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shikimate last won the day on December 26 2019

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  1. just FYI some pathology programs do require residents to do overnight call (likely home call). Although it's uncommon to get called in, it does happen for urgent cases like transplant. Also overnight you could get pages for which you have to call back, but doesn't have to physically go into the hospital. So there is a risk that your sleep will be disrupted more than once when on pathology call, hence you should clarify this with each program. Keep in mind pathology programs are small and they need residents to cover overnight issues, so it's unlikely you could go through the entire residency in pathology and expect other residents to cover for you (assuming call is required by your program).
  2. 2 weeks in pathology should get you interview at many programs (but might not at places like UBC, Toronto). Also the workload of a medical student on pathology is a fraction of the real workload of a resident so don't get fooled. In general I do not recommend 2 backups in first round. There are always pathology spots in the second round but not many IM spots in the second round.
  3. Just to add, for example if a program matches 5 residents per year but there are only 3 PGY2 or PGY3 then find out what happened to the other residents that year that are MIA. Maybe they're off on maternity leave which is legitimate but maybe they switched out because most switches happen around PGY2/3 year. If in a small program you see people switching out frequently that's big red flag, imagine you lose 2 of 5 residents then you lose 40% of workforce and whoever remains will have to take call and pick up the paperwork etc. If you see PGY5s doing heavy clinical work that's also big red flag because you need 6+ months to study for Royal College, so too much clinical work can be detrimental for PGY5s. Even better find out if any PGY5 has failed Royal College recently because that's big red flag. For example if a fellow they have is not Royal College certified find out why, sometimes people who fail exam can do a "fellowship" for 1 year, which is just a euphemism for the program bailing them out while they study so at least they have money to survive. A lot of times the program offer no support so PGY5s are on their own which is big red flag, remember the royal college is the big forest so don't lose sight of the forest for the trees.
  4. What's frustrating with residency is that your time is very precious, therefore everything you do, from seeing cases to studying after work must be high yield because you can't afford to waste time. Your attending and co-residents can make or break it. For example, as PGY2 attending tell you to read 1500+ page textbook and know the stuff in there. That is a completely useless advice, perhaps done with somewhat of a good intention. If you have a good senior resident they'll tell you what resources are most high yield, what's most commonly asked by attending vs on exam, etc. 99% of attendings does not know how to teach, or have any idea what good resources are out there for junior vs senior residents, not someone who's been practicing for 20+ years. Telling someone to just "read this textbook" is the most useless advice I've heard but it is given day in and day out. You can watch Youtube videos and get more out of them for your Royal College exam studying. Also if your co-residents slack off then good luck because as PGY2 and 3 you'll be the ones doing the cleaning up. If you're in a small program and someone switch out or they reduce your residency spot then you're screwed because the work and responsibility will always be there and most likely junior residents will bear the brunt of the new workload. Never match to a program with a high drop out rate. Also pay attention to what happens with the senior residents in that program, because if they're desperate with job search or whatever then you can sense the PD/admin people don't care about what happens to their residents and in a few years it'll be your turn. Ask if the senior residents are happy with what they are doing after residency, there are lots of fellows who are in fellowship because they can't find jobs or their training was poor and they're afraid of going into a job. Also never ask any admin or PD how their residents are doing because that's like asking a wolf if they eat tofu, always ask the residents in an informal setting outside the hospital. Also pay attention don't just ask the most keen star resident because most likely you won't be the star resident and sometimes they have moral hazards like they were promised to be hired back to the program or have some academic aspirations so now they can't speak poorly of the program or chair or PD etc, so also ask the mediocre and even poor residents what they think. Don't dwell on bad people around you, know your goal is to complete residency and find a job. Don't dwell on bad patients, bad admin, bad attending, etc. Let them putrefact and always write down your long term, 5, 10 or even 20 year goals so you don't get distracted by short term. Academic physicians are often stuck in academic because they are too specialized. I've seen those that want to transition to community practice but have forgotten what they learned in residency and don't have the skill anymore so they are basically hostage to the department. So I ask why don't they just retire or do something outside the medicine? Like they've been in practice for 15 years you think they'd save and invest enough money they're financially independent now? Or maybe they're the HENRY makes lots of money but never rich because spent it all on trillion dollar HGTV house and have to pay alimony or something. I always tell people explore the world outside your center, do lots of electives at other hospitals and see how others do their work. Academic hospital runs very differently from community hospital or outpatient clinic etc. Academic center the cases are always harder, more complex, more layers of bureaucracy etc, and your mind get stuck thinking this is how the earth rotates. Sometimes people get sucked into being academic and look up to people with encyclopedic knowledge etc because that's all academic centers teach you. But once you go in community you see people with vibrant lives outside of medical practice who is doing fine even though they don't have some title of endowed chair in useless research studies. They might even teach you a thing or two about incorporation, work less and make more money, or something else you never get taught in academic centers. Also academic center cares too much who's assistant prof, associate prof, full prof and all that, it's all useless titles like the medieval era when you have to be Marquise or Baron of some plot of land or something. If I donate $5Mil to a department I guarantee you I create my own endowed chair then name myself the endowed professor and maybe even have a hospital wing named after me.
