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medigeek

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Everything posted by medigeek

  1. I believe they have discussed this and are looking at a way to not exclude rural docs in this context. This includes possibly revising the new criteria soon. "Rural" is also a bit of a vague term. There are places that see a fair bit of acuity and range of pathology but doing a CT involves sending a patient out 25 minutes. you generally need far stronger clinical skills in those settings. And lets be serious here - how many central lines or airways are actual academic staff even doing? They "supervise" them. The small community (aka most of which is "rural") guys are doing the procedures all alone without any help in house.
  2. In general, aren't resident electives restricted now anyways due to COVID? I know med student ones are, not sure about resident ones specifically.
  3. Given that we will be competing with midlevels, I don't think taking the easy simple approach is the way to go. As a profession anyway. We need to offer a valuable service that NPs and PAs cannot provide. And trust me, midlevels can do basic stuff/refer out.
  4. With the rise of technology and information more readily available - midlevels can absolutely be a huge threat to physicians who are just providing basic services. In the US, ICUs are often staffed solely by NPs or PAs at night time. CRNAs do solo cases with no anesthesiologist in house in most rural areas. Many consults are often just seen by a midlevel, and yes even the first time (not just follow ups). There are NP hospitalists. NICUs are run by NPs now. Derm is run by PAs. And there are midlevels who supervise residents in many places on specialty rotations. Some are being trained to do scopes. Some do bronchs. Many intubate independently. To say there's no threat is insane.
  5. Just to add to this. I think it's just more fair for the patient too and gets the patient better and more timely care if their family doctor had the diagnosis promptly made. It also saves the system money as a whole and shortens specialist wait times. Of course, the more skilled you are - the less of a threat midlevels will be.
  6. I just don't think the FM people should want an easy residency when it is only 2 years. Should in fact strive to do more during that time length. There's way too much to know. Otherwise I strongly agree that 5 year programs often don't need to be 5 years and can be lighter in intensity.
  7. Except I'm in FM. Not sure how you can be salty in my situation. I'm not in a (remotely) chill residency though.
  8. NPs can do patient communication and referrals just as well as we can. I mean, if you're not offering much more than an NP - how do we justify our pay compared to them? Doctors are being displaced by NPs and PAs in the American system and they're competing with doctors in Canada too now. Also, in my experience, doctors who do very little for the patient in terms of workup/management tend to also be weaker on the communication side as well. I think you become a much better trained FM doc if you go to a very intense residency that has great inpatient exposure and culturally relies less on referrals (this sometimes is due to lack of access too lol). Part of it is also how much develop you can develop on your own time/how much reading and studying you do yourself. And lastly, how patient oriented you are. If you have a patient with transaminitis without a clear cause - are you ordering all the ceruloplasmin and autoimmune and a1 trypsin labs or are you just doing a hepatitis panel then referring out? As the patient, I want a doctor who will actually work something up properly to save me time. Excellent communication skills do not compensate for delayed diagnosis. As for the money issue, I diagnosed a case of pheo a few weeks ago. Took me an extra 2 minutes to order a full comprehensive set of labs to workup the refractory hypertension. You might make marginally less money (maybe, probably not), but it's much better for the patient.
  9. This is strictly for family med - but given the duration (2 years), if it's an "easier" residency then how in the world are you supposed to become competent? There's just no way to train someone to do full scope if the 2 years are not very intense. And even if someone is dead set on doing strictly outpatient 100% of the time (minds can change though), you can't build competency with an easy 2 years. It's a good way to train a referologist who can't start and manage insulin for diabetes. I fully agree that being very intense for 5 years is just not a good. But 2 years? You get scammed out of your training. And this is how you waste the system money and lengthen wait times for people who actually need a specialist. Why exactly are you unable to treat a cirrhotic patient? You should know what diuretics to use, how much and how to manage their other (bread and butter) comorbidities. Same goes for every similar patient. CHF, COPD etc. really do not need referrals unless they're out of control and you don't know what to do. If I don't need a procedure (ex. a scope), starting things like biologics, or I'm not needing something like an insulin pump etc. then there's no reason to refer. I also strongly think that family doctors should be working up and ordering more specialized tests to diagnose the lesser common conditions prior to referral. This also saves the system money because then the specialist can focus on treating rather than starting from scratch. It also saves the patient time in getting treated quicker.
  10. What's wrong with an FM applicant wanting to be a hospitalist? Society of hospital med in USA is co-sponsored by the internal med and family med boards. If anything, we should be encouraging more inpatient practice.
  11. Read a lot and find some niches. Learn enough so you can manage most things on your own/minimize referrals. I've done Uworld for internal med and FM in addition to MKSAP. I know attendings several years into practice who still "study" routinely. However, there's going to be a balance. You can do clinic with inpatient/ED but you probably won't be also doing Ob and other stuff while being excellent at all of those. There's just no way to keep up with literature in every single area nowadays. But ultimately strive to be the most well read doctor.
  12. Doesn't traditional and comprehensive kind of reference what I said though? Broad scope that goes well beyond just a clinic practice.
  13. As I posted in another thread - you can do additional things (inpatient, ER, Ob, a large variety of random things etc.) in family medicine. You can also carry very in-depth knowledge in certain niches as well.
  14. You can mix it up and not just do chronic disease. Pick up the skills and also do ED with clinic. Or do inpatient medicine with your clinic set up or whatever else you like. Maybe deliver babies. You don't need to limit yourself to an outpatient practice.
  15. There was a thread here about someone who matched FM there and heavily struggled due to their inability to speak French. Don't do it. Clearly there's a huge disconnect within McGill on this.
  16. Do you know what specific things they were not as confident in?
  17. How come you say it's a lot of work and dedication? You're working and making physician income, while accumulating hours. The remaining part is passing the exam, which is the same exam PGY3 people write.
  18. Can be residency and individual dependent too. And I know USA FM programs (relevant with more American grads coming to Canada) are way more inpatient heavy and their graduates (sometimes, not usually) are definitely on par with Canadian GIM.
  19. We all bragged about medicine being recession proof, till this happened. It's important to never put all eggs in one basket. That apparently will include scope of practice (ex. those working in EDs or hospitals and not just clinics, had less of an income hit).
  20. As life gets busier and more stressful, and the rewards and good times shrink - you will naturally become more jaded. This isn't exclusive to medicine either.
  21. How busy you are is also a good or bad thing depending on your post-residency goals. Often times, busier = more training.
  22. They are the biggest threat (along with PAs) to our profession.
  23. Except in a crash situation Just do the IO.
  24. The university policy is not allowing travel back to Canada? Or do you suspect border issues (no evidence there should be any?)
  25. If your goal is rural then pick a more rural (not necessarily remote rural btw...) program. Not sure where you are but most provinces have good ones. Urban residencies tend to be more outpatient focused, but that's not always the case either. I would also ensure the elective time is there so you get more a more urban/suburban inpatient/ICU experience and get exposed to high acuity and complexity patients. USA programs are more inpatient heavy and a majority prepare you to do what is essentially GIM work in Canada. Some of the exceptionally good ones (ex. ventura county) train you for managing day to day high-acuity ICU patients etc.
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