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ralk

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Everything posted by ralk

  1. For my look, # ranked discipline as first choice is the denominator, not the numerator. It's # who ranked discipline as first choice AND matched to it, divided by the # who ranked discipline as first choice regardless of what they matched to. The CFMS publishes this same statistic in their Matchbook every year, though it looks like they've restricted access to them now and I can't personally access them. I've run the stats on this and posted them somewhere in this forum every year since 2014 (the 2014 stats are in this thread at the start) except last year I believe when another poster ran the numbers and posted them first. I'm not in a position to draw up previous years' stats right now, but will see if I can find the old year's numbers on my computer when I get the chance.
  2. For those interested, ran my version of the stats on last year's match earlier, just not in this thread. I usually look at the rate of successfully matching to a first choice discipline as my main metric - using quotas as the denominator provides a useful look, but I find it can get difficult to interpret as they're heavily impacted by people backing up and by regional mismatches in quotas vs interest, especially for middle-competitiveness specialties. Link is below.
  3. Depends really on your definition of "minimally invasive procedure". Some things are common enough in FM that with some focused training (either as part of a +1 or, more commonly, with less formal training after completing residency) and with a lot of self-marketing to develop an adequate patient load, you could do them as a focused practice. Lumps and bumps clinics, vasectomies, IUD insertions, and some cosmetic work would all be well within the scope of an FP with dedicated training. Vaginal deliveries are routinely part of FP practice, though despite what the CCFP might say, additional training beyond the standard FM residency should be done to do these well. Some of the other things mentioned have been done in the past by FPs, but are on their way out for very good reasons - no FP these days should be doing C-sections or colonoscopies. Even focused training wouldn't provide the breadth or depth of knowledge to do these competently once they move anywhere beyond routine, and there are plenty of specialists available to do them who have far greater expertise. These procedures are simple enough when everything goes right, but no FP has the training necessary to fix things when they inevitably go wrong, such as lancing a ureter or perforating the bowel. The PDF you linked talks about procedures that are fairly advanced and should absolutely be left to specialists - for example, colposcopy, which in Canada can't even be done by an OBGYN unless they have specific certification beyond standard residency training.
  4. For those who went unmatched (and are still reading this thread despite the directions the conversation has turned), please reach out to any and all supports that are available to you, when you're in the mindset to do so. This year's 2nd round is different than in previous years, which provides both some challenges as well as some opportunities. For CMGs, there are now a lot of dedicated CMG spots in the 2nd round, many of which I know would have typically been filled by IMGs in the 2nd round in the past. This means a CMG flexible about location and/or specialty probably has a much better chance of matching in the 2nd round than in previous years, but as others have noted, the unfilled spots are mostly in less competitive locations or specialties. These locations and specialties are typically less competitive for valid reasons, but can still be excellent fits for many students. Please take the time to look into as many of these as possible before writing them off as poor options, especially for FM residencies that are a (relatively) short 2 years in duration. Many CMGs who look at their options, their preferences, and weigh the pros and cons will choose to wait until next year rather than try to match in the 2nd round to an available spot, and that can be the right choice in many cases. Still, it's worth exploring as many of the available 2nd round spots as possible, especially with the reduced competition for CMG spots this year. Anyone who's unmatched and needs to write out their frustrations or bounce ideas off someone, my inbox's open. There are many paths forward from going unmatched, and while none of them perfect, yesterday's result should never be viewed as a dead-end.
  5. To provide a bit more context, we're talking being unable to finish 1 week early, after having completed and passed the standard number of blocks (including all selectives, electives, and core rotations). Family doesn't exactly lack for flexibility in how you spend your time either, at least in 2nd year. Haven't heard anything different from 5 year programs either, admittedly with less exposure. Residency is still very much a time-based committment.
  6. Haven't heard of any examples and I'm skeptical it's going to be available on any significant scale. I know it's not a thing in FM, despite being ostensibly competency-based for some time now (found out from a bit of a unique circumstance it's a shockingly firm time requirement, down to the day and even independent of blocks/rotations passed).
