frenchpress

Not getting what you want in CaRMS sucks. I ended up far down my rank list and no where near the location I wanted to be. I was devastated. When people told me they were surprised, or that I was a strong student or that carms wasn’t fair, etc etc. it just made me feel worse. And when people told me “it’s only X number of year, you’ll be OK” I wanted to scream. Because they kept missing the point. All I could think about was that I gave/continue to give years of my life to medicine and the profession doesn’t care at all about my personal needs, my families needs, etc. The whole experience made me feel so disempowered. I didn’t feel good enough when it happened, and many years later I STILL continue to experience that feeling intermittently, along with a deep, painful rage at the losses I suffered because of how things turned out. And I feel those things at the same time as I often feel joy about the things I have enjoyed about my residency, the friends I have made, the positive experiences I have had in the city in which I live now, etc. The reality of the match is that many of us can’t get what we want, and many just end up with something we have to find a way to live with. Which is easier for some than others. Medicine chews up and spits out many of us. It’s no wonder there are so many jaded, burnt out doctors. Of course we can’t all have exactly what we want. But the system could be better. And for some reason we all continue to go along with it like it’s the only way to do things. That’s my perspective. Anyways, with respect to what your friend is going through and how to help them… Think of it like a grieving process - it will takes time for them to come to terms with it, however they might end up doing that. Listen, and ask them how you can help. For me, I found it helpful when my friends invited me to do things like go for a walk or get dinner or really any activity that I enjoy in my non-medical life. It reminded me I had things outside medicine I could still enjoy and be happy about. Edit: I also did personally find it helpful when people told me it was OK to be pissed off, to rage, to cry. That I didn’t have to pretend to be happy, and they would just listen and let me have my sadness.

The interview selection and ranking on the program’s side was never the issue, at least not at the UofA. I am pretty sure they were not being picky. The issue was not enough applicants were actually ranking the programs high enough to match to them. It would be hard to argue it was a problem with program quality, again at least not UofA, which is a pretty great program. I think location desirability and political climate / poor perception of Alberta played the larger role. I suspect the improved match rate for AB FM has more to do with a gradual change in perception (Ontario was in the news about FM a lot more, Alberta has consistently good cost of living compared to much of Canada, is a pretty good place to practice medicine resource wise, docs are generally happy in AB when they post about lifestyle, cost of living, etc. in the financial independence FB group, etc.) and the programs being allowed to take a higher number of IMGs the first round. Edit: perhaps applicants are also looking at the improved fees structures in BC and Manitoba in the last year, along with the fact the AB is already one of the best places to bill for FM in Canada, and thinking moving out west in general is not a bad plan.

By the time an FR is in practice, an EM that start at the same time has been working as staff for 2 years. In my experience working in centres with a frequent mix of both, it’s pretty hard to tell the difference between the two after a couple years in practice. Billings are also indistinguishable. I actually think a bigger factor in decision making is what you want to do after. E.g., An EM can’t apply for some fellowships like critical care, and it’s harder to get into some areas like transport, etc.

I don’t disagree with any of this, except that Nanaimo is definitely not a rural program. And in terms of acuity, they don’t even do overnight call. Residents get some great training there, but I would not consider it equivalent to a rural program. But in Nanaimo and many of the other urban and mid-sized UBC programs you can potentially do more months of rural rotations. In terms of UBC programs, chilliwack has been historically also been quite popular for emerg gunners due to the longitudinal emerg and hospitalist shifts

From the limited description you’ve given, my high level advice would be to stop engaging so much with this person. If you’ve already explained to this person what your boundaries are, now you need to enforce them. Tell them you won’t be responding to the constant inquiries, and are only going to check your messages with them at most once a day (of even only several times a week), and only to respond directly to relevant things that actually require a response from you - I.e. directly shared-project related questions. Ignore everything else. If she asks where you are, proof for why you missed class, etc. ignore it. If necessary, you can respond 24 hours later and remind them that you discussed this and it’s none of their business, and that’s why you didn’t respond. Do the same in direct conversation. Think of it as a little forced CBT / exposure therapy - if they can’t get an immediate response to quell their anxiety / OCD personality needs from you, they may have to look elsewhere (or deal with it).

The AGM is tomorrow and someone has put forward a motion to essentially put the brakes on the whole thing. Members of the CFPC can vote (and should have already received instructions), but I don’t know that this includes residents / students. Any practicing family doctors who are members should have received info for how to attend / vote by proxy in their email.

1a. Sunk-cost fallacy. 1b. I also think a lot of people shit on family medicine because they are unhappy in their own choices to do something else. For every unhappy family doctor you find out there, I can find you an unhappy specialist. There are plenty of happy family docs, who are often happy in part because of the same things you mentioned - flexibility, shorter training, portability, more time for your life, etc. 2. There are lots of ways to make money in family medicine. Assuming you don’t have astronomical spending habits, you won’t starve, and you’ll probably do pretty well. See if you can find some mentors in your city who like family med to reach out to. Sounds like you already made up your mind, but they may help you make peace with it.

