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Everything posted by GrouchoMarx

  1. Lab fields are limited to what the govt is willing to fund. High demand does not translate to increased supply. Similar to the OR time situation in surgery
  2. GrouchoMarx

    First Aid, Pathoma

    Don't forget uworld
  3. GrouchoMarx

    First Aid, Pathoma

  4. Bad job market + professionally limited for the first two. Terrible exam pass rate + lukewarm job market mostly limited to Western canada + professionally limited for gp.
  5. GrouchoMarx

    Employment opportunities of specialties

    Here's an interesting story about pathologists wanting to get paid fair value, and health authorities balking at the idea. http://publications.gov.sk.ca/documents/13/105162-Dr-Kirk-Ready-v-Saskatoon-RHA-August-3-2012.pdf TLDR: SK had a massive backlog of cases. Dr Ready offered to work through the backlog if he could bill for them. The health authority refused to pay for it. Ready vindictively pointed out the head of the lab as a non-physician, which was against the books, and caused media scrutiny. Health authority fired Ready. Here is a historical take on the dismantling of the Ontario laboratory sector in the nineties. https://ir.library.dc-uoit.ca/bitstream/10155/360/1/Bourne_Lavern.pdf TLDR: govt prohibited billing away from pathologists in hospitals. tried it with radiology but they fought back hard and won. a few northern pathologists sued the government and won the verdict, but the government just started paying $0 for hospital based lab services. the northern pathologists, for whatever reason, ceased legally pursuing this (though i think that if they kept at it they would have been successful as $0 is not fair value for services). Here is the prospectus of the ontario association of pathologists 2018 annual general meeting: https://ontariopathologists.org/ontario-pathologists/wp-content/uploads/2017/03/OAP-Program-Final.pdf Note pathologist "workload", which means that there has been a 10% compounded increase in specimen volume (Aka patients seen) over the last decade, and an unmeasured but subjectively significant increase in complexity (receptor testing and other histologic features that were once only curiosities) without an increase in income or available positions. This is a big problem everywhere and nothing has been done to correct it in over 20 years. Our representatives have decided it is worth talking about for FIFTEEN MINUTES. Meanwhile the government organizations CCO and QMPLS have 2.5 hours devoted to their edicts where they come to pathologists and tell us what synoptic reports we have to fill out, and other such quality-metric bullshit. The specialty is not in control of itself. Poor political situation = think twice.
  6. GrouchoMarx

    Employment opportunities of specialties

    there are a very limited number of positions. those that have them never relinquish them.
  7. GrouchoMarx

    Employment opportunities of specialties

    AFAIK its still a requirement that one pt gets one anesthesiologist in Canada. In the USA its 4 nps on 4 pts to one anesthesiologist
  8. GrouchoMarx

    Employment opportunities of specialties

    Yes. This is almost always a disadvantage
  9. GrouchoMarx

    Employment opportunities of specialties

    It doesn't apply to them, but very few pathologists work at those labs. Most are hospital based. So for all intents and purposes, pathologists can't bill OHIP for their work.
  10. GrouchoMarx

    Employment opportunities of specialties

    Pathologists are prohibited from billing OHIP. That's the crux of it.
  11. GrouchoMarx

    Switching out of Rural Fm

    I'd finish your FM residency. Work one year and then reapply for reentry through the Ontario program. Concurrently I would take the USMLE examinations and apply to the states as a backup. Although you do enjoy acute care medicine, and Rural medicine does have a lot of that, it's not hyper specialized and you'll feel like you're flying by the seat of your pants most of the time, due to the lack of backup. I also figure that you will find small town life boring, considering your rural Family Medicine residency is not shaping up for you.
  12. GrouchoMarx

    I'm done

    A person in my class failed a clerkship rotation and still got into a competitive specialty in Toronto of all places. First year grades don't really count for anything. Get to know the right people too. Don't give up just yet.
  13. GrouchoMarx

    Employment opportunities of specialties

    1. Most all but in terms of pathology, basically only gp is recognized in the USA. Most practices require that the pathologist to be able to run the clinical lab in addition to doing anatomical pathology duties. It's not like that in Canada. However, our Royal College pass rate for General pathology is very low, so entering General pathology is risky. 2. True. 3. I can't speak for cardiac, but Plastics and Ortho I think are equivalent. If this is what you like to do then going in with that mindset is appropriate, but there are more important considerations about the nature of the work than the job market. all of those residencies are brutal. 4. That's true, and your second point is as well. 5. It depends on the subspecialty for internal. For instance Nephrology has a very poor job market because the Old Guard does not want to relinquish their positions in dialysis centers. Or as the FM plus one for emergency medicine is very flexible aside from some academic emergency medicine departments. I recall there being FM plus ones working at St Michaels in Toronto, but that might not be the case now. 6. I don't know how to answer these ones. You should explore Psychiatry, Dermatology, Radiology, anesthesiology, and Ophthalmology. If I had my day over again I would do that. I'm sad I can't recommend pathology because of the current state of the job market and political situation in the field.
  14. Uoft is the best school for this as they are heavily funded
  15. Its not surprising how people assume there are redflags if someone can't transfer, but it is lamentable. We dont know her story. We do know that she look leave, maybe for mental health. That leave got her blacklisted. A reaction like that does nothing to advance the cause of physician wellness, in fact it does the opposite. The smaller the school, the bigger the old boys club. Maybe that's part of it too. Without any objective measure of skill there is no way to determine who is cut out for what. If she was such a bad doctor why did dal graduate her? Im tired of the inflexible system. We should be arguing for complete flexibility. Instead, true to form, we shoot ourselves in the foot being concerned about macro issues we have no domain over. If a doc is competent to graduate they should be assumed competent for any field, including rural ramily med
  16. the greed displayed by some specialties reflects poorly on the profession as a whole, which i think is hard to dispute. but i dont think that we should be paid less for our efforts. ones life is the most valuable thing anyone can have and our job is to make sure it is lived as healthily as possible. wouldnt you want the most intelligent and dedicated people to be attracted to a career of such personal weight?
  17. You're not a US grad so you would need at least steps 1 and 2CS and CK. Id recommend finishing 3 too because then you would be eligible for H1B visas.
  18. Yes, you can. I encourage it.
  19. i am no legal expert but AFAIK wage clawback is not allowed. an employer cannot renege on wages paid to an employee.
  20. there sa lot of talk about histology being only marginally useful, but at least it is. the jvp is voodoo
  21. 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.
  22. what do you suppose we do instead?
  23. 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.
  24. 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.