  7. Hmm, good stats there, that's very helpful. So, there would seem to be a real benefit if this were implemented nation-wide. Wonder what the breakdown would be province-by-province though. When I looked at last year's numbers, it seemed as though there were about as many Ontario IMG spots left as there were IMGs matching to Ontario in the 2nd round (17 each). IMGs also gained some of that ground in less desirable locations (such as NOSM, which had no IMG spots left in the 2nd round but matched 4 IMGs), meaning CMGs correspondingly likely took some more desirably-located IMG spots that they now won't have access to.
  8. That's a bit of a surprising move. Considering how tight the ratio of spots to graduates is for CMGs in Ontario, not sure why the provincial government would want to lock in that ratio moving into the second round. There's no great stats on crossover of CMGs and IMGs to spots originally designated for the other stream, but from what numbers are available, I'd guess that it's close to even (that is, about as many CMGs end up in IMG spots as IMGs end up in CMG spots). This should mean the net effect on match rates should be zero or at least fairly small, but it makes the system less flexible and I'm not sure I see an obvious upside. Programs now have a smaller pool of candidates to draw on for both CMG and IMG spots, meaning they're not going to get the optimal candidate as often. Hopefully there's a bigger plan here - it would be an interesting approach if more CMG spots were added, for example - but in a vacuum I see this change as introducing a few (relatively small) problems while solving none.
  9. To make sure you're getting good financial advice, do some research before and/or after any financial meetings and check what you know against what they say. If it's not lining up, go somewhere else. Financial advisors - whatever their official capacity - will know things you don't, but should always be able to explain their recommendations in a way that makes sense to you. If they can't, they either don't understand the system (or your situation) well enough to give more than the basic information they're comfortable with, or they're selling a product/approach/idea that benefits them or their company more than it benefits you. In that first case, they might still be giving good final recommendations and you might have some wrong ideas, but if they can't work you through the gaps or misunderstandings in your knowledge, they shouldn't be trusted to direct your money. Don't need to know everything about financial matters - that's why you go through and pay experts in the first place - but need to know enough to ask meaningful questions, and to detect BS answers when they come.
  10. Have to agree with this. Rural ERs often function more like well-supplied and well-staffed walk-in clinics than they do as true ERs. Most don't have the equipment necessary to do full resuscitation (and the physicians covering them may lack the necessary skills in the first place), so these get sent along to larger hospitals anyway. Many don't have the volume to justify full 24 hour coverage either - if they only need a single physician covering during the day, then night-time shifts are necessarily going to involve a lot of down-time for the one physician on at night. Sure, it's nice to have a 24 hour walk-in available closer by for semi-urgent issues, but it's not particularly efficient use of resources, particularly in areas with limited healthcare resources in particular. Concentration of personnel and equipment into fewer, larger centres, would be better in some cases. Get some real ER docs in there rather than FPs without dedicated ER training running the show, ensure adequate ER equipment availability, and increase the supply of supportive diagnostic services for longer hours. Turn the remaining ERs into what they are, essentially limited urgent care facilities, for daytime/evening hours. Yes, that means some patients have to travel further to get to the closest ER, but it means that they might have less distance to go to get to an ER that actually functions like an ER - not a place without any lab services, diagnostic imaging, the ability to intubate, or even an awake physician.
  11. Residency programs are not allowed to ask about any medical conditions, including mental health issues. If any were to ask, the best course of action is generally to lie and deny any conditions, then report the program for violating CaRMS rules. According to current rules, your diagnosis should have no direct bearing on your ability to match to a residency program of your choosing. Licensing is a bit of a different issue in that most provincial colleges require a disclosure of any conditions which has or could reasonably affect ability to practice competently. This is fairly vague and the line isn't well-specified, so this sort of disclosure would depend very much on your personal situation. Mental health conditions that are outside the typical anxiety/depression would, in my opinion, generally require disclosure, but it's impossible to say without more details (which you absolutely should not provide on a public forum). If in doubt, this would be a good question for your psychiatrist. Such disclosures can cause some headaches, mostly as regulating authorities may require compliance with certain steps to ensure any risks to patients are minimized, but are necessary if your condition could impact patient care in a significant way. For the most part, health conditions should not impact an overall ability to practice medicine, though could impact what you practice and how you go about things. Someone missing a hand cannot be a surgeon, for example, but could likely make a fine psychiatrist. Likewise, someone with a history of addictions issues might require frequent checks on medication stores if they were to work as something like an anesthesiologist, with easy access to highly-addictive substances. If you've made it through medical school successfully, regulatory bodies generally won't prevent anyone from practicing. People are generally told to avoid mental health diagnoses, not just because of possible disclosure to regulatory bodies, but also for insurance purposes. You have to disclose any diagnoses for insurance, and that can be costly, or leave you open to gaps in your insurance for at least a certain period of time. However, this "do not get diagnosed" mantra should really only apply to mild conditions that do not necessarily require medical intervention to address effectively, and mostly because of the insurance effects - anything serious enough to require disclosure to a provincial college should absolutely get diagnosed and treated, because at that point it is a danger not just to the practitioner but their patients as well. If you've already been diagnosed, then there's not much point stressing about it - disclose when legally required, do not disclose when not legally required, and adhere to any treatment plans required to ensure safety when treating patients, if any are necessary at all.
