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Fresh fry

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  1. Like
    Fresh fry got a reaction from Intermediate in 24 Yrs Old, Continue 2Nd Ug Or Work?   
    I am a resident. I started undergrad at age 28, med at 31 and I have thrown everything I have at this, sacrificed my family's happiness, and have many more years to go before I am anywhere near a stable staff job.
     
    On most days I would trade this for 70 grand a year and no debt in a stable 9-5 provided I didn't treated like complete crap and I got to use my brain for at least 15 minutes a day. Every now and then though I see or do something that no other person on the planet gets to do and I am filled with awe and would gladly sacrifice it all all over again.
     
    I can't tell you it will be ok if it doesn't work out because i don't know the answer myself. What I do know, or rather the reason I don't quit on those days when everything totally sucks is because as cliched as this sounds; you only get one turn at this game and for some people not aiming for the top spot is the ultimate betrayal to oneself.    
     
    I think if you are asking strangers on a website what will make you happy you have someone you need to get better acquainted with and I would do that before i made any life decisions. 
     
    GL
  2. Like
    Fresh fry got a reaction from Sidney Crosby in Will Introvert Dentists Make Less Money Than Extrovert Ones?   
    I know it says dent but I will bite as I have an interest in the whole introvert/extrovert thing that has been going on the last few years.
     
    My thoughts: I don't think it matters.
     
    When the whole "introvert movement" started gaining ground a few years back I really started following it. This was compounded by the fact that my wife is an MBTI evaluator and she used to do practice assessments on me. I thought: this is great, finally there is a label for what I am (I always knew I was a bit weird) and there is a whole movement to normalize it. I have to admit I was really bad at first and used to use my new-found status as an introvert for an excuse. Suddenly it was OK that I didn't want to go to parties and would rather spend lunch by myself. I felt like I didn't have to try and be more extroverted anymore. That was until one day my wife explained to me that the whole introvert/extrovert/MBTI thing was designed to identify your weak points so you can work on them, not to use them as a crutch or an excuse (I know I am getting a bit off track here).
     
    This became important when I decided to pick a specialty. I, like you perhaps, thought that being an introvert would mean i should only follow certain specialties, or that I wouldn't do well in others. I ended up picking a surgical specialty (not all introverts have to go into pathology or med micro!) and although it has been difficult at times I don't think it affects my performance with patients or my earning potential. I treat every patient encounter the way my more extroverted peers do and I don't think the patients have any idea I would rather spend my life locked up in a room (with good internet access) than have to mingle at a party.
     
    That is not to say there are not challenges, man are there challenges. For me I have a ticking clock that starts whenever I leave my house that drives me to want to come home. I would almost always rather be at home or doing things that i want to do versus work. Every minute I am out in the real world I feel the pressure to want to get home and on long surgical rotations where you spend weeks (literal) at the hospital it gets really hard. Couple this with the lack of any "alone" time. I am the kind of person who needs 30 minutes to myself every now and then to get lost in a song or read something not medicine and I rarely get this as a busy resident. It is hard, but no more so than if I was doing anything else outside of med or dent that required this type of investment. When I was younger it was easier to deal with but as I get older the batteries drain faster and my patience for people goes down.
     
    I would suspect as a dentist, it is much like being a surgeon in that outside of the brief intro to clinic stuff you are mostly left to your work and I love being in the OR, I think of it almost like alone time and I am sure the dentist clinic is similar. It probably even helps you when I think about it as you are able to spend long periods of time quietly working away where as extroverted people need constant conversation and interaction.
     
    Hope this was somewhat relevant.  
  3. Like
    Fresh fry got a reaction from Username2020 in Will Introvert Dentists Make Less Money Than Extrovert Ones?   
    I know it says dent but I will bite as I have an interest in the whole introvert/extrovert thing that has been going on the last few years.
     
    My thoughts: I don't think it matters.
     
    When the whole "introvert movement" started gaining ground a few years back I really started following it. This was compounded by the fact that my wife is an MBTI evaluator and she used to do practice assessments on me. I thought: this is great, finally there is a label for what I am (I always knew I was a bit weird) and there is a whole movement to normalize it. I have to admit I was really bad at first and used to use my new-found status as an introvert for an excuse. Suddenly it was OK that I didn't want to go to parties and would rather spend lunch by myself. I felt like I didn't have to try and be more extroverted anymore. That was until one day my wife explained to me that the whole introvert/extrovert/MBTI thing was designed to identify your weak points so you can work on them, not to use them as a crutch or an excuse (I know I am getting a bit off track here).
     
