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Posts posted by quickdraw_mcgraw

  1. On 4/13/2018 at 7:11 PM, Snowmen said:

    I don't think someone should make a career decision based on the possibility of getting HIV/HCV (which is now curable btw, weak example).

    Here is the policy.



  2. On 4/13/2018 at 7:11 PM, Snowmen said:

    I don't think someone should make a career decision based on the possibility of getting HIV/HCV (which is now curable btw, weak example).

    The career decision is whether the college will let you practice if you test positive.  They do not have a policy on cure, the only thing that matters is patient safety, your career does not factor into the CPSO's concerns.

  3. On 4/15/2018 at 9:03 PM, medigeek said:

    Well I mean we've taken an approach of doing less and less tests (both in Canada & USA) for patients, so I always find the extra (relatively) useless tests for health care workers interesting. As you pointed out, TB being the worst of them all. But ultimately it's a hassle that has minimal upside. If there was a exposure, everyone gets tested and gets PEP if needed anyway. 

    Thing with the TB test is... we're handing out a hepatotoxic drug to people who may not (and likely don't) have TB to begin with. Prime example being those who had the BCG vaccine and have a positive PPD. Like at least do the Quantiferon.. lol... pretty insane when you think about it. The infectious disease guys constantly preach this too but everyone else loves the crappy PPD protocol for some reason. 

    Most surgeons, including myself, prick themselves in the OR once or twice a year, higher for residents.  We don't routinely test for HIV or HCV preop, especially in emergency cases.  It is not a controlled environment.  You can tell me, but my understanding is that the prevalence of the two, HCV and HIV are increasing, and no one really knows what the risk is, the 1/300 number is a guess, I haven't found the original source.

  4. On 4/15/2018 at 4:13 PM, rmorelan said:

    Valid points - what is the down side of testing? the cost is minimal, the risks are very small but not zero, and it reassuring to the public at least. The act of constantly being tested may be  one the reasons rates are so low.

    It is an annoying test for sure - so it the TB test you have to do every year. As a side note I gain a small speck of understanding about anti vaccination logic after being told for the 6th time to get a TB test including right now even though I will be in the hospital for about 3 weeks after the results come back.  

    Don't forget, a false positive, while figuring it out, is all over your EMR, under your name.  And you cannot practice during that time.  And HCV is the bigger concern, the CPSO panel has not accepted HCV infection can be cured yet, it might take a few years.

  5. On 4/15/2018 at 3:34 PM, GrouchoMarx said:

    From my studying for the boards, I have learned that there has never been a case of HIV transmission from a physician to a patient, ever, at least in North America. 

    This policy is a CPSO PR stunt.

    Totally right.  And it can really f-ck up your career.  You are at risk of catching it, but at zero risk of giving it to the patient.  Meanwhile you are not allowed to practice.

  6. On 4/15/2018 at 3:23 PM, medigeek said:

    The odds of transmission of HIV in this context is ~0.3% unless the physician recently got it (high viral load). The likelihood of a physician having HIV is <0.1%. Then of course there has to be some form of accident which is quite unlikely on the physician's part. 

    So when we compile these numbers, seems kind of a silly thing to constantly test for. Especially since accidents prompt PEP use. 

    But one positive test ends your right to practice in Ontario, and it happens.  And we don't know the true prevalence in the baby boom population.  One positive test, I cannot do the only thing I know how to do...

  7. On 4/13/2018 at 7:11 PM, Snowmen said:

    I don't think someone should make a career decision based on the possibility of getting HIV/HCV (which is now curable btw, weak example).

    Yes, but I don't think they have developed a policy on what defines cure.  But they will immediately say you must stop practicing the second you test positive.  And that is on your electronic medical record...

  8. If you get a needle stick and test positive for HIV or Hep C the following July in Ontario, you will have to stop practice if you are a surgeon.    The CPSO requires you have clean blood every year to practice.

    I don't think the College of Dentistry has the same rules.


    Dr. McGraw

  9. Something to consider in considering a specialty, from a surgeon in practice.

    Every year you must prove you do not have HIV or Hep C to the College of Physicians and surgeons on Ontario.  If you test positive, you may no longer operate.

    You may live the clean life of a Buddist monk, but if you get something splashed in your eye, or a needle stick from a patient with Hep C, you will no longer really be able to practice surgery.

    The Hepatologists figure there a a whole host of baby boomers out there infected with Hep C, thank you sexual revolution.

    Add this to the calculus of considering your future specialty, it would suck to have to change specialties, and be infected, in the middle of residency.

