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Everything posted by ellorie

  1. Psychiatry makes it very possible to work part time if you're in private practice/in the community. Might have a bit more trouble getting hired for an academic job, though it's not totally impossible, especially if you want to start full time and then potentially drop down to part time later in your career.
  2. Psych is 5 years and it's not hard to get some sort of academic job in Toronto with just the 5 years. I'm pretty sure everyone in my cohort who wanted an academic job got one, though not everybody got exactly the hospital/area they wanted. Even the community hospitals were popular and competitive. CAMH hired very broadly (due to expansion of various programs), but the other central hospitals I think were also competitive. I got hired generally in my areas of interest but had to be a bit flexible about specific clinics and distribution of days. If you want to do one of the RC subspecialties (child, geri, forensics) it's 6 with the fellowship. There are a few non-RC fellowships in psych that are becoming more common - particularly CL - but you can still get a CL job without a CL fellowship I think (I have no interest in CL so never really looked into it).
  3. It depends - the CPSO will ask for more information, usually in the form of a doctor's report and depending on what they get will sometimes kick your licensing application to the registration committee for more review rather than rubber stamping it. There can be some licensing delays due to waiting for the committee to meet, but if you submit your paperwork ASAP and are on top of the documentation, it's usually manageable. Some people end up being monitored/needing to submit regular reports for a while. It stays in your CPSO file that that happened. Ultimately it can make things more complicated but people do get licensed and have careers just fine, and eventually if you demonstrate that you're stable and doing what you need to do, they get bored of keeping an eye on you and leave you alone. The biggest issue I would be concerned about would be CaRMS rather than licensing - but people do match just fine after leaves. The thing that causes you more trouble is if you wait and don't take a leave you need, then get more ill and end up in an even worse condition. In the end, you do what you need to do for your health, you'll face some stigma from the College and some extra annoyances, but from a licensing perspective it's manageable. The best thing you can do as a doctor is attend to your own health. Better to deal with the consequences of a leave than the consequences of untreated illness followed by a leave anyway when you're totally incapacitated.
  4. Almost all psychiatrists train in psychodynamic psychotherapy to some degree during residency, and I imagine we are providing the vast majority of MD psychotherapy. Clinical psychologists don't all train in psychodynamic either. I also doubt that many clinical psychologists would want to drop down to OHIP rates given what they can make in private practice - they won't be any more affordable than we are. I think there is far too much of a push away from individual psychotherapy towards group and far too much emphasis on CBT as a panacea for mental illness. I really don't want to see any more involvement from the MOH in determining who needs what type of therapy, because I think the current trend in psychiatry is moving away from what our most complex, impaired patients actually need. If we are doing supportive therapy, most of us are doing it with complex, traumatized, marginalized, polydiagnostic individuals who need that level of care. Also, most of the patients I see are sick of groups and want individual.
  5. The proposed cap was intended to be per patient per year. There is a lot of opposition and it has not happened as of yet - hopefully we can continue to hold it off.
  6. My experience has been that mentorship works best when it evolves naturally - my biggest mentors in medical school and residency have been supervisors that I formed a bond with during our clinical experiences together, and those conversations sort of happened naturally in between patients or over coffee or at the end of the day or in supervision meetings, and then kept happening even after we stopped working together. A great way of achieving that is through electives and core rotations (or shadowing if/when that's an option again) - just keeping an eye out for supervisors that seem friendly and interested in teaching and working on forming that relationship in bits and pieces when you happen to get a few moments with them. A great time in clerkship can be when you get your end of rotation feedback, because that's a time when you organically get one on one time that's set aside just for you, and you can say that you're interested in the field, and ask a couple of questions. If they're willing to talk more later, they'll probably make the offer themselves, and if not, then you've still gotten some questions answered. The nice thing about this approach is that it doesn't put anyone on the spot, and a few minutes is easier to find than setting aside an hour for a formal meeting. This can be either staff or residents - residents can be great mentors, especially middle to senior ones who have a good sense of what the field is like and are close enough to medical school themselves to be motivated to help you out. If you have specific questions for a particular person (i.e. more than things like "what do you like about X specialty" or "what is the day-to-day work like"), I could see sending an email saying you are really interested in learning more about X specific thing, you know that they do X thing, and you are wondering if they would be willing to answer some questions or point you in the direction of someone who can. I would probably put the questions in the email in that case. Another way if you really feel like you want to actively find someone to talk with, might be to talk to someone who is actually involved in education - for example, the clerkship coordinator or education coordinator for the specialty, share your interests, and ask if they can connect you with someone who might be able to answer some questions - when I've done this, I've found that being connected through another physician often seems less random, and those people often know who is willing to field those types of requests. Or attending interest group meetings and contacting the speaker afterwards. But again, I've found that the informal approach via clinical experiences has worked better for me - just keeping an eye out on rotations and building the relationships naturally. I've had a few occasions where I've been "assigned" a mentor and it's rarely worked out - it always seems to end up feeling sort of forced and random. Also, when someone sees your clinical work and sees that you are hard working and genuinely interested, they become more invested in helping you.