  5. I am selling my house near UWO and moving away. Unfortunately I can't take all the textbooks I've collected over the years with me. So I am willing to give them away to medical students or incoming residents. They are suitable for all years of medical school and junior residency/FM residency, IM, surgery, anesthesia, etc, many books. PM if interested. Also I am selling my house, it's in a great location, walking distance to MSB/UH, recently renovated. Multiple BR, 2 bathroom, 2 kitchens, so you can collect rent and let the house pay for itself. You can walk to school everyday, leave the car home and reduce your carbon emission.
  6. Get your hands on the valuable books that emphasize high yield facts (aka First Aid series) and complement it with YouTube. Do a google search on high yield review books from US med schools for USMLE steps and you'll find many many great resources. Step 1 = first 2 years, step 2 = next 2 years, step 3 = PGY1, read FirstAid series for each step and afterwards read it again because it's so high yield. Problem with med school is they expect great clinicians to be great teachers, which is not true. Famed clinicians are often some of the worst at explaining basic concepts in a way that a newbie can understand, and they don't know what's high yield for your term exam because their term exam was 20 years ago! Whereas I find YouTube has some many great contributors it can basically replace the first 2 years of med school hands down. Also med school emphasize information overload and not enough skills on information finding strategies. If I tell you all the hepatotoxic medications are on the website LiverTox why would you make someone memorize all these medications? If you can find all the mutations on OMIM why are board exams still asking them when you can Google it in 5 seconds? Mind baffling to say the least, they don't ask mathematicians to memorize every square root do they?
  7. I think it's the occasional bad apple that ruins the bunch. Most patients are fine, but one bad patient encounter will foul your mood for rest of the day! It's hard to avoid as student and resident because you have no control over your schedule, and even as attending sometimes "bad apples" are dumped onto you. So I think it's very important to have something outside medicine to keep you "refreshed" so when you start the next day your mind is clear. Maybe go for jog or bike ride, play sports, play music, whatever can help you clear your mind. Don't let the bad experiences linger, move on, physicians are humans too and it's dangerous to let bad patients and experiences drag you into a hole. I've seen people whose entire life is revolves around medicine, it's so embedded, engrossed, it's like medicine phagocytosed them! I always wonder how will they cope if one day they wake up and medicine has changed for them? For example didn't match into their desired residency, or got into medico-legal trouble, or got disabled and cannot practice anymore, or become burned out and depressed they cannot practice anymore. Would their life have any meaning left? Would their minds be able to move on? Would they be willing to pack up their box and direct their energy to excel in another field?
  8. Depends on what type of IMG, if older IMG, graduate degree in Canada/USA would be a big plus. If CSA (Ireland, Carib, etc), then lots of elective and shadowing experience is a big plus. Not sure if FM is any easier, seems most FM IMG spots are taken by CSA now, so older IMGs are facing an ever uphill battle.
