Dr. Robert Chu & the Canadian Residency Matching Service (CaRMS)

You may have heard that a medical school graduate, Dr. Robert Chu, from McMaster University in Hamilton, Ontario recently took his own life. While suicide is always tragic, this situation has several layers of tragedy to it.

As reported by the Toronto Star:
  • Dr. Chu graduated from McMaster (a good medical school in Canada) and applied for post-graduate training (residency) in radiology.
  • Despite having published papers on the subject and having taken elective courses at the end of his medical education in radiology, he was one of 39 students that went "unmatched" out of approx. 3000 applicants to the Canadian Residency Matching Service (CaRMS).
  • Over the next year, he started his education to obtain his MBA and maintained his clinical skills in hospitals.
  • He applied the next year, this time to family medicine and psychiatry (widely considered to be less competitive) and again went unmatched, possibly because he was perceived to not have sufficient interest in family medicine or psychiatry due to his choice of electives and papers on radiology.
  • Without post-graduate training, Dr. Chu could not become a licensed physician in Canada and was saddled with ~ $100,000 of debt.
Dr. Chu's case highlights the lack of transparency in "the match" and the fears that many medical students in Canada have. These days, medical students feel significant pressure to determine their medical specialty early in their medical education. Programs reviewing residency applications gauge interest in a specialty by the number of elective courses taken in that specialty in the last years of medical school. If a student takes many courses in an area of medicine (such as radiology) and then applies to another specialty as a backup, the student can expect to be asked about it or possibly not even interview due to the perception that they are "backing up". But what happens to medical students who are interested in highly competitive fields, such as ophthalmology, radiology, plastic surgery, etc?

While medicine has a much better placement rate than other professions, such as law, there is something fundamentally wrong when such highly educated people cannot even become licensed in the province that has spent considerable money investing in their education and that needs physicians. It would be one thing if he had held out for a highly specialized or competitive field, such as radiology, but it is beyond me why he was not admitted to a family medicine program. We need family doctors.

In 2015, the same year that Dr. Chu first applied for post-graduate training, the field of law was undergoing a similar crisis. Law schools had long graduated more students than could find articling positions, but the problem was getting progressively worse. Students were graduating but could not be called to the bar and become lawyers unless they found an articling position, which was driven by the legal industry. As there is no minimum wage, some articling students took unpaid positions just so they could qualify to be called to the bar.

The Law Society of Upper Canada, the regulator of the legal profession in Ontario, decided to introduce the Law Practice Program (LPP). This is an alternative pathway to gain the experiential component required to be called to the bar. Though it is still controversial, it remains a viable alternative to articling. In the LPP, the student takes several courses and then has a placement in a law firm. Perhaps it is time to consider something similar for medicine so that Canadian medical graduates can at least become licensed family physicians and have the ability to set up their own practices in underserved communities or work in urgent care clinics.

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