  12. Keep in mind that while the tax is decently high, it's the same as it would be for anyone making $230k, in or out of medicine. Student loans are a lot, but with our interest rates, it's a fairly manageable sum. Even as a resident, with a far lower salary and take-home, I've made a solid dent in my overall debt load. The main advantage to medicine is that these earnings are pretty much guaranteed, and start at a young age, while other career paths only earn these sorts of numbers if you're top of your field, significantly older, or both. Even in FM, being a physician is a pretty lucrative career and high earnings mean high income tax, no matter how you get there. The high tax burden is the reason to take full advantage of those tax credits though - no one should be paying anything close to that $85k figure in income tax if they're making responsible financial decisions (and maybe giving a bit to charity ) Tuition credits are a huge benefit, but don't factor too much into staff income. Most residents run out of credits somewhere in the middle of their R3 year, so an FM doc will run out of those credits pretty early into their first year of practice, assuming they didn't do a +1 year. As an R2, I basically pay zero income tax, which is a major benefit when it comes to paying down debt and moving away from the (cheaper) student life, so even if it doesn't impact my future income as a staff, these credits make a big difference to my overall financial situation and quality of life.
  13. Owning a clinic vs working for a clinic doesn't change your tax burden in any way. Owning a clinic means you are in charge of your own overhead, whereas working for a clinic owned by others usually involves some sort of arrangement for the clinic to cover your overhead for you, typically by taking a share of your billings. You get taxed on whatever is left after overhead either way. If you're a particularly good manager of your own clinic, you might be able to pay less overhead than if you worked for a clinic you don't own, but any savings are likely to be very small. Physicians can save money on taxes in various ways by incorporating, but this can be done without owning your own clinic. The net earnings pre-tax are unchanged, while the amount saved in tax is going to be variable and depends on what corporate taxation laws are taken advantage of, and how. Using the $230k figure as an example, taxes would take about $85k in Ontario (which is about middle-of-the-pack in taxation rate). Various deductions available to everyone - such as charitable donations, RRSP, childcare or medical expenses - can reduce this a fair bit on their own. RRSP contributions alone can reduce overall tax burden by at least $10k per year. Holding money in a corporation can allow for income deferment, which over time could reduce the overall tax burden somewhat. Income splitting with a spouse or child is also a fairly common practice to reduce overall tax burden, but is almost certainly being phased out by the current federal government. In any case, none of this has anything to do with owning - or not owning - the clinic where an FP works.
  14. It's tricky, as most of the fields that have large numbers of Saudi residents are not ones in particularly high demand in the Canadian system. In some cases, Saudi trainees were taking the place of CMG spots that were intentionally (and in many cases justifiably) rolled back in favour of spots in other, more in-demand fields (like FM, for example). With a few exceptions (possibly IM), I doubt the answer to this loss of residents/fellows will be more CMG spots. Rather, I think we'll see other internationally-sponsored residents be recruited to fill those spots if possible, or we'll have to see resident call demands adjusted in these programs to account for these lost residents. In the short term, existing residents in these programs will likely see their call adjusted to the allowed maximum, with staff having to cover any holes. To the extent that we see new CMG spots, it should and likely will be in fields with comparatively few Saudi residents, such as FM, EM, or Psych.
