Small change, big problem: Is a shifting of the CaRMS match day messing up Canada’s chance to attract the best IMGs?

A resident “matching gap” has developed between U.S. and Canadian medical schools and it may be costing our residencies an untracked number of fully-trained, high caliber international candidates (IMGs) at a time when we urgently need them. One in five Canadians now lack a family physician, according to the Canadian Medical Association, and many specialties are critically under-resourced. With the exception of positions in four Quebec medical schools—where residency positions are shown as accessible to all in the Canadian Resident Matching Service (CaRMS) data—IMGs can only apply for a limited number of designated positions in the CaRMS first iteration. These positions are predominantly in family practice, where physicians are urgently needed, come with a several years’ return of service commitment in an under-serviced community. The annual CaRMS “Match Day” used to be scheduled before its U.S. counterpart, the National Resident Matching Program (NRMP). As such, Canadian medical schools had precedence in drawing the best IMGs to their programs—among other things enabling Canadian physicians trained abroad (CIMGs) to come home, if they were successful in the CaRMS match. Now, that advantage has been relinquished. “CaRMS changed their schedule in 2020 in response to the COVID pandemic, moving their Match Day to after the NRMP Match Day, and it has remained that way ever since,” acknowledged NRMP senior communications analyst, Stephanie Bartek, in an email to the Medical Post. On the U.S. side of the border, the NRMP “season” opens to applicants shortly, on September 15, offering 39,000 residency positions — all of them fully-accessible to qualified applicants. To be clear, there are no IMG-designated positions in the NRMP, IMGs can compete for any position). The NRMP states on its website that there are 47,000 “registrants” for those 39,000 positions, so success is not guaranteed. Still, for IMGs, the odds in the US are better than in the much smaller pool of accessible positions in the Canadian match. With careers at stake, and a fear of CaRMS rejection, many who might actually prefer to work in Canada apply for NRMP as well. To hedge their bets. Why the date switch? Data provided by CaRMS (see table below) stated that its career-deciding Match Day back in 2020 was March 3, nearly three weeks ahead of NRMP’s (which is always held the third Friday in March). But in 2021 the CaRMS match did not happen until April 20, then in 2022 on April 13. The date did shift back towards earlier norms in 2023, with Match Day held on March 22. And next year it is scheduled to happen on March 19. That’s baby-steps earlier and closer, but still later than U.S. Match Day on March 15, 2024. Event period 2020 Match 2021 Match 2022 Match 2023 Match 2024 Match Transcript and MSPRs Submission Deadline (NOT requiring translation) Wed., October 30, 2019 Mon., January 25, 2021 Fri., January 7, 2022 Fri., December 23, 2022 Fri., November 17, 2023 Application period ends Wed., November 20, 2019 Mon., February 8, 2021 Mon., January 31, 2022 Tues., January 10, 2023 Fri., December 1, 2023 File review period (File review open until interview period opens) Wed., November 20, 2019- Saturday, January 18, 2019 Mon., February 8, 2021 - Fri., March 5, 2021 Mon., January 31, 2022- Sun., February 27, 2022 Tues., January 10, 2023- Mon., February 6, 2023 Fri., December 01, 2023 – Mon., January 15, 2024 Interview period (virtual as of 2021 Match) Sat., January 18, 2019- Sun., February 09, 2019 Mon., March 8, 2021 – Sun., March 28, 2021 Mon., February 28, 2022- Sun., March 20, 2022 Mon., February 6, 2023- Sun., February 26, 2023 Mon., January 15, 2024-Sun., February 4, 2024 Match Day Tues., March 3, 2020 Tues., April 20, 2021 Tues., April 12, 2022 Wed., March 22, 2023 Tue., March 19, 2024 Second Iteration Match Day Wed., April 15, 2020 Thu., May 20, 2021 Thu., May 12, 2022 Thu., April 27, 2023 Thu., April 25, 2024 What’s four days, for a newly-minted Canadian physician, for example, who gets matched in the NRMP but thinks maybe they can lose their phone and stall a little, hoping a lucky break in CaRMS will enable them to come home? Four days is everything. Even a difference of one day would be too much, because at that stage of the match, registrants can no longer choose. Here are the rules as published on the CaRMS website: “If you are matched to an R-1 position through CaRMS’ first iteration, you will automatically and without any notification be withdrawn from the NRMP—and vice-versa, should the NRMP match occur first in a given year.” That theoretical new grad may not even be eligible in the CaRMS second iteration, if having matched in the U.S. they decide to turn it down. Aside from all the other valuable IMGs in the mix, how many highly-trained Canadian physicians are we losing? Promising young people who—with a ninety-percent rejection rate at Canada’s seventeen medical schools— were not successful in securing a position at home and instead trained at high-ranking medical schools in Ireland, Australia, the Caribbean, etc. Hedge your bets or risk missing out? Dr. Desmond Leddin is a Halifax gastroenterologist who spends half the year teaching at a medical school in his Irish homeland. He counsels CIMGs who want to return home for their residency. “The Irish schools are long-established, some of them are four or five hundred years old, and they're very careful about choosing students with high academic standards because they've got an international brand that they want to maintain,” he told the Medical Post. “The Canadian medical students who are there might do three separate sets of exams: the Irish ones, the Canadian ones and the U.S. ones, if they're planning to apply to the U.S. There is no certainty that you're going to get a residency spot in Canada.