VANCOUVER— In February 2016, Britt Harrison was an over-achieving fourth-year medical student with her heart set on becoming a pediatrician.

She had her name on eight pediatric research publications. Her grades were above average, even for medical school. During her undergrad, she was a varsity athlete who volunteered on the side.

She did it all to be competitive for match day: the one day in the beginning of March when all of Canada’s graduating medical students simultaneously receive the results of where they’ll complete paid residency. It’s the last stage of their medical education and it determines the field graduates will work in — probably for the rest of their careers.

Only, when that day came, Harrison didn’t match. She was a medical doctor without a job.

Medical students and faculty are calling for changes to the way graduates apply for and “match to” residency positions, amid expectations that a record-high number of Canadian graduates will go without a residency post in 2018, like Harrison did two years ago.

“I was absolutely shocked. I did not think it was going to be me,” Harrison said. “You just sit there — alone — for a year ... and hope it doesn’t happen again.”

Graduating medical students are matched to available residency positions by the nationwide Canadian Residency Matching Service (CaRMS) algorithm in two rounds. Students rank their top program choices, and medical schools, which run the residency programs, rank their top candidates.

Individual grads found out their own second-round results Wednesday; CaRMS will release the total number of unmatched grads on April 17. All the data points to a larger number of unmatched graduates in 2018 than ever before.

“Based on the system inputs, the number of applicants and the number of available training positions, we don’t see any reason to expect significant changes to the unmatched applicant trendline,” said John Gallinger, CaRMS CEO, in a statement to StarMetro.

A total of 222 Canadian grads went unmatched after the first round this year, the highest number ever.

CaRMS publishes lists of the residency spots that go unfilled after each round. A comparison between those lists shows 150 positions were no longer available after the end of the second round this year — but a significant portion of those were likely filled by international medical graduates, who have accounted for more than a third of second-round match positions for the last four years.

Last year 189 Canadian graduates were unmatched after the first round, then 149 after the second. As more grads go unmatched each year, more applicants apply the next year, and so the problem gets worse and worse.

That’s not only emotionally and professionally devastating to graduates. Every qualified graduate who goes unmatched is one fewer doctor that could be seeing Canadian patients, about 4.8 million of whom did not have a primary health-care provider in 2016, according to the most recent figures available from Statistics Canada.

The factors driving the trend include: an increase in the number of Canadian medical grads coupled with a stagnant number of available positions; the competing interests of the provinces; and relatively new rules allowing international grads to compete for spots initially reserved for Canadians in the second round of CaRMS.

The Association of Faculties of Medicine of Canada (AFMC) and the Canadian Federation of Medical Students — together representing all medical schools and students in the country — have both urged the provinces to action.

A private members’ bill was introduced on March 22 in Ontario to look at the issue, but no province has committed to increasing the number of residencies.

Henry Annan, president of the students’ federation, called it a “crisis.”

“Medical students sacrifice so much of their personal time to go through the rigour that medical school really entails,” Annan said. “To not match — you can imagine how that can take an emotional toll on medical students.”

AFMC president Geneviève Moineau points out that Canadian governments have made significant investments subsidising the education of domestic medical graduates. Government reports have put their cost of training one MD for four years at $260,000. In total, that’s almost $39 million spent on the 149 MDs who went unmatched last year.

The No. 1 priority for AFMC, outlined in a January report, is for provincial governments to increase residency positions available to a number 10 per cent greater than the number of Canadian medical graduates that year. Based on 2017 data, reaching that ratio would require provinces to fund 290 new positions across the country.

Moineau said provinces’ competing interests are a roadblock. Ontario, for example, slashed 25 residency spots in 2015, and positions made available in rural Quebec are only practical for French-speaking graduates.

“Medical school deans have to go to the provincial government and make this request,” she said.

There are also a number of spots reserved for international medical graduates, which the AFMC suggested could, temporarily or permanently, be shifted to spots for Canadian graduates. Barring that, the association proposed Canadian graduates should not have to compete with international graduates for the same spots in the second round of the CaRMS match, a policy implemented in 2007.

