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BigM

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BigM last won the day on October 26 2018

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About BigM

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  1. As others have said, get the disability insurance, max out the most you can get. Your future earnings are your most valuable asset. Illnesses happen all the time and physicians are certainly not immune to them. You don't want to be stuck trying to get by on government disability programs and trying to pay off student loans.
  2. I'm one year out in practice and I would say yea, in my opinion it was worth it. I would do it all again if given the option. Med school was overall a positive experience but flew by and my memory seems to forget huge portions of it. Residency was at times tough. But at the end of the day, now that I am done, I get paid very well to do work that I generally like to do and I have a reasonable degree of control over it. As a physician you gain knowledge, respect and job security in most medical fields. When you are looking at the potential for a 30+ year career after finishing your training, spending 6-9 years training, half of it paid at a reasonably (although still grossly underpaid given your training base) resident wage isn't a terrible sacrifice. I think that when we are training to become physicians we sometimes glorify the experiences that our non-medical colleagues are having in their 20's and early 30's.
  3. The idea of using an all-in-one ETC such as XEQT is that you wouldn't need to do any rebalancing. The only thing you would occasionally need to do is log on to re-invest your dividends quarterly. I am in independent practice now, but if I were to go back to my time at the beginning of residency I would have maxed out my TFSA (there would likely have been financial implications as a medical student on grants, etc that I wouldn't have wanted to effect). I did actually invest $30,000 in my 4th year of residency and made $3,000 interest over a year, but I later needed the money to finance a mini-van for the family so had to pull it out. As someone mentioned above, if you are going to run the risks of leverage investing, then you want to get everything on your side. The expenses you pay for owning an all-in-one ETF on Questrade are lower than the expenses you will incur with Wealthsimple, this lowers your overall risk as the stocks don't need to perform as well to exceed the interest cost of the LOC.
  4. While there's definitely some areas where training is overkill in Canada, just because the royal college accepts the training as equivalent doesn't mean that when the training program is said and done, the clinical skill of the physician is equivalent. Not to knock on Switzerland, I don't know much about their system and assume they have competent doctors. But at some point, when you are the MRP and the buck stops at you, you might not regret being pushed to get more hours under your belt. That said, resident work without quality teaching is just cheap labour.
  5. Residency isn't necessary a sentence to a life of misery. While I only have experience in the field that I trained in, all residencies are going to have their grueling periods. For some, predominately surgical specialties and some medical specialties, it will be a rough ride. For some others e.g. family, PMR, psychiatry, rad-onc, lab medicine, neurology and periods of internal medicine, its tough, and going to make your normal 8-4 job look like child's play, but its not exceedingly miserable. You are going to have some years of heavy call, for me this was PGY2 & PGY3. You are also going to have a year where you bust your behind to get ready for exams. But keep in mind at the end of this you are an independent specialist. In most fields you are not going to struggle to find employment and you are likely going to make $300,000+/year for the rest of your working career. You also get to work in a field where you get to make meaningful differences in the lives of others. That's a pretty sweet payoff for 5 years of sacrifice. Also, there are very rewarding parts of residency. Feeling incompetent sucks, but that gets better with time, and you do eventually feel like you're making meaningful contributions, able to lead teams and feel that you're somewhat prepared to do this on your own. You also get the bonding experiences of working in the trenches with your co-residents that are going through similar experiences.
  6. None of us are the kids that we used to be. I think the first question would be how likely is it that these messages surface again? Is there any chance that you're being a bit overly paranoid about them? Even if they do surface, an honest and sincere explanation that you used to share beliefs about this that you no longer do; or that you said things to be part of the crowd and now regret it can go a long way. Next, keep in mind that actions speak louder than either words or old facebook messages. How can you advocate for equity and equality among diverse populations now? Putting effort into this will not only provide some protection from the past, but also make you a better physician and a better person. Your professional responsibility largely starts when you become a medical student, and it definitely firms up when you become a resident and are now under the authority of the college. You don't need to be an angle before medical school as long as your behaviours were within reason (criminal records are hard to talk you way out of).
