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NLengr

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Everything posted by NLengr

  1. Never discuss (except to a non-academic, neutral, completely third party physician) and never disclose (unless legally obligated and even then, consult a lawyer first and only disclose the minimal legally required). It's sad but this is the worst of all professions. The only way to protect yourself is to assume the worst in every situation.
  2. I would guess not that much better than some of the other common fellowships. All general surgeons are trained to cover trauma and in the community they don't usually have a dedicated trauma guy covering trauma call. And in Canada we just don't have a huge trauma volume so it's not like we are running huge numbers of trauma codes/teams per night necessitating the need for lots of trauma dedicated surgeons. Critical Care also had poor job outlooks last I heard too. If you are to move to a major center and you do general surgery what will very likely happen is during residency you will be told by your program that there is an open spot coming in X number of years in subspecialty Y (usually due to retirement). If they want to have you come back as staff, they will then tell you to do fellowship Y and pray they don't change their mind about you while you are still training. That's how most of the academic hirings seem to work in my experience. There is the occasional case where someone leaves a group more suddenly and needs to be replaced, but that seems less common in academia.
  3. Officially no. Unofficially, I'd say yes.
  4. I would at best assume it is a 30-50% shot. And I am probably being generous. If you are prioritizing a few high demand urban areas, you are best off in a specialty like psych/family/etc. where you can work outside the hospital system. Otherwise you run the very real risk of being forced to work somewhere you dislike just to pay the bills. I'm speaking for experience here. I wouldn't have done a surgical specialty if I had my time back. I would have prioritized location.
  5. If you are looking at large centers, there are no surgical specialties with good job prospects. Competition for jobs in big cities is intense. Even if you do a fellowship, lots of research and an advanced academic degree, luck stil has a huge role in landing a position. You need to be lucky to have a spot open up when you are entering the job market. Those spots don't open up all that often. You also have to be lucky enough the group gets along with you. You could be the best kind of person but if you don't mesh with the group dynamics at the time, you won't get a look in. Plus there will be multiple other people like you who want the job. My advice with choosing a surgical specialty (or any specialty involving lots of hospital resources) is to make sure you would be happy doing that specialty in a community job ANYWHERE in the country (rural NL, Northern Saskachewan, Northwestern Ontario etc.). If you more value a location (urban center, specific city etc.), pick a specialty that can exist with minimal affiliation with a hospital (family, psych, general internal etc). Think very hard about your priorities because once you match, it's hard to change your path in life.
  6. Hell, I'm a staff surgeon and I have learned how to do new aspects of surgery from YouTube. Lots of us have. Don't worry about procedural skills. You just need to practice after you learn how to do them. You can teach a monkey how to perform a task with enough practice. And if you don't enjoy procedures, you can just do a specialty with little to no procedures.
  7. Peds appointments take FOREVER, even as a surgical specialist. Annoyed me to no end as a resident. And the whole peds hospital itself was a giant box of unmedicated anxiety. Drove me God damned nuts. Every single staff in the place (MDs, nurses, allied health, janitors etc.) were always on the edge of a mental breakdown. Hospital should have just put SSRIs directly into the building's water supply.
  8. NLengr

    Speciality Choices

    My advice as someone who is done all training and now working: Decide how important living where you want is. Once you decide, think about it again because if you have any doubt what so ever that you would be happy working in rural NL, northwestern Ontario or northern Saskatchewan, you should make sure you pick something with good flexibility for location and that does not rely on hospital resources (psych, family etc.). The shine of work fades pretty quickly but if you hate where you live, it lasts forever and you could be stuck there for decades.
  9. I know at least one who retired from my residency program. He was around 65. The other surgeon who works with me at my current job is retiring in 15 months at 60 years old.
  10. NLengr

    Pregnant in Med school

    I'd defer. Newborns are a metric ton of work, and I'm just a dad. My wife had it worse.
  11. Bingo. The only jobs that seem open at the current time are jobs that are just as bad as the one I am in (super rural, bad environment etc.).
  12. 4 hour drive is better than a 8 hour flight. But 4 hour drive when you have two kids is still pretty restrictive. That being said, Fort Mac and Thunder Bay are literally sprawling metropolises that way bigger than where I am now. I'd kill for the amenities of those places.
  13. I told my wife today that if we ever win the lottery I am immediately tendering my resignation and moving back to civilization ASAP. I don't care if I never practice medicine again. We spent the weekend in our home city and were driving back to the rural town we live in so I was feeling a bit depressed. Hahaha
  14. It let's wealthy people off the hook. People with med school debt are still screwed. Wealthy people aren't going to allow their children to be stranded in some backwoods town slaving away for an ROS.
  15. Being in a rural location when you have no desire to be there is terrible. I live that reality every day. The solution to rural healthcare is likely some mix of increasing primary care (family docs mostly and NPs in the case of small remote villages) and reducing infrastructure and concentrating specialists (honestly, rural healthcare where you try to offer advanced care in rural areas is a HUGE money pit that is likely unsustainable in our current system). That's the conclusion myself and many of the other physicians in my province have come to. Unfortunately, political will is lacking because the needed action is political suicide (need to be re-elected, gotta get that sweet pension).
  16. ROS agreements vary by province. The Ontario one is very very loose in its rules. Also, with the exception of Northern Ontario, what is called "rural" in Ontario would hardly qualify as rural in many other parts of the country.
  17. Specialty dependent. In my specialty, the academic guys don't make much less at all. Plus they have a way easier life on call and on top of that they don't really need to look after post ops, ER/floor consults, patient paperwork, dictation etc. The pay cut is a trade off for getting the services of residents/fellows.
  18. Plus they have slaves (wait....residents and fellows) to make their clinical work and call much easier.
  19. Lots of academics are ffs too. The difference comes down to the fact if you are researching or teaching you can't see as many patients per week or perform as many procedures per OR day. You also tend to see more complex cases (which take longer to see) because you are in a tertiary care center.
  20. Agree 100% with rural care being a liability for the system. Rural Canada is dying slowly. The rural population is aging. And it costs much more per capita to supply care to rural populations. As for rural vs. urban outcomes in emergencies or acute situations: they are worse. Everyone knows it. You just don't have the resources rurally. At my center (rural center 4.5 hours from tertiary hospital) you aren't getting PCI or neurosurgery if you have a big MI or a head bleed. That's just part of the tradeoffs you make when you decide/have to live in a rural area. (I say have to because many of the docs here, including myself, would never choose to live here if we could help it).
  21. I agree. I would also report to the CPSO or whoever if you believe someone is passing themselves off fraudulently as an MD. As for knowing more than an NP as a resident, I am also in agreement with that. I'm a FRCSC surgical specialist and I still know more about general medicine than most, if not all, of the NPs who work with me.* Most lack a shocking amount of medical knowledge. When I was a resident, I knew even more general medicine. In my experience, NPs are like early to mid year R1's with an independent practice licenses. * Alternative explanation: I work with idiots....
  22. Agree. 70k is not worth 3 years separation.
  23. NLengr

    NP vs. FP

    In my personal experience (and that of a few of my co-specialists I am told), the quality of the consults coming from our local NPs is generally lower than what comes from our family docs.
  24. I actually have some disability through OMA and some through another company. There was some reason we set it up that way after the kids where born but for the life of me I can't remember why.
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