Brian Kwon. President, Aesculapian Society. Queen's University. Kingston, Ont. The residency lottery. T hanks to Dr. Brian Goldman for saying in print (Can Med.
who discover, as they proceed into their residencies, that they hate what they are doing? Because licensure requires certification with the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada one can be sure that few will drop out. No doubt it will be extremely rare to find two people who want to switch programs and whose program directors agree. We shall be stuck with a new "cadre of physicians who resent what they do for a living," as Goldman describes it. This group of physicians will consist of those who were matched to a program of their choice that they later find does not suit them, and those (this year 96) who were initially unmatched and were forced, through the second, emergency match, to select pathology, laboratory medicine, nuclear medicine or another of the less popular specialties. Equally disturbing, as Goldman rightly points out, is the government's plan to reduce the number of training positions by 10% immediBrian Kwon ately instead of making reductions at President, Aesculapian Society the beginning of medical school and Queen's University out programs 4 years later. phasing Kingston, Ont. Goldman is probably right that this process will result in his working harder and longer because there will be fewer house officers. Perhaps other people like GoldThe residency lottery man will pay more attention to what T hanks to Dr. Brian Goldman is happening to their junior colfor saying in print (Can Med leagues and support them. Patrick Sullivan's article Assoc J 1993; 148: 12161218) what most have been saying "Marches, legal action averted as almost all 1993 graduates find training aloud for the past year. The lack of flexibility in this positions" (ibid: 1358-1359), on the new system has been condemned by other hand, is quite misleading. It is everyone I have talked to throughout true that the second match, held a the medical school and in the hos- week later, provided training pospitals in Ottawa. Nobody can under- itions to all but 5 of the 96 graduates stand how the system can benefit who were not initially matched. society or the physicians who serve However, there were only 65 posit. Ironically, nobody will stand up itions available; about 25 graduates and take responsibility for the de- found or felt forced to find positions in the United States, and 25 more cisions that created it. I am a 4th-year student who decided to sit out this year and was matched to the program of my try their luck again next year. choice, and how lucky I feel! But Thus, in the end there were poswhat will happen to my classmates itions that remained unmatched.
sources available we have not decided what constitutes appropriate patient care. Until this happens I cannot help but be rather sceptical about the direction in which the current changes are taking us. We probably have a pretty good idea of what needs to be achieved economically, but I fear that in the interests of short-term economic gain we are sidestepping the larger issue of deciding on a health care goal and then taking appropriate and sensible steps to move in that direction. Where do we go from here? There appear to be no easy solutions. As a medical student I maintain my willingness to participate in fair and well-considered changes to the system. With my perhaps rather myopic view I also maintain my faith that ultimately the voices of reason will prevail in formulating needed change. With a more cooperative effort between government and the health care sector I do believe that we can achieve a more agreeable end point in our health care system.
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Legal action has not been "averted." Legal counsellors have advised students at the University of Ottawa that they would have a very good case for a civil suit. Legal action has not been pursued simply because none of us have the money to do so. I believe that this remains an intolerable situation. Why should students be forced to seek postgraduate training in the United States or to sit out a year? There are approximately the same number of postgraduate training positions as graduates, and there will undoubtedly be about 25 unmatched students next year. What then? Michael D. Hill Class of 1993 University of Ottawa Ottawa, Ont.
In discussing this year's match by the Canadian Intern and Resident Matching Service (CIMS) Mr. Sullivan implies that pathology and other disciplines that did not have postgraduate positions filled are "unloved" and therefore "un-
popular." The CIMS match had not been used in the past for several disciplines in which there were unfilled positions. For example, in pathology the service was found to be next to useless. Rather, excellent residency trainees were found among those who had completed rotating internships or doctorates or who had spent time in practice. I will forbear from commenting on this new nonsense of forcing decisions at such an early stage of a career. I agree with Sullivan that we in are a new ball game and that laboratory physicians had better realize this quickly. They must make sure that medical students appreciate what they do and what the advantages and satisfactions are of a life in their discipline. I disagree that the results of this CIMS match make pathology or other disciplines "unpopular." On the other hand, a repetition next year could justify Sullivan's viewpoint. Aux armes, laboraLE 15 JUILLET 1993
