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Everything posted by Rorzo

  1. This is going to be a personal thing. There are absolutely some people who get satisfaction out of getting a bloodwork level the patient will never feel in to target range, but for the majority of people those visits are on auto-pilot by midway through residency. I've found that satisfaction in a successful Epley, occipital nerve block, bursitis injection, or trigeminal neuralgia treatment. When I've finally been able to get someone to realize what their actual goals of care are despite specialist and hospital visits going no where. Or when they're going through a thousand tests and interventions and they come to you to make sense of it all. Family is varied and because of that I ended up focusing on palliative. But likewise I have friends who get that feeling with a positive pregnancy test, seeing a newborn in office for the first time, getting athletes back to playing condition, getting an airway in a trauma, cutting out an SCC, counselling patients through a break up, or even jsut getting the right referral after years without an answer. And they're able to have those moments in their typical work weeks where I'm avoiding some of them like the plague. At the end of the day a job is a job, and I think going in to family because you like normal BPs makes as much sense as going in to pediatrics because you like normal growth curves. You're going to have boring day to day stuff wherever you go, you have to find something on top of that to give you satisfaction and I honestly think family offers the greatest variety to do that
  2. A lot of it is choice, I know a lot of people in the 11-1300 range but I also don't know anyone who's committed to more than 4 days a week. Nothing stopping you if you want to go past that, but join one of the first 5 years facebook groups if you want to talk specifics with practicing physicians
  3. Hospitalist! I've seen quite a few schedules where people just sign up for weeks; some do every other week, some do one a month, some do two or 3 months straight and then take a long break. There's also cottage towns with way more residents in the summer that require additional physicians only during that time, and you can also cover medium-long term locums for a few months with no commitment after you're done. This is all from a family perspective though, not sure what you're PGY3 in
  4. At the end of the day when you find a school you're interested in you're going to have to do research about actual clinics to get a realistic idea. My rural clinic was done around 330 because they run out of patients, 30 minutes down the road the rural clinic did OB and ER call and it wasn't unusual to be there from 8-11 every third day. When you're staff there may be pressures depending on where you are but at the end of the day you still get to decide call/hours/commitments and as a consequence decide it for your residents as well. The only general rule I found was that community clinics seemed to be better than academic practice;s but even then I've seen solo practitioners with over 5000 patients and an academic staff who never has less than 2 residents with 900. Take home point is to use that interview day well to get the lay of the land.
  5. I agree with the first response, but specifically St. James is notoriously bad. Their attrition rate looks to be upwards of 70%, even if you're set on a Caribbean school I would at least hold out for the big 4.
  6. Use the people who can best advocate for you. Generally you can impress more in 4th year than 3rd, generally people will know you better over a core rather than an elective, generally family physicians can make a better case for you then specialists. But at the end of the day those are all generalities, if a 3rd year surgery elective preceptor connected with you it's going to be way more effective than a generic paragraph from a random family preceptor in 4th year. It gets suspicious if none of your strongest letters are from family preceptors, but I promise you when someone is reading 30 letters in a row the content matters infinitely more than when or where you met the writer
  7. CMA profiles are terrible for salary. If you're a part of the OMA search "selected billings" on the site for hard data about ohip billings. Keep in mind this doesn't include 3rd party billings, makes no mention of hours worked to achieve that salary, and has self-reported overhead numbers from a separate survey that changes wildly based on setting. For example, family is listed as around 30% overhead which is accurate in most cases, but if you're deciding on a job you have a lot of leeway in what you'll accept. As a family resident I had job offers with 0% overhead in the middle of nowhere and passing 40% for a new clinic starting up in an urban area. Last thing to keep in mind is that each of those numbers represents a person with their own goals. You'll see family as the second lowest median salary, yet of the top 100 billers in Ontario the second most represented specialty was family medicine. I, and a ton of other recent grads, can without question be making more than we are right now, but there's a deliberate choice to value life over evening walk-in and weekend ER shifts. Endocrinology should be fine as long as there are family doctors who consult out at an a1c of 7, but when you look at a job with a limited job market, that doesn't just mean it may take a while to find a job. It could mean that choice between life and work gets made for you when you're competing with 10 other people for one position and the person who covers call and takes all the terrible consults gets the job. Focus on a specialty's fit with your personality and it's job market/flexibility; you won't be starving no matter what you do and there's always going to be opportunities to make more money.