  15. 1) Very hard to say. There's plenty of room in any admissions process for bias and a public figure will always be subject to more pre-conceived notions than others. This could hurt, help, or have a negligible impact. Any provincial election will involve taking (or dodging) some potential controversial positions, especially if this is being done in conjunction with a party. Even if you say nothing, you're linked to the rest of your party, and it's pretty much guaranteed one of them will say something controversial to at least some of the population, including some physicians, no matter what political stripe you run as. Overall, I can see a lot more potential to hurt your applications than to help them. 2) Long deferrals are generally not given by most schools, though I have heard of rare examples of extended deferrals (usually on a year-by-year basis) for very good reasons. I doubt any school would give you 4 years credit right off the bat - at best, it would likely be a year-to-year decision where they could rescind your acceptance at any time. Besides, if you are elected, would you not be planning to run again as an incumbent? Being a politician is rarely a one-and-one thing, especially for younger candidates. In any case, both medicine and public office such total-life commitments that, at least initially, it's probably best to choose a path and commit to it wholeheartedly than try to do both at the same time. You're far more likely to do both poorly than either well if you're splitting your focus. It's certainly possible to maintain an interest in the other field (ie be a politician who has a focus on healthcare, or a physician who is active politically), and once established in either field, it's very possible to switch into the other, but trying to do both at once seems like a recipe for disaster.
  16. Seen some rumblings on social media saying some have been instructed to leave by the end of August. Nothing official though from the Saudi end. The Canadian federal government doesn't seem interested in kicking any students or residents out, so it's all driven by Saudi Arabia's timelines.
  17. Well, Yemen might not be the best example here, seeing as Saudi Arabia is a major reason as to why that country is so volatile these days...
  18. We'll see if they carry through with this threat. It would be more disruptive for them and their citizens than it would be for us, so it seems like a very strong reaction for how this situation started. If they do go through with it, the effect on our system will likely be mixed, though probably negative in the short term. Call and duty schedules could go very crazy, especially in some programs with many of these learners. Some residents may unexpectedly find themselves working extra call shifts, particularly in the short term when there isn't as much time to plan around these disruptions. Programs and hospitals also get a fair bit of money from Saudi Arabia for this training and that could see some very real reverberations through the medical education system, resulting in some cuts to certain voluntary hospital- or program-provided perks. Smaller, less competitive fields that rely heavily on these learners will likely see the greatest changes. Over the long term, there could be some benefits. This could open up capacity in some programs to take on new residents, as despite programs' protestations to the contrary, foreign-sponsored students do take up learning opportunities that could be directly elsewhere, especially with the new pressure to open up additional CMG spots. From a quality perspective, while Saudi-sponsored trainees had a wide range of capabilities (as with any larger group of individuals), I generally have found them to be on the below-average end of the spectrum when it comes to residents of equivalent training levels, at least in a Canadian practice setting. On the balance of things, I imagine programs and hospitals will view this as a decided negative - after all, they took on these learners for a reason. The healthcare system overall will probably see changes closer to neutral once the dust has settled. For other residents, I'd argue there will be short term pain, but some rather modest benefits over time in the way of less crowded clinical teaching centres. One element I came across that I believe may be a negative from a broader perspective is that these residents spent years, typically half a decade or more, immersed in Canadian culture. Their kids - and most have kids - grew up around Canadian children. That imparts certain values which are hard to shake, even when they return to Saudi Arabia. Saudi Arabia is, if only very tentatively, starting to make some moves towards a more progressive, open society, and the more people who see the benefits that come with a more Canadian mindset, the faster such changes might happen. Medical residents from Saudi Arabia are universally from a more privileged class than the vast majority of the country, and in many ways have directly or indirectly profited from the oppression of wide swathes of their citizens, but as most successful revolutions - peaceful or otherwise - only occur with the support of at least part of the privileged classes, the more individuals in that echelon of society open to reform, the better the prospects for reform get. Sounds like most of these students and residents will be transferred to other western nations, so it's likely they get the same general exposure to more liberal societies. Still, the chaos of this announcement could lead to some missed opportunities to inch Saudi culture closer to the west, and reduce the frequency of events like the one that started this whole diplomatic row.
