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LittleDaisy

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LittleDaisy last won the day on October 3

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  1. I won't go to UBC, because their medical school and residency has higher rates of intimidation/ not known for being a good teaching site and less support/supervision while still being a busy academic center. There is 33.3% of suicidal ideation among UBC family medicine residents according to this new CFP article: https://www.cfp.ca/content/65/10/730.abstract Personally, I've heard a lot of horror stories about UBC clerks being bullied and intimidated. UBC Is a popular school because of its location. But Vancouver has the HIGHEST cost of living, with second lowest paid resident salary after Quebec (whom has a very low cost of living). TO be honest, residency is so busy, you won't really have time to enjoy life and go out too much.
  2. I think beside St Michael's Hospital and Sunnybrook Hospital who are tertiary trauma hospitals, they prefer to hire FRCPC, although there are a few CCFP-EM who work there. The majority of other Toronto academic and community hospitals' chiefs are CCFP-EM and don't cherry pick over FRCPC or CCFP-EM. After all, 70-80% of emergency physicians in Canada are family physicians. It depends mostly how you network and impress your future colleagues during your residency/fellowship, if you are a good fit, they will advocate a job position for you. There is not too much point to hire a FRCPC in a community hospital, unless the hiring person is very keen on credentials. At the end of the day, you just need to find someone who will get along with the rest of the group and provides good service to the patients. A lot of soft skills can't be taught in medical school/residency. We tend to think that the most brilliant people get hired in coveted academic positions, but actually they tend to have strong interpersonal skills and connect well with the department.
  3. Thanks for letting us know! There was an infuriating post by another forum member asking why Canadian GPs are more "overpaid" compared to American GPs?
  4. No, because the overhead is lower. The rental cost pushes higher overhead, and I assume that employees in Vancouver expect to get higher pay given the insane cost of rent in downtown. The same thing applies to other major urban cities. Of note, B.C is one of the lower paying provinces after Quebec for family medicine. In other provinces, if you are efficient and do some inpatient or find a clinic with lower overhead, you can make 300 K easily as well. A lot of GP work part time: i.e 3-4 days per week with no evening/overnight and weekend duties; and hence the overall CMA lower GP pay. Overall, people choose family medicine for the flexibility, lifestyle and great job market that other specialties don't offer. So overall, my FM colleagues are not very "keen" on making more money rather than living comfortably. If you are an efficient physician seeing > 30 patients per day, and doing some other side inpatient work, you will get very well remunerated as a Family Physician.
  5. I think for GP derm private procedures like botox and fillers, the challenge is that patient shops around and can be challenging in term of their expectations. If they can afford to see a dermatologist, they would go see a cosmetic dermatologist. You end up with patients who are well-educated and would prefer a MD to inject botox and fillers; but sometimes want unrealistic results. You also have to get your name out there for patients to pick you. There is no referral needed, as it's not covered by the government. The lack of regulation around cosmetic dermatology, allows any allied health to inject botox: i.e: cosmetician, nurse; etc; which is worrisome as botox does have side effects and can cause damages.
  6. When you mention urgent care during weekends, and evenings and statutory holidays; does that refer to walk in clinic or doing urgent care clinic at your Family Health Team? or ER work?
  7. I think in Ontario, the FHO/FHT's pay model end up attracting complex patients being registered to a Family Health team with all allied health and community resources. Those patients tend to be higher needs and come back more frequently than q 6-12 months. So physicians in academic FHT end up seeing 20-25 patients per day (9-4 pm; with q 15 minutes per patient). Given they are paid per rostered patient with preventative bonuses; having a roster of 1000 patients pay around 300 K; after overhead it should be around 210 K (30% in Toronto, might be less somewhere else given the rent will significantly decrease). The caveat is that the government is restricting FHO/FHT spots. For FFS, the doctors usually see a patient < 10 minutes; so hence 40-50 patients per day; but the continuity of care and patient dissatisfaction is poor; to a point where the College in Ontario starts to have higher expectations for walk in physicians.
  8. I second rmorelan. Use preferentially LORs from Family Physicians, because we value their opinions more than specialists. I am sure that for FRCPC programs, they would prefer their own colleagues recommend you to their program than a different specialist recommending you to their program (i.e: asking an General Surgeon writing a letter for GIM). I would always recommend using the strongest LORs, instead of going with a preceptor who is well-known in the academia. In the end, the strongest LOR always stands out instead of a mediocre letter from a well-known academic staff physician. Just my two cents.
