Lauren Vogel | CMAJ | April 16, 2019
Canada is still a long way from fixing its residency mismatch despite a drop in unmatched graduates.
More Canadian medical graduates secured residency positions in the second round of this year’s match compared to last year. But “alarming” numbers are still unmatched, according to the Association of Faculties of Medicine of Canada (AFMC).
Thirty-one new graduates did not obtain residency positions in the second round of this year’s match. That’s the lowest number in four years and down from a record 115 unmatched students last year. But according to AFMC, there were also 36 students who dropped out after the first round, and another 31 who remain unmatched from last year.
It’s an overall improvement, says Geneviève Moineau, president and CEO of AFMC. However, “until governments ensure that we have more residency positions than graduates, we will not be able to fully optimize the match results.”
Multiple factors contributed to a better match this year. There were 3346 positions available, up 38 from last year. After medical trainees and educators raised alarm about a crisis level of unmatched graduates last year, Ontario, Manitoba and Alberta reserved more second-round positions for people trained in Canada, instead of opening those spots to international students. The Canadian Armed Forces also renewed an offer to sponsor placements for unmatched graduates willing to enlist.
Political changes in Quebec may have encouraged more students to stay in the province, easing competition for seats elsewhere in Canada. Last year, despite record numbers of unmatched graduates, 78 residency positions remained unfilled across Canada; 65 of them (83%) were family medicine seats in Quebec. This year, there are only 52 empty positions overall, with 29 (56%) in family medicine in Quebec.
According to Dr. Christopher Lemieux, president of the Fédération des médecins résidents du Québec, revisions to expectations of new family physicians “may have lowered the apprehensions of medical students.”
However, Canada still needs a long-term solution to its residency mismatch. According to Moineau, that will require increasing the number of residency positions to 110 seats per 100 graduates, a ratio that would allow flexibility in the match. So far, only Nova Scotia has answered calls for a substantial increase in positions, adding 14 spots at Dalhousie University. Last year, Ontario’s former Liberal government opened one-time seats for unmatched graduates, but the Progressive Conservatives did not renew the offer this year.
The AFMC is urging all provinces to “unblend” competition for positions in the second round of the match, creating separate streams for Canadian and international graduates. The association is also calling for a review of entry routes to residency and the creation of a pan-Canadian resident transfer system.
Each year, up to 3% of residents who already have placements re-enter the match to transfer to another location or specialty. A 2018 survey by Resident Doctors of Canada found that more than a third of residents have considered transferring to another program. But without a transfer system, “these previously matched residents are displacing current-year Canadian medical graduates,” explains Moineau. “Residents require a more flexible system with a method of transfer across training programs.”
Photo credit: DragonImages/iStock
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