Residency guide 15-16

RESIDENCY GUIDE 3E ÉDITION, 2015-‐2016

Presented by the Fédéra&on médicale étudiante du Québec

This document is property of the Fédéra&on médicale étudiante du Québec.

For ques7ons, informa7on, or requests to copy this document, please contact the FMEQ at the following address: [email protected]

© FMEQ, August 2015 Acknowledgments –  Traduc7on team:

Trevor Bruen Victoria Luong Elias Oussedik Andréanne Titley-‐Péloquin Chris7ne Wilk

–  Edi7ng: Olivier Gil

2

Introduc7on The Fédéra7on médicale étudiante du Québec (FMEQ) is proud to present this third edi7on of the Residency Guide. The goal of this guide is to fulfill an important need present in the community of medical students in Québec: the desire to beZer understand prospec7ve aspects of their future careers in the various fields of medicine. Students remain surprisingly misinformed about these perspec7ves, despite the fact that understanding them is essen7al to making such a crucial decision as career choice .

The guide is also mo7vated by the challenges residents’ in Quebec have been met with while seeking employment in the last few years. The work of the fédéra7on des médecins résidents (FMRQ) in striving to guarantee the employment of graduates and to force the government to make more long-‐term plans has been incredible.

Completely re-‐done this year, this guide now contains a sec7on on the most recent CaRMS match sta7s7cs, a chart comparing admissions criteria by program for the 4 Quebec facul7es, as well as per7nent informa7on concerning the process of applying to a residency program.

The informa7on contained in this document comes from mul7ple sources, such as from specialist associa7ons, the FMRQ, doctors, members of the medical federa7ons, the Minister of Health and others. It is thus reliable and reflects the most updated data. We would simply like to stress the ever-‐changing reality of medical prac7ce in the future and thus this guide should not be mistaken for a sure-‐proof and accurate predic7on of the future

Very useful for clerks who have a career choice to make, this guide is equally per7nent for any medical student wondering about his or her future prac7ce. Best of luck!

Jessica Ruel-‐Laliberté Delegate to poli7cal affairs FMEQ [email protected]

5

THE CARMS PROCESS Residency Guide 2015-‐2016

6

Residency Residency Residency, also known as postgraduate educa7on, is what follows your Doctorate of Medicine. During 2 years of family medicine or 4 to 6 years of specializa7on, this training will allow you to become an aZending physician and to prac7ce in hospital centres. Oeen, a residency must be completed by a fellowship, a sub-‐specializa7on ranging from one to two years, in order to obtain a posi7on in a teaching hospital centre.

Salary Aeer comple7ng the CaRMS process, you will officially become a resident on the 1st of July of the same year. The 7tle of resident allows you both a salary and social advantages (4 weeks vaca7on, maternal leave of 21 weeks, paid meals and parking when on call, etc.)

Obtaining a posi4on a5er residency The Minister of Health and Social Services predetermines the number of doctors hired in each region and in each hospital centre for each specialty according to the Plans Régionaux des effec7fs médicaux (PREM). It is necessary to have a PREM to prac7ce in a hospital centre in Quebec. Although it is not a universal phenomena, it is generally more difficult to obtain a PREM in certain special7es, such as in surgical special7es, where new doctors may be forced to work in private prac7ce or outside of Quebec. The Fédéra7on des Médecins Résidents du Québec (FMRQ) is ac7vely working with the Minister of Health to insure that each resident-‐physician obtain a PREM at the end of his or her residency.

7

R1 44 552 $ R2 48 889 $ R3 53 913 $

R4 58 912 $ R5 62 910 $ R6 66 069 $

R7 69 375 $ R8 72 841 $

CARMS Canadian Resident Matching Service (CaRMS)

In the beginning of your senior year of medical school (4th or 5th year of medicine depending on your program), you will begin the process of residency matching, commonly called the CaRMS. To each of the individual programs or establishments (Universi7es) that you choose, you will need to send your clinical and preclinical evalua7ons, leZer of mo7va7on, CV as well as leZers of reference. You may apply to as many programs and Universi7es as you want, anywhere in Canada. Keep in mind that the basic registra7on cost (322$) includes 4 residency program choices and that each addi7onal applica7on will cost an extra 30$. For example, the Neurology program at the Université Laval and the Neurology program at the Université de Montréal count as 2 separate residency program applica7ons. Once your documents are sent to each program, the program will decide to invite you or not to an interview. If you are not invited to an interview, the admission process ends here for this program. Once the interviewing process completed, you will be asked to draw a list of your choices in order of priority, commonly called the ranking. You do not need all the programs you have interviewed for to your rank list; you may decide to withdraw from certain programs. The CaRMS will match you to a program according to an algorithm combining your list of priori7es with the list of poten7al candidates in each program. By registering with CaRMS and submiqng your list, you are signing a contract binding you to the program you are ul7mately matched with. You are thus obligated to pursue said residency program. Failure to do so entails certain penal7es, up to the possibility of exclusion from the CaRMS match for the next three years.

No Match Certain students may find themselves not matched with a program this following march – this is what we call a No Match. There are two op7ons for these students: they can either apply for the second round, or take a year off to improve their CV (par7cipate in a research project, take addi7onal internships elsewhere, etc.) During the second round, you may only apply to the programs that have vacant posi7ons. Every year, most of these are in family medicine.

This year, the CaRMS has reviewed their data to iden7fy the most common modifiable and non-‐modifiable factors causing failure to obtain a first choice of residency match.

Modifiable factors: -‐ Quality of personal leZer of mo7va7on -‐ Quality of CV -‐ Lack of detail in the documenta7on (ex: not answering the specific ques7ons asked by the university in the leZer of mo7va7on) -‐ Applica7on strategy (ranking only 1 program in less than 3 sites)

8

CARMS -‐ Missing documenta7on, poor quality or both (ex: spelling errors, not sending the right mo7va7on leZer to the right program) -‐ No elec7ve rota7ons in the desired specialty The most important factor for ending up with a No Match was found being the applica7on strategy.