  7. Overhead is basically just anything you need to buy or rent to keep your practice going - ranging from office space to equipment to staff to materials. Overhead varies a lot by specialty because different specialties require different amounts of equipment and space to run. If you work in the community you typically need to pay for those things yourself. If you work in a hospital, much of it is likely provided for you so you don’t need to buy it yourself. If you are part time in the community and part time in hospital, you’d likely need to pay for those things that you use in your community office but have things provided while you are at the hospital. However some hospitals will take a percentage of your billings as overhead, and the percentage varies from hospital to hospital. I work in a hospital and am not salaried - I make a stipend per half day worked plus what I bill minus some fees charged by the hospital including a percentage for overhead, but it’s a quite low percentage of my billings. Certainly lower overhead than I’d pay if I had to rent an office and do it all myself, as they provide space, admin support, EMR, office supplies, and all sorts of other things I’m sure I’m not thinking of because I don’t have to buy them myself.
  8. Helps if you stash all your call stipends into a savings account. That savings account pretty neatly covered my Royal College/CPSO application/other final year expenses.
  9. Depends what you mean by "decent lifestyle". I did not use my LOC at all during residency and in fact steadily paid down about 30k while living alone in Toronto. If you are not supporting any dependents and live relatively frugally it's pretty fine. We make decent money. If you are supporting kids or a partner who does not work, maybe more dicey.
  10. It depends what you mean by "safe". Your confidentiality should be kept either way, whether it's associated with your school or not - but certainly you have more privacy seeing someone not on campus - less risk of e.g. running into another student in the waiting room. However if what you're asking is about licensing, then you're the one who has to answer any questions on the licensing application about past diagnoses - so it doesn't matter where you were seen, because you are expected to answer the question honestly no matter where your records are. However, mostly they ask about medical conditions with the potential to impact your ability to practice medicine, so most people who seek counselling can get away with saying no. However, you may want to make sure your disability insurance and any other insurance policies are squared away first, because some do ask if you've ever sought counselling, and you don't want to be lying on your insurance applications.
  11. So many reasons I became a psychiatrist. Out by 10 am post call, and that only because we hand over at 8:30 or 9 like merciful people who like to not show up to work at the crack of dawn.
  12. It's hard enough to assess violence risk in psychiatry when we spend a lot of time with people and often know them well - I can't imagine the difficulties of trying to accurately predict risk in a WIC environment when you don't have much time or much information. The best you can do is never let anybody get between you and the door, look for red flags when you can, leave the room at the first sign of agitation, be aware of potential weapons in your environment, and have some sort of protocol for how to call for help - but without trained help available to call on, by the time anybody gets to you, as in a case like this it's likely already too late. This doc could have done everything right for all we know - sometimes if someone's determined to get you, they just will no matter what you do. Truly, most violence is not due to psychosis, and I would hesitate to interchange the two. There are some messed up, violent people out there, and unfortunately once someone takes it into their head to do something like this, sometimes it's not predictable or preventable with the kinds of resources that we have in the community or even in hospitals. At the hospital where I did call, we would not infrequently have to call SWAT to come in and disarm people because even our security wasn't going to tangle with it. Not like every week or anything, but it was a known thing that happened a couple times a year. Awful for this poor doc and their family. And for everyone involved. Collective trauma for the whole community.
  13. There can be a big mental health component to chronic pain - and for some people who experience chronic pain or any other chronic physical symptom, it's really difficult/impossible to accept that there may not be a "medical" diagnosis/explanation or cure, so people continue to request demand more tests and more treatments (e.g. opioids) that are not really clinically indicated, and this can be a point of major polarization. In many cases, we feel it might be most helpful for people to accept that pain is likely to be part of their life going forward, that there may never be a clear medical diagnosis that can be "fixed" and that it may be important to do things like rehabilitation, engaging in daily activities as best as possible, trying to get back to work, and working on addressing ways of thinking about and interpreting pain, whereas some people may experience that as invalidating and continue to request/demand that a solution be found to the point of being unwilling to engage in any other kind of approach. Also high comorbidity with various mental illnesses, and many non-psychiatrists don't always enjoy working with people with things like personality disorders or trauma or somatoform disorders or substance use disorder or things like that because it isn't always really imminently fixable and it tends to create difficulties building and maintaining a therapeutic alliance, leading to anger, lots of emotion on both sides, etc. Many doctors also struggle with treating patients with problems that can't be fixed, because for some people, that doesn't feel as satisfying and can feel pretty frustrating. Others are ok with it - it's just a personality thing about what we derive value from in our work. That would be my best guess - I don't work in pain but I do see a bunch of these folks from the other side.
  14. Potentially. You can also see if your school would accept a quantiferon but you might need to pay for it out of pocket.
