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BigM last won the day on October 26 2018

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About BigM

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  1. Yes. In general, the more you do research or teaching instead of seeing patients, the less you will make. It's not an absolute as some people pull in big pharma $$$ but it's a general rule for most situations.
  2. Being a resident doesn’t mean that you aren’t experiencing those 5 years. In fact, the experiences you have during those 5 years will be in an entire league altogether from most of your age-matched non-medical friends. It will include both ups and downs likely fairly extreme on both ends. Maintaining a life outside of residency should be doable for all residents, it will be much easier to do in some specialties than others, but regardless, you’re not going to be working ALL the time. So don’t skimp on the small costs that would make a rough day a bit better. At some point you may be an attending waking up to a pager going off thinking that you would be glad to forego making hundreds of dollars/hour on call just to curl back into bed.
  3. It's very dependent on the person. I ended up having two kids during residency and my spouse is stay-at-home with them. Because of this my debt has grown over the course of residency. Ever year you get a raise of $3000 - 5000 which makes it easier to balance the spreadsheet. However, your royal college exams and licensing applications cost in the range of $10,000. You want to strike a balance between not frivolously spending on things that don't had much to Quality of Life (since you will need to pay back about 130% of this amount later) and also getting a reasonable amount of enjoyment out of your non-working/non-studying hours. If you are doing a 5 year residency, that's 5 years of your prime invested. When you finish up and look back, those years are gone and they aren't coming back. Your life may also look very different when you are done (family, dependents, more responsibilities) and you may not have many of the opportunities to spend the money even if you have it.
  4. It's essentially a non-profit plan. The company that provides the insurance (Sunlife I believe) gets enough to cover the costs of running the plan + a certain amount of profit. The excess paid by members is refunded back and split among everyone paying into the plan.
  5. This is based on a small number of online opinions that I read. There were a couple of people who indicated that RBC was difficult to deal with when they needed to use the policy. Additionally, a few people said that OMA (Sunlife I believe) was very straight forward and cooperative. I opted to go with RBC as an M4 and haven't changed it since. The numerous talks from insurance brokers was likely a factor in this, and looking back, conflicts of interest were likely involved on their behalf. They get paid if you go with the RBC plan, they don't if you go OMA. I can't say for certain what I would go with now if I were to re-choose, but I'm probably siding towards OMA. One thing to keep in mind is that over the past few years the rebates on the OMA disability insurance has been lower as the usage of the policies for disability leaves has been increasing.
  6. It's definitely worth considering the opinions of others, but at the end of the day the decision is yours. There are individuals of varied personalities that go into all speciality areas, but there's often at least a bit of truth to stereotypes. People who have spent many years in medicine will have had the opportunity to meet people in various medical fields and have likely concluded that some personality characteristics are more commonly seen in particular fields or area conducive to certain areas. My area is psychiatry and I can say that there is an extremely varied range of personalities. It's one of the biggest specialty areas, both in scope and in number of practitioners, which are likely factors. More and more, people who are very academically focused and research based are going into psychiatry. Our capacity to study the brain is exploding and this will be one of the most exciting areas for research growth in coming decades. Then there's people in psychiatry who like to do things the old school way, these people might be more likely to do things like psychoanalysis. If you're curious about your fit for a field then it's best to spend time there, especially early on. If you're interested in seeing if you might be a fit for psychiatry then I would recommend seeing a few different areas of it (emerg department, on-call, outpatient, child and adolescent, neuropsychiatry, etc).
  7. BigM

    OHIP Billing

    Of course they were smart and made it a global reduction of all your billing amounts rather than making the clawbacks kick in at a certain threshold or by targeting specific billing codes (they did this to a point). If either of those were done, physicians would have just scaled back their services as the incentive to work hard has changed. However, most doctors don't want to make less money, especially in the face of all their overhead costs going up, so many will opt to provide more service to try to compensate for the lower rates. Either way its a win for the government, save more $$$ or get more care for a similar amount. However, the ethics of the move are a bit questionable and my understanding is that the arbitrator has the power to make the government back pay all of that money. It's probably an unlikely outcome, but is likely on the table as a possibility.
  8. BigM