Non-‐modifiable factors: -‐ Academic results -‐ Rota7on evalua7ons

Dates to remember

Speciali4es in demand Certain special7es receive recruitment priority from the government of Quebec. This does not mean that the number of residency spots will increase; it means that the employment opportuni7es aeer residency may possibly be beZer at the end of said residency. These are the only special7es where the Minister ac7vely hires doctors from interna7onal facul7es of medicine. •  Anatomical-‐pathology •  Plas7c surgery •  Dermatology •  Geriatrics •  Haematology •  Family medicine •  Internal medicine •  Physical medicine and rehabilita7on •  Medical oncology •  General paediatrics •  Psychiatry •  Rheumatology

9

September 2nd 2015 at 12 PM (HE) Opening of CaRMS online Pos7ng of program descrip7ons on CaRMS.ca November 6th 2015 Document Transla7on requests November 19th 2015 Final comple7on of all applica7ons November 30th 2015 Deadline: leZers of recommenda7on

From January 16th to February 7th 2016 Na7onal interview period February 18th 2016 at 3 PM (HE) Deadline: submission of rank list March 2nd 2016 at 12 PM (HE)Match day

CARMS Reques4ng a leAer of reference It is ideal, and even mandatory for certain programs, that at least one of your leZers of recommenda7on be wriZen by a doctor prac7cing in the specialty that you are applying to. You will not have access to these leZers sent directly to the programs, so be sure to request leZers from doctors who gave you posi7ve evalua7ons. Some strategies for reques7ng a leZer: (1) write to the aZending who gave you a posi7ve evalua7on immediately aeer the end of the rota7on to request a leZer of recommenda7on to be wriZen when the 7me comes. Re-‐approach the doctor during the weeks preceding the opening of the system. (2) Ask for more leZers than necessary to be sure that you are not chasing aeer reference leZers at the last minute.

USMLE The United States Medical Licensing Examina7on is an exam divided into 3 steps (Step 1, Step 2 CK & CS, Step 3) that opens up the possibility of medical prac7ce in the United States. In the last few years, many medical students in Quebec have decided to write this exam. Some do it for the challenge and opportunity to improve their medical knowledge, others for the opportunity to do a fellowship or to prac7ce in the United States. Not every State requires you to have passed the USMLE in order to do a fellow. If you do not plan on doing your residency in the United States, you are under no obliga7on to write these exams at the moment. The cost of these exams (several thousands of dollars) as well as the extra study 7me needed on top of your own medical cursus (classes, rota7ons) should be factored into your decision to pursue the USMLE examina7ons.

Applying to residency programs in the United States Canadian candidates may apply for a residency posi7on in the United States via a mutual agreement between the CaRMS and its American counterpart, the Na&onal Resident Matching Program (NRMP). You may thus apply for posi7ons in both countries, but you will only fill out one rank list containing both Canadian and American programs. You will only be matched to one residency program. Applying for residency training in the United States therefore allows you to apply to more facul7es, but does not let you browse between a Canadian and American program that would each have been willing to select you. CAUTION: The Canadian matching system is completed before the American one. If you are matched during the 1st round of matches in CaRMS, you will automa7cally and without no7ce be removed from the American matching system, regardless of your rank list.

10

CARMS 2015 MATCH STATISTICS

Residency Guide 2015-‐2016

18

CARMS STATISTICS Candidates matched to their 1st choice discipline Note: Candidates matched to their 1st choice discipline may possibly not have matched to their 1st choice university.

19

Candidates matched to their 1st choice program Note: The candidate matched to his 1st choice program has been matched to his 1st choice discipline and university.

University Number of candidates matched to their 1st choice discipline n=(%)

2nd choice n=(%)

3rd choice n=(%)

4th choice n=(%)

5th choice n=(%)

% of candidates not matched to their 1st choice discipline

Laval 168 (86.6%) 22 (11.34%) 4 (2.06%) 0 0 13.4

Sherbrooke 167 (87%) 20 (10.42%) 4 (2.08%) 0 1 13

Montreal 239 (85.1%) 37 (13.17%) 4 (1.42%) 0 1 14.9

McGill 158 (88.8%) 20 (11.2%) 0 0 0 11.2

University 1st choice program n=(%)

2nd choice n=(%)

3rd choice n=(%)

4th choice n=(%)

5th choice n=(%)

6th choice n=(%)

7th choice n=(%)

No match

Laval 140 (69.7%)

25 (12.4%) 14 (7%) 8 (4%) 4 (2%) 1 (0.5%) 2 (1%) 7 (3.5%)

Sherbrooke 126 (62.1%)

32 (15.8%) 20 (10%) 8 (4%) 2 (1%) 4 (2%) 4 (2%) 11 (5.4%)

Montreal 189 (64.9%)

44 (15.1%) 17 (5.8%) 12 (4.1%) 7 (2.4%) 8 (2.8%) 8 (2.8%) 10 (3.4%)

McGill 118 (63.4%)

23 (12.4%) 12 (6.5%) 7 (3.8%) 7 (3.8%) 9 (4.8%) 9 (4.8%) 8 (4.3%)

CARMS STATISTICS Vacant posi4ons a5er 1st round

20

Compe44on between special4es, 1st round, CANADA

Discipline Laval Sherbrooke Montreal McGill

Anatomical-‐pathology 3

Dermatology 1

Medical gene7cs 1

Family medicine 39 9 11 2

Internal medicine 3

Nuclear medicine 2 1

Microbiology 2 2 2

Psychiatry 2

Radiology 3 1

Public Health 1 2 2

Urology 2

Discipline Number of posiWons in Canada in 2015 1st choice discipline Total # of posiWons/# 1st choice discipline (%) Anatomic-‐pathology 27 24 ≥ 100 Anesthesiology 105 138 76 Cardiac surgery 9 8 88 General surgery 78 92 85 Orthopedic surgery 46 51 90 Plas7c surgery 25 45 55 Vascular surgery 10 13 77 Dermatology 26 51 51 Medical gene7cs 6 5 > 100 Community medicine 14 23 61 Emergency medicine (specialisa7on) 69 120 58 Family medicine 1215 1101 ≥ 100 Internal medicine 430 389 ≥ 100 Nuclear medicine 3 4 75 Physical medicine and rehabilita7on 25 33 76 Medical microbiology 3 3 100 Neurosurgery 14 16 88 Neurology 40 47 85 ORL 29 47 62 Obstetrics-‐Gynecology 85 113 75 Ophthalmology 39 53 74 Pediatrics 129 157 82 Psychiatry 155 171 91 Diagnos7c radiology 76 96 79 Radio-‐oncology 20 18 ≥ 100 Urology 26 32 81

