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Mithril

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Mithril last won the day on July 14

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About Mithril

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  1. Labs and imaging should complement your physical exam and history, not the other way around.
  2. Some clinics have portable ECGs. A patient could be having a heart attack in the absence of traditional MI symptoms, sure, but your training should be preparing you to properly evaluate and refer, not evaluate and then refer anyway because you're thinking of the worst case scenario. 85% of chest pain causes in the ER not being threatening is exactly why ERs are swamped. The FP should be able to reasonably differentiate between cardiac and non-cardiac chest pain. Referral to a neurologist can take months. On/off headaches in the absence of any other findings again need proper evaluation. A family doctor should be well equipped to deal with headaches. If red flags are present, then of course more urgent referral and imaging is needed. If you refer everyone out or order every single test to rule out every potential diagnosis you are not doing yourself, the patient, or the system any favours. This is where your differential diagnosis and pre-test probabilities come into play.
  3. Use more open ended questions or even just tell them that whether they answer yes or no does not impact patient care but allows you to come to a proper diagnosis.
  4. Mithril

    Family Medicine Salary

    25 patients per day is quite low. Most of my patients don't take 15 minutes. There are also other incentives like chronic care billing codes, mental health codes, and private form fees.
  5. As mentioned, doesn't affect your residency at all or even your ability to sign prescriptions. Given that you failed by one point it might be worthwhile to see if they will rescore your exam with a passing mark.
  6. IMG failure rate is much higher than CMG rate, even on subsequent attempts.
  7. We had a vacation week built into the week before the LMCC Part 2. I thought it helped doing parts of the physical exam with other people since many times in a real setting you would often do an abbreviated exam and not mention your pertinent positives and negatives aloud obviously.
  8. Mithril

    Lines of Credit

    There shouldn't be any fees. I don't have any fees at least.
  9. Pre-clinical years were a breeze. I had friends and I had family. I barely studied since a lot of the blocks in pre-clinical years were review from undergrad. Clinical years were a nightmare. I rarely saw friends and my family. I lost my identity and sense of self. I felt like a cog in the wheel, like I was slowly being encased by cement. The days blurred together and I woke up every morning numb and devoid of any joy. It was the worst two years of my life. But once I had more skills and knowledge I felt more confident in myself. My family practice residency was a very fun two years and now I thoroughly enjoy (most aspects of) my job.
  10. Most new grads I know do walk-ins or join a multi-physician practice after residency, sometimes in the clinic where they did part of their residency, and most adopt fee-for-service in BC at least.
  11. Mithril

    Clinic overhead/Joining a practice

    30% is the typical overhead amount in BC. Can't speak for other provinces. Some clinics have 30% for just clinic work, while stuff you bill outside of clinic hours or paperwork is usually at a lower overhead percentage, either 10% or even 0%. Some clinics have incentives like no overhead for the first 3 months, or only 20% to 25% overhead. For a clinic with only two doctors, I don't see the need for an office manager. At the clinic I work at, it's three doctors including me, and one of our MOAs double as an office manager along with the doctor who owns the clinic. If you do a lot of procedures then an extra MOA can be helpful with one attending calls and patients, and another uploading labs or investigations into the EMR or getting things ready for procedures. You'll have to see what's better for you since everyone's practice differs slightly. Some practices also have a fixed amount for overhead, and some clinics charge a percentage. You'll have to see what's more financially sound to you, especially on your vacation weeks. For me given that I work in Vancouver, percentage based is pretty much on par with a fixed cost. If you work in less expensive areas then a fixed cost might make more sense to you.
  12. Mithril

    2018 CCFP exam

    SAMPs were OK for me last year. The SOOs are...interesting to say the least. I felt the LMCC Part II in terms of scoring was more indicative of the clinical knowledge that I need for family practice, but now that I have been in full independent practice for nearly a year, I can see the value in the SOOs. The focus is more on the soft skills of family medicine, which I have to admit is pretty paramount to being a good family physician. You can have all the medical knowledge in the world, but if you come off as cold and distant as a family physician, patients and more importantly the general public lose trust in you and end up going elsewhere for their care or they disparage the profession.
  13. I had to wear the white coat during my clinical skills sessions in first year med, then didn't touch it again for years until the 4th year exit OSCE, then one more time where I just picked up a random white from the hospital, ripped off the badge, wore it for the LMCC 2, then sewed the badge back on and left it back on the rack. I don't think anyone will notice what kind of white coat you wear to be honest.
  14. I highly recommend telling senior program advisors how you feel if you haven't already.
  15. Mithril

    BC Family Doctor Billing

    I recommend that you review the UBC CPD on billing. Dr. Eric Cadesky narrates it and he provides many tips for billing. If you're seeing 35-40 patients per day, that's at least $1200 per day before overhead. Forms, private patients, WSBC claims will drive that up, as will procedures, to $1500-$1700 per day. If you work 5 days per week that's at least $300,000 per year assuming 2 weeks' vacation before overhead. After overhead that's still more than $200,000 per year. This is the bare minimum with 35-40 patients per day and 5 days per week. Remember that you also have other incentives, such as phone billing, complex care, mental health planning, and personal health risk assessments.
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