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BigM

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BigM last won the day on October 26 2018

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  1. Yes, it is safe to attend in Canada. Getting into medical school is no easy feat, you often end up going where you get in. As a Canadian resident you're often far better studying in Canada as the cost is significant less than the states. Getting into an Ivey League school and being able to finance that may be an exception. You can do medical school in Canada and residency in the states if you are certain that you want to look at the American job market. However, getting back to Canada after training in the states may be more challenging. For most pre-meds steps #1,2 and 3 are study hard, do well on the MCAT, get into medical school. Everything else is a down the road problem. You're not going to be starving as a physician regardless of where you are. What is going to happen with physician compensation is a guessing game at best. Some of the provinces are getting close to waging all-out war with physicians in contract negotiations right now, but things tend to be cyclical with better pay increases during times of economic boom and bitter relationships during spending crack-downs. If we end up having more private health care emerg in Canada that can have a significant influence on things as well. It's little more than a guess right now.
  2. It’s field dependent. In the community you show up, do your clinical work and that’s largely it. There’s not much pressure to take on additional non-clinical work. The pay is generally better because patient care usually pays better than teaching/admin. The downsides are often higher clinical volumes as there’s less people to spread the work around, less access to other specialities (if you’re at a teaching hospital and a resident is available with every specialty you will likely reach out more), less resources/specialized programs and higher call frequency. At an academic Center these are largely all flipped. You generally get a stipend/AFP but it comes with a lot of strings attached and the renumeration for your time is generally quite a bit lower than with clinical work. You teach medical students which can be enjoyable when they are actually interested, but if they aren’t interested then it slows you down and is more just checking off a box (teaching hours). Residents are generally helpful and become even more so with every year of their training. Overall academic jobs often involve more work, but it’s not always the case.
  3. Yes, you can do niche things. Methadone medicine pays well (it used to pay extremely well). There is a demand for GP psychotherapists as it's one of the limited ways to see a therapist without paying out of pocket, however, it generally won't pay as well as regular clinic as your appointments will be long and the renumeration codes aren't great (they are much better for psychiatrists). There are certainly things which are an option beyond the traditional family doctor role. Some people who don't mind working varied shifts love being surgical assists at a community hospital - comes with practically no paperwork and the surgeon takes most of the liability. Emerg shifts, especially in community hospitals pay well and you are largely done when your shift ends. There's also some other things which may be of interest, e.g. working at a community health clinic, which is a salaried model. The earning potential for these is lower but you get renumerated for time spent doing your admin work and the patient volumes are generally lower.
  4. It's do-able. Psych comes with 5 years of funding so you have the funding aspect on your side. You would need to find a program that a. Has an open spot and b. is willing to take you. One of the other things on your side is that IM is very large program, so the prospects of losing residents from the program and opening up a spot at some point are higher. Do you know any program directors or have any connections you could use? Overall this transfer would likely be one of the easiest ones to make (maybe not as easy as a 5 year specialty to family medicine, but still pretty good). The other question to ask is do you really dislike psychiatry? Psychiatry has a lot of positive aspects (great employment prospects, reasonably good paying, many patients are really grateful, flexibility to work in any work setting you want, controllable work hours). Is it possible that your desire for a field that is more objective is driven by a lack of comfort with your current clinical skills in psychiatry (you're new after all, its to be expected) and boredom caused by your current rotation?
  5. There's certainly risk that comes along with it as that's a good chunk of money. Are you sure you will get through residency (you likely will, but it's not 100%). Are you sure you will get a job in the city you're buying the house in? Your mortgage on this is likely going to be $3500-4000/month with another $1,000/month property tax and hundreds for property insurance. You won't be able to finance that on a resident salary, although you mentioned renting out rooms which would help offset. Even with that, you will need to claim the rental collections as income and it will likely fall really short of paying your mortgage. I can say that I wouldn't have made a choice like this as a PGY1 and I had a working spouse. My spouse bought a house (<$200K) when I was in clerkship and I bought out the rest of the mortgage using my LOC when the 5 year mortgage term ran out (PGY3), so it's not that I didn't take some level of risk with that. But I'm in a field with very good job prospects and have lived in my city for 15 years now. We also sold our house for 250% of what we paid for it 8 years later so it turned out to be an excellent investment, but that was largely a factor of lucky timing. If you do end up using your LOC, make sure you know what the rules are on borrowing. Most lenders will require you to be able to show that you have had the money for at least 90 days so that it doesn't look like you are financing it from your LOC. They ask that you provide at least 3 months of statements showing the money in your chequing/savings account.
  6. As a physician (specialist) who fairly recently started practice, I would really put some consideration into whether or not this the route you want to go. I worked for a couple of years prior to medical school, more because I didn't know what I wanted to do after my undergrad. I don't regret my medical training, and would do it again, but it's was a significant sacrifice. I'm not sure I would have opted for this path looking through the lens that you have somewhat described. While I can't speak to your personal situation, it's not uncommon that people find that medical training prevents them from having the family life they want or spending as much time with their kids as they would like to (often this becomes more of an issue than people realize once they have kids). You may also find that if you combine a physician professional life and having kids that you really don't have any time to enjoy the property you dreamed about or don't have the energy to actually maintain it. If increasing your family income to be able to afford property is a really important thing to you and your partner, give some serious consideration to how this could potentially be done with your current skill sets before kids come into the picture.
  7. I can say that I wouldn't be offended by that. If you used the title doctor but then called me by my first name, I would assume that you probably just had a slip up, but it wouldn't be a big deal. Just make sure to get it right in the next e-mail, or if they reply to your email, send back something saying Thanks Dr. Lastname. You can certainly send another e-mail with a brief apology if it makes you feel better, but I wouldn't lose sleep over this one.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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).
  14. 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).
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