Plans for more med schools in Canada: Where will the residency spots come from?

Over the last year, three Canadian universities in just as many provinces announced plans for a new medical school. Simon Fraser University in British Columbia led the pack in late 2020, with news it was set to build a medical school at its Surrey campus. About a year later, the University of Prince Edward Island launched a partnership with Memorial University in Newfoundland and Labrador to create a new faculty of medicine. Meanwhile, Ryerson University in Toronto secured $4 million in planning grants to develop a proposal for a medical school in the city of Brampton, just west of Toronto. It’s all good news. With an estimated five million Canadians currently without family doctors, according to the Canadian Medical Association, there’s a pressing need to train the country’s next generations. But adding more medical schools is only part of the solution. Will the graduating cohorts from these new schools have residencies to go to once they leave the classroom? “Any decision by any provincial government with regards to either establishing a new medical school or increasing the number of seats within existing schools has to be connected with the support for the corresponding number of residency positions,” Dr. Geneviève Moineau, president and CEO of the Association of Faculties of Medicine of Canada (AFMC), told The Medical Post. “That’s essential.” Read: AFMC bolsters its residency portal to help medical learners find programs in the wake of COVID disruptions The numbers underline the need. Of 2,915 graduates who applied for an R-1 residency match this year through the Canadian Residency Matching Service (CaRMS), 112 didn't get a spot. Last year, 88 applicants didn’t get a match while the year before the unmatched total was 115. Compare that to 2012, when unmatched applicants totalled 24—a number that's increased each subsequent year, peaking at 166 in 2018. Mohamed Lachemi, president and vice chancellor at Ryerson, said the goal for the university's proposed medical school is to open with 75 spots and expand to 150. The question of how to ensure a residency spot for every medical school graduate is one the school’s advisory committee is working to answer. “We’re interested in exploring different types of placements, such as in long-term care facilities and other community-based settings,” he said. “We’re exploring partnerships towards the creation of interprofessional family healthcare clinics that will train not only medical students but also nurses, nutritionists, social workers, mental health workers and other graduates from the various healthcare disciplines.” Rhonda Lenton, president and vice chancellor at Toronto’s York University—which is currently working to renew its previous proposal for a medical school—said it’s important to take a “broad perspective” that integrates hospital residency placements with community placements. “We’re eager to talk to medical associations about how we can look at residencies in a way that’s more affordable for provincial governments—you can’t put the cost on students,” said Lenton. “There’s also the potential of other countries supporting the cost of residencies, for their students who come to Canada.” Read: Is Brampton, Ont. finally getting a medical school to call its own? In a 2018 report on medical residencies, the AFMC called for a minimum ratio of one med school graduate to 1.1 residency spots, noting the residency match had historically at least 10% more postgraduate positions for every Canadian medical graduate. “It became clear from our research that what the matching system needs is a little bit of redundancy,” said Dr. Moineau. “If you have 100 grads you need to have available 110 residency positions.” Among its recommendations, the AFMC called to keep all positions originally allocated for Canadian medical graduates (CMGs) in both rounds of the match. “What we found is that the vast majority of those positions were being filled by international medical graduates,” said Dr. Moineau. “So we asked decision-makers to unblend, to continue to make positions available to CMGs in the second round.” Alberta, Manitoba and Ontario subsequently changed their policies based on the AFMC’s recommendations, said Dr. Moineau. That led to better matching rates, but the improvements have stalled over the last three years. “We’re still not where we need to go,” she said. “Yes, medical school graduates are an MD but they cannot practise independently without a residency. So it’s important that when a government commits to positions for medical school they’re also committing to positions for residency.” Read: Two N.L. medical graduates studied why their peers leave the province with surprising results

Plans for more med schools in Canada: Where will the residency spots come from?

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