  8. It's also definitely not the same each year. Flights, hotels, application fees etc. are a huge hit as you're trying to match, especially if it's for something competitive
  9. Sorry you're absolutely right - I just checked and what I was thinking of was that you're still responsible for ancillary fees such as health insurance/library. Certainly much less than actual tuition
  10. I don't know an amazing amount as I didn't go through it myself but I can pass along some second hand experiences from friends. It seems like you can decide at any point really - I knew people who decided their career plan would need a 4th year in their first year and people who took an extra year after being unmatched. Subjectively, it does seem that the earlier you do it the better the outcome' that guy who decided early on matched to ophto and all of the people I know who did it after being unmatched ended up in family. The most common seemed to be the middle ground - deciding late that you want a competitive specialty and then taking the extra year and delaying the match to be more competitive. This appears to have been moderately successful, with some of these candidates matching to fairly competitive specialties. There aren't any restrictions I know of, but it isn't a perfect system. You have to pay a fair amount of tuition for that year and you're in a weird insurance limbo where you can't do electives for the entire year (I think it was max 16 weeks but I am certainly not a definitive source). If you do have specific questions I can ask some people who have been through it.
  11. I guess I'll provide a dissenting opinion - I'm a second year resident now and I loved my time at Mac. Caveat being that I can't comment on curriculum changes or if anything else is different since I went there. I was initially interested in a somewhat competitive specialty and while there weren't any summers McMaster clerkship was not typical clerkship. Around the necessary team based learning and professional competency sessions I was able to shadow for 10-20 hours per week, got involved in multiple research projects, and hung out with residents in the specialty at rounds etc. I ended up switching to family in the end based off of those experiences, which aside from MF5 gave me so much free time in pre-clerkship that even without designated breaks I didn't feel close to burn out. And there are people from my class who discovered late in preclerkship or early clerkship that they wanted something competitive and ended up matching to competitive specialties - I can't compare how easy it would have been for them to do it at a 4 year school but it certainly isn't as impossible as it's being made to seem in this thread. That does not mean everything is positive, I do have multiple friends who ended up unmatched, matched to alternate specialties, or who taking a 4th year (which is an option) because they switched focus midway through clerkship. But even if you have an idea of med vs surg there is definitely time to find your niche if you set out to explore from the beginning. To address specific questions: -For public health the unit did a great elective where you could see what the MOH did, do research projects etc. I don't know the specifics but 2 people in our class matched CCFP+PHPM at very competitive (non-mac) programs. I did a lab medicine elective which gave exposure to not only path but med micro and med biochem, definitely not for me but the preceptors were incredibly helpful to anyone showing interest -If you want Derm, Mac is a bad idea. They don't really have a program, just a weird half UofT thing, can be hard to get non-academic exposure. If you want to see something more interesting than AKs and are ok dictating until midnight you can learn a lot at Dr. Lima's clinic though -A car in preclerkship will depend on your goals, I was able to live close to one hospital and bus in to Mac and had no problems without a car until preclerkship -Everyone got bursaries, giant list of additional ones that you could apply to got sent out as well -It seems that non-trad students flourished at MAc moreso than elsewhere. We had veterinarians, lawyers, architects, musicians and eventually everyone came out with a good knowledge base -You have to be self-directed in this program, it is very easy to just coast by. That being said, I recognized my own weaknesses, the school had ample resources to correct them, and I did really well on external electives and continue to do so in residency (I did get lucky with my clerkship stream as well and did almost all of my cores early - those who weren't able to do so felt much more uncomfortable). The individual will matter more than the school here in my opinion, but Mac certainly won't bring a competent student down Lastly the benefits of Mac. If you want something non-competitive you will have zero issues matching from Mac and I really don't see the value of the extra year of training. That will cost you 200k+ of staff money, probably 5 figures of tuition as the 4 year schools tuition inexplicably creep closer to Mac, and a year of living expenses whatever you budget that as. I hated lectures and the minutae that my friends at UofT were being forced to attend and tested on, and I instead got to spend that time researching, getting clinical exposure, and having fun. At the end of the day you have to know yourself because that program is definitely not for everyone, but it was my first choice going in and a couple years out doing residency at a 4 year school I would absolutely not want to go anywhere else in retrospect. Feel free to PM me questions as well, but if you feel comfortable please post them here as conversations like this were incredibly helpful for me when I was making my decision.
  12. It would be crazy to remember everything you've just been through, I'm about to have an independent licence and there's still basic science things that pre-clerks have down better than me. You've got a great foundation and you most likely don't even recognize some of the things you know, but the biggest thing to keep in mind is that everyone's felt that way at some point, and that's why the spiral curriculum exists. Over time you'll be able to match that pre-clerkship knowledge to a patient, that patient to a management plan, that management plan to a morbidity and mortality round, and so on indefinitely. Every good clinician only got there by constantly adding upon their foundation again and again, and that's not only in clerkship but also in residency and practice. I absolutely felt the way you're feeling when I moved in to clerkship, and although it was rough getting used to the culture of medicine I was able to approach everything without any issues after a few months. The realization that got me there was that at the end of the day no one is going to expect a new clerk on the ward to remember everything, they're going to hope for you to do what each one of them had to do as well; take a history, make plan even if it's terrible, but then read around that case and use the experience to build upon your knowledge until the next plan needs no correction.
