Jump to content
Premed 101 Forums


  • Content Count

  • Joined

  • Last visited

  • Days Won


BigM last won the day on October 26 2018

BigM had the most liked content!

About BigM

  • Rank
    Senior Member

Recent Profile Visitors

The recent visitors block is disabled and is not being shown to other users.

  1. Just briefly glancing over the psychiatry billing codes, saying that they are double what Ontario pays wouldn't be far off.
  2. I'm a former Schulich graduate, now a consultant, I'm not involved with teaching or curriculum at Schlich. Your feelings on this are entirely valid and much closer to being the norm rather than an oddity. Going through medical school is like trying to take a drink from a fire hose. The volume of material you cover is certainly more than can be digested, you will not learn everything, you simply won't. There many things that can be helpful to keep in mind. Failing out of medical school is uncommon. For those who do not get through the program the most common issues are related to unprofessionalism (often this is merely a transient slip of judgement that ends up with unfortunate outcomes rather than being someone who never should have gone into medicine) and mental health issues, rather than inability to pass based on academic capacity alone. Unfortunately some people are the victim of medical concerns (mental, physical, somatic, all the same in the end) that develop or just bad luck. Overall this occurring to the degree that you don't make it through isn't common, but be careful not to jump to conclusions too quickly about your colleagues and their struggles. As far as the material, you need to do well enough to get through, there's no way around that unfortunately. From what I have read here it seems that the expectations have increased compared to what they used to be. The IL content was always heavy. Upper years will generally minimize the stresses they went through because they want to seem like there is an olive branch and they have always had more time to develop a sense of what material needs to be prioritized. Classes all morning long in M1 with 2-3 afternoons tied up with group work has been the case for many years). Not that the expectations were ever low by any stretch of the imagination, but there was more room to have a slip and recover from it. As far as the long-term learning is concerned, your M1 and M2 blocks are just the first kick at the can for learning the material. The first blocks are hard, not necessarily because the blocks themselves are brutal, but you don't know much at this time. Every time you do another block your knowledge will grow synergistically. Once you get more blocks under your belt you see how different pieces fit together and will find that overall things make a lot more sense. Although the end of semester exams are a super busy period, I always felt a sense of accomplishment getting to the other side of them as its amazing to see how much better sense the material makes when you get another chance to review it again (with a bit of pressure to motivate you to work hard) and put it in the context of having other blocks under your belt as well. Then after that you will get into clerkship and realize that everything is extremely different compared to what you thought it would be. In the reality of the clinical world things aren't black and white, its not a situation where you are looking for those key few words within a multiple choice question that will make one answer correct rather than another. The reality in the clinical word is that most things are in various shades of grey, a lot of things are done based on it being the norm rather than it being supported by data and things are done drastically different from one person to the next. You will get your hand slapped just because the person supervising you does it one way vs another or just because they are having a particularly bad day. Clerkship and residency are probably more about learning process rather than learning fact. The longer you have been in clinical practice the more you will start to realize just how much we don't know as a medical field. You will also start to realize how much of what you learned in the past you have never used and probably won't use. Your work will become more and more related to acting based on clinical experience, pattern recognition and learning when to act vs when to let something go. You will also get a better idea of what is imminently serious and what is reasonably within your scope vs when to ask for help. This is a long process, it doesn't happen overnight. Most people make it out the other side okay, the chances are very good that you will be among them.
  3. The penalty isn't enormous if you break it, you need to pay the interest that they covered, the interest on the interest and they MAY charge you up to a $4,000 admin fee. I didn't directly ask if they would charge the admin fee if I didn't complete the return of service but the tone of e-mails made me feel it was probably less likely. The interest is at a higher rate than what you'll pay through your LOC but its not ridiculous. If you have a sizable amount of government student loan and think that it's probably that you'll be in Ontario then its a reasonable consideration. The return of service is also pro-rated, if you serve 4 of the 5 years before leaving you only pay back 20% of the interest the government paid.
  4. You can help patients with psychotherapy without getting all Freudian. CBT is a well established modality with a solid research base for many disorders and it makes sense. DBT is a very practical skill set that works and has a growing evidence base for borderline personality disorder as well as other conditions. If you want an opportunity to save lives within psychiatry, learn to become good with trauma therapy for patients with addictions, young people are dying in large numbers from addictions. I suspect I know what institution you are at just based on the description you provided. Also, I would argue against your statement that psychotherapy is all placebo. What can reasonably be said is that many different psychotherapies work about the same and work better than waitlist control. What has been established over and over again is that the therapeutic rapport is a very important common denominator in all therapies. As a patient you are coming in, talking about some things that you normally probably wouldn't discuss to someone who generally cares about you and wants to see you get better. The fact that you are discussing it with a highly educated professional is going to create some placebo effect, but processing difficult emotional content and putting effort into thinking about and working around these problems is a big aspect of it. The reality is that discussing this with a psychiatrist or psychologist wouldn't be entirely different from discussing it with a spiritual leader in that regard. Also keep in mind that what we say isn't always what we actually believe. We all have days where we are frustrated by what we are doing and may say things based on that. I would hope that a psychosis psychiatrist wouldn't truly believe that psychosis was best treated by psychoanalysis. There was a time when that was the case, and that time was also closer to the time that being institutionalized meant there was about a 50% chance that you weren't leaving, ever. SPMI is largely biological and requires biological treatments, everything else is adjunct. Lesser severity illnesses are generally a combination of crappy life circumstances, and to a lesser degree, genetics. In reality there is a very limited amount that we can do to target crappy life circumstances, but society is having higher and higher expectations for us that we can. Unfortunately this is probably a contributing factor (one of many) to why we are trying to use medications to fix problems that are rooted elsewhere.
  5. A lot of psychotherapy is speculation, but that doesn't mean that it doesn't work. Medicine is about pattern recognition. When you work with a lot of patients with personality disorder you pick up on patterns that seem to occur over and over in patients with that diagnosis. With more time, you recognize similarity in early life patterns of patients who go on to develop a particular personality disorder. Formulations are ways to understand these patterns. At the end of the day its just a best guess of linking cause and effect, but that's really no different compared to when we are try to determine the cause of other medical illnesses. There is a lot of bizarre things that have been brought forward in psychological theories that have no real basis. Like many other fields, sometimes people just come up with a theory and are bounce-determined that their understanding of things is right. Sometimes people just want to put things out there to get their name out there. Overall psychotherapy is becoming less and less of a focus of psychiatry. This will continue to be the case as we get a better understanding of the biology of mental illness and more effective treatments to address this. However, psychotherapy is a treatment that by and large patients want, many patients improve with it and access to psychotherapy elsewhere is pretty poor. 50 years ago psychodynamic psychotherapy was really the main treatment that was available for patients, even for inpatients. These days inpatient psychiatry is about assess, stabilize with medications and discharge. This is only becoming more the case as the clinical volumes are increasing rapidly and new psychiatrists are being trained around this model of care. 10 years from now psychotherapy will be even less of a focus of psychiatry residency than it is now. Bigger training programs are in general going to offer better access to psychotherapy training just based on the fact that they have more services available and more expertise.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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).
  12. 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.
  13. Yes, there has been an across the board cut of 7%.
  14. 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?
  15. 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.
  • Create New...