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The unmatched Canadian medical graduate: the victim of a broken system

A generation ago, as a medical student, I remember that I went from deciding I would be a psychiatrist in year 2, then a family doctor in year 3, and then in my final rotation of my fourth year I confirmed that my true passion was pediatrics. And off I went to my rotating internship…

Today our students feel compelled to be making career choices as early as in their first year of medical school. They are feverishly planning their match strategy based on hearsay regarding what they need to do to go into family medicine or neurosurgery. It is inconceivable to me that our best and brightest, who spend years preparing to apply to a given discipline, are progressively less successful in matching to that discipline, or matching at all.How can it be that in 2009, across the country we had 11 unmatched Canadian medical graduates and that eight years later we now have 68 current year graduates from Canadian medical schools that are unmatched? And don't forget to add to that the 46 previous-year unmatched Canadian graduates. How is it that students are becoming so uncertain with their ability to match that this year they felt the need to apply on average to almost 19 residency programs?

We know that the system is complex. Each provincial government makes final determinations regarding residency positions and is under tremendous strain to improve the healthcare system in their jurisdiction, reduce costs and improve care. All have different approaches to international medical graduates and to choosing the number of residency spots for Canadian medical graduates. This has led to the overall ratio of undergraduate to postgraduate positions to go from 1.12 in 2009 to 1.026 in 2017. Add to that the fact that 64 positions, most of which are in the province of Quebec, in family medicine and labeled as Francophone, are unfilled after the second iteration. This goes to show that the overall ratios don’t tell the whole story.

It could've been me. These unmatched Canadian medical graduates are no different than I was at their stage. They are victims of a system that no longer meets their needs. The effect of this on each of these graduates is overwhelming: these smart high-achieving individuals perceive that they are incompetent and not worthy compared to their peers. Several have gone on to develop significant health issues and one of our young colleagues lost his life, largely because of what he had suffered from his ordeal with the match. This should never happen. We, as a medical education community, need to view them no differently than we do ourselves, as each and every one of us has been challenged at one point or another in our careers, and we need to admit that.  

We need to have a system that can enable us to support these graduates who are struggling at that point in time. Our university structures need to allow our Student Affairs Offices, Undergraduate Offices and Postgraduate Offices to support unmatched students and give them priority for elective experiences. We need to have the flexibility to better integrate them early in order to ensure their success for the subsequent year match.

The AFMC has clearly communicated its grave concern about the increasing number of unmatched Canadian medical graduates. The current match process no longer meets the needs of our Canadian medical graduates. We are working with our learner organizations and our entire medical education community to do an urgent, detailed analysis of the root causes of this problem with a view to creating concrete and actionable next steps to immediately change this trend. 

The AFMC is committed to doing all we can to fix this system problem. We need to ensure that our best and brightest, our Canadian medical graduates, are served by a system that enables them to have successful careers that will allow them to ensure the best health and healthcare for all Canadians.

I vow to you that I will not rest until the AFMC has accomplished this goal.