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  1. Like
    distressedpremed got a reaction from Tullius in Things you wish you knew before you started med   
    I think the best advice I got from anyone before med school was from another resident at the time, which was that the point of med school wasn't necessarily to train you to become a physician (it used to be). The point of med school is to match. I didn't believe him that much initially in first year but now I would have to say I agree with him. 
    You can't be a practicing physician or surgeon in canada without matching. Hence your energy in the next 3/4 years is to pass exams, do well in extracurriculars, and find out which residency you want and pursue it 100%. 
  2. Like
    distressedpremed got a reaction from yonas in Things you wish you knew before you started med   
    I think the best advice I got from anyone before med school was from another resident at the time, which was that the point of med school wasn't necessarily to train you to become a physician (it used to be). The point of med school is to match. I didn't believe him that much initially in first year but now I would have to say I agree with him. 
    You can't be a practicing physician or surgeon in canada without matching. Hence your energy in the next 3/4 years is to pass exams, do well in extracurriculars, and find out which residency you want and pursue it 100%. 
  3. Like
    distressedpremed got a reaction from hiyayosup in What Did You Wish Someone Told You Before Starting Med School?   
    CC3 here. Should be studying, but this is a welcome distraction.  
    I've got a long list but here's my top ten. 
    1) Social circles/dynamics, especially at a large school, are not that important. It might feel that way in M1/M2 when you're in the classroom setting, but people are rapidly segregated and social dynamics change immensly in clerkship and beyond. Don't invest too much into making sure you show up at every party or accept every invitation for a social event.  It's low yield unless you for some reason, it's something that you value immensely as a person. Eventually the high school setting disappears and people are left to fend on their own. 
    2) That being said, in a large school, inevitably cliques will happen. Accept it as a law of nature, just like oil and water. Find your clique, have a group of close friends that you feel comfortable with and understand your values. Treasure your friends outside of medicine. Your friends in med school will be the ones laughing/whining with you, and your friends outside medicine will help to keep you feeling like a "real person" who isn't worrying about a patient's eGFR at 2 AM.  This is high yield and has been reiterated by many med students and residents before me. 
    3) Be passionate about something in medicine, and follow-through with it. If you're interested in a speciality, and you know that speciality is something you most likely pursue, be proactive about it.  Go do research, present and publish publish publish. Meet faculty and residents. Buy books in that specialty and read outside of your classes.  Ask for opportunities. Question yourself consistently about why you like the speciality - if you have a good answer most of the time that you personally feel comfortable about, it's most likely right for you.  Shut out the haters or people calling you a "gunner". 
    4)  If you're not sure what you're interested in you should be spending even MORE time than the guy/girl doing #3 exploring in your M1/M2 years.  There are a lot of people that aren't "sure" and says "I'll wait till clerkship to decide", and near the end of clerkship they still don't have an answer that they're happy about.  Well, there are a lot of specialties that aren't covered enough in clerkship or covered at all. You might be missing out, and you won't be able to retrospectively blame anyone but yourself. It's your responsibility to do career exploration. Use your school's resources, and again ask for opportunities. Find your passion in medicine - remember what you interviewed here for. 
    5) You should be doing a sport. You need to exercise as a med student. The number of hours holed up neurotically studying is not good for anyone's health, let alone yours and you are not the exception. Start making exercise something you're passionate about it.  Solitary or team based, it doesn't matter so long as it's a regular part of your routine. Do it starting first year. Not asking you to get ripped or swole, but get out there and sweat and have fun. It'll fight off the fat and depression.  Very high yield stuff here. 
    6) Sometimes it's easy to say "yes" to too many people, and forget about self-care. Learn how to politely say no, especially when you don't have much to gain from the encounter and there is a power differential. It will help immensely later on. When asking for opportunities, it's easy to get shut down sometimes. Be persistent, try again or ask for advice from someone. Grow a thick skin. 
    7) Ask for help when you need to, especially for mental health. If you're struggling with depression or thoughts of suicide, please seek help. Talk to your friends and family, or your school counselling services.  Other people might seem happy on the outside, but everyone in medicine has thought about quitting at least once - I know I have. You're not the exception. 
    8) P=MD. P =MD. P=MD. Pass, move on with your life. You have better things to do with your time, like spending time on yourself or your loved ones. P = MD. P =MD. P =MD.
