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How concerned should we be of job prospects when deciding our residency?


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3 hours ago, Arztin said:

Some problems are related to the nature of FM:

- The main problem I realized is that you just don't have enough time per patient. For example, I saw many elderly patients with multiple comorbidities. A 10-15 minute yearly visit just isn't enough time to take care of the patient properly. I have seen some staff doing a mix of hospital and office and after a while, they decided to not do office anymore because of this problem.

Can you not extend that at your discretion? I've had FM doctors spend more time with me in the past when necessary.

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Very. I can speak for path. The job market sucks despite the misconception that there's a pathologist shortage. Getting a job in a city like Edmonton or Winnipeg is now requiring fellowships and experience. Small town positions are being filled by Americans since they have CP while we mostly only do AP, and by foreign pathologists since they're desperate and have to sign ROS agreements and also don't require recruitment incentives. All in all, gambling on pathology isn't worth it.

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It's also about the quality of the jobs available. For example a medicine subspecialty resident mentioned there are jobs in her subspecialty, but seems to be mostly 0.5 FTE, with onerous on call requirements and little control over the type of consult she will she (aka she gets the leftover consults the seniors in the practice group don't want). She doesn't know if the 0.5 FTE will eventually convert to 1.0 FTE if some one retires, but who knows how long that will be. She is hesitant about starting a family and purchasing real estate given the uncertain future trajectory of this job. 

 

Another case: FM grad from a few years back, has been doing locums and look for practice. Has difficulty with health teams since their entry is heavily regulated in ON. So he buys a retiring family doc's solo practice. The practice is very busy >1500 patients, hospital duties and overhead is high due to the solo nature of the practice. He is over-worked and has little time to spend with his child. Financially he's no better off since the real estate in his area is rising rapidly and he has little cash flow due to the loan  taken up on setting up his practice.

 

Let me put it this way, if you can increase your mobility, do it. Write USMLE, be open to working/living in another location. The entire labour market of the world is facing similar trend. The negative effect of this labour trend is clear: delayed marriage, anemic discretionary spending, etc. 

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15 hours ago, NLengr said:

You've assumed that community surgery jobs are just basically academic jobs without residents, which isn't true at all. The style of practice in the community is much different which makes the lifestyle much better. For example, the ER only calls you overnight for actual emergencies that need OR right now. That's probably about 0-5% of the ER consults you get in an academic center, where they don't give a shit about waking you up cause you are a resident. That's just one example. There are many others. 

There are jobs around in my specialty but you need to be willing to move around and work community. Every person I know in my soecialty who  finished is working, just maybe not in thier dream job. Almost everyone seems happy though. 

Ahahha that's nice to know. When I was in my gen surg rotation and surgical elective (mandatory)lol, sometimes, we get called for consults that could easily be seen the next day, or elective consults, or just irrelevant that residents don't even bother revise with the staff. I guess that in community hospitals, the lifestyle is better since everyone knows that you work alone and want a life after all the hardwork :)

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11 minutes ago, LittleDaisy said:

Ahahha that's nice to know. When I was in my gen surg rotation and surgical elective (mandatory)lol, sometimes, we get called for consults that could easily be seen the next day, or elective consults, or just irrelevant that residents don't even bother revise with the staff. I guess that in community hospitals, the lifestyle is better since everyone knows that you work alone and want a life after all the hardwork :)

like that in a lot of fields - and on top of the altruistic reasons you mention if you piss off a service and have to work with them for 30 years it is a major pain. Not like residency when you know you are just on for a short time etc.  

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5 hours ago, shikimate said:

It's also about the quality of the jobs available. For example a medicine subspecialty resident mentioned there are jobs in her subspecialty, but seems to be mostly 0.5 FTE, with onerous on call requirements and little control over the type of consult she will she (aka she gets the leftover consults the seniors in the practice group don't want). She doesn't know if the 0.5 FTE will eventually convert to 1.0 FTE if some one retires, but who knows how long that will be. She is hesitant about starting a family and purchasing real estate given the uncertain future trajectory of this job. 

 

Another case: FM grad from a few years back, has been doing locums and look for practice. Has difficulty with health teams since their entry is heavily regulated in ON. So he buys a retiring family doc's solo practice. The practice is very busy >1500 patients, hospital duties and overhead is high due to the solo nature of the practice. He is over-worked and has little time to spend with his child. Financially he's no better off since the real estate in his area is rising rapidly and he has little cash flow due to the loan  taken up on setting up his practice.

 

Let me put it this way, if you can increase your mobility, do it. Write USMLE, be open to working/living in another location. The entire labour market of the world is facing similar trend. The negative effect of this labour trend is clear: delayed marriage, anemic discretionary spending, etc. 

Would you mind expand a bit on the FM situation? Do you mean that the entry to Family Health Teams or FHO is heavily regulated by the Ontario government? I.E: limited spots? 

Anyway, it shouldn't be worse than my home province in Quebec, where every position in Family or Sub- Specialty has to be approved by the Ministry of Health, before senior residents could apply with ambiguous selection criteria.