    This became important when I decided to pick a specialty. I, like you perhaps, thought that being an introvert would mean i should only follow certain specialties, or that I wouldn't do well in others. I ended up picking a surgical specialty (not all introverts have to go into pathology or med micro!) and although it has been difficult at times I don't think it affects my performance with patients or my earning potential. I treat every patient encounter the way my more extroverted peers do and I don't think the patients have any idea I would rather spend my life locked up in a room (with good internet access) than have to mingle at a party.
     
    That is not to say there are not challenges, man are there challenges. For me I have a ticking clock that starts whenever I leave my house that drives me to want to come home. I would almost always rather be at home or doing things that i want to do versus work. Every minute I am out in the real world I feel the pressure to want to get home and on long surgical rotations where you spend weeks (literal) at the hospital it gets really hard. Couple this with the lack of any "alone" time. I am the kind of person who needs 30 minutes to myself every now and then to get lost in a song or read something not medicine and I rarely get this as a busy resident. It is hard, but no more so than if I was doing anything else outside of med or dent that required this type of investment. When I was younger it was easier to deal with but as I get older the batteries drain faster and my patience for people goes down.
     
    I would suspect as a dentist, it is much like being a surgeon in that outside of the brief intro to clinic stuff you are mostly left to your work and I love being in the OR, I think of it almost like alone time and I am sure the dentist clinic is similar. It probably even helps you when I think about it as you are able to spend long periods of time quietly working away where as extroverted people need constant conversation and interaction.
     
    Hope this was somewhat relevant.  
  4. Like
    Fresh fry got a reaction from Dentiste in Will Introvert Dentists Make Less Money Than Extrovert Ones?   
    I know it says dent but I will bite as I have an interest in the whole introvert/extrovert thing that has been going on the last few years.
     
    My thoughts: I don't think it matters.
     
    When the whole "introvert movement" started gaining ground a few years back I really started following it. This was compounded by the fact that my wife is an MBTI evaluator and she used to do practice assessments on me. I thought: this is great, finally there is a label for what I am (I always knew I was a bit weird) and there is a whole movement to normalize it. I have to admit I was really bad at first and used to use my new-found status as an introvert for an excuse. Suddenly it was OK that I didn't want to go to parties and would rather spend lunch by myself. I felt like I didn't have to try and be more extroverted anymore. That was until one day my wife explained to me that the whole introvert/extrovert/MBTI thing was designed to identify your weak points so you can work on them, not to use them as a crutch or an excuse (I know I am getting a bit off track here).
     
    This became important when I decided to pick a specialty. I, like you perhaps, thought that being an introvert would mean i should only follow certain specialties, or that I wouldn't do well in others. I ended up picking a surgical specialty (not all introverts have to go into pathology or med micro!) and although it has been difficult at times I don't think it affects my performance with patients or my earning potential. I treat every patient encounter the way my more extroverted peers do and I don't think the patients have any idea I would rather spend my life locked up in a room (with good internet access) than have to mingle at a party.
     
    That is not to say there are not challenges, man are there challenges. For me I have a ticking clock that starts whenever I leave my house that drives me to want to come home. I would almost always rather be at home or doing things that i want to do versus work. Every minute I am out in the real world I feel the pressure to want to get home and on long surgical rotations where you spend weeks (literal) at the hospital it gets really hard. Couple this with the lack of any "alone" time. I am the kind of person who needs 30 minutes to myself every now and then to get lost in a song or read something not medicine and I rarely get this as a busy resident. It is hard, but no more so than if I was doing anything else outside of med or dent that required this type of investment. When I was younger it was easier to deal with but as I get older the batteries drain faster and my patience for people goes down.
     
    I would suspect as a dentist, it is much like being a surgeon in that outside of the brief intro to clinic stuff you are mostly left to your work and I love being in the OR, I think of it almost like alone time and I am sure the dentist clinic is similar. It probably even helps you when I think about it as you are able to spend long periods of time quietly working away where as extroverted people need constant conversation and interaction.
     