    9) As much as people think that their speciality or subject area is God's gift to the planet, it is not.  This is why people carry pagers around. If you're interested you will revisit and develop your own approach to the material. If not, know enough to pass, show some (polite) interest and move on with your life. 
    10) Read Ralk's blog. Some good stuff there. He's more articulate than I will ever be, and it has good pearls/perspectives on med life and education. 
    11) if you don't agree with any of the above, just remember this: "Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind."
  4. Like
    distressedpremed got a reaction from Hanmari in Things you wish you knew before you started med   
    I think the best advice I got from anyone before med school was from another resident at the time, which was that the point of med school wasn't necessarily to train you to become a physician (it used to be). The point of med school is to match. I didn't believe him that much initially in first year but now I would have to say I agree with him. 
    You can't be a practicing physician or surgeon in canada without matching. Hence your energy in the next 3/4 years is to pass exams, do well in extracurriculars, and find out which residency you want and pursue it 100%. 
  5. Like
    distressedpremed reacted to Hanmari in How can we reduce burnout in clerkship?   
    Go into it with few expectations and you won't be disappointed. Hold on tight to your memory of true life and your humanity and don't let the scut eat into it, and always know that in the end you will be able to return to the life you deserve. Every time you hate your life in clerkship say to yourself that life is actually more than just this bullshit. Every day you go into hospital tell yourself you are one day closer to autonomy. You don't need to agree to or even rationalize the status quo to be resilient, you just need to show your staff that smile in that very moment they fuck up your day, and not let it shitstain your memory of happiness.
  6. Like
    distressedpremed got a reaction from Hanmari in Unhappy in medicine?   
    Hey dude/dudette, 
    First of all, it's ok. It's something everyone goes through. I'm not saying first of all that you'll "get over it" and decide to go back, but I understand your feelings and I've been there as well. 
    I think some of the more senior members here can help a bit of you let us know: 
    1) Is there any specialty at all you're interested in
    2) Can you tolerate ANY clinical work (including radiology/pathology etc) at all in your future 
    3) How much debt do you have from med school 
    4) Any other careers you're interested in 
    I think that this would help a bit more for us to give some advice and this thread to be more productive. There are groups on facebook in regards to helping people quit medical school/residency and find better outlets for their time and energy. 
  7. Like
    distressedpremed reacted to rmorelan in Online Master's Degrees   
    sure - although I will point out purely for discussion purposes that often you can still do call during such training years anyway so there isn't necessarily an impact on the call schedule (and since you end up doing the same total amount of call in the end it doesn't hurt you either - this is all just something that is worked out basically). I don't know your particular situation mind you but always try to expand the possibilities to their limits so any decision is made with all things explored
    Data scientist would be another variation on the same thing - really often not much difference between masters in epidemiology, public health, data science or applied statistics. 
    One area you didn't mention is that someone with that background also makes a good reviewer of papers - which leads to editorship and so on academics - obviously useful ha. 
    There are a ton of similar programs - I have an option of doing Harvard's MPH in epidemiology (it is highly subsidized for me which is good because it is nasty expensive ha). There are a bunch of these out there to chose from and we can try to explore them all as well. 
    First I will say the key I will say is not just the degree - it is finding a large data source related your specialty that you can use to practice the various things you are learning and build them up to a thesis which is applying that data in a practical clinical way - that way you yes get the degree but equally importantly you get a string of quality publications out of it as well and things merge together. You also then are the master of a particular important dataset - which greatly improves your chances of getting hired at the place you are doing your residency in particularly - you use that data set over and over to pump out paper after paper, and attach yourself to anyone else using that data as well. That is the academic approach to success - ha never do one thing when you can do 3 things at the same time. You talked about branding - that is how branding is done. 
  8. Like
    distressedpremed reacted to Hanmari in Are Residents in Canada Overworked and Underpaid?   
    I respectfully disagree. This seemingly popular belief of "resident pay is low because staff pay is high" or vice versa is a non sequitur. The pay staff physicians receive is representative of their skill and their contributions to society, and is fairly deserved. It does not retroactively render residency pay irrelevant, since staff pay is payment for work done as staff, not as residents.
