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GrouchoMarx

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  1. i am no legal expert but AFAIK wage clawback is not allowed. an employer cannot renege on wages paid to an employee.
  2. there sa lot of talk about histology being only marginally useful, but at least it is. the jvp is voodoo
  3. I'm also a resident. guess how many JVPs I've seen in the last three years? or how many babies I've delivered since medical school? or how many bones I've set? that logic goes both ways.
  4. what do you suppose we do instead?
  5. ditto with path. "the field cant recruit good students because of a bad job market and pay structure? lets fill the gaps with unqualified IMGs instead." said some policy idiot somewhere. meanwhile we have a bunch of errors.
  6. I disagree. the practical points of medicine have science underpinnings. i have found that knowledge of the basic science of medicine has augmented my clinical skill imo. knowing the why is what separates us from the midlevel provider. if we are just doers, and not knowers, then other doers will try to do too.
  7. oh, dont get me wrong, there are some really strong CMG residents in pathology. yet the notion persists that a CMG in pathology = someone who didnt match and had to backup and is therefore seen as tainted, or some sort of incel here is how my email correspondence to the PD went GM: Dear bla bla bla, I am interested in your field and am wondering if you would be able to inform me if an opportunity exists for transfer, and what steps I should take if one is available. Signed GM pathology PGYx PD: Dear GM. Sorry, there are no transfer opportunities. I have wondered if it was just a hard year but I have spoken to other transfer residents and the PD will at least ask for the CV, or arrange a meeting or something. I have never seen a path resident switch into anything competitive. same goes for psych, and family is very rare. the hierarchy of fields is real and path is at the dead bottom. the problem is compounded by an overreliance on IMG recruitment. lots of IMGs in path should not be in medicine at all, IMO. poor communication skills and questionable medical knowledge combined with a stubborn misguided faith in it. not all, but there are more than is acceptable.
  8. it's not that easy. rmorelan mentioned a lot of the hang-ups. once you make your intention known to your pd, its not certain how they will react to it. if the transfer gets blocked somehow, youll have a black mark on you for the rest of your residency. once you do path your electives are basically all path outside of PGY1 which are core rotations more or less assigned to you without much flexibility. I have a lot of ward experience, of course, but little experience in the discipline I'm interested in. family i have seen but im not interested in family. It also doesn't help that path is looked upon poorly by this particular program. I cant blame them really. but it makes it impossible to stand out because youre assumed to be low-quality from the get-go and are afforded no opportunities to prove otherwise due to rigid pgy1 requirements and a home-program-centric residency. unlike many other fields, path doesnt see a lot of anyone else besides the occasional surgery resident for frozens. even then its just the nurse you see most of the time.
  9. I wouldve loved an objective measurement of skill, because then maybe the programs ive tried to transfer to would believe im capable of their curricula instead of just assuming that because im in path im the medical school equivalent of an incel
  10. focusing on the 'greater good' ideal of how medical care should be delivered always ends in frustration and creates more problems than it solves. supporting NPs will only weaken MDs. i recall a study that showed that fewer than half of NPs could pass a dumbed down version of the USMLE step 3. in contrast, basically all doctors who take it pass. there is certainly the argument that NPs cannot practice medicine as they do not have the theoretical underpinnings required for it. the studies quoted by ralk may be biased, either through involvement by nursing organizations, large facilities that want to cheap out, or doctors that profit from running multiple NPs at once. its hard for me to trust those studies, even in tandem, and even with their clinical trial structure. even if you do believe that an NP can run easy cases, and even if you do believe that the above studies are legitimate, the definite possibility of the unexpected complex case being misdiagnosed or mismanaged by NPs is still possible, given the stochastic nature of these events. in those cases, and I cannot think of a study design that could answer the question, one has to assume which professional would be more likely to get it right. The MD or the NP. 10 times out of 10 I would bet on the MD. From a policy analysis point of view, sure, that one case is worth the potential cost savings of having NPs. But from that one patient's point of view it is not. we have a duty to uphold the standards of our profession. allowing NPs to practice our profession, which is what they are doing despite them calling it something different, is our failure.
  11. when the human resource is a fixed variable you can either increase the reward to obtain said resource, or lower the standards of recruitment for the service. the latter is always cheaper on the front end. we'll see what the govt goes with
  12. would rotating rosters of workers be sufficient in industries that require long term presence, such as farming? month on, month off sort of deal?
  13. i dont think anything can be done. rural living is a vestige of the pre-industrial era. the sprawling distance between our small towns is the result of historically cheap gas and expensive airfare. now that its become vice versa there are few reasons for anyone to want to move to a rural location but plenty to make them want to leave. cities are expensive. rural life does not provide the opportunities for people to gain the capital to make the move. rural skills are not transferable to city life. nobody cares if youre a farmer on bay street. nobody cares if youre a logging roughneck in the arts district. these people are stuck there. canadian small towns are torture. isolation, xenophobia, cold weather. i lived in a few and counted the days until i could leave each time. the way our parliamentary system is set up, these rural outposts have a disproportionate amount of voting power. hence they want doctors, so the government tries to figure out ways to entice/strongarm doctors there. id much rather see the money go towards subsidizing these people to move to the city, and the companies can just fly out the workers when theyre needed like they do out in the oil sands. otherwise i dread that the future of our political system will become feudalist, with wealthy city-states and sprawling fiefdoms.
  14. I agree. Derm is incredibly fascinating when you learn it the right way. the right way involves knowing the pathophysiologic basis of medicine and disease. canadian med schools teach students what to do, and how to do it, but rarely why. this focus on the practical over the fundamental core sciences is a huge weak spot in our medical education system. we put the cart before the horse. in the USA the sciences are heavily emphasized. step 1, which is their science exam, is the benchmark by which residency applicants are measured against each other. canadian students should study for and take step 1, even if only to cement the basic science underpinnings of medical practice.
  15. I'm not impressed. ROS are ineffective. For one, they're temporary so you get a revolving door. If the government was truly concerned about remote, terrible places having medical care, they'd pay the care providers a huge premium to stay. Another problem is as mentioned above the government slashed these spots recently. Bringing them back with an ROS attached is a shitty bait-and-switch tactic to help get some votes during election time. evidence dictates that ROS programs dont work. People leave early, buy out, just ignore the buy out, or find other ways of not staying there for too long. finally i wonder if anyone has challenged the ROS in court. i wonder if youd actually have to pay back an ROS since the money is tied to a salary you get as a resident, and employers cannot recover salaries theyve already paid to employees. so in essence, much of the ROS$ is untouchable once paid to the resident. But IANAL...
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