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ACHQ

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  1. Tbh get letters from your core CTU rotation and see if you can get at least 1 elective. If not no biggie just apply to all 3
  2. Recent staff GIM grad here and staff at a community hospital. if you don't mind me asking what was the 5 year surgical specialty? Is this something you still want to pursue and did you love it as much as CTU (or more?). Do you like family medicine as much as either of those? What did you love about CTU most? was it the inpatient/ward work? was it the new consultations from the ER (or other areas)? was it the resuscitation's? was it clinics? was it all the above? if you exclusively only enjoyed inpatient ward work then family medicine with extra training in hospitalist medicine is not a bad idea, but doesn't offer the range of work possibilities GIM does (ER consults, urgent GIM clinics, inpatient consults to non-IM services). Given the COVID-19 pandemic (and the fact that we are definitely in the beginning of a 2nd wave) it may be tough to organize, but try to and see if you can get *any* Internal medicine related electives (GIM or sub-specialties). If your heart is truly set on it then at least give it a shot. Even if you can't get an elective you can at least apply and see what happens and delay making a decision right now (or at least have a decision made for you via carms interviews received or not received). I have seen people get interviews with minimal electives (they were using it as a backup), and given the pandemic you can definitely use that to help out your case. The one thing I would consider is if you are applying for a 5 year specialty and get it it would be easier to transfer to Internal medicine (or family medicine) than the other way around (due to funding issues) Good luck!
  3. I'm assuming you meant downtown Toronto (in which case you're not necessarily wrong). But in *GTA* (including Toronto proper: Etobicoke, Scarborough, East York, North York and downtown Toronto), then definitely won't be at an academic centre. There are actually more community hospitals in Toronto/GTA than fully affiliated academic teaching hospitals (No I don't count the community-academic hybrid hospitals as academic, they are mostly still community). Also although commuting can suck a bit, you don't have to live next to where you work, I still live downtown for now and commute to the community.
  4. I know two former classmates/friends of mine who are in the midst of their CVSx residency. One of them is definitely doing a PhD (they already had a masters and knew that going into the field they needed a PhD), the other is doing another fellowship in CCM/ICU (so as to be marketable to the CVICU groups), and I believe they had a masters/PhD before starting medical school. I would say most doing a CVSx residency in Canada realize that they "need" some sort of extra training (graduate degree and/or fellowship) and is not limited to just a 6 year residency. I think you have prepare of a 8-10 year residency. We have to start being realistic with medical students so that when they go into fields they don't have this mismatch between what they thought a field was and the actual reality of the field. This mismatch between expectation and reality is what leads to bitterness, regret and burnout. Its good you are open and flexible to going to the U.S. because it makes it a bit better trying to find a job. If you "know" you want *any* surgical career (but by your signature it seems you just started medical school this year, so you have time to truly decide if you are willing to make major sacrifices for a career in surgery), then I would definitely do the USMLEs (step 1 and 2CK, while in medical school, Step 2CS with MCCQE2/LMCC2, and step 3 thereafter). I would also look into if you do a CVSx residency in Canada whether you need any extra training and whether the U.S. has a reciprocity agreement when it comes to training in CVSx (from my limited understanding I thought CVSx in the US was a combo of Cardio-thoracics...), and potentially look into U.S. residency programs as well. I think ultimately it would probably be longer than 6 years of residency and/or extra training/degrees....
  5. alot of the american trained IM's do an extra chief year to make up for the shorter residency.
  6. Your staff, fellow or senior residents will let you take time to grab lunch (time of day and amount of time will vary) Please take time to eat. If your residents and staff are too busy to notice the time, just speak up and say "I'll do that once I just grab a quick bite to eat". If anyone says no, they are the biggest tool on earth.
  7. I decided I wanted to make money and not have someone with the same credential's tell me how to take care of patients. The independence of staff life although scary is extremely liberating. I can't really answer your second question because it doesn't make sense to me at all... but I presume people do the 5 year, (or worse even 6 years if they do a chief resident year) to *try* and get an academic position but if I told any of them how much I made for the month of August they would instantly regret their decision
  8. GIM staff here, GIM can do whatever they really want. That being said to do primarily outpatient is not very common due to the high overhead for an outpatient practice which eats into your take home income. The real money in GIM is a hospital based practice, where you do a mix of inpatient hospitalist/MRP work, ER consultations (variety of days, evenings and nights), and outpatient GIM clinics. Not only do you get a nice variety of work, but you also pay 0 overhead. I won't comment any further on GIM hospitalist vs FM hospitalist, as there are lots of regional variability to this. All I will add to that is at my specific site of practice there are FM hospitalists and some of us in the GIM division that do hospitalist work as well (myself included). TBH I don't think they give the GIM'ers the more acute patient's (but I could be wrong), I think they just generally divide the new admits across everyone. I personally find the FM hospitalists will consult more if they have a more acute patient.
  9. Just finished GIM training (4 years), the core 3 years are very tough. First two years have frequent and busy calls is what makes it tough. 3rd year there is overall less call (again dependent on program) but you are studying for the royal college (biggest exam of your life). Depending on how supportive (...or not) your program is can make life tougher. I would say rough averages (not including time spent reading/studying) when your on GIM/CTU, ICU and CCU is roughly 80-100+ hours/week (including call). On sub-specialty blocks its usually better (as long as they don't kill you will too much call, again program dependent), around 40-60 hours/week. As mentioned, Rheum is after core IM. If you mean do you need a fellowship to get to get a job after a rheum residency... probably not, unless you want to stay academic.
  10. Not to put down tech/finance/corporate careers, and I'm sure they work extremely hard, but unless they are working 24-26 hour shifts with literally someones life in their hands... I don't think that is an accurate comparison. But I do think many of those outside medicine work very hard and long hours (and sometimes comparable or similar hours to those in medicine), with less compensation. I will just add this, that 500+k for sub-specialties (that take 5-8 years AFTER medical school to achieve, because lets face it in a big city you'll need additional fellowships), pay a exorbitant amount of overhead (30% at minimum, for the ophtho or others that require specialized equipment, it could be up to 50%). And any of the "kush" specialties (allergy, endo, rheum, even family or psych) have 30% overhead for their clinic as well... so that 250-300k is really 175-200k I think this argument that you can make lots of money outside or within medicine is moot. Yes you can make a lot of money in medicine, but trust me (as a staff), there are huge trade-offs (just like any other field). With medicine I still believe we are underpaid and undervalued for the work we do, and the pandemic has really shown me this. At least we are in the publics good books for now.
  11. 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.
  12. 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
  13. 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).
  14. 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.
  15. 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...).
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