Use people who know you well AND who you think will be able to write a good reference. It’s a balance sometimes to pick someone who can do both, and I’d say ‘professional title’ is less important. There’s nothing wrong with using a retail boss, might even be a great choice. But writing references for medical student admissions might not be something they have any skill at. I used to have to write references fairly often when I worked in academia - it’s actually pretty hard to do well. If you choose someone who doesn’t know you, like the volunteer coordinators you described, you should expect the letter might be pretty generic. It also depends on the school’s application style - some letters are more of a form and easier to fill out for people than others that want just a plain letter.

No. Still in early stakeholder discussions/ visioning stages by programs. Won’t be sooner than 2027 if it does ultimately happen.

It’s helpful to think about residency as being for your learning - it’s there so you’re prepared to be staff at the end of it. It’s different from medical school, where showing interest is enough. In residency the point is to practice doing it, and to fill in the gaps, so that you CAN do the work when you finish. If you come at everything you do in residency from that perspective, you’ll get as much out of it as you can.

“Procedures” is very broad, and the types a procedures one might do would depend on the context - emerg has lots of procedures, for example, but these tend to be different from the sorts of things you might do in an office setting. So in general, there’s lots of ways to combine procedures with other things, but maybe not every procedure possible… And of course it is not impossible to be skilled in all 3, many doctors in rural areas do this. Although many of the docs I know personally who do this are either old, or from South Africa, where their training exposes them to a tonne of both obstetrics (often low resource) and trauma/the scary parts of emerg. Whether it’s possible to feel confident to do all three after just 2 years of family medicine will really depend on you, what you spend your time doing in residency, and how much experience you need to personally feel confident. If I were in your position, I’d do as much as I could of emerg and OB and procedures you’re interested in without burning myself out, in part to help you decide if you actually want to do those things in practice. Sometimes things that seem great as a med student suck once you’re more responsible. This will also help you figure out where your gaps are as you go and help you figure out if you need/want to do a +1 in something (e.g. emerg). It’s easier to get extra training in OB later as there are a variety of +1 programs of different lengths (e.g 3 and 6 month options). Whereas for the emerg +1 in addition to being very competitive, many programs will only accept people at the end / 1 year out of residency - so if you want to do it, you’ll likely need to decide fairly early on during residency. I know several people going into straight into doing OB out of residency because they felt they got enough experience, and far fewer who feel comfortable doing rural emerg and dealing with traumas/air way disasters/etc. I also know several of people who thought they wants to do a bit of everything in family med, and then realized the lifestyle sucked. Again, not that it’s impossible, but many people realize it’s not worth it

I don’t think most of them are billing QUITE that much. Most staff I know take at least a couple months of vacation a year, so probably more like 350-400k gross, and then with 30% overhead. But still good for what I honestly think is a reasonable workload. In AB you’ve really got to understand how to bill properly though - a lot of people do not bill what they deserve in terms of time modifiers.

Depends on the province and how many patients you see in those 5 days, assuming FFS. Remuneration varies wildly between provinces. I’m in AB, which I understand pays better than many places. The staff I’m working with this week bills ~$8000-9000 gross per week for 4.5 days of work, with very normal billing practices (nothing shady). So that would be at least ~22k every 4 weeks before taxes, after 30% overhead but before taxes. Very roughly it works on average to $225-250/hr most hours. Actual take home would depend on a number of other factors (RRSP contributions, other methods of tax deferral such as private corp, etc). I’ve met docs who are slower and bill much less, and docs who bill a lot more. It really depends. BC should be similar if you’re on the new longitudinal model, assuming 4 patients per hour (which works out to ~230/hour on average) and not too much time doing indirect patient care like charting etc (which you can only bill $130/hr for).

Yaletown is not far at all. That will be closer than many people in your class will commute from. Also, FYI, unless things have dramatically changed, there’s a good chance that your clerkship will be all over the lower mainland, not mostly VGH. When I was in clerkship people regularly went to St Paul’s, Surrey Memorial, RCH, Richmond General among other places for their rotations. Some were out in Delta, Eagle Ridge, even Abbotsford (and I’m not including the ICC students). But from downtown Vancouver many of those places will actually be fairly reasonable to get to by car, and some you might be able to sky train to depending on your hours.

Where would you be commuting from? 45 minutes sounds like a long time. But honestly, the commute on the bus from Cambie can take 30 minutes. The only things I’d say is be sure the commute is actually 45 minutes in traffic… but if you’re gonna have a long commute, 1st year is probably the time to do it If you can afford it, doesn’t sound crazy to me.