wish my brain would shut up. I'd like to think my application is fairly strong, but this is when the uncertainty creeps in. So, I'm going over trivial differences in wording and obsessing over what content to emphasize. It's going to be an exciting weekend...
Nevertheless, it feels good to be at this stage and to have everything put in. I'm confident in my interviewing skills, and while I won't be leaving anything to chance their either, once my written applications are in, I'm over what I consider to be my last major hurdle in my residency applications. Well, assuming those go well and I get the interviews I'm hoping for - we'll find out in a month or two!
I'm starting to over-analyze those personal letters a bit, and it's getting to the point where I really wish my brain would shut up. I'd like to think my application is fairly strong, but this is when the uncertainty creeps in. So, I'm going over trivial differences in wording and obsessing over what content to emphasize. It's going to be an exciting weekend...
Nevertheless, it feels good to be at this stage and to have everything put in. I'm confident in my interviewing skills, and while I won't be leaving anything to chance their either, once my written applications are in, I'm over what I consider to be my last major hurdle in my residency applications. Well, assuming those go well and I get the interviews I'm hoping for - we'll find out in a month or two!
Saturday, 17 September 2016
Electives - Initial Thoughts
Got to start my electives over the past few weeks. They say the 4th year of medicine is the best year, and based on my experiences so far, it's hard to disagree. I don't have to worry about evaluations, I'm getting sleep and a bit of actual exercise, and I'm learning a ton. Getting to choose my rotations, or at least have significant input on them, is a major bonus. Learning comes so much easier when you want to learn and are motivated to do so.
It is a bit disorienting though. Perhaps not quite as much as clerkship, because I at least know the medicine well enough. Yet, being in a different environment every 2 weeks, particularly when that often involves being in a different city, it does take a fair bit of mental energy just to keep up.
There's a trade-off between variety and consistency when it comes to absorbing new information. Too much variety and there's so much rattling around in your brain that little if anything sticks. Too much consistency and you only pick up what's right in front of you, missing experiences you may have to encounter on your own later down the line. Right now I'm on the "variety" side of things and I am definitely missing my time where I could count on doing roughly the same thing for weeks on end - I'm getting a lot of experience I otherwise wouldn't, but less is sticking than I'd like.
The other wrinkle here is that this is my main chance to explore different settings for residency considerations. As someone leaning heavily into FM, the main question I'm wrestling with right now is how rural do I want to go? I knew I didn't want to do the extremes on either end - I don't want to be in the GTA, nor do I want to do overly remote medicine. However, that still leaves open anything from mid-sized cities to small towns with only a few thousand inhabitants. I don't have any major preferences when it comes to living in these locations, so it's coming down to practice types. In larger centres, FM is much more restricted to clinic work, home visits, and nursing home care, possibly with some OB thrown in. Smaller centres, you could be running clinic, covering the ER, taking care of inpatients, then doing trips to people's houses or to nursing homes, potentially all in the same day.
I'll have more to say on that soon - right now, I'm trying to keep an open mind to fully explore each of these settings and which ones might be a better fit for my residency, and my eventual practice.
It is a bit disorienting though. Perhaps not quite as much as clerkship, because I at least know the medicine well enough. Yet, being in a different environment every 2 weeks, particularly when that often involves being in a different city, it does take a fair bit of mental energy just to keep up.
There's a trade-off between variety and consistency when it comes to absorbing new information. Too much variety and there's so much rattling around in your brain that little if anything sticks. Too much consistency and you only pick up what's right in front of you, missing experiences you may have to encounter on your own later down the line. Right now I'm on the "variety" side of things and I am definitely missing my time where I could count on doing roughly the same thing for weeks on end - I'm getting a lot of experience I otherwise wouldn't, but less is sticking than I'd like.
The other wrinkle here is that this is my main chance to explore different settings for residency considerations. As someone leaning heavily into FM, the main question I'm wrestling with right now is how rural do I want to go? I knew I didn't want to do the extremes on either end - I don't want to be in the GTA, nor do I want to do overly remote medicine. However, that still leaves open anything from mid-sized cities to small towns with only a few thousand inhabitants. I don't have any major preferences when it comes to living in these locations, so it's coming down to practice types. In larger centres, FM is much more restricted to clinic work, home visits, and nursing home care, possibly with some OB thrown in. Smaller centres, you could be running clinic, covering the ER, taking care of inpatients, then doing trips to people's houses or to nursing homes, potentially all in the same day.
