Provincial governments should guarantee a residency for every medical-school graduate: Editorial

The case of Robert Chu, a high-achieving medical school graduate who took his own life following two unsuccessful attempts to secure a residency program, has highlighted the need for governments to rethink how we train doctors. In particular, provinces must ensure that there are enough residency placements for all medical-school graduates, lest a steep investment by students and taxpayers be wasted. Before his death in 2016, Chu, a 25-year-old McMaster University medical student, sent a letter to a number of politicians decrying the state of the residency system. “The enrolment of medical students has been steadily increasing over the last 10 years by about 100 each year,” he wrote. “The number of residency positions has not kept pace, and now it is decreasing.”The residency program is the last requirement in a doctor’s training. By the time students have reached this step, they have already invested years of rigorous study as well as tens of thousands of dollars in tuition and living expenses (tuition alone for an Ontario graduate medical program runs around $25,000 annually). Failing to secure a residency means students are forced either to take on more debt and attempt to match the following year or abandon their training altogether.By the time graduates get to their residency, provinces have also invested significant funds. The president of the Association of Faculties of Medicine of Canada, Dr. Geneviève Moineau, estimates that it costs the government “upwards of $75,000 to $90,000 or more a year” to educate a medical student. Article Continued BelowYet the promise that these investments will lead to a meaningful and lucrative career for medical students is becoming increasingly uncertain. In 2017, while more than 2,700 students began residency programs after being assigned via an algorithm, 68 were left unmatched. That record high is well up from 2009, when 11 students went unmatched.Ontario had the highest number of unmatched students at 35, not surprising given the province cut 25 residency positions last year, and 50 the year before. In defending the cuts, the provincial health ministry cited the need to prevent an “oversupply” of doctors. But that foresight should also be applied to the medical-school admissions process.