    Hope this was somewhat relevant.  
  5. Like
    Fresh fry got a reaction from Fiatvoluntas in Almost 1/3 Of Med Students Are Depressed!   
  6. Like
    Fresh fry got a reaction from ZBL in Dermatology   
    As fun as it has been watching the back and forth I think we have reached an impasse.
     
    Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.
     
    At the heart of this is just the definition of the term "competitive", this time it really is just semantics. 
     
    If we are defining 'competitive" as a program where there is a high ratio of people applying versus spots open then derm is unarguably number 1 or 2 and has been for many years for reasons that have been well established on this thread and others (lifestyle, etc).
     
    If we are defining the competition as "competitive" then yes we can only infer that derm candidates are highly "desirable". The fundamental problem with this is that we are comparing apples and oranges. A good candidate for derm is not necessarily a good candidate for neuro surgery. It has been advanced that you can objectively compare these groups by metrics such as time spent on research and graduate degrees obtained but I would argue that there really is no way to fairly compare the groups of candidates by these means.
     
    I think what we would all agree to is that in programs where there are many more candidates than positions the people that tend to match to them usually work fairly aggressively towards them and are more differentiated towards that career earlier in their training.
     
    I think there are certain attributes that can make a candidate appealing to a wide range of specialties, the things everyone is looking for: mature, good team player, strong work ethic, good hands (surgery). I would even argue that there are some people (we all know one or two) who are so personable they can make up for lack of research or limited electives with a strong performance but I don't think this extends to most people and so I council that the things that most people need to do who are looking at highly subscribed specialties are 1) research and 2) multiple electives in that field. 
     
    I have heard of, and know some, people who have slid into highly competitive specialties with limited investment but these are almost always special cases (not to say that anyone is suggesting this). The safe route is to follow the path for what makes a person competitive for that specialty and I would say, based on my experiences, that if you want derm/optho/plastics/EM than you need to know early and you need to put in the hours.
     
    As far as who are the best all around candidates and what specialty do they end up in I mean this with all honesty that there is no rhyme or reason to it. Some of the best doctors I know have decided that family medicine is the life that they want to live. I think they would have made excellent neurosurgeons or cardiologists but family is where their heart was. I think as a group we tend to look down on pathology but probably the smartest person I ever met went for it. As a surgical resident myself I would say there is nothing innately special about the neurosurgery or CV surgery residents at my site and they could just as easily have been ENT or ortho if they had gone that way.
     
    My two cents
  7. Like
    Fresh fry got a reaction from haps in Dermatology   
    As fun as it has been watching the back and forth I think we have reached an impasse.
     
    Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.
     
    At the heart of this is just the definition of the term "competitive", this time it really is just semantics. 
     
    If we are defining 'competitive" as a program where there is a high ratio of people applying versus spots open then derm is unarguably number 1 or 2 and has been for many years for reasons that have been well established on this thread and others (lifestyle, etc).
     
    If we are defining the competition as "competitive" then yes we can only infer that derm candidates are highly "desirable". The fundamental problem with this is that we are comparing apples and oranges. A good candidate for derm is not necessarily a good candidate for neuro surgery. It has been advanced that you can objectively compare these groups by metrics such as time spent on research and graduate degrees obtained but I would argue that there really is no way to fairly compare the groups of candidates by these means.
     
    I think what we would all agree to is that in programs where there are many more candidates than positions the people that tend to match to them usually work fairly aggressively towards them and are more differentiated towards that career earlier in their training.
     
    I think there are certain attributes that can make a candidate appealing to a wide range of specialties, the things everyone is looking for: mature, good team player, strong work ethic, good hands (surgery). I would even argue that there are some people (we all know one or two) who are so personable they can make up for lack of research or limited electives with a strong performance but I don't think this extends to most people and so I council that the things that most people need to do who are looking at highly subscribed specialties are 1) research and 2) multiple electives in that field. 
     
    I have heard of, and know some, people who have slid into highly competitive specialties with limited investment but these are almost always special cases (not to say that anyone is suggesting this). The safe route is to follow the path for what makes a person competitive for that specialty and I would say, based on my experiences, that if you want derm/optho/plastics/EM than you need to know early and you need to put in the hours.
     