    Wish you luck in your career endeavors.

    Dr. McGraw

  10. Surgery resident:


    7am rounds, OR's 8-6pm three days per week=33 hours

    or clinic 8:30-4pm two days per week=15 hours


    2-3 nights per week on call- additional 6-14 hours each night=12-39 hours


    So, roughly, 33+15 +12=60 or the higher number 33+15+39=87 hours


    60-87 hours per week approximately involved in patient care and learning.


    168 hours per week,


    Leaving 81- 108 hours for sleep and life.

  11. And lets not forget when you kids go through your ER rotations at the academic hospitals your risk of getting TB that is resitant.



    Jonathan Guss

    Chief Executive Officer

    Ontario Medical Association



    Dear Mr. Guss,


    Thanks for your reply. The late Dr. Yanga died of SARS, not TB. The problem is that if eiher you or I developed multiple drug resistant tb and were incarcerated in Westpark, YOU would receive your salary, but my colleagues and I would not (non-salaried). It is difficult to get private insurance after a certain age. Private disability insurance often stops in the "70's". Many doctors are working who are in that age group. In general, we have to concentrate on Occupational disease and death, which should be covered by Government, such as firemen, police, nurses, etc. As a group, many doctors are extremely and justifiably concerned that they would leave their families penniless if they were to develop mutiple resistant TB. Again, see the warning in this week's BMJ. OMA should co-operate with WSIB for free WSIB coverage for all Ontario doctors (similar to all other "workers"). This issue is of great concern to an increasing number of physicians, especially those of us who are in contact with new immigrants.


    In summary, It would be quite simple for the OMA to arrange with the WSIB to have "occupational disease and death coverage" for all OMA members.


    As a very concerned and growing number of physicians, we are looking forward to OMA's reponse to the need to protect the welfare of our families and ourselves.

  12. It's really not about money, it's about freedom.


    You give up the best years of your life to a classroom and residency. Then you discover that you are under a mountain of debt.


    Then, if you pay really close attention to what the "bureaucrats" are planning for your profession, you will understand that doctors are slaves.


    You ask for more money because costs are increasing---"No doctor, you are greedy, you shouldn't be asking for money, you should do this work out of your love for the job."


    You ask for time off---"No doctor, you should be selfless and give ALL of your time to patient care"

    An epidemic happens, and you want to protect yourself and your family---" No doctor, there is no evidence that you should get this respirator suit, or an early version of the vaccine, but it's okay, we respect your selfless and tireless care, just don't ask for extra compensation"


    On that last note, who knows how many doctors got sick or died during SARS, also, who knows if their family got any compensation from the provincial government?


    Oh and doctors don't get pensions, how much will you need to save to retire? How much per year to retire?


    Ask yourself those questions and tell me if $90 000 is such a great income.


    Sorry, these are things I worry about and so should you.

  13. Everything being tried now in Ontario has already been tried in the UK. The MOHLTC thinks the NHS is the "bees knees" of public health care.


    Here is the honest truth, the government will NEVER significantly increase doctors incomes, meaning increases at least at the level of inflation.


    Why? They do not want to look weak.


    Here is another truth, it's not how much you earn, it's how much you keep.


    Work hard in your first ten years of practice, save most of it and invest it in dividend paying income trusts/stocks/mutual funds. That will supplement your income. Then you can chose your pace.


    It's the docs who go out and buy the big house and fast car right away who become slaves to their work.


    And, because everyone thinks your rich and will already give you unsecured LOC's at prime when you have no income! You can use that to invest too, if you take the time to learn how.

  14. "This is very true, and, it's why the day of the solo practioner has come and gone. However, the most substantial costs here are fixed and readily reduced by smart practice management as simple as getting together with a few other docs and buying your office space rather than renting. A little financial saavy (not taught in residency unfortunately) and you're laughing at people losing 40% of gross billings to overhead."



    Most group practices, the last time I looked, collect 30% of your gross billings.

    More irritatingly, you are now an employee, there is usually a community board, to whom you must report every quarter.


    An interesting anecdote, I have a friend who left a group practice, to start a lone practice. This was after 30 minutes of a meeting that was wasted deciding where to place a new garbage receptacle.


    One of the reasons I went into medicine was to be my own boss, that is being lost. Personally, I would trade 10% of my gross income for the freedom of making decisions for myself and not having to explain my decisions to a nurse manager or layperson.