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2 hours ago, LittleDaisy said:

Would you mind expand a bit on the FM situation? Do you mean that the entry to Family Health Teams or FHO is heavily regulated by the Ontario government? I.E: limited spots? 

Anyway, it shouldn't be worse than my home province in Quebec, where every position in Family or Sub- Specialty has to be approved by the Ministry of Health, before senior residents could apply with ambiguous selection criteria.

At the moment, entry to FHOs is limited. We'll see if that changes with the new negotiations - I'm guessing some restrictions will apply given that FHOs increase costs fairly substantially without a clear advanatge in outcomes besides patient preference. They'll almoet certainly stick around in underserviced locations, but it wouldn't surprise me to see continued restrictions in placss like the GTA - there's not much reason for the government to support those practices.

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7 hours ago, ralk said:

At the moment, entry to FHOs is limited. We'll see if that changes with the new negotiations - I'm guessing some restrictions will apply given that FHOs increase costs fairly substantially without a clear advanatge in outcomes besides patient preference. They'll almoet certainly stick around in underserviced locations, but it wouldn't surprise me to see continued restrictions in placss like the GTA - there's not much reason for the government to support those practices.

Hey I read up on the FHO and FHN restrictions in non high-need areas. I guess that it is still possible to be a part of Family Health Group (only physician) or Solo practice, being paid fee-for-service.

Ideally, I think that the FHO and FHN with a multidisciplinary approach is the best for complex patients, sad that the ON government is restricting those structures in urban areas. I personally don't mind being paid fee-for-service in a FHO or FHN, since the rendered service will be more complete and thorough:)

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I think the Employment Study that Royal College conducted in 2013 will of interest to a lot of people.

It's an interesting read for sure. There is a "high-level summary of key findings" for those that don't want to read the actual report. 

The URL link is attached below:
http://www.royalcollege.ca/rcsite/health-policy/initiatives/employment-study-e

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On 6/2/2017 at 4:28 PM, shikimate said:

Let me put it this way, if you can increase your mobility, do it. Write USMLE, be open to working/living in another location. The entire labour market of the world is facing similar trend. The negative effect of this labour trend is clear: delayed marriage, anemic discretionary spending, etc. 

3

Solid advice. I second this. 

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The situation is less about describing the job market today versus projecting the job market of tomorrow.

Since I started med school in the later half of the 2000s, the job market for most specialties has only become tighter and tighter. Granted, what this means varies from specialty to specialty. For instance, you can often count on doing a fellowship or two post-surgical residency for a job in some specialties. Emergency med is still very reasonable, and you can work in many places without further post-residency training. But things are generally getting tighter. 

If you are starting med school in 2018, you might finish around 2027. It is hard to project so far ahead. But provincial economies are under more strain every day. Subsoverign debt is increasing. Cuts in training and healthcare are much more likely than infusions of funds. The trend is not promising for new trainees when it comes to CaRMS sports and in mobility. 

One must look at this in a sober manner. Med training is a decade plus of your life and 100k +. Your earning potential is placed on hold over these years. At the end of this period, you will want to live in a place you desire and work in a field you enjoy. This outcome is getting harder with each passing year. Caution is warranted. 

 

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6 hours ago, rogerroger said:

 

The situation is less about describing the job market today versus projecting the job market of tomorrow.

Since I started med school in the later half of the 2000s, the job market for most specialties has only become tighter and tighter. Granted, what this means varies from specialty to specialty. For instance, you can often count on doing a fellowship or two post-surgical residency for a job in some specialties. Emergency med is still very reasonable, and you can work in many places without further post-residency training. But things are generally getting tighter. 

If you are starting med school in 2018, you might finish around 2027. It is hard to project so far ahead. But provincial economies are under more strain every day. Subsoverign debt is increasing. Cuts in training and healthcare are much more likely than infusions of funds. The trend is not promising for new trainees when it comes to CaRMS sports and in mobility. 

One must look at this in a sober manner. Med training is a decade plus of your life and 100k +. Your earning potential is placed on hold over these years. At the end of this period, you will want to live in a place you desire and work in a field you enjoy. This outcome is getting harder with each passing year. Caution is warranted. 

 

It's hard not to agree that the situation is getting more difficult each year and that caution is absolutely warranted. The job market situation right now is not great and uncertain. We're at a point where there's a confluence of factors working against a favourable physician job market - a massive expansion in medical school spots, an even greater expansion in residency spots (if dedicated IMG spots are included), delays in physician retirement, and provincial governments now unwilling to cover the full cost of those additional physicians reflecting in limiting of hospital beds, OR time, and access to advanced diagnostic imaging. If all those trends continued, things would be very bad for future physicians' job prospects.

Yet, there's signs of change. Medical student spots are no longer increasing, have actually declined slightly, and are not projected to increase any time soon (at least with the defeat of the BC Liberals). Retirements can only be delayed for so long. Physicians as a whole are moving to wanting fewer work hours, even if it means lower pay, meaning more physicians are necessary to keep up service levels. And while governments are reluctant to pay more for healthcare, the healthcare needs of the population are increasing and will eventually be met one way or another. Unlike the US, there's no real threat to jobs from non-physicians like NPs or PAs, and while internationally-trained physicians will continue to make up a significant portion of new doctors, their pathways to practice are becoming more restrictive. All told, there are encouraging factors for newly-accepted CMGs.