    As far as who are the best all around candidates and what specialty do they end up in I mean this with all honesty that there is no rhyme or reason to it. Some of the best doctors I know have decided that family medicine is the life that they want to live. I think they would have made excellent neurosurgeons or cardiologists but family is where their heart was. I think as a group we tend to look down on pathology but probably the smartest person I ever met went for it. As a surgical resident myself I would say there is nothing innately special about the neurosurgery or CV surgery residents at my site and they could just as easily have been ENT or ortho if they had gone that way.
     
    My two cents
  8. Like
    Fresh fry got a reaction from ralk in Dermatology   
    As fun as it has been watching the back and forth I think we have reached an impasse.
     
    Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.
     
    At the heart of this is just the definition of the term "competitive", this time it really is just semantics. 
     
    If we are defining 'competitive" as a program where there is a high ratio of people applying versus spots open then derm is unarguably number 1 or 2 and has been for many years for reasons that have been well established on this thread and others (lifestyle, etc).
     
    If we are defining the competition as "competitive" then yes we can only infer that derm candidates are highly "desirable". The fundamental problem with this is that we are comparing apples and oranges. A good candidate for derm is not necessarily a good candidate for neuro surgery. It has been advanced that you can objectively compare these groups by metrics such as time spent on research and graduate degrees obtained but I would argue that there really is no way to fairly compare the groups of candidates by these means.
     
    I think what we would all agree to is that in programs where there are many more candidates than positions the people that tend to match to them usually work fairly aggressively towards them and are more differentiated towards that career earlier in their training.
     
    I think there are certain attributes that can make a candidate appealing to a wide range of specialties, the things everyone is looking for: mature, good team player, strong work ethic, good hands (surgery). I would even argue that there are some people (we all know one or two) who are so personable they can make up for lack of research or limited electives with a strong performance but I don't think this extends to most people and so I council that the things that most people need to do who are looking at highly subscribed specialties are 1) research and 2) multiple electives in that field. 
     
    I have heard of, and know some, people who have slid into highly competitive specialties with limited investment but these are almost always special cases (not to say that anyone is suggesting this). The safe route is to follow the path for what makes a person competitive for that specialty and I would say, based on my experiences, that if you want derm/optho/plastics/EM than you need to know early and you need to put in the hours.
     
    As far as who are the best all around candidates and what specialty do they end up in I mean this with all honesty that there is no rhyme or reason to it. Some of the best doctors I know have decided that family medicine is the life that they want to live. I think they would have made excellent neurosurgeons or cardiologists but family is where their heart was. I think as a group we tend to look down on pathology but probably the smartest person I ever met went for it. As a surgical resident myself I would say there is nothing innately special about the neurosurgery or CV surgery residents at my site and they could just as easily have been ENT or ortho if they had gone that way.
     
    My two cents
  9. Like
    Fresh fry got a reaction from psychiatry2017 in Dermatology   
    As fun as it has been watching the back and forth I think we have reached an impasse.
     
    Without grades and firm stats for applicants going into various specialties there is no way to objectively determine which specialty is attracting the "strongest" candidates. Intuitively it would follow that the programs with large numbers of candidates applying for limited spots would tend to select the best candidates from their applicant pool but as has been pointed out, that says nothing about the type of people who are applying for those programs. It could be possible that all of the candidates applying for derm are sub-par and there just happens to be more of them than there are spots giving the illusion that it is competitive.
     
    At the heart of this is just the definition of the term "competitive", this time it really is just semantics. 
     
    If we are defining 'competitive" as a program where there is a high ratio of people applying versus spots open then derm is unarguably number 1 or 2 and has been for many years for reasons that have been well established on this thread and others (lifestyle, etc).
     
    If we are defining the competition as "competitive" then yes we can only infer that derm candidates are highly "desirable". The fundamental problem with this is that we are comparing apples and oranges. A good candidate for derm is not necessarily a good candidate for neuro surgery. It has been advanced that you can objectively compare these groups by metrics such as time spent on research and graduate degrees obtained but I would argue that there really is no way to fairly compare the groups of candidates by these means.
     
    I think what we would all agree to is that in programs where there are many more candidates than positions the people that tend to match to them usually work fairly aggressively towards them and are more differentiated towards that career earlier in their training.
     
