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Birdy last won the day on January 30

Birdy had the most liked content!

About Birdy

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    Kinda Bossy
  • Birthday 03/15/1987

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    Hamilton, ON for now

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  1. Birdy

    Mcmaster Family Sites

    Great question. A major difference is that I didn’t work in a big team. No JMR/SMR, usually no medical students or other residents at all unless there was someone on elective. It was me one on one with my staff. The patients overall did tend to be in hospital for more ‘bread and butter’ stuff since that hospital also has IM, but I did have some more complex cases sprinkled in as well. Honestly I feel like the mix I had at my site was about the same with respect to breadth and acuity as what the family residents on my CTU team in med school were being assigned from the list. We also work with the internists when doing call (no overnight call, but evening/weekend) so you do get some internal medicine exposure, so more complex consults, and I often got to follow these patients if they stepped down to hospitalist. I got to pick and choose my own cases and go where the learning was best since there was no one ahead of me. Plus the staff docs I worked with loved teaching and it was a heck of a lot of fun to work with them. One of the staff docs I worked with was IM-hospitalist (the others were FM) and so his list included both IM and hospitalist patients. My understanding was I could only be required to care for the hospitalist patients on the list, but I was allowed to be part of internal cases as well as there were some interesting ones.
  2. I know of at least one small hospital that pairs FM docs interested in emerg who plan to challenge the exam with experienced emerg docs as a sort of mentoring relationship for more acutely ill patients to ensure adequate skill-building. As someone with an interest in doing some emerg work in addition to family practice, I’ve been looking at places where FM docs can do emerg work without the +1 and there are several areas I’ve been able to find in my region of interest (Maritimes.)
  3. I honestly don’t have any sympathy for her. Her behaviour was unacceptable and she is receiving professional consequences, as she should. This is not unprofessional in the manner of stressed out doctor snapping back at some rude patient. I could feel bad for that sort of conduct. This is big-U Unprofessional, the consequences of which are clearly laid out and explained to us in med school. There was an inherent inequality in the professional relationship which made true consent impossible. This is one of the really big no-nos in medicine.
  4. Birdy

    Mcmaster Family Sites

    I’d like to plug one of the smallest Mac sites - Grand Erie Six Nations in Brantford - because quite honestly the learning is fantastic. I feel like it’s a bit of a hidden gem of a program. There are bimonthly sim sessions with the emerg docs, POCUS training, really fantastic staff who work 1:1 with residents for the most part so you end up with quite a bit of independence. Admin staff are responsive. Oh, plus overnight call is only on one rotation, otherwise you’re done at 11pm. And no CTU; it’s two blocks hospitalist.
  5. Mac has eight weeks of clinical electives at the end of first year (well, an eight week block. There’s one week of vacation.)
  6. https://www.carms.ca/data-reports/ Pick a year, go to town analyzing the data. Looks like last year there were 9 CMG spots and 8 people ranked it first.
  7. Birdy

    What do you think about this blog?

    Honestly I don’t know the averages off the top of my head. I don’t imagine they’d represent more than 30% or so of their overall revenue, but that’s just a very rough estimate. We’re talking $5-ish for the majority of visits (intermediate visit) with a few additions like smoking cessation, psych work, or diabetes visits thrown in there. But I’m estimating based only on a very incomplete understanding myself. Back home, as a contrast, family docs have the option of being straight FFS or having a salary plus 31% of shadow billings. To be eligible for a salary, you have to shadow bill at least 85% of your salary’s equivalent, so the minimum earnings for a salaried doc is actually 1.26x the salary (most make more. They don’t pay overhead when they’re salaried, and there is paid vacation and defined benefit retirement, so it’s equivalent to a lot more than it looks at first glance.) NS offers a straight salary option (no one has been able to actually clarify for me whether they have shadow billings on top of that) which they call their “alternative payment plan” since it’s an alternative to FFS. There are a couple setups for academic docs too that are slightly different. Making heads or tails of FM income is... not a straightforward proposition.
  8. Birdy

    What do you think about this blog?

    Capitation models (there are several different kinds) are common in Ontario but not so much elsewhere. Average per patient annual rostering fee is $144 last I recall. But they still bill per visit. There are “in-basket” services - things that are expected to be part of the basic services a family doc should offer - for which they receive usually 15% of the standard fee on top of the rostering fee, and then they have “out of basket” services that they receive the full fee for. Those are usually things that are being incentivized or are specialized FM services. And that’s just touching on the basics of it in Ontario. A straight up salary from the province isn’t an option here for community practice but it is elsewhere. Family docs often have multiple revenue streams; it’s not just their capitation payments or just FFS.
  9. Birdy

    What do you think about this blog?

    I would expect he’s talking after-tax and after overhead take home, assuming no tax-saving measures are used.
  10. And for McMaster you don’t actually have to live in the province at the time of application to be considered in-province. I hadn’t lived in Ontario for eight years when I applied and was still considered IP for Mac.
  11. Birdy

    On Podcasts...

    Bedside Rounds is great!
  12. Ah, what can’t be blamed on “kids these days” and the lazy parents raising them. Nonsense like that has been said about every generation, and it will be said about every generation in the future. My oldest does absolutely have issues with his fine motor skills, but he’s autistic, it kind of goes with the territory. It’s something we work on. My second oldest wants to be a surgeon and has been able to do simple interrupted and running locked sutures since she was six.
  13. Several of the things I found difficult about clerkship have largely been fixed by becoming a resident. I love that as a resident I have things like employee protections, vacation days I can book, a contract I can refer to for resolving disputes, actual maternity leave, a paycheque, and a signature that actually does something. That’s all pretty cool. I’m far more accustomed to being an employee than a postsecondary student, so the fact that I’m now the former instead of the latter is considerably more comfortable. One thing I do absolutely think clerkship could use is some sort of floating time off for personal use, like doctor’s appointments. I found the difficulty scheduling time off in clerkship for self care - as there is no built in time off outside of scheduled vacations, so all missed time must be made up, which makes it effectively impossible to actually take time off - to be very frustrating and I was not able to adequately attend to my own health, which became an issue.
  14. Some of the smaller hospitals have newer family doctors who do ED coverage without the +1 who do not handle CTAS 1/resus patients and always work with a seasoned EDP who handles those. Some do mentorship programs to help prepare family docs to challenge the CCFP EM exam after four years of practice.