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ACHQ

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  1. I just finished residency and I'm starting staff life, and I also left a career before starting medical school. I will start off with my overall impression: Yes I am *generally* happy with my choice. I think the biggest issue is many not actually in medicine/premeds/even medical students have a very skewed and idealist perception of what being a physician is all about. They fall in love with the good aspects of medicine (and these are the reasons why we all go into medicine, at least I think it is): being able to use our minds (and hands) and solve problems, being able to effect and impact someones life, being able to work with people (whether it be patients, allied health or colleagues), having a "secure" job with very good income potential etc... What they fail to see or realize is how much we have to put up with and how much BS is within medicine (even as a staff): *long* training times, long work days (including working off hours/holidays), red tape bureaucracy that makes our lives painful (whether it be via the hospital, or government), being underappreciated (by literally everyone) and overworked and then just expected to do more with less. It's this mismatch between ones perception of how life would be and how life actually is that causes people to become jaded or bitter, and to some degree question whether they should do it. No matter how much you say as a premed/med student you can put up with the negatives, until you actually go through it and get your A$$ handed to you on a platter, and still feel like you can go to work, then you can truly put up with the negatives.
  2. I'm not neurology, I'm GIM but I work in the community and have a friend who is a community neurologist. I also can only speak of the GTA (but I think it is probably consistent with other places as well). I think there is a neurology staff on these boards that can comment (probably better than I can) Unless you work in a designated stroke/tPA center (there are a few tPA centers that are community sites) then you will rarely (if ever) have to come in *overnight*. All neurology admissions and consults from ER will go to GIM on call and they will decide to admit or d/c to outpatient follow up. If they need a consult they will ask neurology to see in the AM usually. IF its a more complicated/acute case which requires neurology input: e.g. Acute GBS, Myasthenic Crisis, weird inflammatory encephalitis's or myelitis's etc... AND I'm worried I would speak to the neurologist on call overnight and run the case by them and get their preliminary input/blessing on my plan (and they can decide whether they need to come in or not). Not sure how often this actually happens because MOST of those Dx wont be made in the ER right away anyways... Also often when a neurologist is on call, they maybe in hospital doing consults late and therefore may see a patient/consult in the ER/ward since they are already there. All bets are off if you work at a tPA center
  3. Moonlighting means different things to to different people. Restricted registration is a form of moonlighting. What some other people refer to as "moonlighting" within Internal medicine, is doing GIM locum (i.e. call shifts at community hospitals.). To do locum work at hospitals in Internal medicine, you have to have completed 4 year of internal medicine residency (i.e. be PGY5 or above) and completed the royal college exam in internal medicine (which anyone above PGY4 should have done).
  4. By broad I mean general. The fact that they are referred to as SUB-specialties tells you that its probably narrow. Yes a general cardiologist or (insert sub-specialty here) will see a lot of varied presentations but they will be limited to the heart. I would say that IM sub-specialties are *still* better off than most surgical (and other procedure/resource intensive) specialties for the following reasons: - You can always do GIM locum/call (even if things are tightening up there is still work to do the worst shifts, which pays well) - You can always do more of a outpatient based practice (and many of them are purely outpatient based anyways) The problem is that sub-specialist WANT to practice their own subspecialty to the full breadth/scope. That means although they can get work it may not be exactly what they wanted/envisioned, unlike a surgeon who cant find work...period.
  5. You're not wrong, and with the economy taking a downturn, governments will want to reign in spending, I see job prospects getting worse (even though tbh the job market has not improved at all since when I started medical school in 2012...).
