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ACHQ

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  1. ACHQ

    Stress level

    As someone with their royal college exam this year.... this x 10.
  2. ACHQ

    GP hospitalist job market

    Most of the large GTA hospitals have ER-call/overnight coverage by a GIM/sub-specialists. That's because they are "the doctor" in the hospital and handle admissions to ICU, code blues, seeing deteriorating patients on the floor etc...
  3. ACHQ

    GP hospitalist job market

    technically yes. People who chose to sub-specialize typically don't want to do GIM work, or are too busy with their sub-specialty to take on GIM work. Many will take on ER-call shifts because it pays $$$. Some (but less so) will also do MRP work because it can also pay decently. Most who do this don't do too much because they are busy with a sub-fellowship, or clinical associate positions, or other subspecialty locums etc.... but this helps pay the bills
  4. Hahahahahah sorry I didn’t mean to be so harsh, but it is the reality of the situation. Some of the best medical students will be an asset to a team (an asset as much as a JMR can be). My point was that CTU won’t crumble in their absences. tbh I could care less if med students slow me down, but their job during their IM rotation is NOT to help make me more efficient (which they cannot do anyways), it’s to learn Internal medicine. I WANT my clerks learn something that they can carry with them forward regardless of what they eventually go into, even if it means we have to spend a little bit more time for it. “CTU” is a constructed system to teach medical students and residents internal medicine. As people mentioned if we just wanted to provide patient care and peace out we could (like how weekend rounding works, although we’re on call and there the whole day ahah)
  5. I have been on several teams where we had no medical students (at all), both during the day or on call at night. They are by no means essential to running my CTU team. If I am the on call SMR and I have no medical students, then I cover the ward pages, as well as admit to my own team with no issues (I'll likely be up all night anyways) If I have no medical students during the day then the JMR's might take 2 extra patients each, and/or I will easily pick up the slack and can see 5+ patients myself. No offense but CTU can and has run without medical students (at least I can only comment about UofT, but I'm sure this is similar at other sites). Can clerks save time for the team? of course! but it usually balances out for the most part. Even with medical students (even excellent ones, that function like JMR's) I always know what is going on behind the scenes and implement investigation/management plans, if the medical student doesn't know or missed it etc..., they are their to learn ultimately. I even do this with my JMR's but to a less extent depending on the complexity of the patient, whether they are a medicine resident vs off service etc... and try to give them autonomy without sacrificing patient care. All the SMR's I know do this and we make it seem like we are giving all the power to our JMRs and medical students. Any SMR that says they don't are lieing or are not doing their job Note: I really like having medical students, especially ones that like internal medicine and/or want to do internal. I like being able to teach them and have them learn and eventually grow as clinicians. That doesn't mean they are essential to my team by any means.
  6. This is NOT true. I personally know lots of sub-specialty fellows (PGY-5's and above) that do GIM call at large GTA hospitals (North York, TEGH, St Joes). Alot of the GIM people start to give away their overnight/weekend calls because they can still make 350-375k without having to do too much overnight work
  7. Correction I doubled checked its 7 people
  8. Yeah there's about maybe 4-5 people from Mac that matched to UofT IM in my cohort (PGY-3 class)
  9. When you do your internal medicine rotation they should teach you how to look for the JVP. Also its pretty helpful if its abnormally high (Elevated JVP has a + LR of 5, for CHFe which is pretty decent). For the JVP specifically, no medical student (and some Junior residents) ever actually see it. Even staff have a hard time seeing it at times. Change the position of the bed, press down on the abdomen (HJR), palpate. These things should help... and if not then just move on and say you didn't see it. It'll come with practice. Do I make any clinical decisions based off of JUST my physical exam findings... no. But do I use them to corroborate my history and in my gestalt... yes absolutely. Just like investigations/tests. I don't treat numbers or images (even though sometimes I might be very tempted to), I treat patients. That means History + physical + investigations = A/P There are some specialties/sub specialties that are highly dependent on physical exams, like neurology, rheumatology, Dermatology (skin exam)
  10. You don’t need to rely on hospitalist coverage in those specialties. If you wanted you could open up your own Clinic much like FM. The majority (if not all) of patients that require endo/rheum/Geri/allergy care do so in an outpatient setting, you shouldn’t have trouble filling your clinic (especially if your working part time), initially it might be hard when you start off because you need to establish a referral base, but if you market yourself well to the local FMs you won’t have any issues. obviously part time purely outpatient practice will pay less than a full time practice or a mixed practice (but that’s the sacrifice you have to make)
  11. Seems like you just finished first year (from your signature). Things will become alot more clear when you do clerkship.
  12. You have to ask yourself this question: - Do you like Internal medicine? If you only like the Geriatrics portion of IM and nothing else, going through 3 years of core Internal Medicine with the rigors of call and the royal college exam is not worth it. What if you weren't able to match to Geri?? Would you be happy being GIM? If the answer is no then I wouldn't do Internal medicine. Core Internal medicine's goal is to train Internists, not subspecialists (even if we want to be a subspecialist). Also something big that often people forget is, if you want to be a good sub-specialist you should be a good internist first. You should only do a specialty that you see yourself interested in (for any specialty). Otherwise you will hate your life. The only reason I can tolerate residency in Internal medicine is because I generally enjoy what I do.
  13. I’m currently a resident, did medical school at UofT but not at MAM, but know people from MAM There were “MAMers” from my year that matched to ENT, Urology, Ophtho, Emerg. The chances are equal as long as you work hard.
  14. ACHQ

    U of T vs. MacMed

    Depends on specialty and your own goals. I can really only comment for Internal Medicine (my specialty), I would go with Approach to Internal Medicine by Hui or Pocket Medicine by Sabatine. I heard good things about step-up to medicine, but never used it myself. As a medical student I often just used my class notes for that specialty during clerkship + whatever resources that rotation gave (most give out a hand-book/notes package for exam purposes). For the LMCC I used the USMLE Step 2 CK book which was also better (but much more abbreviated) than TO notes.
  15. ACHQ

    U of T vs. MacMed

    I hate Toronto Notes. I hated it as a medical student, I especially hate it as a resident. There are so many far superior resources, and I did medical school at UofT. They really need to overhaul it, its just a bunch of UofT medical students with staff "editors/supervisors". It needs to be cleaner and with less errors. 5. I think the specialization emphasis at UofT is more the "hidden curriculum" then them actually encouraging specialization. As per UofT style, nothing exists outside of Toronto and academics, and the unfortunate thing is medical students (and residents) get roped into this mentality. 7. People are generally friendly at UofT and not very competitive (even when going for the same competitive specialities). Because of the large class size, you often find your own "cliques". If you are someone who is already connected within Toronto with your own set of friends, you definitely don't need to worry about finding friends.
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