“ “COVID came along and a difficulty with (completing) electives. And you know what the Canadians studying abroad said? They said, ‘I'm not going to do my Canadian exams and go through that hassle of rejection. I'm going to do my U.S. exams and go to the U.S.’ ” Dr. Mikaela Murphy, a Canadian physician who recently graduated from University College medical school, Cork, did secure a residency at Memorial University in Newfoundland and Labrador. Some of her Canadian classmates were not so fortunate. “Previously CaRMs was before the U.S. match, allowing them to match back home first and then in the U.S. if they were unsuccessful. But in my year students were committed to the (U.S.) seats they received if they matched, preventing them from even applying back to Canada,” she told the Medical Post in an email. In December, 2022, the Globe and Mail ran a story on this: Canadian Doctors Trained at International Medical Schools Increasingly Giving Up On Their Home Country For Work. The CaRMS data CaRMS data is posted on its website, with 2022 as the most recent year with complete information. In that year, there were 331 IMG-designated positions in the first iteration, nine in the second, with a total 323 filled. Of IMGs, 883 who participated remained unmatched. Then, 2023 saw a record number of IMG matches: 555, out of a total 3,532 available positions (not all filled). Additionally, 555 international medical graduates were successfully matched, an increase over last year because medical schools in Nova Scotia, British Columbia and Newfoundland and Labrador added some new IMG positions. CaRMS match dates are set by the Association of Faculties of Medicine of Canada. Asked about the recent CaRMS switch in Match Day dates, with the U.S. match now happening earlier, AFMC president and CEO, Dr. Geneviève Moineau wrote to the Medical Post saying, “International Medical Graduates (IMGs) select which matches to apply to. This means that they have the option to apply for the Canadian residency match or the American residency match.” New bureaucratic tangles Securing a residency in their home country is not the only stumbling block for Canadian physicians who have trained abroad. If they complete a residency outside of Canada, they still face the same licensing hurdles that any other IMG faces, other than having to go through an immigration process. The Canadian College of Family Physicians has evaluated a number of international programs and has decided that physicians trained in the U.S., U.K., Australia and Ireland are equivalent to their Canadian counterparts. It will evaluate candidates from those “approved jurisdictions” and issue them a certificate of equivalency (with no exams) if they are in good standing and satisfy a specified list requirements. With jurisdictions across Canada working, each in their own way, to streamline their licensure process so that more properly qualified IMGs can be out in the community serving patients—as soon as safely possible—there are now new processing wrinkles. In late June, CBC News ran the story of Dr. Stephanie DeMarchi, a Canadian family physician who trained in Australia (one of the CCFP’s “approved jurisdictions”) and has worked there for 10 years. Dr. DeMarchi wanted to come home to Ontario with her husband and two kids, to take over her retiring mother’s Hamilton family practice. Dr. DeMarchi reportedly ran into a huge tangle of red tape and had spent 16 months trying to get a license to practice—to no avail. She sat for the LMCC last October and was waiting for the Medical Council of Canada to evaluate her Australian documentation and credentials. That process was taking so long, Dr. DeMarchi had to go back to Australia to work and protect her active license while she waited. In a statement posted on its website, the MCC said: “The MCC is . . . responsible for source verification of medical credentials for physicians who have trained outside of Canada to confirm their credentials are authentic and meet specific requirements. Although the overall process is standardized, requests for source verification can differ and processing time relies on several factors, including the engagement of the candidate/physician, the responsiveness of the institution authenticating the credential and where the candidate is in meeting the licensure requirements of the provincial or territorial MRA or in other related application processes. In 2022-2023, the MCC processed over 13,300 source verification requests. In the last fiscal year, candidates electronically shared approximately 145,000 documents with our partners via physiciansappy.ca. We acknowledge that the current processing times for reviewing documents are longer than what we aim for. We are committed to addressing these longer timelines and are actively recruiting additional staff to improve the processing times and offer our candidates the best possible service. We are also collaborating with the MRAs and government to streamline pathways to licensure, specifically for physicians trained outside of Canada, while ensuring they can practice safely in the Canadian context.”

Small change, big problem: Is a shifting of the CaRMS match day messing up Canada’s chance to attract the best IMGs?

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