  19. Yep, those stats are available here. There's definitely diminishing returns on program rankings, as about half of people match to their #1 choice program and after about the 5th ranked program, candidates are more likely to go unmatched than go matched to a lower ranked program. That said, if you're not getting one of your top 5 programs, those lower ranked programs suddenly matter a lot because they can reduce the chance of going unmatched significantly. What I tend to tell students is to apply as broadly as they can, but then not to sweat it too much if they've got fewer interviews than expected. Once CaRMS comes around you can't do anything about the number of interviews you received anyway, and it only takes a relatively small number of interviews to get close to the "optimized" chances at matching.
  20. Have you seen the tattoos some old people have?! It'll be a good conversation starter for a lot of them. Yeah, there might be a few who don't fit perfectly with your personality including with how you appear, but every physician has patients like that, who aren't a perfect fit for whatever reason, but for whom a good relationship with can still be developed. That you're aware of the possible perception is important, as you may have to adjust your conduct for more traditionally-minded patients, but that's a very small challenge to overcome.
  21. As long as the tattoos themselves are not offensive and you're generally presentable in dress and decorum, don't think most people in medicine would care much about tattoos, even large ones. Facial tattoos or obvious neck tattoos might be the exception there, just because they can be distracting and aren't anywhere near as common as tattoos elsewhere, but I can't see anyone objecting to something a sleeve of flowers and waves. Plenty of physicians have tattoos, even ones that are visible in their day-to-day work.
  22. Match rate's below 90%. These days I'd call pretty much every specialty besides FM and a few smaller unique specialties moderately competitive or worse.
  23. Absolutely. Being geography-constrained and going for competitive specialties still means a risky match overall, but by focusing heavily on only a few programs (especially if it's at the home school), it opens up some back-up options that might not be as feasible when applying cross-country for the 1st choice specialty.
  24. Quick update - when I first made this post, CaRMS data on specialties that applicants back up into was essentially missed. CaRMS has since updated the numbers, so I think a quick dig into those is worthwhile. About 360 people backed up into a specialty - that is, they matched to a specialty that wasn't the one they ranked the highest. Over those, 290 backed up into either FM (228 applicants) or IM (62 applicants). Another handful backed up into the larger, moderately competitive specialties (11 to Psych, 10 to Peds), with scattered numbers elsewhere. The highly competitive specialties like Derm essentially have no one backing up into them, as could be expected. Split specialties that are essentially the same once again skew the numbers here a bit, such as with the research track programs, likely account for about 10 of the remaining slots and I'd call these backing up in name only. All told, the situation is essentially the same as it has been for years - if you want to back up, chances are you'll be backing up with FM or IM. There's always a shot at backing-up to some other specialties - even relatively competitive specialties like Gen Sx and OBGYN get a few every year - but it's a riskier option and personal circumstances are likely major factors in walking that tightrope that public data just can't reveal. Overall, backing up remains a viable option for a lot of people who would be comfortable with something like FM or IM as a 2nd or 3rd choice option, so long as they approach their electives planning and CaRMS match strategically.
  25. Yeah, that's a tough spot. Polite persistence is what I would recommend. Be direct in asking what you're looking for, whether that's a chance to get further into the research project or clinical opportunities. Often these preceptors won't say "no" to any requests, but will try to string you along with vague promises or by saying they'd like to but can't for whatever reason. They want you to keep working for them. Just keep asking. They can't take you along with them in clinic? That's fine, do they have a colleague who would be willing? They'd love to go over your research questions but never sit down to do it? Ask when, provide times. None of those times work? Give a bunch more. Get them to set timelines and firm commitments. When they go past their timelines to get back to you, send them another message reminding them of your earlier discussion. Do it politely, do it respectfully, and don't do it excessively (for example, if they ask for a week to get back to you, give them at least that week), but do it persistently. Don't avoid being a nuisance, just be a reasonable nuisance. My first real research supervisor was an incredibly busy person who was upfront about telling me to annoy them. Best research advice I ever got. It is a bit of a balancing act, as it's possible to go to far, but doing nothing gets you ignored. Keep holding up your half of the deal (do the scut work and do it well) while gently pushing them do hold up their implicit end of it. If in doubt, start slow and ramp up as necessary.
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