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The times I have seen surgical assists (in obs by FM-ob and in a rural area with surgeon IMG who didn't have surgical license in Canada), the assists never did anything more than retraction/direct laparoscopic camera. They didn't even close up. Unless you're actively doing something surgical, I think it's a waste of government money both in MD billing and lost potential (all those years of training to just retract...) I think we can put our FM training to more useful skills. There's plenty of other areas needing FM (clinic, hospitalist, ER, obs...)

Then surgical assist should be removed from MD activities

I never understood why you would need a MD to be surgical assist... why don't they just have nurses do this? Seems like a waste of medical training..

I think cosmetics is different, because it's not covered by RAMQ (so you can do both at the same time). Not sure how it works for telemedicine.. I think you can do telemedicine through the public system and that's ok (during the pandemic anyways). You just can't have a private practice (offering services covered by RAMQ) and work in the public system as well.

Yes exactly. If you work in an area without PREM, you will be cut 30% billings and you will not be allowed to apply to that area for 5 years.

Some programs only allow finishing R2, others allow candidates already in practice. I think theoretically you could apply over and over again to Carms. However in reality, the further you are from training, the less competitive you will be. I presume much of the match decision is based on the candidate having done a rotation at the program. You need letters of recommendation as well. The further you're out in practice, the less you will be known to the program / the harder it will be to get a letter. Re-entry programs are separate from the Carms process. I don't know much about this.

If you work private, you can work wherever you want. However, there is the ethical/moral consideration and higher overhead usually. No cut from government billings.. you can't participate in the RAMQ public system and be in private system at same time

I do not speak from personal experience, but people who work outside of Quebec say that work is very easy to come by.. you can arrange things a few weeks in advance. Anywhere that's looking for a MD will be able to give you the position. The reason it's complicated in Quebec is because it's government regulated. PREM allocates a certain amount of spots for new graduates to work in different geographical areas. PEM = hospital privileges (hospitalization, ER, obs). Even if certain hospitals in Quebec need doctors, if the hospital wasn't allocated a PEM or if you don't have a PREM, you can't work there.

If you're aiming to work rural, PREM is not as difficult vs getting one in the city. I've heard FM pays better in Quebec than in Ontario (at least in first years of practice, there are incentives to get you to enroll more patients), but I think there is really too much variance to make a sweeping generalization (depends on payment model and how rural you want to go). Anywhere rural will pay better. In Quebec, rural areas will be paid anywhere from 105-140% base rates. Even in the city, FM doctors can work in obs and hospitalization. However, getting PREM and hospital privileges (PEM) will be more complicated in Quebec than in rest of Canada

I would aim for non major city programs.. even then.. hard to match to FM/EM even as a CMG. In my province, people basically only got interviews in-province. Someone did an elective at a big center in another province and was not granted an interview. Electives will be your best chance.

Purpose of getting disability insurance earlier is to lock in an insurer/lower rate before developing medical issues. Depends on your age, your residency length, debt/dependents and risk tolerance. Since my residency was only two years and I'm young, I didn't get one after medical school since it was provided by my provincial residency association. I figured it would be low likelihood that I would develop something and was willing to take the risk (Worked out for me in the end.. but I know, I know, you can never predict if something happens.). As long as you buy a disability insurance within 6m of graduating as a resident, you benefit from no medical and similar discounts from RBC.

I studied only in English and was in an Anglo bubble before med school. Went to one of the francophone schools and knew a handful of students in the same situation. Unfortunately, hard to generalize.. I will say in general, most Anglo students will get through med school without any problems. Some went on to match to competitive specialties. I think I would have performed better both during preclinical and clerkship if I went to an English program. During preclinical, there's a lot of small group learning and I found it hard to follow all the discussions especially during the first year. However with time, my French improved and it wasn't much of an issue anymore. You don't need to study translations of different medical terms now, that'll be easy to catch on. During clerkship, I found I wasn't as eloquent when answering questions on the spot. Even though my French was eventually very good professionally/ for medical communication, my French was not as good in respect to socializing/networking. Clerkship evaluations can be quite subjective and is in part influenced by how much they like you as a team member. Harder to relate to them (to the same level that I would with Anglos) because we had different cultural backgrounds (music, movies, TV shows..). I don't regret anything though. My French has improved significantly and I am now comfortable to work with francophone patients and to work in French hospitals. Even if you are in the Mcgill network, a lot of your patients will be Francophone. Being able to communicate and evaluate patients in their mother tongue is invaluable. Even though I feel like I could've achieved more, at the end of the day I learned how to function in another language and that is priceless.

I think it really depends on the program and school. Look on the Carms R3 program description page for details. For ER, programs in my area expected us to start at least by P2-P3. I think it's because of their teaching schedules / common intro month scheduling. For shorter programs (<1 year) and programs with less rigorous teaching schedules, I would assume they are more flexible. It really is program specific.

Family medicine is not comprised solely of incremental adjustments of HbA1c and BP...... patients present to you with a multitude of complaints, literally anything and everything. Career satisfaction comes from being a generalist and knowing a little about everything. Throughout my residency, I have counselled parents about newborn problems, delivered babies, inserted IUDs, counselled about diabetes, counselled for depression, performed a multitude of intraarticular injections, accompanied families when their loved ones were losing their autonomy / facing a cancer diagnosis, helped someone quit smoking, diagnosed skin ailments, removed foreign bodies, given patients the knowledge/tools to better their health / to prevent ER visits / reduce their health anxiety, etc. My patients trust me to tell me their secrets and fears. My staff have diagnosed malaria in walk-in, performed abortions, worked in rural Northern Canada, worked for Doctor's Without Borders, worked as hospitalists/in obstetrics/in EM. As a family doctor, you are the first line of contact. You have the flexibility to transform your practice throughout your career. Throughout my residency, I saw the value of my generalist training. The staff that performs scopes doesn't remember how to treat HTA, defers to the patient's family doctor, delaying care. The IM subspecialist didn't remember how to treat hyperkalemia. The pediatric subspecialist doesn't remember what is a normal adult HR. The medical team doesn't think of fracture to explain the patient's sudden decrease in mobility. Of course for a lot of these specialties, they don't need to know these particular things to function within their domain. I am a specialist of common diseases in the general population. I don't want to only know one organ system. I don't want to only treat one small subspeciality of medicine. I don't want to know how many different ways we can resect a certain body part. I love working with people of all ages. I derive career satisfaction knowing that I have the knowledge to guide my friends and family through a large range of health issues.

Not just FM... Surgeons at my center have had all elective surgeries cancelled.. Doctors all across the board have been affected. FM are easily re-deployed to other areas of need (Er, wards, long term care). Other specialties have been redeployed, sometimes as pseudoresidents working under other specialists e.g. wards