Governments, universities and even the military are now openly discussing the crisis of “unmatched” medical school graduates and launching piecemeal efforts to address the issue. But, according to the Canadian Federation of Medical Students, while the initiatives will help some, they won’t resolve the overall issue.
“Everyone from undergraduates to postgraduates to staff doctors to the deans [of medical schools] sees it as a problem,” says Kaylynn Purdy, outgoing vice-president of medical education for the CFMS. “It’s being seen as a systems issue, which is what we’ve been saying for a long time.”
Medical school graduates must apply for a residency position in a specialty of their choosing after they graduate. Completing a residency is the final step in their training before becoming a practising physician. However, a growing number of graduates don’t get a residency spot, also known as going unmatched. They can apply again in a second round, but if they are again unsuccessful they essentially spend a year in limbo before they can try again.
In 2018, 172 Canadian medical school graduates went unmatched after both rounds (the number includes this year’s graduates and those applying from previous years), up from 149 in 2017. A decade earlier, in 2008, only 28 went unmatched. The number is rising because the number of funded English-language residency positions is falling compared to the number of graduates.
The situation for French-language medical graduates is much different. Rather than a shortage of residency spots, in Quebec this year 69 residency positions went unfilled. These spots were primarily in family medicine and most require fluency in French.
The provincial governments determine the number of residency training programs they’ll fund each year. This past year, two provinces, Ontario and Nova Scotia, decided to add new spots.
Ontario’s then Liberal government announced an additional 53 residency positions in April. The spots were opened up after the match process had ended, to provide training opportunities for those who had gone unmatched. The positions have a string attached: the doctors must serve for two years in underserviced Ontario communities after completing their residency.
However, with the recent election of a new Conservative government in the province, it’s unclear if the additional spots will be available to future graduates. In an emailed statement, Mark Nesbitt, spokesperson for the Ministry of Health and Long-Term Care, said: “The Ministry recognizes that there is a lot of competition for residency spots in Ontario and the government will be determining how to proceed with the issue of unmatched medical graduates in the longer term now that it has been sworn in.”
Nova Scotia, meanwhile, announced 10 new family medicine residency spots will be available for students in the 2019 matching process as well as in subsequent years. “The purpose of the addition of the 10 new seats is to expand rural and small-town training sites,” said Tracy Barron, media representative of the N.S. Department of Health and Wellness, who noted that positions have opened up in towns like Truro, Inverness and Yarmouth. Research shows that doctors are more likely to practice in a rural area if they trained in a rural area. With over 50,000 people on a waiting list for family doctors, Nova Scotia is facing a shortage of family physicians, especially in rural and remote areas.
The Canadian military has also stepped up. This spring, five unmatched graduates were given military-funded family medicine residency spots at Canadian universities. Successful candidates get a $150,000 signing bonus and commit to serving the military for the first five years after their training.
Major Mike Strawson, a Canadian Armed Forces medical officer and flight surgeon, said unmatched students are often highly skilled and go unmatched precisely because of their ambitious efforts to pursue highly competitive specialties. But, once unmatched graduates have a chance to consider military medicine, many say they wished they’d been exposed to it earlier, he said. “Military medicine is not family medicine, it’s not occupational medicine, it’s not emergency medicine, it’s its own thing and a combination of all of those things,” he said.
Despite these efforts, at least a handful of Canadian medical graduates who applied to both the military and the additional Ontario positions still weren’t successful. “You try to do more good than harm but there were people … who went unmatched yet again,” said Dr. Strawson.
In Manitoba, meanwhile, for the past six years, the University of Manitoba has worked with the government to create extra spots for all unmatched graduates. There is only one medical school in the province and the number of unmatched graduates per year has always been fewer than five. In some cases, unmatched graduates are offered positions that go unfilled; other times, the government provides funding to create a residency spot for the resident. Usually, the spots are in family medicine, but a quarter are in other specialties for which there is a need, such as anesthesia.
Brian Postl, dean of U of M’s Max Rady College of Medicine, said that unmatched graduates are “good students who had performed well in medical school and often appeared to be caught in the crap shoot effect of the match, where one year there might be many people interested in a specialty and in the next year few people interested.”
Dr. Postl suggested other provinces could follow suit to guarantee spots for unmatched graduates willing to go into family medicine or another in-demand field. “It’s a combination of a bit of political will at a provincial level and the will at the medical schools,” he said.
While applauding these efforts, Dr. Purdy of the CFMS said that the unmatched crisis is likely to only get worse, as the overall ratio of residency spots to applicants isn’t increasing. “We don’t expect the problem to change unless the ratio increases,” she said.