For more informa7on •  Number of vacant PEM in Quebec for each specialty hZp://www.msss.gouv.qc.ca/sujets/organisa7on/medecine/prem/index.php?postes_disponibles_prem_specialiste •  Working condi7ons in residency hZp://www.fmrq.qc.ca/en/working-‐condi7ons/collec7ve-‐agreement •  Applying to residency in Canada and the United States hZp://www.carms.ca/wp-‐content/uploads/2015/07/ResidencyLink-‐NRMP-‐en.pdf

•  USMLE hZp://www.usmle.org/frequently-‐asked-‐ques7ons/ •  CaRMS contract hZp://www.carms.ca/wp-‐content/uploads/2015/07/2015-‐Residency-‐Link-‐Match-‐Breaches-‐fr.pdf •  Program descrip7ons for residency in each university hZps://phx.e-‐carms.ca/phoenix-‐web/pd/main?mi7d=1241# •  Specialty descrip7ons hZps://www.cma.ca/Fr/Pages/specialty-‐profiles.aspx

21

INDEX OF SPECIALTIES Residency Guide 2015-‐2016

22

Family Medicine

The prac7ce of family medicine is extremely versa7le in that it offers many different kinds of prac7ce, a privileged contact with pa7ents, as well as a very diverse set of cases as pa7ents are followed throughout different periods of their lives. The need for more general prac77oners prac7cing in first line care being well known, the number of residency posi7ons in family medicine has con7nued to grow, and is es7mated to reach up to 57% in 2017. Thus, future general prac77oners will not be lacking work in the coming years. The job prospects are excellent. The FMOQ and the MSSS has made addressing pa7ent’s need for care throughout the Province a priority in order for all Quebec residents to have access to a family doctor as well as receive medical aZen7on in a reasonable delay. To do so, they advocate for flexible access to care or «accès adapté», an administra7on method taught to doctors and their support staff. This method has been proven effec7ve. In addi7on, it has brought great sa7sfac7on to pa7ents, doctors, and staff who have put it into prac7ce in their clinics. Other measures, like coopera7on with other health professionals and the recogni7on of pa7ent coverage as AMP (Ac&vités médicales par&culières) have also been put in place in collabora7on with the Minister of Health, to allow family doctors to see even more pa7ents.

23

Excellent

Good

Possibly difficult

Difficult to very difficult

Undetermined

405

428

450

473

495

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Years

PosiWons offered in Quebec

2012 2013 2014 2015 2016 409 455 455 472 485

DistribuWon of posiWons

University 14 15 16

Laval 115 122

McGill 86 89

Montréal 144 158

Sherbrooke 110 103

SURGICAL SPECIALTIES Residency Guide 2015-‐2016

24

Cardiac surgery

•  FMEQ’s point of view: For many years now, the number of available posi7ons in cardiac surgery has been saturated. It is very difficult for new cardiac surgeons to work in Quebec. You will need to carefully reflect on your decision before jumping into this long residency where future career prospects are scarce. The number of posi7ons will most likely not open up in a short term 7me-‐frame.

25

Excellent

Good

Possible difficult


Undetermined


University 14 15 16

Laval 1 0

McGill 0 1

Montréal 1 1

Sherbrooke 0 0

0

1

2

2

3

4

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Years


2009 2010 2011 2012 2013 2014 2015 2016 2 3 2 2 2 2 2 2

General Surgery

•  FMEQ’s point of view: There is a lack of technical ressources and specialized facili7es, crucial to a surgeon’s work . There is also a need to

create new jobs. It is star7ng to be difficult for some surgeons to find employment.

•  Useful link hZp://chirurgiequebec.ca/

26

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 5 4

McGill 3 4

Montréal 6 6

Sherbrooke 4 4

0

9

17

26

34

43

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 29 33 27 24 20 18 18 18

Neurosurgery

•  According to the Associa&on de Neurochirurgie du Québec, some graduates have a hard 7me finding employment. For the coming years, there will be only two residency posi7ons available annually.

•  FMEQ's viewpoint: Like other surgical special7es, lack of OR 7me is an important issue. Considering the long dura7on of the residency, it is difficult to accurately predict the situa7on 7 years from now. One should think seriously before seqng their sights on this surgical specialty. There is presently no foreseeable change to the number of posi7ons offered.

•  Useful link

hZp://www.ancq.net/

27

Excellente

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 0 1

McGill 1 1

Montréal 1 0

Sherbrooke 1 0

0

1

3

4

5

6

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 4 5 4 3 3 3 2 2

Obstetrics and Gynaecology

•  According to the Associa7on of Obstetricians and Gynecologists of Quebec, job prospects for the next five years are good to excellent. In 2014, there were 508 obstetricians and gynecologists, of which almost 20% were aged over 65. 10% were aged over 70 years represen7ng about 51 members who gradually leave their posts in PEM in hospitals in the province. According to a survey of their members in 2012, 40% of obstetricians and gynecologists want to reduce their prac7ce and 40% want to quit pra7ce from 60 years. All residents of this specialty have got a job in previous years.

•  FMEQ's viewpoint:The decrease in the number of posi7ons offered could mark the beginning of a trend in coming years. As is the case for most surgical special7es, we do not expect an increase of the posi7ons offered in the near future. So far, it is difficult to accurately predict work posi7on availability for OBSGYN.

•  Useful link hZp://www.gynecoquebec.com

28

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 5 3

McGill 3 3

Montréal 6 5

Sherbrooke 4 4

0

7

14

21

28

35

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 24 27 26 23 18 18 15 13

Ophthalmology

•  FMEQ's viewpoint: There is a significant need for ophthalmologists in the public network. Work prospects are very good in this field. The number of residency posi7ons should be fairly stable in the coming years, considering the current available posi7ons reflect the maximum capacity of the various programs.