A common refrain about physician job markets is that they're cyclical. This is both absolutely true and generally unhelpful. Job markets for physicians rarely stay terrible or amazing indefinitely. Yet, the timescales of these cycles can be very long, stretching for decades. The point is, don't assume the worst or the best case scenario, but be prepared for either. Be ready to be mobile. Unless you're doing FM, write the USMLEs. Hunt for your ideal job but also look for ones that don't fit all your criteria. Always have a decent back-up plan in mind.

If you search hard enough, you can find plenty of reasons for optimism or pessimism. I've been warned about the tough FM job market while also being told I can set up shop pretty much anywhere. I've seen surgical residents despair over their lack of opportunities, while others land desirable positions. No one story paints the full picture.

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10 hours ago, ralk said:

It's hard not to agree that the situation is getting more difficult each year and that caution is absolutely warranted. The job market situation right now is not great and uncertain. We're at a point where there's a confluence of factors working against a favourable physician job market - a massive expansion in medical school spots, an even greater expansion in residency spots (if dedicated IMG spots are included), delays in physician retirement, and provincial governments now unwilling to cover the full cost of those additional physicians reflecting in limiting of hospital beds, OR time, and access to advanced diagnostic imaging. If all those trends continued, things would be very bad for future physicians' job prospects.

Yet, there's signs of change. Medical student spots are no longer increasing, have actually declined slightly, and are not projected to increase any time soon (at least with the defeat of the BC Liberals). Retirements can only be delayed for so long. Physicians as a whole are moving to wanting fewer work hours, even if it means lower pay, meaning more physicians are necessary to keep up service levels. And while governments are reluctant to pay more for healthcare, the healthcare needs of the population are increasing and will eventually be met one way or another. Unlike the US, there's no real threat to jobs from non-physicians like NPs or PAs, and while internationally-trained physicians will continue to make up a significant portion of new doctors, their pathways to practice are becoming more restrictive. All told, there are encouraging factors for newly-accepted CMGs.

A common refrain about physician job markets is that they're cyclical. This is both absolutely true and generally unhelpful. Job markets for physicians rarely stay terrible or amazing indefinitely. Yet, the timescales of these cycles can be very long, stretching for decades. The point is, don't assume the worst or the best case scenario, but be prepared for either. Be ready to be mobile. Unless you're doing FM, write the USMLEs. Hunt for your ideal job but also look for ones that don't fit all your criteria. Always have a decent back-up plan in mind.

If you search hard enough, you can find plenty of reasons for optimism or pessimism. I've been warned about the tough FM job market while also being told I can set up shop pretty much anywhere. I've seen surgical residents despair over their lack of opportunities, while others land desirable positions. No one story paints the full picture.

Just wondering, is there a thread on here that talks about writing the USMLE as a Canadian, i.e. do you have to take all the steps or just some of them, what you need to get a residency or fellowship position in the US, etc.

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2 hours ago, gangliocytoma said:

Just wondering, is there a thread on here that talks about writing the USMLE as a Canadian, i.e. do you have to take all the steps or just some of them, what you need to get a residency or fellowship position in the US, etc.

Not sure of a full thread but in short: If you want to do a US residency after a Canadian MD, you need to do all the steps (at least step 1 before residency applications), and get competitive scores. You can apply first round in ERAS but you have an uphill battle as USMD medical schools teach to the USMLE exams, and Canadian schools do not so you will have to study on your own time. For fellowships, some require you to be competitive in your step scores, some require you to pass them, and some don't require you to take them at all. This is highly state, specialty, and program dependant.

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48 minutes ago, bearded frog said:

Not sure of a full thread but in short: If you want to do a US residency after a Canadian MD, you need to do all the steps (at least step 1 before residency applications), and get competitive scores. You can apply first round in ERAS but you have an uphill battle as USMD medical schools teach to the USMLE exams, and Canadian schools do not so you will have to study on your own time. For fellowships, some require you to be competitive in your step scores, some require you to pass them, and some don't require you to take them at all. This is highly state, specialty, and program dependant.

Awesome thanks! So for someone who finished their residency here in Canada, would they need to complete all the USMLE steps to work in the US?

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3 hours ago, gangliocytoma said:

Awesome thanks! So for someone who finished their residency here in Canada, would they need to complete all the USMLE steps to work in the US?

Most states will let you practice without having to do the USMLE if you are board certified in Canada. However this varies by state and specialty, and can change, so you'd have to look at a specific state's criteria, and a specific specialty's requirements for board certification. Some states do require you to pass the USMLEs.

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  • 2 weeks later...
On 2017-06-01 at 7:19 PM, MacMed2018 said:

except for family and derm where you can go set up shop anywhere.

Not if the area is oversaturated with MDs. Some areas in Canada are already flooded with GPs to the point that there are clinics advertising on radio to join their practice (ex. Calgary).

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  • 2 weeks later...

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