I'll have more to say on that soon - right now, I'm trying to keep an open mind to fully explore each of these settings and which ones might be a better fit for my residency, and my eventual practice.
Sunday, 4 September 2016
CaRMS Cycle - Go Time
So, the new CaRMS cycle started this week. My CaRMS cycle.
It's a very weird feeling, having residency start to become a reality rather than an abstract concept in the future. Before this week, anything I did - aside from passing all my courses and rotations - only had a tangential effect on my residency chances. Now it's all quite direct, and that is... well, a little stress-inducing.
Don't get me wrong, I've got months to get things ready and have put myself in a reasonable situation. Most of my documents are already prepared. I've only got a few personal letters and letters of reference to arrange, but not too much else beyond that. Still, I've had months disappear on me in the blink of an eye, so I don't want to get complacent.
On the positive side, it feels like I'm coming to the end. I'm done my pre-clerkship courses, the ones I merely tried to get through while doing as much as I could outside the standard curriculum. I'm finished clerkship, where I largely enjoyed the work, but detested the working conditions and treatment of patients for many rotations. Someone reminded me that, because I'm going into Family Medicine, the required part of my training to become a fully qualified, independent physician is now over half complete.
I can't wait to start working. I know I have a lot to learn before I'm able to do that, but I'm so excited to get to that point, to be finally done with my formal education and onto learning for life instead.
So, as stressful as this is, starting my CaRMS application is a great step to be allowed to take. It signifies that it's time for the next stage of my training. I'm quite thankful for that opportunity.
It's a very weird feeling, having residency start to become a reality rather than an abstract concept in the future. Before this week, anything I did - aside from passing all my courses and rotations - only had a tangential effect on my residency chances. Now it's all quite direct, and that is... well, a little stress-inducing.
Don't get me wrong, I've got months to get things ready and have put myself in a reasonable situation. Most of my documents are already prepared. I've only got a few personal letters and letters of reference to arrange, but not too much else beyond that. Still, I've had months disappear on me in the blink of an eye, so I don't want to get complacent.
On the positive side, it feels like I'm coming to the end. I'm done my pre-clerkship courses, the ones I merely tried to get through while doing as much as I could outside the standard curriculum. I'm finished clerkship, where I largely enjoyed the work, but detested the working conditions and treatment of patients for many rotations. Someone reminded me that, because I'm going into Family Medicine, the required part of my training to become a fully qualified, independent physician is now over half complete.
I can't wait to start working. I know I have a lot to learn before I'm able to do that, but I'm so excited to get to that point, to be finally done with my formal education and onto learning for life instead.
So, as stressful as this is, starting my CaRMS application is a great step to be allowed to take. It signifies that it's time for the next stage of my training. I'm quite thankful for that opportunity.
Tuesday, 7 June 2016
Ontario Residency Spot Reduction - Update
Getting word that the announced plan to reduce the number of residency spots in Ontario for 2017 has been pushed back to 2018 pending a review. Word was initially that these were to be CMG spots, a statement which then got unofficially amended to being IMG positions. Either way, if any cuts do happen, it sounds like it won't happen this year.
Obviously I wish this pause for analysis would have happened before the first round of cuts occurred for this cycle, but I guess I can't object to a better-late-than-never situation. This year's reduction in residency spots was tempered during implementation and still seems to have had some minor negative effects.
I'm not all that opposed to reducing residency spots in general. We're stretching our educational resources a bit thin as it is and there's reasonable cause to believe we have or are heading towards an oversupply of physicians. However, a straight cut to CMG spots is a fairly terrible way to go about it. CMG spots should be cut only after medical school spots get reduced. Alternatively, my preferred approach would be an elimination of IMG spots, particularly in fields with already-poor job prospects (CMG spot cuts tend to get absorbed by IMGs anyway, just in a more messy, convoluted manner).
I'm hoping this pause in reduction of residency spots signals the start of an effort to be more deliberative in human resources planning in medicine, because right now it's a bit of a mess. Far too many actors involved in the decision-making process at various steps, few with enough information to make effective choices and rarely working in conjunction with other actors. However, if this is just a pause and not part of a greater strategy, this isn't much of a win.
Obviously I wish this pause for analysis would have happened before the first round of cuts occurred for this cycle, but I guess I can't object to a better-late-than-never situation. This year's reduction in residency spots was tempered during implementation and still seems to have had some minor negative effects.