•  Useful link

hZp://www.amoq.org/

29

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 3 3

McGill 5 4

Montréal 5 5

Sherbrooke 2 2

13

14

14

15

16

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016

13 13 14 15 15 15 14 15

Orthopaedic Surgery

•  According to the Associa&on d’Orthopédie du Québec, surgical special7es currently face major restric7ons in terms of hospital budgets. This is combined with a limita7on to the posi7ons of regional staff. The number of admissions for Orthopaedic Surgery has thus decreased to avoid a surplus of orthopaedic surgeons without a hospital posi7on. However, the need for orthopaedic surgeons will increase in the future due to an aging popula7on. It is foreseeable that in the medium term, addi7onal funds will be alloZed to supplying the demand for care in musculoskeletal surgery. An orthopaedic surgeon's career is exci7ng but also demanding. Our medical and surgical prac7ce is changing rapidly, as technological innova7on are at the forefront of our field’s growth. •  Viewpoint FMEQ: At the comple7on of their residency program, residents are struggling to find work posi7ons. Despite the forthcoming opening of new specialized facili7es, there may be a rise in unemployment for orthopaedic surgeons in the coming years.

•  Useful link hZp://www.orthoquebec.ca/

30

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 3 2

McGill 2 2

Montréal 4 3

Sherbrooke 3 3

0

6

11

17

22

28

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016

21 22 21 16 12 12 10 10

Otorhinolaryngology

•  According to the Associa&on d’Otorhinolaryngologie et de chirurgie cervico-‐faciale du Québec, ENT is a surgical specialty, thus access to specialized facili7es and technical ressources remains limited, hindering the opening up of this specialty to more students. With a significant por7on of ENT being medical, it is s7ll possible to adjust to said constraints by changing one’s ac7vi7es. The associa7on believes that the prac7ce of ENT will con7nue to be s7mula7ng while expanding its therapeu7c reach. ENT needs to adapt to specific distribu7on needs inherent to the public system. Future graduates will have to plan well before the end of their residency program, keeping the «where» and the «how» of their future prac7ce in mind. •  FMEQ's viewpoint: Like all surgical special7es, lack of facili7es and ressources could cause trouble for future ENT graduates in their search for employment. One can expect a stabiliza7on in the number of residency spots available and perhaps even a possible reduc7on.

•  Useful link: hZp://orlquebec.org

31

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 2 2

McGill 2 2

Montréal 3 3

Sherbrooke 2 2

0

3

5

8

10

13

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 6 8 8 10 9 9 9 9

PlasWc Surgery

•  FMEQ's viewpoint: Plas7c surgery is considered a recruitment priority by the government in light of the lack of plas7c surgeons in the public system, with many working in the private field. It is one of the rare surgical fields where job prospects are good. The number of posi7ons available should remain stable in the coming years.

•  Useful link hZp://www.ascpeq.org

32

Excellent

Good

Possibly difficult


Indetermined


University 14 15 16

Laval 1 1

McGill 1 2

Montréal 2 1

Sherbrooke 1 1

5

6

8

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2008 2009 2010 2011 2012 2013 2014 2015 2016

6 6 6 6 5 5 5 5 5

Urology

•  FMEQ’s viewpoint: Like all surgical special7es, it could be difficult for some spring urologists to find work in the future. However, there are presently no signs of such a problem.

•  Useful link

hZp://www.auq.org/

33

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 2 3

McGill 2 2

Montréal 3 3

Sherbrooke 2 2

0

3

5

8

10

13

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 8 8 8 9 9 9 10 10

Vascular Surgery

•  FMEQ's viewpoint: Historically, this specialty was completed following residency training in General Surgery. Vascular Surgery is now a full-‐fledged surgical specialty. It is difficult to predict its prospec7ve work opportuni7es, but it seems that the number of residents trained are presently aligned with the popula7on’s needs. However, like for all surgical special7es, access to specialized facili7es and technical ressources remains limited, hindering the opening up of these special7es to more students.

•  Useful link: hZp://www.acvq.net/

34

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 1 1

McGill 1 0

Montréal 0 1

Sherbrooke 0 0

0

1

2

2

3

4

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 3 2 2 2 2 2

MEDICAL DISCIPLINES DISCIPLINES WITH AN ASTERISK (*) AFTER THEIR NAME ARE SPECIALTIES FOR WHICH ONE MUST FIRST APPLY TO INTERNAL MEDICINE AND THEN BRANCH OFF

Residency Guide2015-‐2016

35

Cardiology*

•  FMEQ's viewpoint: There might be a decrease in the need for cardiologists in years to come. Internists will be called upon to increase their coverage of a cardiology pa7ent base. One can expect a satura7on of posi7ons by 2015.

*The number of posi7ons displayed matches the number of

posi7ons that will be available at the R3 branch.

36

Excellent

Good

Possibly difficult


Undetermined

20

20

21

22

23

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016

20 22 22 22 21 20 20 20

Dermatology

•  According to the Associa7on des dermatologistes du Québec, the need for dermatologists is enormous, both in the short, medium and long term, especially for medical and hospital oriented dermatological care. Also, there are significant needs for dermatologists in a teaching seqng. Available resources ( 7me for outpa7ent care, staff, equipment) are oeen limited. It is however not necessary to have a PEM since dermatological prac7ce is oeen exclusively in office.

•  FMEQ's viewpoint: Future prospects are very good given the current shortage of dermatologists.

•  Useful link: hZp://www.adq.org

37

Excellent

Good

Possibly difficult

Difficile à très difficiles

Undetermined


University 14 15 16

Laval 3 3

McGill 2 3

Montréal 4 3

Sherbrooke 3 2

0

3

7

10

13

16

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 7 8 8 13 12 12 11 11

Endocrinology

•  FMEQ's viewpoint: You must have completed three years of internal medicine to apply to this program. Like most special7es in internal medicine, job prospects in Endocrinology are expected to remain good. Keep in mind that the University of Laval currently does not have a residency program.

* The number of posi7ons displayed matches the number of posi7ons that will be available at the R3 branch.

38

Excellent

Good

Possibly difficult

Difficiles à très difficile

Undetermined

0

3

5

8

10

13

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 9 8 9 10 9 9 9 9

Gastroenterology

•  A c c o r d i n g t o t h e A s s o c i a & o n d e s Gastroentérologues du Québec, with the arrival of a province-‐wide screening program for colorectal cancer, the demand for endoscopy will be increasing. Furthermore, the latest technological innova7ons are not yet being used to their full poten7al, beckoning new growth of the prac7ve. There should therefore not be a decrease in need for gastroenterologists in coming years. •  FMEQ's viewpoint: You must have completed three years of internal medicine to apply to this program. The number of jobs should remain fairly stable, but demand may increase with the arrival of universal diges7ve cancer screenings.