  7. It’s hard to say that’s globally true. For family doctors in Ontario, many would agree with that. However, a lot of specialists love FFS and would have no interest in changing to salaried. There is motivating aspect to know that you are getting paid for the extra effort you put in, but it also becomes frustrating when it comes to all the time you aren’t being paid. I.e. as a psychiatrist I get paid for the time that I spend getting collateral history from a family member only if they are there in front of me. If I spend the same amount of time getting the same info from then over the phone, I would get paid nothing (pandemic billing codes aside).
  8. Yet family doctors generally hate it if their patients have been managed by psychiatrists, have had multiple med changes and then show up at the family doctor's office for something and they aren't in the loop/have no records to fall back on. That's why I side on sending them everything and they can just superficially read it if they're not that interested. I figure that after I routinely copy them in on every note, the family doctors just get accustom to it and likely don't spend much time absorbing the info. I will often bold anything that I want the family doctor to manage/follow-up on.
  9. I would estimate that when I was doing fee for service I was doing 45 mins of admin for every hour of time spent with the patients but I tend to be very thorough and medicolegally defensive when it comes to documentation. I'm also a new consultant so would likely have decreased over time. I'm salaried now so I don't really pay a lot of attention to it. I have a patient roster, I see my patients as often as necessary, I fill out any forms necessary and I document during the downtime, it's very chill to ffs by comparison. However, I'm working in a niche area where the reports are extensively long and detailed. I generally copy the family doctor in on all my progress notes (I dictate them or use Dragon) so on top of all their other stuff, they have my notes to skim through. Family docs have an enormous scope of practice, like everyone else, they will get more efficient at their bread and butter over time, but I imagine there are a lot of things they need to look up/research as you can only know so much and guidelines are always changing. Then there's an enormous amount of blood work and investigations to review.
  10. I would have imagine it’s family medicine. I’m in psychiatry, our notes are generally long and detailed, so they take time to compose but we generally don’t get huge quantities of reports sent to us that we need to review and our case load is usually much lower than a family doctor. When you have a complex mental health patient it can take an extensive amount of time to chart review then.
  11. I also disagree with the clain that medicine isn’t the thing to go into if you want $1 mil + income. Medicine is a great thing to go into if you want $1 million+ income, but you’re going to bust your rear end to get it. Most professionals don’t have realistic prospects for making $1 million/year no matter how much you work. Nurses won’t, pharmacists won’t, retail clerks won’t. Vets & dentists may if you’re extraordinarily successful and working the equivalent of multiple jobs. However, if you’re a physician willing to combine putting in very long hours with being efficient, you can do it. Nothing prevents you from working 8-6 Monday- Friday with call and then doing a busy private practice on weekends. I’m not going to do it, as I agree with you, above $500,000 it’s questionable what the increase in quality of life is (likely decreases in the case of physicians), but saying that medicine isn’t a good path in order to achieve this just isn’t true.
  12. It comes down to a personal assessment of your level of risk tolerance. When I was a PGY5 I borrowed $30,000 from my LOC to invest in my TFSA. At the time I decided I was going to take a couple of weeks and focus my learning on investing, wanted to do this before I ever started to make staff $$$. I made $3,000 over a few months but ultimately had to cash out the TFSA to buy a larger family vehicle. I have a higher tolerance for risk that others may not have and I knew that my prospects for employment were exceedingly good. While the stock market is lower at this time, we are also in a period of time which has given some unpredictability for the future (i.e. will you get sick and need to take time off? will your exams be delayed? will you be readily employable after you finish?)
  13. Its variable. Inpatient billing codes for your time-based billing codes are about $10 higher for inpatient psychiatric care and family care (e.g. family meetings). Inpatient care has the potential to be more lucrative as your patients are there on site so you don't need to worry about no-shows (although patients being on passes when you want to see them can be a common-enough occurrence). Right now a regular inpatient unit of time (20 mins =1 unit, 46 mins = 2 units) is around $90 and will be increasing to close to $100 with the billing schedule increases. You also get compensated for placing people on mental health forms ($130 for a form 1 and around $100 for a form 3 from what I call) which can be billed in addition to psychiatric care units. If you did all your charting while the patient is in front of you, kept all follow-ups to 20 mins and did some form renewals along the way you could make like make $330+/hour, but in practically, the reality of making anywhere near this amount is low. Additionally, anything that doesn't involve a patient sitting in front of you (team rounds, etc) is generally not paid. There are some billing codes for team rounding but I don't think they're very lucrative and I think that a lot of psychiatrists don't bother with them.
  14. BigM

    .

    Just briefly glancing over the psychiatry billing codes, saying that they are double what Ontario pays wouldn't be far off.
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