  9. Well I have to admit that having treated patients from the U.S in the Canadian health system, they straight come to my clinic for the first time and asking to see specialists for medical conditions that can be well-managed by a first year FM resident. My U.S patients told me that they can directly go to the specialists without any referrals, which undermines the role of the Family Physician in the United States. We have to understand that U.S is mostly private-funded health care system. It may seem much that the system is efficient, however only for people who are generally well, and who can afford to have private insurance. You tend to neglect the marginalized and vulnerable patients with multiple medical comorbidities; and who can't afford to pay the medications nor access specialized care because they can't AFFORD. I don't know why the U.S sets up their healthcare system this way. Regardless, there is already a huge economic disparity between the U.S citizens, same as for physicians in the States, where people pick specialties because it's much more well -respected and pays much better. I am not sure if you are a Canadian family physician. I want you to be aware that most Family Physicians pay 30% overhead, and spend countless hours DOING UNPAID WORK by filling out insurance forms, writing advocacy letters, doing social advocacy by being a social worker & psychotherapist & dietitian etc, filling out governmental forms for their patients; calling specialists so they can see a concerning patient sooner; and not counting being held always LIABLE for all their patients. In Canada, most patients NEED to go through a GP to get triaged to see a specialist; and we are trained to manage most pathology comfortably on our own from a new-born baby, to a schizophrenic patient, to a pregnant lady in labour, to a dying patient in palliative care, to a fairly complex patient with COPD, and to a frail elderly. In fact, patients trust their GP the most, and we save the health system money by triaging if patient needs specialist care, where in U.S, patient shops around for a tertiary care specialist for simple complaint like warts. Family Physicians ACT as the front gatekeeper of Canadian healthcare system, we KNOW patients the best, and ADVOCATE FOR them the most. If a specialist does not figure out what our patient has or dismisses our patients, we don't STOP trying and say too bad, see you in follow up PRN if you want to. U.S health system underpays family physician, as their healthcare is PRIVATE, and given patient can SHOP around specialists; what's the point of increasing financial incentives for GP? Your posts of NP and PA taking over Family Physicians show how little you KNOW about what Canadian Family Physicians do! I work closely with NPs and PAs, and honestly, they see a patient q 30 minutes to 1 hour for simple minor complaints; and will end up consulting MD for any complex presentation; they end up seeing 5-6 patients per day; and paid by the government with a salary over 130,000$ with all the benefits and no overhead; which is almost comparable to a GP working 60-70% full time who has to pay overhead. I find it personally insulting that the Canadian government tries to "sell" to the general population that a NP and PA are as "good" as a family physician who did 4 years of undergrad, 3-4 years of medical school, and 2 years of residency to still feel unsure of what patient comes in with; and where one constantly reads up all the guidelines and having full responsibility of all the patients under their name with higher standards of medical ethics and professionalism; IT'S NOT THE SAME. To @edict who said: "With that being said, I do have an issue with the short training time. I think training is too short. The possibility of doing 3 years of med and 2 years of residency and then staff a clinic or even an emerg all on your own is a bit too little training I think, but that's just me. " To be completely honest, I think you learn the most as being a young staff when you have the FULL RESPONSIBILITY. When you are a resident, you don't think as a staff and being the final person making the final decision. As for the ER work, most family doctors who just graduate is backed up by older colleagues during first year of ER work. Having done my residency in an academic center, with a few of ER electives and great exposure to acute care medicine, I myself feel that I am ready to work in an ER setting. It's up to the FM resident on how to bests advocate for their residency training. I am certain that my colleagues doing rural Family Medicine residency are fully competent as ER doctors by end of their training. And you HAVE TO remember that You just have to know your limits and WHEN to call for help. The majority of Canadian ER chiefs (> 75%) are CCFP-trained, https://canadiem.org/routes-to-emergency-medicine-practice-following-a-family-medicine-residency/ You have to remember that FRCPC- EM do not work in rural areas, they are trained to work in tertiary centers. So for the undeserved rural population, the family physicians fill in the gap and serve the communities that needs the care the most. Some family physicians work in urban ERs but mostly in community hospitals; or in academic hospitals after CCFP-EM fellowship. To be honest, having worked with CCFP-EM and FRCPC EM, except for trauma cases, I don't personally see much difference. I don't want to start an eternal debate for CCFP vs FRCPC EM; but I personally feel that if you advocate for your family medicine residency, and have a good exposure to acute care medicine, you are ready to work in an ER setting if that's your inner calling. To @OP, please remain respectful to the other members. You certainly don't behave as a professional MD, if you are one!