*The number of posi7ons displayed matches the number of posi7ons that will be available at the R3 branch.

•  Useful link: hZp://www.ageq.qc.ca/

39

Excellent

Good

Possibly difficult


Undetermined

0

3

6

9

12

15

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 9 11 12 11 11 11 10 9

Geriatrics *

•  According to the Associa&on de médecins gériatres du Québec, in the next thirty years, geriatricians will be in high demand. Quebec, second only to Japan, will experience the highest rate of aging. In the emergency room, almost 25% of pa7ents are now aged 75 or older. In 2015, 57 posi7ons are s7ll vacant in Geriatrics. In the next ten years, a quarter of geriatricians are expected to re7re: those working in teaching hospitals. For some years now, geriatricians have been increasingly well compensated for their work. •  FMEQ's viewpoint: You must have completed three years of internal medicine to apply to this program. The prospects are excellent in this specialty. *The number of posi7ons displayed matches the number of posi7ons that will be available at the R3 branch.

•  Useful link: hZp://www.amgq.ca

40

Excellent

Good

Possibly difficult


Undetermined

0

3

7

10

13

16

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 8 8 8 11 13 13 13 13

Haematology/Oncology *

•  FMEQ's viewpoint: Both residency programs, Haematology as well as Oncology, include three years of core internal medicine rota7ons followed by two years of training in Haematology and Medical Oncology. The dual cer7fica7on in Haematology-‐Oncology internal medicine requires three years basic training in internal medicine followed by three years in said dual-‐specialty, for a total dura7on of six years. The number of posi7ons should remain fairly stable and may even increase as this specialty is in high demand.


•  Useful link: amhoq.org

41

Excellent

Good

Possibly difficult


Undetermined

0

3

6

9

12

15

2011 2013 2014 2015 2016

Num

ber o

f posiWon

s

Year


2012 2013 2014 2015 2016 Hémato 12 12 12 12 12 Oncologie 8 9 9 9 9

Clinical Immunology and Allergy Medicine *

•  FMEQ's viewpoint: You must have completed three years of internal medicine to apply to this program. Like most internal medicine speciali7es, job prospects are expected to remain good.


•  Useful link hZp://allerg.qc.ca

42

Excellent

Good

Possibly difficult


Undetermined

0

1

2

3

4

5

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 4 4 4 2 3 3 3 3

Internal Medicine

•  FMEQ's viewpoint: The Internal Medicine program provides access to a mul7tude of other special7es. Overall, employment prospects are good enough for internists and other medical specialists. The number of posi7ons available represents the number of seats offered through CaRMS as an M4 while the R4-‐R5 posi7ons represents the number of posi7ons that these same students can choose once they reach R3 if they wish to con7nue in medicine internal.

•  Useful link: hZp://asmiq.org/

43

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 35 34

McGill 30 32

Montréal 43 45

Sherbrooke 35 34

0

40

80

120

160

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016

Entrée 140 133 137 138 143 143 145 143

R4-‐R5 40 31 33 33 33 33 33 34

Medical GeneWcs

•  According to the Associa&on des médecins géné&ciens du Québec, employment prospects are quite large with Medical Gene7cs experiencing a phenomenal growth in recent years. The increased understanding of gene7cs and their rapid applica7on at a clinical level reflect this reality aptly. With the advent of genomics and personalized medicine, the involvement of medical gene7cists is growing. In Quebec, many posts remain vacant and the number available is increasing. This is a specialty to discover for those who love clinical and diagnos7c laboratory ac7vi7es.

•  FMEQ's viewpoint: Medical Gene7cs are is expanding and if the current rate of new research in the field maintains itself, it is certainly a field of the future. The number of residency posi7ons could increase in the coming years.

44

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 0 0

McGill 1 1

Montréal 2 2

Sherbrooke 0 0

0

1

2

2

3

4

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 3 3 3 2 3 3 3 3

Medical Microbiology

•  According to the Associa&on des médecins microbiologistes-‐infec&ologues du Québec, the prac7ce of the specialty encompasses two main components: Medical Microbiology (laboratory) and Infec7ous Disease Medicine (clinical). In terms of employment, the distribu7on plan predetermined by the MSSS seems to favour rural posi7ons. Several new jobs are expected to become available in the medium term. Moreover, following efforts in harmoniza7on by the Royal College, there is now a new recognized Infec7ous Disease Medicine specialty.

•  FMEQ's viewpoint: The number of available residency posi7ons can be expected to remain stable in the next few years, with job prospects being quite good.

•  Useful link hZp://www.ammiq.org/

45

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 3 2

McGill 0 0

Montréal 2 3

Sherbrooke 3 3

2009 2010 2011 2012 2013 2014 2015 2016 8 8 8 11 11 8 8 9

0

3

6

8

11

14

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year

Positions offered in Quebec

Nephrology*

•  FMEQ's viewpoint: Employment prospects are difficult to predict and a revalua7on is advised. There is talk of possible posi7on satura7on. You must have completed three years of internal medicine to apply to this program.

*The number of posi7ons displayed matches the number of

posi7ons that will be available at the R3 branch.

•  Useful link: hZp://www.sqn.qc.ca/

46

Excellent

Good

Possibly difficult


Undetermined

0

3

6

9

12

15

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 12 11 12 8 8 8 9 10

Neurology

•  According to the Associa&on des neurologues du Québec, neurologists now have a much more proac7ve approach in the treatment of diseases and no longer limit themselves to only a diagnos7c role. They can provide useful treatments for diverse diseases. New treatments are looking very promising and thus Neurology’s clinical mandate may be expected to expand in 7mes to come. The number of new residents between 2015 and 2024 required is 110. Quebec has accepted 10 new residents per year in neurology 2015-‐2024. •  FMEQ's viewpoint: Some difficulty is reported by some graduates when it comes to finding a job. The number of admissions should remain fairly stable.