  15. For the record, I met with an advisor from MD Management last night; he told me that family doctors in Ontario can make up to $250-300k/year. Plus, it's the specialty with the (or one of the) fastest-rising compensation rates.


    That's can BILL 250-300K/year. Add up your expenses and take off your tax rate first. You might pocket 100K in Ontario. You have to see quite a few patients to do that. The province pays $38 per visit to a GP and $15 for a follow-up visit. You do the math, I already have.


    At least the media is starting to recognize the reality:




    Forget the country club image, it simply doesn't pay to be a family doctor







    April 29, 2008


    You want to know why fewer students entering medical school these days want to become family doctors? Or why those who are general practitioners sometimes refuse to take patients with the kind of complex, time-consuming problems that cost doctors money?


    Or why young GPs are gravitating to walk-in clinics where they can share overhead costs while tending to patients who generally have problems that are easy to fix?


    Have you ever considered that maybe it's because we don't pay our family doctors enough?


    I think there are many of us who still cling to this outdated notion of the family doctor who lives in the best part of town and who regularly knocks off early from work to make his tee-time at the local country club.


    Well, that doctor doesn't exist any more. Not to mention the fact that the doctor in that stale image is male when in fact there are more women entering medical schools these days than men.


    But back to money.


    The average gross salary for a GP in British Columbia in 2006-07 was just over $160,000. In other words, that is the amount for which he or she billed the Medical Services Plan. And that doesn't sound too bad.


    But now that same typical GP has to start paying overhead costs such as rent, the salary for a receptionist, malpractice insurance, association dues, medical supplies, medical equipment, computer, telephone, photocopier, fax, heat and lots more.


    So let's do a little math. A GP in B.C. is paid $30 by MSP for a standard patient visit. And let's say the doctor sees 15 patients in an average day. So she's making $450 a day. According to the B.C. Medical Association, a doctor's overhead in B.C. averages about 40 per cent of total billings. So that doctor who billed the system $450 for a day's work yesterday actually took home $270.


    And that is before taxes and other outside-work but work-related expenses such as child care.


    Now the doctor who has seen 15 patients also needs to spend an hour or more at the end of the day making calls and doing paperwork associated with the patients he or she has seen. Most GPs work a minimum nine-hour day. So, nine hours divided by the $270 the doctor took home after expenses works out to about $30 an hour.


    And unlike many of us out in the work force, this doctor gets no benefits, no pension and no paid holiday.


    Oh, I almost forgot one thing: the debt this GP will likely be carrying before she has seen her first patient.


    According to a 2006 survey carried out by the Canadian Medical Association, the average debt of a postgraduate medical student in this country was $158,728.


    Knowing you are going to finish medical school with that kind of debt, is it any wonder fewer students want to become GPs where you can make $30 an hour?


    I could list 30 jobs right now where you could make $30 an hour or more and not need any postsecondary experience. Our typical family doctor, meantime, needs four years of undergraduate study, four years of medical school and then another two years for a family practice residency.


    And on top of all that there is the constant worry that accompanies the responsibility a family doctor has. That one mistake could potentially kill someone. Who'd want that headache for $30 an hour?


    My point is it's easy to rail against doctors for refusing to take on new patients with cancer because they gobble up so much time during consultations that cost a doctor money, but perhaps now you can see why money might be a concern.


    Doctors have mortgages (and often a student loan bill the size of a small mortgage) just like the rest of us.


    There is nothing in a doctor's Hippocratic oath that says he or she has to make financial sacrifices for the good of the world. Yes, there are some GPs who work the system and bill MSP for far more than $160,000 a year. And, of course, there are specialists who are multimillionaires. But the average family doctor is not a rich woman or man and does not live in the fancy part of town with memberships to all the right clubs.


    Those are the plumbers and electricians.


    But as we boomers age, we are going to need family doctors more than ever. We are going to need them to diagnose those weird aches and pains we never got before and now worry could be the sign of something serious. The family doctor is going to become our best friend.


    As such, I think we'd better begin treating them much better. And that starts with paying them much better.

  16. Everyone's learning style is different. If you can't learn well from PBL or CBL, Mac and UofO would be terrible choices.


    On a side note: in practice, if you can't solve a medical problem with your memory alone, you're most likely going to have to read. If you don't get used to this, you will not be very good at diagnosing things other than strep throat, mono, broken bones, etc (all the simple stuff that doesn't require any reading).


    But, if you are in the OR, and you are scrubbed, you can't pull out an anatomy book. You should have that anatomy memorized prior to scrubbing. His complaint was that he had no anatomy education. Key for surgery.

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