  6. I just finished my residency in Internal medicine (4 year GIM program) and went through the process of looking for a job this year. I can't comment on various specialties and how easy or hard it is to find a job, there is huge variance in terms of specialties AND locations. I can talk about generalities: *Generally* it is "easier" to get a job in a specialty that does exclusively/primarily outpatient work (can either join a clinic, or start up your own) *Generally* it is "harder" to get a job that requires hospital resources (In-patient/ICU beds, OR/endoscopy/procedure time, etc...) *Generally* it is "easier" to get a job in a more broad specialty then a hyper-specialized one (as the more specialized one requires more resources... see above) *Generally* it is can be more difficult to find a job in a big/attractive location (Toronto/GTA, Vancouver etc....) than in a smaller/more rural location (big cities are saturated with talent) For me I was able to find a job at a centre I enjoyed and stayed within the city I wanted to live in. I did a more broad specialty, which still has decent job prospects... (although this even in GIM is tightening up...) The process of finding a job is a complete gong show. There are very few posted positions, most of it is word of mouth. I would try to set up electives at sites only if they had openings or the prospect of hiring someone, and a lot of the time I got "we don't know, come do an elective". I find the whole medical human resource planning, job search and hiring a bit trouble some, but unfortunately that is the way it is. The one thing that is slightly positive compared to other places is that setting electives at sites that are hiring really gives you a good feel of whether or not you like working at a location instead of blindly accepting an offer and being stuck.
  7. I went to UofT medicine (accepted in 2012, graduated in 2016), and I had a wGPA of 3.82 when I got accepted, that year I believe the avg GPA of the class was like 3.9 or 3.92 (something in that range, I know it was definitely about or equal to 3.9, but below 3.92). That being said I entered medical school 8 years ago, graduated 4 years ago (and I'm about to be a staff in July). Things have gotten way more competitive for sure. I don't know/think I would have gotten in with my stats now... (even though I would like to think I would have ahaha)
  8. Yeah I would agree with this. No one likes someone who doesn't want to be there in the first place.
  9. Sorry to hear that but at the same time congrats on matching to Canada (no easy task for an IMG), and the fact you got even 1 IM interview as an IMG shows that you are competitive IMO. And now you are in the Canadian system. I have met over the years a couple of FM residents transfer to IM at UofT (and even someone from IM at another *school* transfer to IM at UofT), so it is definitely doable. The biggest thing is that the IM program has to have a spots available that they want to fill. So once the academic year starts I would contact the various programs *across the country* (if you truly want IM that badly), about the possibility of transferring into their program and what you need to do. My school sent out an email around ~ Jan (of my PGY1 year) regarding transfers, be proactive and see what you need to do to accomplish that. It kinda sucks you don't have any IM rotations in the first 6 months of residency. I would definitely use that 1 elective block in IM, CTU would be the best one only because it will give you face time with the program and the ability to get reference letters and support for your transfer. If you can't do CTU than other GIM electives or subspecialty medicine electives are fine as long as you can make a positive impression and gain support from them.
  10. You still have to be a in a residency training program (PGY4,5 etc...) to be able to apply to CCM, you cannot finish residency and then apply (AFAIK). I don't know if non-canadian trained IM grads are in the first or second iteration... I actually think there in the 1st iteration. CCM is one of the few specialities that will allow you to apply beyond PGY3, (as long as your are not done residency though like I mentioned). I think pain and palliative may be like that but I am not 100% sure. For sure Geriatrics is NOT. "Lets say respirology has a few spots unfilled in the second iteration, would I be eligible to apply for that or is it basically a no go if you have graduated/completed R3 aside from CC? " - Nope once, you are done R3 you cannot apply for those second iteration spots at ALL, even if they go unfilled. I mean you can try contacting the school and seeing whether they can accommodate but I really doubt they will (funding usually goes away if spot is unfilled)
  11. Hence my comment bout those people being tools... they think it will make them better physicians, but in reality it just a waste of time and will lead to burn out
  12. welcome to the nonsensical red-tape political BS that is rampant in medicine!
  13. So there are basically a few components to interpretation of a TST: 1. The size of the induration 2. The PPV of the test (any reason for a false positive as you have identified, and exposure history) 3. The risk of reactivation (immunocompromised/transplant, HIV, CKD, silicosis etc...) They have nice calculators to help with the risk quantification: https://www.tstin3d.com/en/calc.html you were identified as "very positive" but now we know it was a false positive via the Quantiferon test. TST's should not be done unless one is going to treat for latent TB. The only reason we do it is because we are health care workers, and if it does turn out to be positive (a true positive) treatment for it should be strongly considered. That being said I don't believe a positive TST ever goes away (i.e. will always test positive every year so most people will just get the yearly CXR)...
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