•  Useful link: hZp://www.anq.qc.ca/

47

Excellent

Good

Possibly difficult


Undetermined


University 14 15 16

Laval 3 2

McGill 2 2

Montréal 2+1 ped

2+1 ped

Sherbrooke 2 3

0

5

9

14

18

23

2008 2010 2012 2014 2016 2018

Num

ber o

f posiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 17 18 14 12 10 10 10 10

Physical Medicine & RehabilitaWon

•  FMEQ’s viewpoint: Physical medicine and rehabilita7on is one of the said “priori7es” among medical special7es for future recruitment by the Ministry of Health. Future physiatrists should therefore have no problem finding work.

48

Excellent

Good

Poten7ally difficult


Undetermined

DistribuWon of PosiWons

University 14 15 16

Laval 2 2

McGill 0 0

Montréal 3 3

Sherbrooke 0 0

0

1

3

4

5

6

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year

PosiWons Available in Quebec

2009 2010 2011 2012 2013 2014 2015 2016 4 4 4 4 5 5 5 5

Respirology*

•  According to the Associa&on des pneumologues du Québec, the demand for respirologists will con7nue to increase in the coming years. Respiratory diseases are in con7nual progression in Quebec, in Canada and around the world. Quebec respirologists struggle to meet this demand; there is therefore ample room for young doctors.

•  FMEQ’s viewpoint: It is possible that a satura7on will occur over the next few years—the situa7on will be re-‐evulated. 3 years of internal medicine must be completed in order to apply for this program.

*The number of posi7ons listed corresponds to the

number of posi7ons that will be available for the R3 match aeer 3 years of internal medicine for R1 residents beginning the internal medicine program the year indicated. •  Useful link: hZp://www.pneumologue.ca/

49

Excellent

Good



Undetermined

11

11

12

13

14

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 11 12 13 13 11 11 11 11

Rheumatology*

•  According to the Associa&on des rhumatologues du Québec, rheumatology is thriving. Over the last fieeen years, few medical special7es have made as much progress as that of Rheumatology. Considered a recruitment priority by the MSSS, the AMRQ currently has seven to ten residency posi7ons to fill and this number is expected to rise in the next few years, due to increasing demand.

•  FMEQ’s viewpoint: 3 years of internal medicine are required before applying to this program. Considered a recruitment priority by the ministry, job prospects are expected to remain on a steady rise.

* The number of posi7ons listed reflects the number of posi7ons that will be available at the 7me of the R3 match, aeer 3 years of internal medicine, for R1 residents beginning their internal medicine program the year indicated.

•  Useful link

www.rhumatologie.org

50

Excellent

Good

Poten7ally Difficult

Difficult to Very Difficult

Undetermined

0

3

5

8

10

13

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 7 8 8 8 10 10 10 10

OTHER DISCIPLINES Residency Guide 2015-‐2016

51

•  FMEQ’s viewpoint:

There is a considerable shortage of pathologists in Quebec. It should be easy for future pathologists to find work.

•  Useful Link hZp://www.apq.qc.ca

52

Excellent

Good



Undetermined

Anatomical Pathology


University 14 15 16

Laval 4 4

McGill 4 4

Montréal 5 5

Sherbrooke 2 2

0

4

9

13

17

21

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 10 17 17 15 15 15 15 15

Anesthesiology

•  According to the Associa&on des anesthésiologistes du Québec, Anesthesiology is a thriving specialty. In addi7on to their work in the opera7ng room, anesthesiologists are increasingly in demand in many areas such as intensive care, pain clinics, interven7onal radiology, procedural seda7on, organ dona7on, etc. Moreover, a global scale movement supports the increased par7cipa7on of anesthesiologists in the field of peri-‐opera7ve medicine, which will contribute to a significant province-‐wide increase in the need for anesthesiologists. Employment prospects are expected to be good in the short term (over the next two years) and excellent in medium (2020) and long term (2025).

•  FMEQ’s viewpoint: The number of posi7ons should remain stable.

53

Excellent

Good



Undetermined


University 14 15 16

Laval 7 6

McGill 4 5

Montréal 7 7

Sherbrooke 5 5

0

8

16

23

31

39

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 31 30 30 26 26 23 23 23

Emergency Medicine

•  FMEQ’s viewpoint: Created in 1999 in Quebec, Emergency Medicine is s7ll struggling to take its righ�ul place in todays health-‐care system. Employment prospects, however, could be expanded in the coming years, but it is difficult to say for now.

•  Useful Link: hZp://www.asmuq.org/

54

Excellent

Good



Undetermined


University 14 15 16

Laval 5 4

McGill 3 3

Montréal 5 5

Sherbrooke 0

11

11

12

13

14

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 12 12 12 12 13 13 12 11

Medical Biochemistry

•  FMEQ’s viewpoint: If the trend con7nues, the number of posi7ons available should remain stable in the coming years. It is difficult to assess future prospects for this specialty.

•  Useful Link: www.ambq.med.usherbrooke.ca/

55

Excellent

Good



Undetermined


University 14 15 16

Laval 1

McGill 1

Montréal 1

Sherbrooke 1

0

1

3

4

5

6

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 4 4 5 4 4 4 3 3

Nuclear Medicine

•  FMEQ perspec7ve: There is liZle informa7on available for prospec7ve careers

in nuclear medicine. However, there is no evidence of surplus or shortage in this area. Admissions should follow the current trend.

•  Useful Link:

hZp://www.medecinenucleaire.com/

56

Excellent

Good



Undetermined


University 14 15 16

Laval 0 0

McGill 1 1

Montréal 2 2

Sherbrooke 2 2

0

1

3

4

5

6

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 5 5 5 5 5 5 5 5

OccupaWonal Medicine

•  According to the Associa&on des médecins spécialistes en santé publique et médecine préven&ve, Occupa7onal Medicine is a growing specialty. The number of available posi7ons should soon increase, given the high demand in both the public and private sectors. The specialty allows the combina7on of an individual clinical approach, a popula7on-‐oriented approach (group perspec7ve), as well as a forensic approach. Furthermore, it delves into a world that is liZle known to other special7es, namely that of companies of all types and industrial technology, while working with a wide variety of healthcare professionals. Finally, this specialty explores both the posi7ve and nega7ve effects of the workplace on the pa7ents’ health.

•  FMEQ’s viewpoint: An innova7ve young field, Occupa7onal Medicine is offering 1 posi7on this year and could increase to 2 soon.