  10. I have to unfortunately agree for the nurse unions. I might be biased by working in academic hospitals. There are a number of times that I can count as being on a call for a very busy rotation, where the nurses would page me because their contract says that "I can't push this medication in" " I can't give this because this patient should go to ICU even though the patient is literally going to a code blue" "I can't put the NG or Foley catheter or IV line in, a MD should do it! " The tasks I described above all fall under their realm of practice and clinically it doesn't make sense to wait for the resident or MD. Despite the fact that the patients in front of them are crashing or too unstable to be transferred to another unit; all they seem to care about is to document ++++ and put all responsibility onto the MD. Professionally, as a physician, the patient safety and their lives count more than saving my own skin and put the blame on other allied health professionals. Once again, I am biased as I work exclusively in academic hospital setting.
  11. I think that you learn this unfortunately as you advance through medical school, residency and as a young staff. I was clueless about job market in medicine, and was angry at how government was unable to hire so many aspiring surgeons/radiologists despite a high demand. The more you advance through medicine, the more you learn about the hidden curriculum in medicine, the job market and how much government really "cares" about healthcare. One thing for sure, the government tries to cut down budget for healthcare, and has consequently asked physicians being " more productive", without realizing that we need more social workers, nurses, psychologists to be more productive. I can't count how many times I have spent on filling out forms, writing rebuttal letters to the insurance company, advocating for welfare services for marginalized population; counselling a depressed patient, being a social worker for my patient who is getting evicted out of his house because the system can't afford more public social workers; public-funded psychotherapy except by GP and psychiatrists who have a long wait-list already; and who knows if I will be more efficient if I saw a patient with acute medical concern that as physicians, we are trained exclusively to diagnose and manage; as we are short of social resources to delegate tasks to the other allied health professionals. Same thing goes for surgeons; the newspaper publish the wait time for elective knee surgery; they haven't considered that the government cuts down on O.R time; the O.R administrator constantly monitoring by how many minutes the surgeons are going over by closing time; and how they cancel the last O.R patient because unpredictable things happen. The whole population wants a more efficient health care system; but that won't happen if each political party tries to down health-care budget by just telling the physicians: " You work harder and see more patients" Sometimes it's more than a volume issue; it's a social resource issue and how our society as a whole views the importance of health care.
  12. The cardiology residency is very tough and involves long hours. I know a few cardiology residents who do GIM locum night shifts on top of being the senior at CCU unit. You have to be highly motivated, okay to sacrifice your personal lives and extremely hard-working and able to multi-task, it takes a group of talented and extremely type A ++++ personality. The job market nowadays is saturated. To work in a community hospital, most of the cardio fellows are looking for at least 1-2 years of fellowships. Their residency is a one long interview; and quite often, a few leaves for the States, as the job market is not that great for intervention cardiology. If you are talking about mostly outpatient work, I think that most of the people who want to be cardiologists, can't imagine themselves seeing mostly bread and butter of heart failure, HTN without any sort of hand-on intervention; it's not what attract them to this field in the first place. Just my two cents
  13. I would be most concerned regarding this: "Dr. Dempsey admitted that between 1998 and 1999, and between 2001 and 2004, he entered into sexual and romantic relationships with the mothers of two of his patients while continuing to provide care and treatment to the patients. " CPSO has clear guidelines that physicians should not enter into romantic or sexual relationships with a patient's family members due to power differential and conflicts of interests. The above mentioned physician was suspended for 2 months and will begin to practice in November 2019, I hope that he learnt his lessons.
  14. They pay no overhead. All physicians who work in hospital primarily pay essentially no overhead if at all--> very minimal amount like 5%. Like threads above, you don't have to be a specialist or be a rural FM doc to make money. It's a FFS, i.e, it depends on how efficient you are and how many patients you are seeing. However, you have to be careful for quality of care provided and patient safety; otherwise, you will run into trouble with the college later down the road. There were a few Family Doctors on the top 10 Physicians paid by Ontario government published by Toronto Stars. The caveat is that you will be required to do calls and depend how large your group is and how nice they are to young attending, your life will not be very friendly for the first 5 years of practice. Just my two cents.
  15. That's a lot but good for you if you love your work ! How many weeks do most FM hospitalists do in a major-sized city? I think that most people work 2 weeks straight and 2 weeks off per month? Am I correct? I agree that working a lot after graduation to pay off debt aggressively might be a good idea, but I can't see myself doing that long term as I realize that I get older and sleep has become a major factor of my productivity and wellness In Toronto, for community hospitals, they prefer GPs with +1 degree, but I've seen a few young staff got hired without extra training. I think that if you have enough training during residency and feel comfortable managing acute care patients and happen to know people in the group, you can get hired from a word of mouth. I personally believe that you learn the most during the first 5 years as a staff, because for once, you are it and you get to make the major decisions, which pushes you even further!
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