Moineau said it’s the right thing to do to continue training medical doctors in Canada, so slashing medical school admissions is not a good solution.

“Until every Canadian has a family doctor, I personally don’t think that we’re training too many positions,” she said.

Even the problem of family doctor shortages is unevenly distributed. For example, according to the Canadian Medical Association, there were 252 doctors per 100,000 people in the northern city of Prince George, B.C., in 2015.

Vancouver had a total number of 6,308 doctors. (This number includes both generalists and specialists for all areas.)

Finding family physicians to serve these areas is a high priority for the province, which often relies on bringing in international physicians. The University of British Columbia, as the sole medical school, is responsible for all residency programs in the province.

Dr. Roger Wong, UBC’s executive associate dean of education, said the province and university are answering the call. They have expanded residency offerings over the last five years, with 49 per cent of its total spots offered in the field of family medicine.

“I am obviously concerned about the number of unmatched Canadian medical students,” Wong said. “Every student that remains unmatched after two rounds is a student too many.”

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Still, the fact that the matching program is national, while the distribution of residency programs is jurisdictional, leaves a “disconnect,” Wong said. “If this is what I’m doing at UBC, the question is: what are the other jurisdictions doing?”

Christine Kennedy knows that disconnect first-hand. She will graduate this June from the University of British Columbia’s northern medical program in Prince George, established in 2005 to fill gaps in medical services available in northern B.C.

“Seeing the program in the north, knowing people that have gone through the program, and realizing that I could get so much of my education in the north — that was a huge pull for me to enter medicine,” Kennedy said.

Her roots in Prince George are strong: she lives with her fiance and raises her 11-year-old sister there. That’s the community she believes she’s best suited to serve as a doctor.

Kennedy’s story in many ways fulfills the intention of UBC’s northern medical program. But since the CaRMS process is national and requires applicants to sign contracts before they find out where they matched to, she went into her final year of medical school knowing she may have to leave the place she was most needed by both her family and future patients.

She ended up applying to only psychiatry at UBC — a risk considering students are encouraged to apply for a dozen or more programs to increase their chances of matching.

“I’m fortunate, I’m matched, but I didn’t want to forget how I felt during the process — how I felt that there must be a better way,” she said.

***

On March 1, last year, at 11:59 a.m., Britt Harrison was sitting in front of a computer at her boyfriend’s place in Ottawa, literally shaking from head to toe as she refreshed a webpage. She was “dysfunctional” the entire week leading up to that moment — in what she describes as a perpetual state of “pure anxiety.”

She spent the year after her non-match taking electives at the University of Ottawa, working with an interview coach and getting her anxiety under control. She also had to study for her licensing exam — even though she had no residency to go to — and passed.

“The main emotion I had in that entire year was embarrassment,” Harrison said, even to the point where she felt she couldn’t go to the hospital in Ottawa. “It was a fear, like ‘What are they going to say to me?’”

In that year she also shifted her professional goals: She decided primary care was the best fit for her.

When the result appeared in front of her — showing she had been assigned to her first choice of residency in family medicine at Hamilton’s McMaster University — she couldn’t muster up any feeling other than relief.

“I was so numb because of the whole process,” she said.

She’s now in a residency program she loves. But despite having gone into medicine absolutely certain that it was the only career path for her, Harrison said she wouldn’t necessarily do it over again.

“I became very disillusioned about the whole medical process,” she said.

She hopes the provinces will take notice of the need for more residency positions, so that qualified candidates don’t go through the “grueling” experience she had. In the meantime, she’s enjoying a rewarding family medicine residency that she wouldn’t hope to trade.

And she’s waiting for the official results of the second round of the CaRMS match 2018 with bated breath, certain she’ll discover an even greater number of medical graduates will go through the hellish limbo she did two years ago.

Update - April 13, 2018: The poll question that was included with the previous version of the article was removed as it did not accurately reflect the main premise of the article.

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