    We have a professional degree which, as you said, is getting harder and harder to attain by the year, and work experience/set of skills that are really quite exclusive, in a field which is essential and relevant to people's lives in a constructive way. If we need to put ourselves further into debt to make ends meet after all that (and clearly, with all this credentials inflation you mentioned, many of our cohorts are now filled with non-trads with families and even more degrees), we are underpaid, period. You cannot justify this with a fair pay that comes only after years, no matter how high it is. I agree it's good to learn good financial habits. It's better if we can learn it while actually being able to save anything meaningful.
    I do agree with the limited supply idea as far as it applies to within medicine. Healthcare system is overburdened, residents are cheap labour and will unfortunately likely continue to be. If a raise at resident level means a cut at staff level, I'm sure most residents would opt to endure the status quo. That being said, there should always be an effort to draw the resources from outside so that staff physicians are not hurt by resident raises. I could not care less about what happens to the pay in other industries. To stay still in a zero-sum game means your cut of the pie is eventually taken from you, as all current staff physicians must know so painfully well from their terrible negotiations with the government. I hope that the residency associations across the country realize this as our situation is essentially just a micro version of theirs.
    Definitely look at the staff pay down the line. Counting your blessings is a great way to stay sane. But I will not be told that what I am getting is fair when it isn't.
  9. Like
    distressedpremed reacted to Hanmari in Attrition rates for each medical school?   
    I buy every draw, it's the only thing that gives me hope
    I can buy it if I skip meals, meals don't give me hope
    at least not when I'm trying to choke them down in 30 seconds while getting paged
    btw today is the draw, everyone go buy
  10. Like
    distressedpremed reacted to Hanmari in Ontario to fund new residency spots with return of service requirements   
    Because they are actually paying for spots that otherwise would have existed; all they're doing is just returning spots that were previously taken away, which were of course without ROS. The whole process is more or less a farce in which the med students and the public are led to believe they are being given a solution when really it's still below baseline. Residency spot allocations shouldn't feel like a Black Friday sale where they hike the price then cut it.
  11. Like
    distressedpremed reacted to rmorelan in When to use tuition tax credits?   
    uhmmm huh - I have no idea where that is coming from. I mean first off 500K is a huge investment amount speaking overall, so although the population would be biased here (ie future doctors) relatively few people have 500K invested in the stock market. So that is almost saying wait until you are rich until you start doing it right..........I say do it right so you become rich. 
    Second the overall fees for wealth simple are around 0.7% (0.5% up to 100K, and the underlying funds in the portfolio also have fees of about 0.2% if I am recalling correctly). So on your 500K investment you are spending 3,500 in fees yearly. I mean it could be worse - the bank or MD would charge you twice that (I remember laughing when MD financial made this big marketing push when they dropped their MER to less than 2% like they were doing some amazing thing. Their fees were still 10-40 times what I was paying). Still 3,500 is a lot (I could eat out at my favorite all you can eat sushi place every other day all year long with that. Yes, I evaluate purchase decisions sometimes on equivalent purchase and joy of eating good meal(s). It works for me)  
    I mean when you are starting off a robo advisor can be convenient  and comparatively low in fees compared to traditional things. You also don't have to re-balance anything, and ignore all trading costs (the 9.99 I pay every time I buy stock - which is roughly 4 times a year. Now is 40 dollars a year (to put it in perspective on 100K investments you would pay 40 dollars as well for vanguard's VTI fund in management fees so the fact that I have to buy the stock that way is effectively doubling my costs in that situation. Of course with wealth simple I would be paying 700 dollars on that same 100K investment in fees so I still think I am out ahead). 
