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    Int Med Staff

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  1. crackers

    Dogs during residency?

    My wife and I were both residents, and we got a dog 4 months before I wrote my Royal College exams. Between call and study groups it's lucky we didn't drive the poor thing nuts. Having someone who thinks you're the greatest being in the world, because you can open the food container, gives you a nice balance against medicine, when you think about it. Advice: crate training is a must unless someone will always be home, lots of walks are therapeutic for both of you, and try to keep to a routine as much as you can.
  2. the subspecialties are usually represented in towns about 20 000 or more... depends on the size of the hospital. Some smaller sites (example, Wingham, ON, about 4000) will have certain capabilities (like an endoscopy suite) that make them attractive to subspecialists to come for a day or two a week/month/quarter and do procedures. There are cardiologists in the community centres --- the sub-sub specialists, like interventionalists/EP (which require expensive equipment and extensive support (like ICU or cardiac surgery)) are only going to be located where there is a lot of capacity --- the major cities and the academic centres. The cardiologists are in higher demand in the community, and the academic subsubspecialty jobs are pretty much unavailable. Hence my decision a few years ago to switch from Cardio to General Medicine, where I am now employed! In the community, general internists and family docs will see and treat a lot of cardiac disease (BP, cholesterol, angina, CHF), but farm out the highly acute or the highly complex to the specialized centres. Everyone from ER docs to internists to cardiologists can give thrombolytics when someone's having an acute MI. But what happens if they don't work, or you get a contraindication? That's where having access to a cath lab in the major centres has the greatest benefit.
  3. crackers


    I'm now on to a real job... where did you match?
  4. The DaVinci robot gets used in cardiac (beating heart) surgery. AESOP is a remote control surgery system used in Video-assisted thorascopic surgery (VATS) in thoracics. There are 64-slice CT, cardiac MR, and all sorts of fun gadgets in interventional radiology. Significant caveat: time to get there. Cardiac is 6 years residency. Thoracic is 5 years gen surg + 2 years thoracics fellowship. Interventional Radiology is 5 years radiology + 2-3 years fellowship Interventional Cardiology is 3 years Internal Medicine, 3 years cardiology, and 2-3 years interventional cardiology.
  5. crackers

    Core IM and IM

    thanks, Ian and ffp. Just signed a lease yesterday...
  6. crackers

    CCFP exam?

    The CCFP is rather new (last 20 years or so)... but ALL of my classmates in family med PGY-2 last year HAD to write it --- once you've written it, you don't have to write it again. It is a licensing requirement for new family docs.
  7. crackers

