What to Know When Selecting a Residency Program

After getting into medical school, most of us take a HUGE sigh of relief, feel like the worst is over, and figure we’ll begin opening the books and start studying again. Then comes residency selection, and another interview process.

In Canada, this is done through a centralized, nationwide matching process called CaRMS (The Canadian Residency Matching Service). Some people have a vague idea of how it works – on Match Day, you get one spot, and that’s the spot you have to take. The idea of the whole process can sound overwhelming and anxiety provoking, with an ominous finality to getting your match. In this blog, I go through my own thought process of selecting a specialty and program, with the hopes of easing some of the anxieties CaRMS can create for medical students.

Most people have a general idea of the type of specialty(ies) they want by the time CaRMS comes around and a clear idea of how to proceed forward. However, many others are torn between two specialties, or still have no idea what they really want. There’s also the never ending question of “Do I have a back up, and with what?”. If you’re confused and unsure, honestly, it’s no big deal. The CaRMS process itself is a learning opportunity, and many people make their final decisions after they have finished their interviews (the final rank order list you need to submit to CaRMS happens AFTER all interviews).

I would like to give a few basic pieces of advice around the selection of a specialty. Ask yourself these questions: “Will I enjoy the lifestyle?”; “Can I put up with what the negative aspects of a specialty?”; “How competitive is the specialty?”.

Every specialty has a very specific lifestyle associated with it. Do you like the variable and flexible life of a family physician, or the intensity of a surgical program? Do you like the structure of a regular schedule often seen in psychiatry, or the fast-paced shift work in an emergency setting? That last one is a question I personally asked myself. I love the ED and I love Psychiatry. I quickly learned in my rotations that I do not do well, physically and mentally, with shift work, so I was able to rule out emergency medicine as a desired specialty and focused my efforts on Psychiatry.

People are often attracted to the positive characteristics of different specialties, and end up having difficulty ruling out specialties since they all have so many pros. I found an easier way was to rule out specialties by looking at what I did not like from a specialty – whether it was the rotations, scheduling or intensity of the role, and asking myself if, at the end of the day, would I be able to deal with those negatives.

One big issue that always comes up is that of “back up” specialties. It has become even more of a focus with the recent trend in increasing number of unmatched medical graduates. The new reality is that the CaRMS match is very competitive across the board, and you have to plan for that. Backups are sometimes essential, or at the very least, they need to be strongly considered and carefully chosen. Even if you have your heart and soul set on a specific specialty or sub-specialty, consider alternatives that would make you happy otherwise. And remember that a match is not as “final” as it may seem.

Something medical students are generally not fully aware of is that although their Canadian residency  spot match is bound by a contract through CaRMS, this contract is only for a year. Many more people switch in and out of programs than you might think. When looking at specialties and programs, always consider alternatives that might end up getting you where you still want to be. Some switches are more common, like family medicine and psychiatry, but there are switches that happen between many different specialties. It’s important to note that these switches often happen outside the confines of CaRMS, are on a case by case basis, and involve agreements between both programs. This adds flexibility to the process. Remember to consider alternative specialties and that a match result does not define the rest of your medical career.

For those that want more information on residency selection and the CaRMS process, here are two very practical links.

The Canadian Medical Association (CMA), has a great section on their website with profiles of
different specialties. Find it on the CMA website and explore the lifestyle, pros and cons, and information on supply and demand of each specialty.

For help with the CaRMS process itself, the Canadian Federation of Medical Students (CFMS) publishes a yearly Matchbook with all the information you need. Find the 2018-2019 version here.