    Now I am also a very simple investor - I don't understand having 20 different mutual funds in your portfolio with weird percentages of your assets in each. I do not understand the point - the data shows that makes less than simpler index funds, and I have no idea (and no one else does either) exactly what percentage you need in emerging markets or any other arbitrarily constructed part of the investing market. I mean take a look wealth simple's main portfolio for growth:
    Your portfolio will be invested in the following funds:
    iShares Core MSCI EAFE IEFA Large, mid, and small cap stocks in developed Europe, Australasia and the Far East 15% iShares Core MSCI Emerging Markets IEMG Large, mid, and small cap stocks in more than 20 emerging markets 10% iShares Core S&P/TSX Capped Composite Index XIC 250+ Canadian equities representing 95% of the Canadian equity market 22.5% iShares Canadian Short Term Corporate + Maple Bond Index ETF XSH Exposure to variety of short-term Canadian corporate debt securities 12.5% Vanguard Total Stock Market VTI 3800 large, medium, small and micro-cap companies mirroring the US equity market 20% BMO Mid Federal Bond Index ZFM Mid term debt securities issued or guaranteed by the Government of Canada  7.5% Vanguard US Total Market ETF (CAD-Hedged)
    VUS Diversified companies mirroring the US equity market with hedged currency exposure 12.5%  
    The MER of this portfolio is 0.1% and the management fee of this portfolio 0.50%
    The indicated dividend yield of this portfolio is 2.32%
    Ok first off I see some of my old friends in there (VUS is the Canadian dollar traded version of VTI, and oh look there is VTI as well - It is 30% VTI basically. Then for some reason they have XIC for 22% - which is the total Canadian stock market - ok but why would you want to own almost as much stock in the same Canadian market as the ENTIRE US market - which has vastly more international exposure as well as most major US companies are international. Someone didn't read the diversification and long term market performance of the US vs Can part of their economics book. They got their 20% bonds in there for fun, and 25% in international funds and emerging markets. How did they pick all of these various percentages - well no one is exactly sure ha). 
    Since that fund was started it has made 27.8% (aug 20, 2014) (source https://help.wealthsimple.com/hc/en-ca/articles/214187018-How-has-the-Growth-portfolio-performed-)
    VTI has performed 35% NOT including dividends - which are another say 7% for 42% (compound interest is a wonderful thing). Of course it has been a good period of time for stocks though (we don't have the lower bond yield, the lower Canadian stock performance, and the 0.6% MER off the top.)
    to be clear I am not trying to sell VTI stock (ha Vanguard doesn't have salespeople really - I love the fact that a 4.2 trillion dollar investment firm doesn't actually try to sell anything). Just to make it very clear how wealthsimple works - they take your money, then use it to buy index funds which other companies run - still pass the costs of those index funds on to you (that is the MER of 0.1% above - so low I might add because again VTI is only 0.04%), and charge you a middle man fee of 0.5% for basically running a website, and making up some portfolios (which are similar to the ones you get for free at Canadian couch potato). You can see why they are advertising like crazy right now - they are making money for basically no effort at all, and their costs are fixed so the more people that do it after a point - pure profit. They have oh 1.9 billion in assets, 75 employees and if that asset count is correct they have a revenue of about 100 million a year. Clearly enough money for all those adds appealing to millennials
    and yet I am still not as mad at all that as I am at more standard investment firms. They are saving people 50% relatively. 
  12. Like
    distressedpremed reacted to rmorelan in When to use tuition tax credits?   
    It is good to hear people with all these variations. Everyone has a different comfort level. 
    One thing I didn't mention but feel I should is if you are going to "try some investment" as practice then make sure you have learned enough to practice properly (say as I would argue index funds for instance over mutual funds). Our friends at MD financial for instance lately have developed their own trading platform and are encouraging residents to practice investing by starting now with small amounts (quite the sales pitch actually). Of course that means small amounts in their mutual funds, which is their product basically, with the long term hope that you will continue to use them as you move forward. Well there are a lot of arguments that going that way is learning the wrong approach and it is self serving for them (they aren't alone - many bank's investment branches are like that). 
    So sure practice - but make sure you learn the basic rules of the game first  Otherwise you are just reinforcing bad habits. 
  13. Like
    distressedpremed got a reaction from PhD2MD in When to use tuition tax credits?   
    I think what rmorelan is generally saying is to try to pay down as much debt first before thinking about a TFSA or RRSP. 
    If you had to pick one, it would be the TFSA because of the flexibility in withdrawals. There are still a lot of expenses when you become staff (licensing, etc). The TFSA would allow you to withdraw some of that money without "penalty" compared to an RRSP, making it more useful in the short term (5-7 years). 
  14. Like
    distressedpremed reacted to Hanmari in When to use tuition tax credits?   