    I think there are certain attributes that can make a candidate appealing to a wide range of specialties, the things everyone is looking for: mature, good team player, strong work ethic, good hands (surgery). I would even argue that there are some people (we all know one or two) who are so personable they can make up for lack of research or limited electives with a strong performance but I don't think this extends to most people and so I council that the things that most people need to do who are looking at highly subscribed specialties are 1) research and 2) multiple electives in that field. 
     
    I have heard of, and know some, people who have slid into highly competitive specialties with limited investment but these are almost always special cases (not to say that anyone is suggesting this). The safe route is to follow the path for what makes a person competitive for that specialty and I would say, based on my experiences, that if you want derm/optho/plastics/EM than you need to know early and you need to put in the hours.
     
    As far as who are the best all around candidates and what specialty do they end up in I mean this with all honesty that there is no rhyme or reason to it. Some of the best doctors I know have decided that family medicine is the life that they want to live. I think they would have made excellent neurosurgeons or cardiologists but family is where their heart was. I think as a group we tend to look down on pathology but probably the smartest person I ever met went for it. As a surgical resident myself I would say there is nothing innately special about the neurosurgery or CV surgery residents at my site and they could just as easily have been ENT or ortho if they had gone that way.
     
    My two cents
  10. Like
    Fresh fry got a reaction from freewheeler in Failed Lmcc Part 2   
    1) Everyone has a bad day. You know you are strong, you know your capabilities, it is "just a test". In this job no one will hold your hand. It can seem "cold" sometimes but you are at the top of the food chain and are going to have to find comfort and strength inside because there is no one above you to tell you you did good anymore, you need to know it yourself.
     
    2) Re-write the exam in the spring. I think you guys get priority status or something. After reading this i would call them. yes it is 2.5gs but I'm sure you can find the money. i know you don't want to spend it but you will be making that in a few days this time next year.
     
    3) Easy to say, hard to do: but don't beat yourself up. We are not used to failure on the whole, we as in people in this situation. We are used to being the best most of us have never failed anything. It hurts, I failed a test once in undergrad med and it made me physically ill. If you are having a hard time know this, you will feel better, you will get through this, in a year or two you will be looking back on this as an inconvenience and life lesson.
     
    4) Study outside your comfort zone. Run the scenarios with some people who you are not very familiar with and who can be hard on you. You really aren't in a position where you want to re-write again so get'er done and get away from people who won't be tough on you.
     
    5) No one cares about the test because no one cares about the test. It is a lame exam, it is not real life, it won't make any difference in what kind of doctor you are going to be. What will make a difference is how you let this affect you as a person. be the capable person you know you are and face this set back as what it is: a minor inconvenience, a chance to grow, and a check of your self confidence.
     
    GL
  11. Like
    Fresh fry got a reaction from Arztin in Almost 1/3 Of Med Students Are Depressed!   
    This +1
  12. Like
    Fresh fry got a reaction from LittleDaisy in Almost 1/3 Of Med Students Are Depressed!   
    This +1
  13. Like
    Fresh fry got a reaction from RRRAAAWWW in Almost 1/3 Of Med Students Are Depressed!   
  14. Like
    Fresh fry got a reaction from Arztin in Almost 1/3 Of Med Students Are Depressed!   
  15. Like
    Fresh fry got a reaction from RedLily in Almost 1/3 Of Med Students Are Depressed!   
  16. Like
    Fresh fry got a reaction from MountainAmoeba in Almost 1/3 Of Med Students Are Depressed!   
  17. Like
    Fresh fry got a reaction from Friendly Magpie in Toronto Neurosurgeon Charged With Murder Of Wife   
    What?!?
     
    "Unaccomplished citizens"? Pardon me but who are you and what accomplishments does one need to have to be able to discuss their opinions on an online forum?
     
    Not sure if you have any insight into how pretentious what you wrote sounds so I will check back in an hour or so to see if you may want to reconsider spouting off all holier than thou on here (if you delete/edit your post I will remove this one).
     
    People, independent of their education, are entitled to their opinions, to the right to express their opinions, and no one here has said anything disrespectful or against the forum's rules 
  18. Like
    Fresh fry got a reaction from technobabble in The Carms Algorithm   
    No one ever asked me what order I was ranking schools, pretty sure this is a no-no question anyway. Being on the other side of it now I can definitely say that schools just rank their top choices, there is no consideration as to what the candidate might rank.
     