  13. Our school lets us do a "vacation block" where instead of an elective you just have that 4 weeks off if you don't take any other vacation that year. You'd have to get in contact with your PGME office relatively soon to arrange it but it should be doable as it wouldn't affect any other blocks. That being said, especially in first year that may not be the best idea. There are some service heavy rotations you'll probably prefer to do 3 weeks in, it can be hard to go for months and months without any break, and that elective block can be really valuable for networking/building skills/covering some weaknesses. I spread my vacation throughout the year and had some great electives and certainly don't regret it
  14. Can't remember the specifics but it looks like I applied for reimbursement in the September of my R1 year and still got the full reimbursement amount. They're really helpful over email (MLPReimbursement@ontario.ca) and clearly amenable to late applications in the worst case scenario
  15. If you don't end up finding a resident, I had an excellent elective with Dr. Murray Potter at Mac who was more than happy to go over all of those logistical things while I was with him. From what I can recall the job market was pretty bad, and even when you find a job you're likely to be running a lab and doing a lot of QI instead of what most people imagine with medical genetics.
  16. If you're in Ontario my understanding is that it isn't necessarily 85%, just reimbursing whatever extra you paid over the base rate. I got reimbursed 2722.50 in 2018 (first payment of the year was over 664.50), so I'm claiming 235.50
  17. You should certainly know research methodology for family, however I don't think it's that relevant in being a competitive applicant. I can't speak for other schools, however at mine I reviewed some 20 family applications each of this year and last, and have seen 1 family medicine related research project in that entire time. You can be very competitive without it, and the vast majority of applicants are. In residency, our research project can be a QI project as well, with lots of support working through it so it's not all that needed for the future either.
  18. You don't have to know current medical or political news. It can certainly help add to a question, in some cases quite significantly, but all of the questions are made and validated long before interview day
  19. As it stands you can read many articles in the media outlining the arguments about whether or not to make such information available to the public. The raw data can be misleading with physicians receiving no benefits, some people paying 30% overhead, others billing an additional 30% privately, and countless other things. Every medical student who's a member of the OMA already has access and I think that's a fantastic idea - it can make a huge impact on their career decisions and there's tons of people surrounding them to put the numbers in to context. However, I do question how good of an idea it is to post that data on a completely public forum when the OMA has recently gone to court to keep it private.
  20. Family medicine, and job offers will come up in residency. Part of the reason I ended up in family is that you have so much flexibility. Once you're staff, the only barriers you have to work around are the ones you put up yourself. Don't want to take call? Don't want to work Tuesdays? Never want to run a clinic? That's all your choice, yeah it will limit your job options and salary potential, but you're the boss and there's nothing stopping you from putting yourself in a situation you want to be in
  21. In my experience, PIs and funding sources couldn't care less how many degrees you had as long as you were doing something relevant when you applied
  22. Primary care as he mentioned can allow you to work a few days per week, especially with a group practice or in certain locums. In my example above, you can take urgent care/ER shifts basically as often as you want. Basically just find something where you aren't dependent on working for OR time, or need to cover call - for me the vast majority of those opportunities seemed to show up in family medicine and it's branches, but I've also seen similar from peds and psych
  23. I won't be so flippant as to say just try it out, but I would ask you to try to take a step back and look at your situation objectively. At the end of the day, the only thing that matters is your happiness, and I do think there are many paths withing medicine that can be fulfilling for a wide variety of people; I also think it's incredibly easy to make numerous small sacrifices for dubious goals that accumulate to an overall frustrating life. I've absolutely experienced that miserable feeling you're describing, few people get to experience being berated by someone at 4am because you're still on the low end of the totem pole in your mid twenties. And there are a ton of people in my med school class who pushed themselves to do research in med school on top of that, put time in to networking, over-studied for every test, only to continue the cycle for another 6 years of residency. You don't have to do that if that's not your picture of happiness though. I was initially pushing for a difficult specialty and I would feel anxious every second I wasn't working on my research project, I was attending rounds for that specialty and doing additional clinic on top of normal school duties, and I honestly felt terrible. Then I realized that this doesn't have to be my life, my peers from high school who I was jealous of treated their jobs like a job and there was no reason I had to let it consume my life. I studied to around the median, I played sports and video games instead of researching, and I got in to a fantastic community family medicine program. And now my average days are 9-4 with some charting on either end and the occasional home call. And while I found a niche I'm really excited to pursue full time, I know someone who recently graduated and makes 80k a year off one hard day of work per week - something you won't find in any other field and allows him to pursue his true passions. So that's where I'd ask you to be objective. Whatever career you're comparing medical school to, don't compare it to the jaded or overworked staff you never hope to be. Compare it to what you, with your values, would do with that degree. I can't guarantee it's for everyone, but if you've come this far there's a very strong chance you find something that works for you better on many levels than most alternatives.
  24. OMA has billing data available on their site for all specialties if you're a member.
  25. There was both at the afternoon session, can't imagine it wouldn't be there in the morning
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