Growing numbers of Canadian medical school graduates are unable to find any residency positions, as a new study suggests competition for the most sought-after of those training spots drives some students to fudge their research accomplishments.
Even with a medical degree, doctors must complete a two-year family medicine residency or five-year residency in another specialty before being allowed to practise.
Yet in 2014, 55 Canadian graduates were unable to be “matched” with any training program, a fivefold increase from 2009, an advocate for the country’s medical schools said Wednesday.
The problem looks destined to get worse, as some provinces plan to cut the number of residencies they fund, said Dr. Geneviève Moineau, president of the Association of Faculties of Medicine of Canada. “That for us is unacceptable,” she said. “If a Canadian medical student is able to demonstrate their competence and receive their MD and that MD was supported by taxpayers’ money … those individuals should be able to find a residency spot. (But) that is becoming less and less the case.”
One source familiar with the process but not authorized to speak on the record said there is not a shortage of residencies; the problem is that more positions are being allotted to “international medical graduates” – immigrants or Canadians who studied medicine abroad.
“There are some that believe that if you’re accepted to a (Canadian) undergraduate program and you graduate from it, you should be entitled to a residency position,” the official said. “And then there are others who believe it should be a pure meritocracy and if there are better-qualified candidates coming from other places, then they should have those spots.”
The number of Canadian graduates failing to win a training position has climbed steadily from 11 in 2009 to 41 in 2013 and 55 the following year, Moineau said.
Those students are essentially “in limbo” for a year before they can apply again, she said.
Six of those who were unmatched in 2013 did not reapply, potentially sacrificing medical educations that can cost them $100,000 or more, Moineau said.
By contrast, Moineau said when she graduated from medical school 30 years ago, “you were told you could become whatever kind of specialist you want, just go for it.”
The news comes on the heels of a new Canadian study that appears to highlight the fierce competition to get into a desired residency.
Nearly one in four medical graduates who claimed they had been published in a peer-reviewed journal actually misrepresented that research history, the study found. Some graduates cited journal papers that did not exist, articles they did not author or ones where their contribution was less significant than advertised, it found.
It was a surprise and a concern that so many applicants for popular spots may have padded their resumes, said Dr. Lily Nguyen of McGill University, an ear, nose and throat specialist who headed the study.
It could also be a sign of just how intensely graduates fight for what are considered the best – or the rarest – residency positions, Nguyen said.
If administrators are seeking “the top of the top of the top” to be their residents, they look beyond just marks, she said.
“The competitive programs are the ones where everyone has good reference letters, everyone has good dean’s letters,” Nguyen said. “So one objective way to be able to distinguish between students is to look at the quality and quantity of their academic publications.”
The study examined 182 applicants to otolaryngology – earn, nose and throat — programs across the country, from 2006 to 2008. Of the group, 124 claimed to be authors on a published research paper. And 24 per cent of those had misrepresented their publication history, said the study in the journal Medical Education.
However, the researchers were not able to check why the misrepresentations occurred, and admitted that in some cases students may simply have been confused about their participation – or lack thereof — in a study.
Honesty in any profession is crucial and deliberately padding a CV is unacceptable, Moineau said. But she stressed that it may have been an honest mistake in some instances, and that other research has found a high rate of misrepresentation on resumes among the general population.