    Been giving talks on CaRMs and coaching people through it for a couple years now and it really is this simple: rank your choices in the order that you want them whether you are the school or candidate. That is it, that is all, the algorithm takes care of the rest.
     
    Where I think people get confused is trying to figure out how they fit into the match with everyone else. There is no way to "game" the system through your choices, the only potential way to affect the match in any way is to get other people to change their rank order.
     
    IE: Harry needs to convince Tom to rank a different school (one that accepted Tom) higher than Toronto so that Harry will get the spot that would have gone to Tom if he had not chosen the other school. 
     
    Doing this in real life is virtually impossible unless you are the pied-piper or a manipulative puppet master.
  19. Like
    Fresh fry got a reaction from NutritionRunner in Toronto Neurosurgeon Charged With Murder Of Wife   
    What?!?
     
    "Unaccomplished citizens"? Pardon me but who are you and what accomplishments does one need to have to be able to discuss their opinions on an online forum?
     
    Not sure if you have any insight into how pretentious what you wrote sounds so I will check back in an hour or so to see if you may want to reconsider spouting off all holier than thou on here (if you delete/edit your post I will remove this one).
     
    People, independent of their education, are entitled to their opinions, to the right to express their opinions, and no one here has said anything disrespectful or against the forum's rules 
  20. Like
    Fresh fry got a reaction from Birdy in Toronto Neurosurgeon Charged With Murder Of Wife   
    What?!?
     
    "Unaccomplished citizens"? Pardon me but who are you and what accomplishments does one need to have to be able to discuss their opinions on an online forum?
     
    Not sure if you have any insight into how pretentious what you wrote sounds so I will check back in an hour or so to see if you may want to reconsider spouting off all holier than thou on here (if you delete/edit your post I will remove this one).
     
    People, independent of their education, are entitled to their opinions, to the right to express their opinions, and no one here has said anything disrespectful or against the forum's rules 
  21. Like
    Fresh fry got a reaction from futureGP in Internal Medicine Followed By A Subspeciality?   
    https://phx.e-carms.ca/phoenix-web/pd/main?mitid=1327#
  22. Like
    Fresh fry got a reaction from sometimesmad111 in Hi   
    You need to supply a police records check and vulnerable sector check with application to every medical school you apply to. 
     
    You can not receive Royal College Accreditation if you have any unpardoned offences on your record and therefore medical schools will not consider you for entrance if you have anything on your record.
     
    I am no lawyer but it is my understanding that charges which you have not been convicted of do not show up on your record. It is against the Charter or Rights and Freedoms to be prejudiced against for something you have not been convicted of. THAT BEING SAID: you stated you pled guilty and received 1 year of probation for one of your charges (don't know which one, doesn't really matter). To my understanding this means you are likely to have this on your record but again you will have to check.
     
    It is possible, at great expense and time, to get a pardon for an offence and if that is granted it will be removed from your record at which time you can apply.
     
    I highly doubt anyone on this forum will have any further insight into this matter as this is highly irregular. Your best bet is to get a copy of your record and if there is a recorded offence, discuss it with a lawyer. I would definitely avoid inquiring to medical schools about this until it is resolved.
     
    Please refrain from using profanity on this board, and good luck.
  23. Like
    Fresh fry got a reaction from Neural_Ark in Future Of Surgery   
    Preface: I can speak on my province and my specialty but how generaliazable that is, I have no idea. I also like making up words apparently.
     
     
    This is the major detractor for many people looking at surgical specialties; your livelihood and your ability to set your own schedule and pace are not completely in your control. OR time is an almost an absolute necessity to be a surgeon. I say almost because I am aware of a few people, in a few odd situations, who are trained surgeons who do not actually operate. These situations are definitely not the rule and probably only encompass at most 5% of trained surgeons. They also tend to be closer to the end on the retirement spectrum and are from subspecialties where they can rely on niche aspects of their profession. Examples include:
     
    Gen surgeon who strictly does ICU
    Gen surgeon who does trauma coordinator
    O&Gs who has given up gyne and only does obs
    Uro and ENT who only do outpatient (scoping) and refer surgical patients to their partners
    Various who work as assists (almost 100% people who are retiring/semi-retired)
     
    Most people who go on to become surgeons absolutely intend to operate and to be able to maintain your skills and be able to afford to be part of a practice you generally need 4-5 OR days a month (obviously variable). So a graduating surgeon, who probably owes a couple hundred grand, needs to find what we essentially call a "job" but the reality is much more complicated.
     
