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Everything posted by NLengr

  1. You need to have more than a 1:1 ratio of students to residency spots. If you don't than a whole lot of people would be forced to do things they hate, are ill suited for or both. You need some flexibility in the system. The flexibility should not come at the cost of ROS's for CMGs. Being forced to work in an undesirable location doesnt sound that bad as a med student because you honestly have no idea what it will be like. I am speaking from personal experience here. Most of the locations are rural, so right away, forget most of the things you enjoy about being in an even medium sized city (restaraunts that are decent, shopping, nightlife, cultural activities etc). You will probably be away from all family support and I can tell you first hand that makes your life very difficult, especially if you have children. You also will be away from your entire social base and it may be hard to build a new one in a smaller center. Smaller centers mean a lot more call for you. Even if you aren't getting called in all night, just being on call limits your life. Also, don't expect to have all the services you are used to at an academic center. This increases your workload and limits the type of practice you have or procedures you may perform. Once you are done your ROS and want to leave, it is still difficult. You'll realize that after a few years in practice it's hard to find new job opportunities in many specialties. Canada doesn't have great mobility for physicians to change jobs. So maybe your 3 year ROS is now a 6 year stay because there is nothing avaliable anywhere else you would be willing to work. Expect the administration of the hospital and the local government to not give a shit about your concerns because you are on ROS so it's not like you can easily threaten to leave. If you do leave at the end of your ROS, who cares, the government will force another ROS new grad in the position. That removes the motivation for anyone to address problems or concerns you have. CMG ROS contracts will reduce our ability to negotiate contracts because it will force people to stay and work in a province. If you can't leave, why would the government care about trying to pay you well and keep you? Even if you do leave at the end of your ROS, they have more ROS's to replace you. Make no mistake, the government sees physicians as an expense before anything else. They would like nothing more than to pay you 60k a year like a standard government without providing you with any of the benefits government workers are given. It is a slippery slope because, again, the politicians you as the enemy. You are an expense item, nothing more. They don't care about you. They care about getting re-elected and getting that pension. They will do whatever it takes to do that. Once they realize they can force.CMGs into ROS's, it's very easy to whip up public support for this. Then they can claim they are using the ROS to: 1. improve staffing (even if it doesn't) 2. reduce costs (no need to pay incentives if you are locked into working for them) 3. Stick it to those fat cat doctors (make no mistake, this plays really well with a segment if the electorate). All three of those help them get re-elected.
  2. If you open the door to making standard cmg's do ROS for a residency spot, the government will push for all CMGs to do an ROS eventually. It gives them more power to force people to work where the government thinks they should (think crappy undesirable locations) and it will reduce physicians ability to negotiate fee schedules (yay pay cuts!) etc. Once you get into practice, you realize the government rarely has any idea what the hell it is doing in the healthcare system. The last thing you want it to hand more control of your life and career over to them.
  3. I agree. A united front is what is needed but it seems like that has crumbled. Sadly, this won't stop with just a few specialists. Everyone will be cut in the end.
  4. NLengr

    Undergrad vs Medical School

    My residency program was the most desirable program in a competative surgical specialty. I participated in ranking candidates for almost the entire time I was there. I can tell you with certainty, we never discussed someone's extracurricular activities from med school. That's my experience anyway.
  5. That's stupid. If an ER doc can't see the bread and butter of ER they should be let go and replaced with someone who does.
  6. NLengr

    Stress level

    You'll find that it takes a bit of time (6-10 months) to really settle into outpatient stuff and get a good system going. But it will happen eventually and things become easier. I found by the one year mark a few months ago my efficiency had improved so much that I only took 2/3 of the time to see a new consult as I did when I started. And by a year in I had a good system developed for triage and running my day to day life. I talked to many others I knew in my specialty (in the province and in other provinces) about how they did things from a practice management point of view. I then cherry picked the best parts and copied them in my own practice. That was my smartest move I think.
  7. NLengr

    Stress level

    I have no idea why they are allowed to leave early if everything is done and yet they still seem to get paid till 4. They should have to be in the hospital till 4 no matter what. There is always something that could be found to do. I think it's because the OR nursing admin is super weak and more concerned about being liked than being a good manager. Yeah the gossip is brutal and they all trash talk each other behind each others backs constantly. The thing is, they all love doing it, they all know it happens and it's accepted as normal behaviour amongst the OR nurses. It's crazy but given the fact the entire town is a giant mill of gossip, jealousy and pettiness, it's not surprising. As for why they don't have the common sense to not do it around other people it's a simple answer: A surprising amount of them don't have it at all.
  8. NLengr

    Stress level

    1800s. To be honest, some of the OR nurses are quite a few cards short of a deck in the intelligence department.
  9. NLengr

    Stress level

    Pharmacy stocks beer. Shitty labatt beer, but beer none the less. Every hospital I worked at had beer on stock.
  10. NLengr

    Stress level

    I'd say the royal college exam year is universally stressful. At least I don't know anyone who didnt find it extremely stressful.
  11. NLengr

    Stress level

    This is totally program and year dependent imo. The last 2 years of my specialty were/are study related hell. I got hypertensive from stress in my 5th year. Plus you deal with the normal residency stress.
  12. NLengr

