ameltingbanana

Wrote the exam in 2020. Do not attempt without aforementioned resources. the IMR slides and questions were great and quite representative, but there's a high rate of some questions being recycled and those end up being free marks.

Agree, you should be able to take time off. As long as it doesn't affect your evals, letters, ability to interview etc I don't think it should be an issue. Any program that vilifies you for a 1 month absence to care for a newborn is not one you want to be at. A month sounds like barely any pat leave to be honest...consider taking more. That being said, I've been through the MSM match twice (once for IM subspec, once for critical care)...most people kept it quiet until asked about it/matched. Just part of the workaholic culture and playing it safe. Sorry you're having to navigate this. For what it's worth, I know people in competitive subspecs (cardio, ICU, GI) who took parental leave and were relatively open about it.

Haha, it's a matter of balance I'd say. Set yourself a budget of what you'd be okay with your LOC going to (and ensure that you can afford the interest payments at that balance +/- another 1-2% of interest). It's also important to enjoy yourself and relax during residency! It's tough - I remember when I started (I'm a PGY7 now) there were people in my class buying BMWs etc with their LOC, speculating on stocks, going on vacation in Hawaii (i brought that up because i definitely did that) investing in property....I think those days are past now for quite some time. Definitely not fair to the incoming MS1s but you will all do well as physicians financially. I would give strong consideration to moonlighting; used it to go after my LOC aggressively. You can think of it as an investment that's providing a 6-7% dividend (whatever your interest rate is). I was also able to moonlight after PGY3 then locum at the start of PGY5). Definitely a big hit to wellness, but will start you off on the right foot financially in this new environment that's come about.

I would also add that the type of residency changes this pretty significantly: family med, vs IM/subspec (moonlight from PGY4 onward), vs 5 year subspec without moonlighting opportunities. This is what I would probably do: - I agree I would not consolidate my loans at the moment - you can always do this later if the interest rate environment changes - I would try and find a way to pay off the provincial portion of my loans only (possible but a bit convoluted to do) as the federal portion does not incur interest under the current federal government. - Be very wary of taking on more debt than you can handle (car, house, luxurious purchases NOS - debt is no longer cheap and a 5-10K vacation to Hawaii on Scotiabank's dime may bite you in the rear later on) - Depending on gas-in-the-tank, think about looking for locum and moonlighting opportunities if you are in a specialty that lets you do so and doing well academically and have gas in the tank to not burn out. This made a massive dent in my LOC personally.

Yeah, I completely agree with this. We are not primary care in Canada nor are we trained to be. Doesn't matter if our archaic billing code lets you do so. OP if this is your jam family med +/- hospitalist is a better fit.

I'll be honest, it seems in the GTA that outpatient GIM doesn't get to do a ton of management - the major role for outpatient GIM clinics is in the style of "rapid assessment clinics" where people present to ER; determined they don't need admission but need urgent followup for their issue --> see GIM as an outpatient within 1-2 weeks. I will say this type of clinic can be pretty fun to do depending on the setup. Otherwise it's fairly vague stuff that comes up, or very multimorbid patients where every organ is sort of slowly failing and the subspecialists are all focusing on their own system and the real discussion is probably about palliative care. For full scope longitudinal outpatient care, I think you'll have to go away from the GTA a bit and/or be comfortable setting up your own shingle. Or do a PGY5 year/AFC like thrombo/hepatology/something less formal like obstetric medicine/cardiodiagnostics etc and have that be your outpatient "niche". I get the sense the job market is still decent for GIM as long as you're willing to do some after hours call and be flexible. 4 year will likely be primary community hospitals in the GTA, but there's tons to choose from and a lot of community GIM docs seem quite happy. I know @ACHQ posts here and is a general internist in the community and may be able to answer some more questions - I went back and did some more training after GIM so I'm just intermittently locuming at the moment, he/she may be able to provide more info. My perspective is coming from someone who doesn't really like clinic outside of rapid access clinic that much, so I focused a lot more on inpatient - just noting my bias here.

You can do this - I'd be very careful about doing this as we do not get sufficient training in things like: Ob, Pediatrics, fractures, etc and if you are seeing patients without referral you'd have to restrict your practice. This is speaking as a general internist who was offered the chance to do some of this in PGY5, in a virtual med capacity, and I said no. We function best in a consultant role in my opinion and shouldn't be going into primary care and that's not how we're trained.

This is a very good point and one I should have clarified - yeah, you need to know you're applying to ICU and apply in the fall of your last year of fellowship.

The only specialty you can re-enter the CaRMS MSM match for after completing a medical subspecialty is critical care to my knowledge. This is of course without contemplating the routes that ACHQ is describing above.

That's interesting - definitely agree there can be tons of bloat in Epic. It's incredibly functional though (I'm probably a bit biased as I've been using it for > 5 years now in various forms) - you can prescriptions, route notes to family docs/specialists, send referrals, pharmacists/nurses/docs message me on there (saving me pages), there's a phone/tablet app so I can put in orders without needing to boot up my computer.. I found Cerner fast but not terribly functional (though to be fair I really only used it for a a couple months in London and a community rotation in Waterloo). It does seem that Epic is starting to take over

All of Alberta is in the process of switching to Epic or has switched already. Edmonton and most of Calgary already have. Hamilton is also now fully on Epic (though 2 different builds between HHSC and St Joes). edit: I really did not like Powerchart when I worked with it at Western, but anything beats meditech

You can access this data through the CaRMS website - they display statistics for their matches. Bear in mind it can vary wildly from year to year especially with some of the smaller subspecialties.

This is correct (great typo). The exception is critical care which you can apply to again to my understanding (which though it is through the MSM match it is of course open to IM/surgery/ER/anesthesia/etc.),

Speaking as someone finishing the 5 year GIM program - a 5 year is more or less required in most academic centers in southern ON (for sure Toronto/Mac/London). Some academic centers are fine with 4 year + an area of interest (obstetric medicine, thrombosis, periop medicine, etc) Most community centers are fine with PGY4 and nothing additional, as the focus is more on work and clinical excellence. If you are coming from the States, my understanding is you need an additional year of training to be Royal College/FRCPC IM eligible (4 years IM + successful royal college). As it stands now, the 5 year GIM program is primarily to develop a niche/consolidate/research/pursue an academic interest though I believe in Quebec there is some sort of billing/payment difference between 4/5 year. And I think US PGY3s can apply to the CaRMS MSM match...but not entirely sure. The point of the PGY4 year relative to US IM is that IM is a bit of a different field compared to the US up here. Essentially no primary care, and IM is purely consult based. More of an in-hospital presence/ICU/stepdown, and less time in clinic (though this certainly varies depending on the internist, certainly our training does not have a significant clinic component until PGY4/5).

1. Similar to CaRMS round 1 but with very variable levels of competition purely depending on who wants what subspecialty. All it takes is a few extra people wanting to do a small subspecialty for there to be more applicants than spots. Get exposure early on and narrow things down so you can plan your electives out well for second year. First thing to narrow down I would say is: inpatient, outpatient, or both? 2. Show up, work hard, show initiative, be safe, take on responsibility. 3. All very important. In order of importance from what I understand: electives, LOR, evals, CV/research, with some changes depending on the school or instutition. I don't think medical transcripts factor in really 4. No specific resources. Ensure you make time for stuff outside of medicine. R1 year is draining and overwhelming because it feels like a lot of responsibility after a decent amount of time off from medicine (summer between med school and residency) Current PGY5 here.