  9. Jobs are plenty for GP everywhere, AP job prospect is poor without fellowship, even without fellowship it's hit and miss where jobs that match your fellowship will appear. Training and job market just doesn't match up, too many AP, too few GP graduates! They need to tell med students who want community to apply to GP, not AP!
  10. FM and IM aren't what they used to be, nowadays even for CMG applying to IM they have to try hard and apply broadly. The only fields that are relatively uncompetitive are laboratory specialties like pathology/microbiology. Pathology in the US is also relatively uncompetitive for many cities/centers who are IMG friendly, some research experience or grad degree are definitely looked up favorably there.
  11. I know ON actually has a government sponsored re-entry program for those who already finished 1 residency. Not sure if this applies to your situation, but let's say someone matched to FM as backup, they could still have a chance of re-matching into a 5 year program after 2 years of FM residency and working 1 year (3 years total). http://www.health.gov.on.ca/en/pro/programs/hhrsd/physicians/reentry.aspx
  12. Renumeration is relatively on the lower end for RCPSC trained physicians, usually about 250-300K in Ontario (search the sunshine list and see for yourself). But I imagine if that allows you to enroll in one of the government defined benefit pensions then it kinda make up for it because DB pension is so good and so rare now. Not sure if you can moonlight with your CCFP certification, that would be some nice icing on the cake though, put your moonlight income in your corp and have a DB pension from the government when you retire.
  13. I recommend people to consider dentistry, after lengthy discussion with friend who graduated few years ago and already bought his own practice with excellent income. What he does is equally interesting with mix of medical and surgical management. There is no residency match to worry about. The only downside is school tuition is higher during the 4 years, but you make that up since you don't have to do residency. People don't realize how many barriers there are in medicine beyond just getting into med school. CaRMS is a mess, with specialties like psychiatry becoming competitive, that would've been nonsense few years ago. Good luck if you want to do derm or plastics. Then you gotta find job or fellowship after residency, another mess. Trying to secure a good fellowship is even harder because there is no open system like CaRMS, it's all about who you know, and if there is an internal applicant (who might be much weaker than an external applicant), they'll still take the internal applicant. Jobs are spotty, with specialties that need hospital infrastructure suffering the most. People who can't find job are doing 1, 2 or even 3 fellowships in some specialties. Renumeration is stagnant is many provinces, while marginal rate of income tax goes up and advantage of incorporation shrinks. Changing specialty is next to impossible, because CaRMS second round has fewer and fewer spots left. Many academic physicians are there not because they like academics, but because there isn't enough community opportunities. Some academic physicians lose their general skills, and they're stuck in academics for rest of their career. Many community physicians well past 65 aren't retiring, because they know they are sitting on a goldmine, and any new graduating resident will never get the deal and leeway they get.
  14. Grades mean nothing in retrospect, pass = MD, pass = FRCPC, same billing code lol, you don't get to bill more for been top of class. I remember a joke about med school: the top 1/3 of class become renowned physicians-scientists, the middle 1/3 become well respected community physicians, the bottom 1/3, well they become renowned donors to the top 1/3 and landlords to the middle 1/3!
  15. When you go on elective, you'll find some attendings don't care too much about med students. That's normal. It's important to identify people who can bat for you, push the right buttons for you. That is really hard, because sometimes the heavyweights are the least readable, and departmental politics takes a long time, or insider knowledge, to decipher. Residents are a good source, usually by PGY3 they would know pretty well the personalities of PD and prominent staff in their department. Ask them how they feel about working with so and so, often you get a good hint as to whether it's easy or hard to deal with that person. Take note of secretaries and admin people, what's their attitude and reaction when they talk about that person? Lastly, note any potential personnel changes. PD usually change every 5 years or so. If some prominent person left the department suddenly, there's usually some story behind it, and departmental power balance will shift. For example, a "puppet" PD might get put in, who's completely unwilling to do the job of PD, but have to do it because the Chair or some senior person in the department said so. These situations usually the senior person will sit on the selection committee, but won't necessarily poke their heads out. They'll act as the "invisible hand" behind the choices PD make, so one wouldn't be surprised if their choice/ranking is very different from the reaction students get from the PD.
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