    OHIP Billing

    Yes, there has been an across the board cut of 7%.
  9. It’s interesting to see the announcement of the Ontario Specialists Association’s board of directors which is “representing a broad range of specialties”. Two radiologists, a gastroenterologist, a cardiologist, a nephrologist, an eye surgeon, a vascular surgeon and an emerg doc. Is this a group that looks like they are going to defend the status quo?
  10. That’s one of the difficulties of the situation. As someone in one of the lower paid specialties (psychiatry, a 0.86 based on CANDI score) why would I want to support a group that I suspect wants to maintain the status quo of having such significant disparities in pay between different medical specialties? I certainly wouldn’t feel that a specialty interest group would see the interests of my specialty as being a priority despite the fact that we are one of the largest based on numbers. The group being formed by a radiologist makes me suspect the intentions of this right from the get-go. This current malignant environment has existed between the MOHLTC and Ontario physicians for at least the past 8 years (I was a pre-clerk when our previous contract ended and things started to escalate in ugliness between the OMA and MOHLTC). It’s been very difficult to have any meaningful decision about rebalancing/realitivity for this exact reason, when the OMA finally started to talk about making concrete changes based on realitivity, it caused splinters within groups of doctors which now weakens our overall bargining power. It’s also an understanding of mine that the grassroots organization Concerned Doctors Ontario was largely funded by and driven by the high paid specialties. Unfortunately at the end of the day money usually talks louder than everything else. We like to consider our physicians at large to be much more altruistic than we are. Especially coming from a speciality which is often treated with hostility and disrespect (at least at academic centres, but I also suspect in the community setting to a lesser degree) from other medical specialties, it makes it a bit harder to find a lot of sympathy for some of these groups being targeted by realitivity changes. I really don’t feel that the current remuneration is reflective of the hours worked and responsibility that some specialties have. One group in particular that I do feel bad for is pediatrics. IMO they are certainly undervalued financially (compared to other physicians at least) for the responsibility that they carry.
  11. I agree with what other people say above. However, I should preface this by saying I'm not in surgery and didn't have much interest in that path. At the end of the day, attitude is more important than achievement. That said, some of the people who are quite accomplished are so because they have great attitudes and strong work ethic. However, A good portion of the people that have graduate degrees in your program likely did so because they were unsure of what they wanted to do next after their undergrad or they didn't feel that they were competitive enough for medical school admissions directly after undergrad. The more difficult part is going to be looking more competitive on paper than these individuals. If you're serious about being more competitive than them, start early and be keen. In person time and electives are going to be your opportunity to shine. Your first couple of years of medical school are a great opportunity to do observerships and to start meeting some people in the field. It's also going to give you some exposure to help answer one of the most important questions, is a surgery career really what you want with your life?
  12. I’m not aware of any hidden agenda. One thing that it’s good to be mindful of is that the end of each residency year will be moved back by the amount of time you take off. I.e if you take 1 month of paternity leave in PGY3 then your PGY4 year won’t start until the end of July (vs July 1st), likewise for PGY5. This matters as you won’t move up on the salary scale every year until a month after your classmates.
  13. PGY5 is a year of electives if you opt not to do a sub specialty. So you can basically make what you want of it. You can do outpatient care and maintain a fairly steady 8-4 with call shifts being in addition to that, or you can opt for a busier service if you want. The thing to keep in mind is that this is generally your last year before independent practice so you need to see enough and do enough that you feel comfortable being the MRP. Personally I have opted to focus more on learning around my cases and reading topics of interest rather than following more traditional routes of exam preparation. What is the most yield info for exam purposes is often not the same high yield info for clinical practice. The pass rates for royal college exams are also very high, I believe in psychiatry it is over 99% for Canadian grads. As I get closer to the exam I will likely get spooked and spend more time practicing old exam questions, etc, but right now I am able to remain fairly confident that I can focused on learning the most clinically useful stuff and still do okay on the exams.
  14. I’m a PGY5 psych resident. My undergrad contained all of one 1st year course in psychology. Psychiatry and psychology are in many ways different. As a psychiatrist you will learn the theoretical backbone of different psychological models, but unless you do work is focused on psychotherapy (which isn’t the case for most psychiatrists), most of your work will include taking a history, reviewing symptoms and discussing medications, I.e. practicing medicine. However, your knowledge of psychology will help you understand/formulate patients, explain things to them and work alongside other health care workers who primarily provide therapy. The requirements for neuro knowledge depend on what you do in your practice. Neuropsych obviously needs a lot of neuro knowledge. Likewise, geriatric psychiatry and consultation-liaison also require you to have a good working knowledge of neurology. In general, child and adolescent involves much less neurology and general medicine.
  15. My understanding is that it doesn't require going through CaRMs but does generally require a space in the program you want to match to being available and an agreement from the program directors of both programs. Having matched to ENT you have 5 years of funding that was allocated to your postgrad training which apparently results in less of a barrier than switching from family medicine to a 5 year program.