MONTREAL—A record number of medical-school graduates this year missed out on residency programs, their final training stage, due to an “alarming trend” that puts at risk the hundreds of thousands of dollars provincial governments have invested in the next generation of Canadian doctors.
This spring, more than 2,700 medical students were accepted to residency programs that begin next month at university hospitals across the country.
But the program, an algorithm used to match applicant preferences to universities’ preferred candidates, has left 68 students without a residency assignment.
The problem highlights a gap between the numbers of spots in medical schools and the number of residency spots, which have been cut back in recent years due to tighter budgets, according to the Canadian Federation of Medical Students.
Students who don’t find a spot in residency after the two-round selection process end up in a year-long limbo. They are free to reapply, but their debts mount and they must struggle to keep up their skills and remain competitive.
Banks are suddenly unwilling to extend them more money to get through the next uncertain year.
“You realize the double standard,” the resident said. “From day one in med school (the banks) love you and would do anything for you and then you realize the huge switch. That’s the kind of feeling you have in everything that you do. It’s an outsider kind of feeling.”
A number of unmatched students get into residency programs in successive years, but others abandon their medical training, said Tavis Apramian, vice president of education for the medical-student association. With those who abandon medicine goes a significant investment of government funds.
Calculating the costs of a government-subsidized medical education, which includes class time, hospital internships and administration is no easy thing. Provinces provide funding at different levels, such that in Quebec yearly tuition costs are less than $4,000 while they can exceed $25,000 in Ontario, according to the Association of Faculties of Medicine of Canada.
“It has been estimated that the yearly cost to educate a medical student can be upwards of $75,000 to $90,000 or more a year,” said AFMC president Dr. Geneviève Moineau, who said medical schools are also concerned about the growing number of unmatched students.
“Everyone involved in the system agrees that we want to be able to have pretty much all Canadian medical graduates matching to a residency.”
In 2009, there were only 11 unmatched medical-school graduates, representing just 0.5 per cent of all residency applicants. But the 68 students from 2017 represented 2.4 per cent of the total. There were also 46 graduates from previous years who went unmatched for a second year.
“So when you think about it, the system didn’t match 114 individuals. It’s alarming in that sense.”
The problem was most acute in Ontario, where 35 medical graduates went unmatched, compared to 20 in western Canada, eight in Quebec and two in the Maritime provinces.
In a written response to questions, the Ontario health ministry said the problem is due to a range of factors that could include academic performance and a student’s decision about which schools and programs to target.
Ontario cut 25 residency positions last year to prevent an “oversupply” of doctors in the province, but the ministry said it is still on track to increase the number of physicians in Ontario by 650 each year until 2025.
But it is getting harder to harmonize the number of students working their way through medical school with the number of available residency spots.
In 2009, there were about 112 residency spots for every 100 medical school graduates, according to figures released by the Canadian Resident Matching Service, which runs the application process in Canada. Last year, there were only 102 spots for every hundred graduates.
“That buffer that existed practically does not exist anymore,” Moineau said.
The tighter ratio makes the entire system more susceptible to minor shifts and changes.
In Quebec, for example, there are 58 unfilled residency positions, all but two of them for residents in family medicine and all located in rural areas where fluency in French is a prerequisite.
Dr. Hélène Boisjoly, the dean of the Université de Montréal’s faculty of medicine, said the province has set targets to increase the number of family doctors in the province, meaning that while 56 family-medicine posts were unfilled this year, there are still a growing number of doctors being churned out.
But there may also be a reluctance to get into family medicine in Quebec due to changes to the health system, including forcing doctors to take on a greater patient load, said Dr. Frederic Turgeon, president of the Quebec College of Family Physicians.
He said the grumbling of practitioners has filtered into the thinking of medical school students who may in turn seek safety in other provinces and other medical specialties.
Nationally, though, there is a growing consensus that the system for matching medical graduates with residency programs needs to be overhauled to save public money and students’ anguish.
Student advocates say they need more information about the competition for spots and post-residency job prospects. They also want feedback and support for unmatched graduates to counteract the isolation and stigma that currently reigns.
Moineau said the issue is being studied by provincial governments across the country. Problems are being identified and changes are being proposed.
“Once we’ve identified those, we’ll know how to potentially work on solving the problem.”