I'm not all that opposed to reducing residency spots in general. We're stretching our educational resources a bit thin as it is and there's reasonable cause to believe we have or are heading towards an oversupply of physicians. However, a straight cut to CMG spots is a fairly terrible way to go about it. CMG spots should be cut only after medical school spots get reduced. Alternatively, my preferred approach would be an elimination of IMG spots, particularly in fields with already-poor job prospects (CMG spot cuts tend to get absorbed by IMGs anyway, just in a more messy, convoluted manner).
I'm hoping this pause in reduction of residency spots signals the start of an effort to be more deliberative in human resources planning in medicine, because right now it's a bit of a mess. Far too many actors involved in the decision-making process at various steps, few with enough information to make effective choices and rarely working in conjunction with other actors. However, if this is just a pause and not part of a greater strategy, this isn't much of a win.
Sunday, 5 June 2016
CaRMS Match 2016 - Further Thoughts
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?
-----
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.
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?
-----
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.
Tuesday, 31 May 2016
CaRMS Stats 2016!
CaRMS released their stats from the 2016 match today. I get way too excited about the chance to analyze these numbers. That's especially true this time around since this the last year before I'm part of those numbers.
Anyway, here are the match rates to each specialty for those who ranked that specialty first, in order of competitiveness. The CFMS always puts out the stats below as well, but they take a few months to get them up and I get impatient.
| Specialty | % Matched 1st Choice Discipline | % Alternative Discipline | |
| Dermatology | 43.8% | 43.8% | |
| Plastic Surgery | 46.0% | 22.0% | |
| Emergency Medicine | 50.4% | 41.1% | |
| Physical Medicine & Rehabilitation | 60.0% | 20.0% | |
| Medical Microbiology | 63.6% | 18.2% | |
| Urology | 64.3% | 28.6% | |
| Neurosurgery | 66.7% | 12.5% | |
| Nuclear Medicine | 66.7% | 16.7% | |
| Otolaryngology | 69.0% | 21.4% | |
| Ophthalmology | 69.1% | 18.2% | |
| Obstetrics & Gynecology | 69.7% | 22.0% | |
| Anesthesiology | 73.4% | 17.3% | |
| Pediatrics | 74.9% | 18.0% | |
| Cardiac Surgery | 75.0% | 8.3% | |
| General Pathology | 75.0% | 25.0% | |
| Neurology - Pediatric | 75.0% | 25.0% | |
| Vascular Surgery | 75.0% | 25.0% | |
| Public Health & Preventive Medicine | 77.8% | 16.7% | |
| General Surgery | 78.6% | 11.2% | |
| Orthopedic Surgery | 87.3% | 7.3% | |
| Diagnostic Radiology | 88.2% | 9.2% | |
| Internal Medicine | 88.2% | 6.8% | |
| Psychiatry | 88.4% | 8.7% | |
| Neurology | 90.5% | 7.1% | |
| Family Medicine | 96.5% | 1.4% | |
| Anatomical Pathology | 100.0% | 0.0% | |
| Hematological Pathology | 100.0% | 0.0% | |
| Laboratory Medicine | 100.0% | 0.0% | |
| Medical Genetics | 100.0% | 0.0% | |
| Radiation Oncology | 100.0% | 0.0% | |
Ignoring the smaller specialties that tend to have a lot of year-to-year variance, the big things that jump out at me at the uniquely competitive years for PM&R, Urology and Internal Medicine. Diagnostic Radiology went right the other direction, with a rather uniquely uncompetitive match by their standards.
Derm, Plastics and Emerg continue their reign atop the competitiveness standings, which is no surprise, but they keep pushing that boundary further. Derm and Emerg are at least maintaining a decent back-up match rate. They both can fairly naturally back-up into Family Medicine, so that certainly helps. Plastics is another story... like most surgical specialties, it doesn't have a natural back-up option. All the other surgical specialties are decently competitive themselves and non-surgical specialties can stand out like a sore thumb in a Plastics-oriented application package.
As expected, Family Medicine remains the surest option - but not a guarantee - for those who simply want to match to something. Despite its increasing competitiveness, Internal is also the best non-FM option for a back-up specialty.
I'll likely post a bit more on this later - there's always a fair bit to parse out from the CaRMS numbers and this year is no exception. With the possible exception of some PM&R gunners, I don't think this year's stats should change anyone's approach for next year, but I'll try to go into more depth on that next time.