    Core IM and IM

    If you google "r4 match", you get a website from U of A that shows the progress of the match to the various subspecialties in medicine beginning the first full week of November each year. It lists the schools, programs, number of spots, number of offers, and number of acceptances and declines. Depending on the discipline, an application to a subspecialty program (with references, CV, program-specific forms, etc) has to be submitted sometime between the end of July (cardio deadline) and mid-September in your PGY-3 year. Inteviews are in September and October with about two weeks' notice, and the match is done in early November. The specialties involved include GIM, Geriatrics (1 year), Endo, Resp, Critical Care, Nephro, Rheum, GI, Allergy, Heme, Onc (2 years) and Cardio (3 years). Right now the match is a phone-call or e-mail based match; you can apply to a number of programs, and they can contact you with an offer as early as the first Monday of November. You have the option to accept the offer, decline the offer, or hold the offer. Here's where it gets confusing. You can hold two simultaneous offers for a total of 48 hours, and you can hold one offer for the entire length of the match. As an example, Dr. J desperately wants Cardiology in Winnipeg. They apply to Cardiology in Winnipeg, Calgary, Toronto and Vancouver, and General Internal Medicine in Winnipeg too. They get an offer from Vancouver, which they decline. They get an offer from Calgary on Monday, which they hold, so they have a spot in Cardiology now. They get an offer from Winnipeg GIM on Tuesday, which they also hold. Dr. J now has to decide whether to pick specialty (Calgary Cardio) or location (Winnipeg GIM) before Thursday, as they have to drop one of their offers; Dr. J can also accept one of the offers or hold one, hoping a spot in Cardio in Winnipeg comes up. While checking the website for the R4 match, they notice the number of accepted offers for Winnipeg Cardio is the same as the number of spots --- it's full. Decision time. Like I said it gets confusing. And when you are waiting a week for a spot in a program you REALLY want that isn't full to open up, it's a little soul-sucking too. IM PGY-3s are either very happy or very bitter the first week of November. Every internal medicine resident will write their FRCP© exams in two parts in the spring of PGY-4; for GIM, that's it, for the others, there's a subspecialty exam usually in September after the final year of fellowship. Hope that helps... I had to wait a week in November, but now I'm off to Toronto for GIM in the summer!
  8. I think the more important thing isn't getting good marks... it's can you get good marks and still do other stuff besides! I had about a 91 in HS but I did a ton of other things (swimming, badminton, choir, drama) etc and that's what made it fun. But it also taught me how to manage my time, and THAT'S the big key to being successful at university and in med school (and as a resident!). If you have the brains to do well. Great. But can you do well with a million things on your plate at the same time, because that's what medical school, residency and practice will be like. I would rather have a doc without the highest GPA, who's well-rounded, well-read, and can talk about golf, bridge, Sudoku, music or bungee jumping. Good luck, and have fun! You're only young once. A rapidly aging resident (PGY-3 Internal)
  9. crackers

    IM residents...

    Depends on the program... some schools have residents on the CaRMS interview panel, others do not.
  10. crackers

    Oncology - salary?

    Depends on the province and/or clinic. In Ontario, at the cancer care centres, a lot of the oncologists are on an alternative funding plan (roughly $200-250K/annum); not sure what it is in other provinces.
  11. Being fiercely independent and being a medical practitioner are almost mutually exclusive. The point is to help people and interact with them to sort out their needs and ailments. The positions that are most removed from patient contact are (in no particular order) Pathology --- you and your microscope slides, working with techs occasionally, writing reports when completed. Very few people will go to the pathology lab to ask additional questions (some do); it can be quite isolated. Radiology (not interventional) --- setups occur when physicians read X-rays/CT/MRI from halfway around the world, and never see the patients (taking advantage of time-zone differences); people will often come talk to radiologists for interpretations, ask specific questions, find out when a certain scan can be done. Medical microbiology and infection control --- usually an MD (it helps), works on samples/isolates/specimens. Tends to run like a microbiology lab. Academic community medicine or epidemiology can be run from an office, but often you have colleagues; doing collaborations on line often occurs, however. Working nights (and being happy working nights) increases the demand for your skills, and will reduce the number of people you have to interact with, but it's never zero. No one in the profession of medicine, which is about dealing with and treating people, can completely remove themselves from human interaction. Good luck with your studies.
  12. crackers

    Medical Micro/Infect. Disease

    Medical microbiology at UWO is a 5-year, separate entry PGY-1 program from CaRMS. In the first two years, a lot of off-service rotations like medicine and pathology need to be done, but thereafter it's purely medical micro. Their area of expertise would be analysis of resistance patterns, infection control, nosocomial infections, and laboratory characterization of infectious organisms. Low patient contact, but highly important. ID is a 2 year subspecialty after 3 years of core internal medicine. Their areas of expertise would be treatment plans for HIV patients, clinical management of serious in-hospital infections, assessment of wounds, fevers of unknown origin, and in some hospitals, oversight of antibiotic prescription patterns. HOpe that helps. Check out carms.ca for med micro info.
  13. crackers

    MCAT Expiry

    MCAT scores are good for 5 years. I had to rewrite mine...
  14. crackers

    How would you present yourself

    Nickname from when I was a gradeschooler, easy to match with my first name. Would not endear me to psychiatry program directors.
  15. crackers

    Physician Skillsets

    awareness of self awareness of others awareness of personal and physical limits