  15. People are not obligated to tell you "nicely" when they are asking you to look at your own racism. When somebody tells you to look at your own racism, you are obligated to swallow the instinctive urge to deny it and really take a good hard look at yourself. Even if it's painful and doesn't line up with your own self-concept. Tone policing is yet another form of violence that is rooted in privilege. Even those of us who do not see ourselves as consciously believing that Black people are inferior still a) benefit from living in a society that is systemically racist and b) are steeped in that normalized racism such that even "good people" can believe, say, and do racist things without meaning to. I also don't understand how it is possible to argue that Black students are not systemically disadvantaged in Canada today. If that is true, how do you explain the underrepresentation of Black people in the medical profession? It can't be purely moderated by SES without any interaction between race, racism, and SES - otherwise you wouldn't see the racial disparity. SES is absolutely also important and we should be supporting low SES applicants as well - but that does not directly address systemic racism, which is in fact still alive and well in Canada.
  16. I didn't have any research at all and I ended up with 3 Ontario acceptances including U of T. Although that was 10 years ago now (yikes!) so my experience might no longer be relevant.
  17. Some staff are also honestly just really really picky and need things "their way" to feel comfortable signing it off. So you don't always need to take it too much to heart. When I correct clerks' notes, if I make changes it's often related to considerations that I don't expect them to know about yet - e.g. I make a lot of corrections and additions based on addressing medicolegal risk. I document very defensively, especially in the ED, and while I teach the clerks why I am doing what I'm doing, I don't really expect them to have the language for that yet. In my specialty there is also just very specific language around things like consent, capacity, and risk - certain words or phrases that need to be used in a very particular way, whereas if it's not your specialty you might never need to know that. I remember when I was a clerk on paeds ED I thought a kid's belly looked a bit round so I wrote "distended" on my note and I got absolutely reamed by the staff because apparently that meant something very specific and pathognomic to her, but I just didn't know. You could definitely ask your staff if s/he has any overall feedback for you about what to work on next - it can be hard to just see their changes and distill it down to how you need to change your approach. Often with clerks it's about some combination of getting more concise (excluding details that are irrelevant to the audience and including everything that is important) and using certain specialty-specific language/phrases that convey certain things. But really the reason our training is so long is that it really does take time. If a clerk were ready to function at the level of a staff, there would really be no point in any of the rest of it. So I wouldn't interpret it to mean that they're displeased with you as a clerk or that there's something wrong with your performance.
  18. How's everybody feeling, aside from all of the exam drama? It feels completely surreal to me! I've been a resident longer than I've been anything/anywhere else in my adult life, so even though I'm staying at the same hospital it's still a bit bizarre. However - CONGRATS everybody!
  19. Oh I don't know, I don't go to UBC - I was just reacting to @PlantZaddy's post.
  20. I think it's like - even in weeks or rotations that are really demoralizing, there are bright spots that remind you why you're doing it. Times where you really helped someone, or made a cool diagnosis, or learned something that really made you feel intellectually stimulated, or had a bonding moment with a colleague. And I think you sort of hang on to that stuff rather than focusing on the shitty supervisors or sleep deprivation or the patients who treat you horribly. And then you just take it one moment or day or block or year at a time, and go on living your life around it as best as you can. I think I've also sort of learned to ration how much I give a shit about things, and what things are worth giving a shit about. You can't take everything to heart or you'll lose it. When I used to care about what every supervisor thought about me, it felt kind of impossible. I also still care very much about my patients individually but I've learned to divorce my morale/self worth from the outcome, a bit, and instead focus on the care I provide rather than feeling like I've failed if patient or environment factors still result in things going wrong. When I'm feeling burned out and have limited resources I try to be very conscious about maximizing them and focusing them where they do the most good.
  21. I think it varies by province - in ON we get 4 weeks, 7 conference days, a floating holiday, and then 5 consecutive days for Christmas/New Year (you get one of the two off). TBH I get through it by reminding myself that all over the world, people have jobs where they work horrifying hours for terrible pay basically indefinitely and get much less respect/appreciation than we do. Like long haul truck drivers. I would way rather be a resident than do that.
  22. Well this whole thread sure is a blast from the past (and my adolescent coming out experiences). Kinda sad to hear that 12 years hasn't improved all that much - except that I think it's been a long time since anyone actually called anyone a homosexual. Happy Pride.
  23. Not really, I just had to do it, because what other option is there? You try to continue with as much of whatever hobbies or activities you find replenishing as you can, and catch up on sleep when the opportunity presents itself. Take your vacation regularly - I'm not a fan of saving it all for huge vacations that come very rarely but some people find it better to do it that way. I try to take a week about every 2 months to recuperate. I wouldn't say we are coping great, but what can you do? We are all absolutely powerless over the Royal College - they do what they want and we are just kind of scrambling to transition to practice while also preparing again for the exam. One day at a time.
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