A residency for every M.D.

The tragic 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 last10 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.

Yet 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.

There also seems to be a need to better counsel students on how to find a residency. The ministry, in a written response to the Star, said a number of factors can lead to a student not being matched, from academic performance to a student’s school and program preferences.

Yet, according to Chu’s family, he didn’t receive much counselling on how best to secure a position. After being denied, Chu complained he received little advice or feedback, and resorted to using provincial freedom of information laws in an attempt to get insight.

Despite the cuts to the residency program, Ontario insists that the supply of doctors will more than keep pace with population growth, with an increase of 650 physicians each year until 2025. But that’s little comfort to the students left without a path to finish their training.

As Chu wrote in his letter, “What good is a doctor who cannot practise as one?”

Provincial governments, which oversee post-secondary education and set the number of residency positions, need to ensure that all those who are trained as doctors are given an opportunity to contribute. The alternative is too much wasted investment and the squandered potential of talented students.

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