Sunday, 22 May 2016
How To Pick A Specialty - A Follow-up
It's been a bit less than a year since I made this post about picking a specialty, where I described the approach I took to narrowing down my specialty choice. Now that I'm done the majority of clerkship and am coming around to a final decision, I figure now's a good time to follow-up on that post to reflect on where my approach worked and where it might have fallen flat.
At the end of second year, my list of specialties, in no particular order, looked like this:
Diagnostic Radiology
Emergency Medicine
Family Medicine
Internal Medicine
Nuclear Medicine
Obstetrics & Gynecology
Pediatrics
Physical Medicine & Rehabilitation
Now, it's a bit smaller and it has an order:
1. Family Medicine
2. Pediatrics
3. Emergency Medicine
4. Psychiatry
5. Radiation Oncology
Two things to mention. First, a number of specialties dropped off my list. Two fell off because of less-than-great experiences in clerkship (OBGYN, Internal Medicine). A few fell off due to attrition - I didn't necessarily have bad experiences with these specialties, but I had enough good experiences in other specialties to feel comfortable eliminating them. That's all in keeping with my original strategy for picking a specialty.
Secondly, and decidedly not in keeping with my original strategy, you'll notice two specialties that weren't on my list from a year ago. I had a really good experience in Psychiatry, which I wasn't expecting. I also had a great experience in Oncology, which I was expecting, but even then the rotation exceeded my expectations.
Many residents and clerks say that you really won't know where you stand on a specialty until you experience it. I'm inclined to agree.
Nevertheless, I think my approach still has some merit. My top three specialties are ones I was considering heavily prior to clerkship. The specialties that jumped onto my list aren't overly competitive - if I wanted to, I could still make myself a reasonably attractive candidate for these fields by re-arranging electives, doing side projects, etc. Eliminating a good number of specialties because of more superficial attributes (hours, patient population, job market) proved reasonably useful because at the end of the day, they still factored into my final ordering. Radiation Oncology, for example, fit my preferences extremely well. However, its job market is pretty bad and flexibility of location is rather limited. Despite defying expectations and making my short-list, it's at the end of that list and will not factor into my elective planning.
Still, I did give too my credence to reputation about specialties, Psychiatry in particular. It hit my goals for those lifestyle-focused parameters, yet I wrote it off prematurely due to perception of the practice rather than reality. I wish I had explored it more thoroughly in advance of clerkship. It's important not to pre-judge the actual practice of a specialty until you see it first-hand.
At the end of second year, my list of specialties, in no particular order, looked like this:
Diagnostic Radiology
Emergency Medicine
Family Medicine
Internal Medicine
Nuclear Medicine
Obstetrics & Gynecology
Pediatrics
Physical Medicine & Rehabilitation
Now, it's a bit smaller and it has an order:
1. Family Medicine
2. Pediatrics
3. Emergency Medicine
4. Psychiatry
5. Radiation Oncology
Two things to mention. First, a number of specialties dropped off my list. Two fell off because of less-than-great experiences in clerkship (OBGYN, Internal Medicine). A few fell off due to attrition - I didn't necessarily have bad experiences with these specialties, but I had enough good experiences in other specialties to feel comfortable eliminating them. That's all in keeping with my original strategy for picking a specialty.
Secondly, and decidedly not in keeping with my original strategy, you'll notice two specialties that weren't on my list from a year ago. I had a really good experience in Psychiatry, which I wasn't expecting. I also had a great experience in Oncology, which I was expecting, but even then the rotation exceeded my expectations.
Many residents and clerks say that you really won't know where you stand on a specialty until you experience it. I'm inclined to agree.
Nevertheless, I think my approach still has some merit. My top three specialties are ones I was considering heavily prior to clerkship. The specialties that jumped onto my list aren't overly competitive - if I wanted to, I could still make myself a reasonably attractive candidate for these fields by re-arranging electives, doing side projects, etc. Eliminating a good number of specialties because of more superficial attributes (hours, patient population, job market) proved reasonably useful because at the end of the day, they still factored into my final ordering. Radiation Oncology, for example, fit my preferences extremely well. However, its job market is pretty bad and flexibility of location is rather limited. Despite defying expectations and making my short-list, it's at the end of that list and will not factor into my elective planning.
Still, I did give too my credence to reputation about specialties, Psychiatry in particular. It hit my goals for those lifestyle-focused parameters, yet I wrote it off prematurely due to perception of the practice rather than reality. I wish I had explored it more thoroughly in advance of clerkship. It's important not to pre-judge the actual practice of a specialty until you see it first-hand.
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