•  Useful Links: www.amsscq.org www.oemac.org/

57

Excellent

Good



Undetermined


University 14 15 16

Laval 0

McGill 0

Montréal 1

Sherbrooke 0

0

0

1

1

1

1

2008 2010 2012 2013 2015 2017

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 -‐ -‐ -‐ -‐ 1 1 1 1

Paediatrics

•  FMEQ’s viewpoint: There are 30 admission spots this year, 6 of which are for paediatric sub-‐special7es. There is a significant need for general paediatricians. The number of residency posi7ons in paediatric special7es is limited, oeen decreasing and unpredictable from year to year; it is therefore not a good idea to base your choice of a career in Paediatrics on an interest in a par7cular sub-‐specialty: it may very well not be available the year of your applica7on. As a guide, here are the posi7ons expected to be available for 2016:

– Neonatal and Perinatal Medicine: 5, Hematology-‐On c o l o g y : 3 , R e s p i r a t o r y Med i c i n e : 2 , Gastroenterology: 1, Rheumatology: 1, Nephrology: 1.

•  Useful Link: hZp://www.pediatres.ca/

58

Excellent

Good



Undetermined


University 14 15 16

Laval 9 8

McGill 6 7

Montréal 10 10

Sherbrooke 7 7

0

11

21

32

42

53

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016

30 36 40 41 32 32 32 30

Psychiatry

•  According to the Associa&on des médecins psychiatres, Quebec is experiencing a situa7on of rela7ve scarcity. With the re7rement of several psychiatrists expected in coming years, it should be easy to find work in this field. In 2015, there are 75 available PEMs in psychiatry, mainly outside major teaching hospitals. There is also a boom in psychiatric research, and thus work opportuni7es, aiming to beZer understand biological phenomena and improve treatments in the field.

•  FMEQ’s viewpoint: There is currently a cap on the number of residency spots, which reflects each programs’ maximum carrying capacity.

•  Useful Link: hZp://www.ampq.org/

59

Excellent

Good



Undetermined


University 14 15 16

Laval 14 13

McGill 12 13

Montréal 14 15

Sherbrooke 12 12

0

15

30

45

60

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 41 40 40 46 52 52 53 53

Public Health and PrevenWve Medicine

•  According to the Associa&on des médecins spécialistes en santé publique et médecine préven&ve, Public Health offers highly diversified prac7ce opportuni7es. Moreover, intersectoral collabora7on (e.g. with school communi7es, municipal or work) is more and more present in the Public Health prac7ce, allowing diversifica7on of exper7se. Reversing the growing trend of chronic disease, reducing health-‐care and social inequali7es, crea7ng healthy environments for people, adding life to years gained and preven7ng mental illness are exci7ng challenges in public health. Finally, several specialists con7nue to see pa7ents in a clinical seqng and this trend appears to be increasing.

•  FMEQ’s viewpoint: The number of posi7ons offered should remain fairly stable. The cuqng of a posi7on (1) in 2015 is due to the transfer of a posi7on to the new Occupa7onal Health specialty.

•  Useful Link: hZp://www.amsscq.org/

60

Excellent

Good



Undetermined


University 14 15 16

Laval 2

McGill 1

Montréal 2

Sherbrooke 2

6

6

7

7

8

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 7 7 7 7 7 7 6 6

Radiology

•  FMEQ’s viewpoint: There is currently a great need for radiologists in Quebec; employment should therefore not be a problem in this specialty. However, the number of residency spots should not increase significantly in the coming years given the limited training capaci7es of the various residency programs

•  Useful Link hZp://www.arq.qc.ca

61

Excellent

Good



Undetermined


University 14 15 16

Laval 7 6

McGill 7 6

Montréal 9 10

Sherbrooke 4 5

25

26

28

29

30

31

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 27 26 30 28 27 27 27 27

RadiaWon Oncology

•  FMEQ’s viewpoint: There is currently a state of work posi7on satura7on in radia7on oncology. This specialty is highly dependent on expensive equipment, and it is therefore unlikely that new posi7ons will open soon. The ministry has brought up the possibility of new openings in coming years, what with the construc7on of new hospitals, but it is highly unlikely that this will be done quickly. In the short and medium term, the situa7on will be difficult for graduates. Despite this, there is no expected decrease in admission spots.

•  Useful Link

hZp://www.aroq.ca/

62

Excellent

Good



Undetermined


University 14 15 16

Laval 1 1

McGill 1 1

Montréal 1 1

Sherbrooke 0 0

0

2

3

5

6

8

2008 2010 2012 2014 2016 2018

Num

ber o

f PosiWon

s

Year


2009 2010 2011 2012 2013 2014 2015 2016 6 6 3 3 3 3 3 3

POLITICAL ISSUES Residency Guide 2015-‐2016

63

Physician Workforce Planning in Quebec 2012-‐2032

Important Changes Ahead IntroducWon The medical workforce’s planning and distribu7on is not the most popular topic of discussion among medical students in Quebec. However, it is an unavoidable cornerstone of our training and future prac7ce. It will have a determining impact on our career, influencing our specialty choice, the region we work in and the type of prac7ce we have.

In Quebec, the government has near absolute power over medical prac7ce: the Ministry of Health determines the number of admissions to medical school, the distribu7on of residency training posi7ons, the plans régionaux d'effec&fs médicaux (PREM), that establishes where doctors can work, as well as oversees the ac&vités médicales par&culières (AMP) that require family physicians to do certain compulsory ac7vi7es.

EvoluWon of the medical workforce’s distribuWon In recent years, distribu7on has greatly changed

in Quebec.

For instance, we went from nearly 6,500

prac7cing specialists in 1990 to over 8,300 in 2011. During the same period from 1990 to 2011, the number of family physicians increased from nearly 6300 to more than 7700. There has thus been a steady increase in the number of physicians in Quebec, with the excep7on of a period in the late 90s when the PQ government at the 7me encouraged accelerated re7rements of physicians. Over the years, there has also been an increasing propor7on of women in medicine. In 2010, women represented 49% of ac7ve family physicians and 35% of specialists. The age of physicians has followed the province-‐wide trend of an overall aging workforce. All these factors and many others have transformed the reality of medical prac7ce in Quebec and will con7nue to have a significant impact in the future. Here is a graph showing the evolu7on of the physician workforce in Quebec (Table MSSS.)