    Hahah I am one of those people who feel the need to be in the market. I pay my LoC interest and then pay down a small portion of the principal each month, treating my LoC as if it was the conservative portion of an investment portfolio; there are arguments both for and against this, but essentially I am treating my LoC as an investment vehicle that provides a guaranteed prime-0.25% return. Currently I allocate a small percentage of my monthly income to this. The rest is going into index stocks held in a TFSA. Essentially I am running an aggressive mix of equities vs. pseudo-bonds, although I might up the LoC portion soon as rates are going up and prime-0.25 is already far above bond yield levels. I've heard of staff running 80-20 and more with equities (which I'm not sure I would emulate) so I think I'm being relatively reasonable given a hopefully long horizon.
    I keep a small stash of emergency funds to last me 2-3 months, and beyond that I am counting on my disability insurance kicking in if any severe needs arise. For mandatory costs like exams/fees I will draw on my LoC, as I have room left to cover all such foreseeable expenses. Of course in a real pinch I could take out the money in my TFSA, but I am treating that money as if it doesn't exist - I am throwing it into stocks and more or less forgetting about it. What I have in there is chump change compared to staff earnings and for me it is more about the experience of investing, learning its ropes and getting an idea of my risk tolerance levels during market fluctuations. What better time to learn this than when stakes are relatively low, during a time of global uncertainty?
    When I am staff, I will need to handle staff level finances, so I want to put myself through what is essentially a financial residency. I understand that investing in residency seems like an undue risk during a time with lesser earnings (and therefore lesser returns) and proportionally larger expenses, but If I threw all my earnings into LoC and forgot about it, I fear that I would not put in as much effort to proactively learn what kinds of financial issues staff docs deal with. I would encourage any of my colleagues who are not severely debt burdened (with either high-interest debt or excessive LoC debt causing +++interest per month) to get into investing or at least start learning about it through the various blogs run by MDs, or books. It really doesn't take That much time to get started and I don't think I've been any less of a proper medical learner for it!
  15. Like
    distressedpremed reacted to rmorelan in What happens to our LOC's now that we've matched?   
    yeah that is about it! you can chose to pay more than the interest of course as you mention. When you go into repayment you may have a splitting of the loan into a smaller personal LOC and loan part that is just to be paid off. You can also have variable repayment plans (some up to 15 years) although most pay it off way before that. 
    One other note - if you do a fellowship that counts like residency - so for me I "gain" two years of interest only status. That is important because you may need that year of grace at the end to find a job, set up your practice etc and you will still have it if you want to do more advanced training. 
  16. Like
    distressedpremed reacted to ArchEnemy in Salaries of specialists adjusted for overhead expenses   
    We should not be fighting amongst ourselves. 
    The government is trying to sow discord between the various specialties so as to justify its cuts to ALL specialties. Additionally, they are not transferring the money from cuts to the higher paid specialties to the lower paid specialties, but rather it is used to fuel their own political agenda.
  17. Like
    distressedpremed reacted to humhum in Salaries of specialists adjusted for overhead expenses   
    A rising or fall tide affects all boats. While the top earning specialties are seemingly the lowest hanging fruit, let's not be naive. The cuts will affect everyone. If the government is going after doctor's salaries, they will cut them across the board. The rhetoric right now is that they want to cut the tallest blades of grass and even the playing field. However, 0.5% less pay to all family doctors will save the system more money than 20% cut from all dermatologists. There are just that many more GPs.
    There is no crystal ball for the future, but a historical track record is the only means to make appropriate decisions. The top earning specialties have been more or less top earning for the past few decades. People feel they should be apologetic for going to specialty X or Y for their earning potential, and I for one disagree.  Giving the benefit of the doubt, every medical student wants to help people with their ailments. And every specialty in medicine does exactly that. Beyond that it is just personal factors detached from the patient. Maybe someone has a hilariously amazing time watching a prostate get shredded into a paste with TURP, and that is why they fell in love with urology. That is no more noble of a reason than going into that specialty for its somewhat higher earning potential.
  18. Like
    distressedpremed reacted to Hanmari in Quebec doctors demand a pay cut?   
    I hesitate to write this off as the action of socialist radicals. Maybe it's just my bias but it is difficult for me to understand it as an act of pure idealism in the light of the already punitive atmosphere towards physician income in this country; if you want lower income, just let the status quo do its job. What do these physicians think they will gain from doing this? We are clearly in the spotlight often enough as a profession that the "any publicity is good publicity" argument doesn't work.