    Stress level

    I'm staff in a surgical specialty at a rural secondary care hospital. I'm back in my hometown with my family this weekend so zero stress except when I think about having to return to the town where I work (my family will come back with me). Unlike residency, where lack of control and study stress dominated your life, I find my biggest sources of stress now are: 1. Hospital administration, especially non physician admin. Most of them are terrible managers and make decisions that make no sense from a financial and/or management POV. They do make lots of sense from a personal feelings, petty politics or plain old "I have no idea what I am doing" POV. They have also taken actions in the past which directly effect me or my patients without asking my opinion before taking the actions, or informing me that the action has been taken once it occurs. 2. Nursing, specifically OR nurses. Generally the floor nurses are ok. Our OR is a cesspool of pettiness and gossip between the nurses. They continually want to be off early to the point they will start asking why we aren't done yet, even if I have two or three hours left in my day. A few of them will argue with me about why I am doing something despite it being well backed with evidence or it being the standard of care. After I explain the logic and evidence to them, they will continue to argue with me that they are right (example: I had a post op guy in DTs. I had him on ETOH withdrawal protocol, which at our center uses Ativan. One of our OR nurses told me it was more effective just to give him beer to treat his DTs. I explained that ativan is a drug with well understood metabolism, a controlled dose and is the standard of care. I also explained that the patient had an ileus and couldn't drink a bunch of beer without puking it back up. Even after this, the nurse continued to argue with me that she was right). Don't get me wrong, we have some good OR nurses, but the place stresses the hell out of me lately. 3. Living in the town we live in. This town is shit and myself and my spouse hate it.
  13. Medicine is much closer to engineering than science and I don't think 99% of the people in pre-med or pre clerkship understand this. You take a system (the patient) with a bunch of unknowns. Then you try to apply what you have avaliable to gather information (history, PE, labs and imaging) to guess what the problem may be. You make educated assumptiins about what you don't know. You create a plan based on what you know about the system and what you know about your potential solutions (aka treatments like drugs or surgery). You then implement those solutions and see if they work. The entire process is fraught with uncertainty and assumptions. I think most science background people have a huge issue trying to wrap their heads around this whole concept at first. It's just so different from the precise and methodical nature of lab science. I did an engineering background and I grasped the entire idea from day one luckily. I think most engineers in medicine did.
  14. I was gonna bring this up earlier but figured it would stir the pot too much. I don't agree that all specialties should be earning the same. Some just are higher stress, or more work, than average. Some are both. For example, imo, there is no way vascular surgery should get paid the same as rheumatology, endo, nuclear medicine, rad once, public health etc. Vascular surgery is crazy busy, full of the sickest patients and performs extremely high stress surgeries. That is not to say I don't value all specialties. I think everyone e has a role and is valuable to the patients when they are needed. Now do I think some specialties should get more money for ffs work? Yes. Just like I think some are overpaid for ffs work. But I don't buy into the whole "everyone should earn the same amount" arguement. For the record, I'm pretty happy with my pay. I'm not in the best paid surgical specialty, but I'm also not at the bottom.
  15. You'd probably have a shot at the urology programs you rotated through. In those programs, your elective performance will be how they rank you. You are very unlikely to match or be competative in a place you never visited. Don't worry about "well rounded". That's BS the universities force PDs to say. PDs in small competative surgical programs care about how you will work out as a resident in thier program. That means elective performance at their center. They don't care if you have done other electives in peds rheumatology, GI and forensic psych.
  16. The problem is once the government has cut the obvious targets, they aren't going to stop there. Your specialty will eventually be on the chopping block too. They vilify all physicians as overpaid fat cats, they dont distinguish. Either does the public. Make no mistake, if the government could pay you 60k a year like the average civil servant, they would. Politicians do not value your work. They just care about reducing spending on healthcare no matter what the effects on the system. If we don't all stand together in this, we will be picked off one by one and have nobody but ourselves to blame.
  17. The problem would be that's even more time until you get to whatever specialty you want. Most people are already in their early 30's when they finish specialty residency (then add on a couple years for potential fellowships). I think to see that work you would need to shorten training somewhere else. Maybe get rid of the undergrad degree requirements and go back to letting people in to med school after 2 years of university. Like you said, that is a lot of changes to the system.
  18. NLengr

    How to do well on clerkship?

    This x 1000. Medicine, especially an academic center, is full of self important, self serving, blow hards with terrible social skills.
  19. NLengr

    How to do well on clerkship?

    I'm staff and I'm lucky to hear the lub and the dub parts of the heart beat. /kidding.......I actually don't own a stethoscope.
  20. NLengr

    Online Master's Degrees

    Oh academia. Such BS. Hahaha Can't surgerize worth a God damn, but I can work a data set like an SOB.
  21. I've never seen a breakdown of numbers, and I know pilot loses to commercial operations are a big deal for the RCAF but I wonder if most of those losses are multi engine pilots (Hercs, Polaris, CP-140 etc) and helicopters vs fighter pilots. I mean, non fighter pilots would have a more similar civilian flying job. It's easy to imagine how mind numbing flying an Air Canada 737 would be after years of flying a CF-18. In the States it would be less of an issue to leave fighters because the Air National Guard gives you an opportunity to fly commercial and continue to fly fighters part time.
  22. The OMA is the worst interest group I have ever seen. The only logical conclusion is that the executive must be getting bribes from the government.
  23. This thread reminds me how much I love the government and bureaucracy.
  24. You need to be able to compliment someone then immediately bad mouth them the minute they step out of the room.