64

Admissions A variable that has been par7cularly important in the evolu7on of the medical workforce’s distribu7on in Quebec is the number of admissions to medical programs. In 2013, the number of admissions, although stable compared to last year, was at a record level of 847 admissions in the regular stream (879 if we add the special quotas (i.e., army, first na7ons, etc. .)). Un7l now, medical facul7es have dealt with the high number of students appropriately, although some concerns about the quality of clinical exposure remain. The Ministry of Health has recently commiZed itself to reducing the number of medical admissions in the coming years.

The FMEQ fears that with an increased number of admissions, students have decreased clinical exposure and face a more challenging search for employment. We have seen in recent years that although many in Quebec do not have access to a doctor, the graduates of several medical disciplines are struggling to find jobs. This

difficulty oeen reflects a lack of available resources and the reduc7on of the number of posi7ons available (lack of opera7ng rooms, personnel, equipment, etc.) These cases, ini7ally sporadic, have since become more and more frequent, and, combined with admissions increases, have raised many concerns on our part. The FMEQ fears that some students might not find employment in Quebec at the end of their res idence, an outcome we deem unacceptable considering that it is the MSSS that controls admissions, resident posi7ons and job posi7ons. During the year 2011-‐2012, the FMEQ subsequently took a stance in favour of a cau7ous reduc7on in admissions to medicine.

Here is the graph of the evolu7on of medical school admissions.

65

ProjecWon of workforce distribuWon The MSSS has adopted a new method of calcula7ng the appropriate distribu7on of the medical workforce in the long term, reflec7ng several key variables. The model takes a number of important factors into account, such as the number of admissions, the distribu7on of posi7ons offered in residence, the posi7on filling rate, the original Facul7es of the students, the rate of installa7on in Quebec, arrival of students / residents / foreign doctors, age, aZri7on and more. The mathema7cal model seems reliable enough at the moment and makes it’s projec7ons by altering the variables over which the government has control.

Too many specialists, not enough family

physicians The first results are quite striking. If no steps are taken to shie the present current, over the next 20 years we would have far more specialists than needed and too few family

physicians to meet the needs of the popula7on. However, regarding family medicine, services would be more efficient than they currently are. We cannot afford to train doctors who do not respond to the needs of the popula7on, as this may lead to unemployment or exile of Quebec doctors.

Aeer more than 600 projec7ons, the model adopted by the government proposes a reversal of the tradi7onal family medicine vs. specialty ra7o to obtain, respec7vely, 55% family physicians and 45% specialists, and that, in 2017.

DistribuWon of residency posiWons Previously, 45% of posi7ons offered were in Family Prac7ce versus 55% in medical special7es. Currently, the government aims for the 55-‐45 ra7o by modifica7ons of 1% per year. We are, in 2016, at 53% in Family Prac7ce and 47% in medical special7es. FMEQ supports this change, as the medical students have clearly demonstrated a growing interest in Family Medicine with record rates of applica7ons in this field. We are also aware that it beZer meets the needs of Quebec.

The distribu7on of specialty posi7ons is based on the individual needs of each specialty, but also on the programs themselves and several other factors. It is therefore a somewhat unpredictable and imperfect process that is far from an exact science. The overall trend is downward in several special7es, including surgical special7es.

EvoluWon of the populaWon’s needs Quebec's popula7on will change in the coming years, and their health needs will too. Based on various projec7ons that seem fairly reliable, the Ministry calculated the number of physicians that would be needed to maintain the current service offered as well as the number of doctors needed to meet the real needs of the popula7on, which is not currently the case.

There should be 11 400 specialists and 10 660 family physicians in 2032 to maintain current services and 12 200 specialists and 11 840 family physicians to meet the needs of the popula7on.

It is difficult to argue with such figures. However, it begs a big ques7on: can the system absorb all these numbers? Before new posi7ons are opened, will some graduates hit a wall? In this context, the FMEQ defends the need for a cau7ous approach to admissions. The last posi7on of the federa7on is to decrease them, even if this contradicts the strict needs of the popula7on. It is important to have a long-‐term vision, but we must not lose sight of the short or medium term, where future doctors may find themselves unemployed because the government does not put the necessary means to hire them all in place.

67

40,

47,5

55,

62,5

2001 2003 2005 2007 2009 2011 2013 2015 2017

Médecine familiale Spécialistes

What this implies for students today P r o s pe c7ve c a r e e r c ho i c e s a r e unfortunately l imited for students. Universi7es will be, and has been implemen7ng the new ra7o of 55% of family medicine posi7ons and 45% speciali7es in the short term despite the difficul7es it will cause. Students should be aware, from the moment of their admission to medicine, that specialty posi7ons will be increasingly limited.

There is no denying it: we need to train more family doctors as well as keep admissions numbers similar to what they are now if we hope to meet the popula7on’s needs . We must ensure that the MSSS is not focused solely on the popula7on’s needs, as they present significa7ve discrepancies with the reality of training availability in the medical system. Unemployment in graduate medical students should be avoided at all cost. FMEQ’s posiWon Your student federa7on, with the agreement of your local associa7ons, has posi7oned itself in favour of a cau7ous decrease in medical admissions. Although the model shows, from a str ict ly popula7on-‐needs perspec7ve, that the number of admissions should remain stable, our reality, in which new doctors are struggling to find employment Quebec, as well as government's inability to ensure that all admiZed students will be able to remain in Quebec, forces us to maintain our stance. As men7oned previously, it is

important to have a long-‐term vision without unwiqngly funnelling doctors towards unemployment and subsequent exodus, which could prove itself to be detrimental to the people of Quebec in the coming years.

In terms of the ra7o of family physicians

to specialists, the FMEQ ruled in favour of the 50-‐50 ra7o currently achieved. The numbers, however, led us to believe that we will have to adapt rapidly, ensuring that t h e qua l i t y o f e du ca7on i s no t compromised.

In any case, rest assured that your federa7on will con7nue to work 7relessly to ensure that decisions taken by the government will not go against the interests of Quebec’s medical students. We will also con7nue to inform you of developments regarding these issues.

Residency guide 15-16

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