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On Predicting the Future

February 15, 2009

I have until February 26th to submit my “Rank Order List” to the Canadian Residency Matching Services (CaRMS). My applications are all in, the interviews are over, and now I have to figure out what I want. Each university I have interviewed at will rank all applicants in order from best to worst as candidates for Family Medicine. Each applicant (eg. me) will rank the universities (or their subsites, in some cases) in order of where they wish to do a residency for the next two years. Traditionally, 90% of my university’s students get one of their top 3 choices. Some of my interviews were great, some weren’t. I’ve done a lot of extracurricular activities, but what’s to say the next applicant hasn’t done more, or more significant ones? I don’t know where I stand. Academically, I’m no powerhouse, but Honours in Family Practice and some (hopefully) strong reference letters

This entry might be of interest to other med students or program directors, curious as to how one person goes through the ranking process. Moreover, it’s an excercise for me.

In looking for a program, there are many factors I consider:

– best representation of practice; i.e. what I will be learning parallels what I will be doing as a GP
– administration actually cares, are receptive to change
– even when “off service” – i.e. rotating through surgery – emphasis is on Family Practice learning
– community hospital setting or unique population (eg. Downtown Eastside Patients in Vancouver)
– good learner: teacher ratio- horizontal (aka longitudinal) rather than block arrangement of KEY rotations, especially Family Practice
– and as a bonus: flexible call schedule, nice facilities for residents (call rooms, lounge), Electronic Medical Records,

– near family and/or friends; some support system necessary, but an aunt or old high-school friend will fill the bill
– some multi-culture = good food and music in the city, or nearby
– good transit system or small enough to have minimal traffic
– and as a bonus: amenable to continuation of personal life (significant other, contact with family, skiing, playing hockey, eating local produce, seeing great bands play, etc.)

OK, so how does this pan out for me? What will I rank?

1. Dalhousie – NO – don’t want to live on the East coast, no family or friends there AND I sucked at the interview
2. McGill – NO – although the city is lovely and they have one excellent site, they have some that are not suitable for me; there is no guarantee that I would get my top choice of site (St. Mary’s Hospital) and if I got stuck with the busy Jewish General Hospital, I’d not be happy.

3. UBC – YES – Solid interview (I hope!), several good programs, and friends/family near enough to each of them. Each must be ranked separately.
–>Vancouver : Oh no! The residents weren’t enthusiastic, and the program sounds like a tonne of driving to different hospitals, no sense of cohesiveness or camaraderie, no administration that cares about us. Basically, my undergrad, on “repeat.” Vancouver is great but being miserable in this program is not going to fly.
–>St. Paul’s: Administration cares, residents are happy, great set-up for R3 in ER if I pursue that. Get longitudinal family practice experience, and work with DTES (marginalized) population. It’s in Vancouver. Friends and culture abound. Drawbacks? Busy hospital, learn to practice with lots of specialists around (which might not happen in real life). Vancouver is expensive.
–>Chilliwack: Small program, few learners, keen teachers, great responsibility, flexible call. Cons include the city, but I’ll be working most of the time, it’s less expensive, and at least it is close to Vancouver.
–> Nanaimo: program like Chilliwack, but less established. Oceanside, inexpensive, a bit more culture, closer to my parents, closer to my favourite ski hill, but harder to get to Vancouver from.
–>Victoria: I’d enjoy living there, but the residents saying that clinicians are reluctant to teach, well, it turns me off the idea completely.
–> Kelowna: “You will basically be living out of your car, as you move at least 4 times over the 2 years.” No home? No thanks!
–> Prince George, Terrace, Fort St. John, etc. I don’t want to live there. I don’t know anyone there.
4. University of Ottawa: YES – great range of programs, ability to work on French, caring faculty, reasonable list of “things to do” in the area, but no friends there long-term, cold/snowy winters, and far from where I eventually want to practice
5. University of Toronto: YES – I didn’t think I would rank their program before I went to the interview, but it’s sounding better to me lately. Good urban programs (St. Mike’s) and some community hospital placements that won’t be too ‘big city’ in feel. Family and culture in the city, but not where I want to wind up in the future.
6. McMaster: YES – pioneer in Family Practice and medical education, lots of community programs with great responsibility and keen preceptors. Family in the Niagra region, but I don’t like the idea of living in Hamilton very much.

Conclusion? Oh crap, it’s gonna be hard. I’ve got a lot more thinking.

Tips? Tricks? Factors I haven’t considered? Help!

4 Comments leave one →
  1. Jenn permalink
    February 15, 2009 8:20 pm

    Nanaimo isn’t that far from Vancouver – the transit system to and from the Ferry on both sides makes it rather doable. I’ve done the trek several times and am happy to fill you in on the details if you want?

    Here’s hoping you get something nice and close!

  2. Dawn permalink
    February 15, 2009 10:48 pm

    Oh man, Jessica, you have a lot to think about. It sounds like a really rough decision in terms of weighing up career pros with personal life cons but as you pointed out already, the work-life balance has got to be there or something will fall through the cracks. And we don’t want it to be you. I had this and continue to have this decision but on a much smaller scale, so small it’s barely to be noticed. But I think that eventually a combination of decision-making on your part about what you are willing to give up (because I think that many options will be open for you), hard work, luck, and fate will come together to phase the new plan into your life. I wish you much luck when you make your choice, I wish you much patience and strength while making your choice, and I wish that you would stay near to us (but don’t let that sway). Mind you, we couldn’t possibly see each other any less. 😛 Let me know if you want to bend my ear sometime on choices and stuff. I am off around 8pm Friday nights, days on Sat. and Sun.

  3. February 15, 2009 11:06 pm

    i really enjoyed reading this and seeing what you’re expecting- it’s a bit luck of the draw and comparison shopping, isn’t it. I agree with Dawn- we really don’t see you enough. But you know my parents are in Ottawa and so if you end up there, you’ll get visits from me too. No matter what you do, you’ve got friends in Vancouver for life, so whatever happens, I hope its one of the places with the best medical experience for your time. Although, hopefully, with us. 🙂

  4. Jeremy permalink
    February 16, 2009 6:09 am

    Hey Jess,

    Congratulations on getting through the interviews. Personally, I hope you get in with St. Paul’s. You seemed really keen on it while you were there, and even if it might be busier than Chilliwack, you seemed to be quite passionate about it, which I hope would more than make up for it.

    Best of Luck!

    – Jeremy

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