  19. Like
    distressedpremed reacted to humhum in Salaries of specialists adjusted for overhead expenses   
    You sound disgruntled, and under-appreciated. If you think the flexibility, portability, and years you saved from your youth NOT slaving  as a resident is somehow not commensurate with the per-hour compensation you keep harping on, what is stopping you from going back into residency into a highly paid specialty you covet so much?
  20. Like
  21. Like
    distressedpremed reacted to Hanmari in Salaries of specialists adjusted for overhead expenses   
    Hey hey I know we are this but you don't need to rub it in our simian faces 
  22. Like
    distressedpremed reacted to rmorelan in Salaries of specialists adjusted for overhead expenses   
    It is true - unlike say 20 years ago radiology now is much busier. We have had multiple fee cuts and mostly respond by just upping the work volume. Since people at the same time keep order more and more imaging we have been able to maintain a high income at the cost of lifestyle. Radiology now, particular as new staff, is kind of hellish (6 days a week 12 hour days). That is pure reporting time - not paperwork, keeping trained, and admin time etc. Simple ass in seat reading studies. One of the reason radiology programs have people dropping out is the realization of what is involved (some programs have higher drop out rates than gen surg ha. It is all about managing expectations).
    You really want to factor in the amount of hours involved, and the intensity of work somehow in the calculation. I am not speaking in specifics here but in general I don't think every hour of work should be equal in pay regardless of what you are doing and what specialist is doing it. By the math being used here many of the specialists would be 1-1.2 million salary in the hole before starting as staff - with their say 4 years of extra training (including long resident style hours, call, more interest payments etc, etc). Using our traditional numbers of most specialties making around 350K and most family doctors making 200-250K it can take a bit of time just to get "caught up", and as with most other professional fields out there you would expect people with longer training to earn more in the end (otherwise the logic goes why would anyone actually do that - and as someone studying for my final year college exams that is the kind of logic that comes up - not a good time for all my family doc friends to be posting their vacation photos ha - I still have at least 2.5 years to go, and they were done 2.5 years ago).  Should the person standing in the OR doing delicate work for 7 hours straight get paid the same as someone sitting in a office for the same time where a lunch break is a real thing? There is a lot of room for debate on both sides. 
    That doesn't mean that some of the fields are imbalanced, and gross income is a way of looking at that (although overhead for some fields, including radiology if you are running your own scanning clinic are quite high - more than family medicine as well the machines involved are a whole new class of expensive). Part of the problem is we never have an easy way of computing take home pay. Gross is a start but causes a lot of issue still - some people go into particular fields because they are reduced hours and more flexible (no 5:30 am surgery start times, and they haven't seen a pager in a decade). Some fields have low gross but actually very high hourly (nuclear medicine per hour beats radiology for example - they just only work 6-7 hours a day often). 
  23. Like
    distressedpremed got a reaction from LostLamb in Thanks   
    Every step you take
    every move you make 
    Ian’s watching you....
  24. Like
    distressedpremed got a reaction from humhum in Salaries of specialists adjusted for overhead expenses   
    As a non-radiologist (and maybe Rmorelan can chime in here), it's completely justified based on how hard they work.
    Everyone is sending stuff down and expecting radiology to find something, and according to everyone, everything is urgent.
    In the ER, CT PE protocols in some centers are way overused. It's almost calling on a friend to help you practice some form of defensive medicine. 
    I don't understand sometimes - if you want to pay them less but send more scans down expecting immediate results, especially complicated modalities like MRI and thoracic CT,  then I'm sorry but there needs to be some incentives to keep that in place.  
  25. Like
    distressedpremed reacted to Hanmari in Average amount of student debt at the end of med school?   
    Not asking to be contrarian, but what is the reasoning behind keeping cash instead of throwing it into the LOC and then re-withdrawing later when needed? Since our LOCs are guaranteed to remain open until at least the end of residency, I would've thought the funds will be available for us when we need it. I am putting everything into LOC right now including my call stipends so that I can save (admittedly paltry amounts) on interest payments and am looking to draw on LOC again when RC/PGY5 hits. Should I be doing this differently?
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