    1st hurdle is location and career stream. Like other aspects of medicine surgery is broken down into academic and community designations. Academics work in what we call the "ivory tower", medical school or university affiliated centers. These are big centers that offer a wide spectrum of care and for most specialties if you want to work as an academic surgeon you need a lot more training and to fill a required niche (last time I will use the word "niche" I promise). This can be surgeon-educator, surgeon-scientist, or specialist-surgeon. These are your PhDs or people with high end fellowships that bring something unique to the center. OR time is usually divided up by the academic center but the total ammount available is dependent on the province. 
     
    Aside: To put a rumor to rest it is not about the amount of physical ORs or space. Many large centers have multiple unused ORs and only operate them at a limited capacity. Building one is usually not an issue either. The hold up is always 1) operating and staffing costs 2) post op bed numbers. 
     
    Physicians are fee for service but nurses/housekeeping/techs certainly are not. The province pays these people's salary and they pay to maintain, equip, and staff the ORs. Each OR runs at a staggering operating cost per suite and it is always humbling to walk into one knowing that a measurable proportion of our country's GDP is being spent in this one room on a yearly basis. Surgical beds also cost. I have heard many different figures but it is almost certainly in the low thousands of dollars per day per bed. Each surgical bed requires staffing and equipment costs too which all get factored in. The surgeon pays for none of this and it is all provided contractually for them providing a service to the community/province. They are, without blowing up their heads even more, a community resource because they posses a capability to perform a service no one else in the community can. A surgeon is a living breathing angry and bitter MRI machine with legs in one sense.
     
    One of the ways provinces/regions control health care costs is OR time. It is a massive part of the budget and is easily controlled by allocation of resources and time. 
     
    In short: the ORs are there, there is no shortage of trained people to keep them going or surgeons to operate, the restriction is in the funding department.
     
    Back to surgeon types. A community surgeon is someone with a much broader scope of practice. They will work in community hospitals and will provide a base level of capabilities that is usually dictated by their respective colleges. They tend to be the work-a-day type of surgeons and do the bulk of the more common operations. Community Gen surge will do appy's, choley's, maybe some basic bowel work, but the transplants and heavy oncology stuff is all going to the big academic centers. Same goes in most specialties. Community surgeons are the generalists doing the general things that there is a high demand for. To get one of these "jobs" you need OR time and to either make or join a practice.
     
    As a rule almost no surgeons go solo they all join a practice. A practice means you can pool resources and more importantly: call. As part of a service a surgeon provides a community they are expected to provide a certain amount of call and support to the community site. They ma have to sit on a board or be available to perform a certain required service. Having never negotiated a contract I am not entirely sure how this works but from what I do understand you basically need to find a community that can support the surgeon with OR time and patient catchment that has an open space or retiring surgeon already filling that role.
     
    Think of it like this: OR time is like farm land, there is only so much of it and all of it is essentially spoken for. If you want to be a farmer you can take over for someone who is retiring, find someone who is farming and wants to subdivide their land and share it with you, or find some land no one is farming and set up shop. As a rule the first analogy generally applies to academic centers where OR time is tightly regulated and most services are well covered with a waiting list of potential previous surgical graduates waiting on the periphery to pounce on any openings. In my program the people who are retiring have essentially selected their replacements who are undergoing fellowships the practice has pretty much dictated to them to fill the requirements of the center. These people have traded about 95% of their decision making for an academic job with security but will be set for life. This is just becoming the reality of academic surgery. Big centers will need oncology, transplant, and other specialists. These roles have been filled and you need to project many years out to find a gap to fill and then shape your career path toward that end. 
     
    Community surgery is much more like the second and third analogies. As smaller centers grow they pick up capabilities and their populace demands better access to services so more surgeons get hired on to provide a new capability or help someone who has been doing it at a limited capacity on their own. The downsides to this is it is very difficult to forecast, the centers are smaller meaning you will have limited support, no residents, and a heavier call burden. You will also not have much choice as to where you live as you basically take a job wherever you can. OR time is usually controlled by a board and you negotiate your access before setting up shop.
     
     
    There is obviously more to it than this but this is a general overview. I would say to anyone looking at anything in medicine "get away from your med school and see how they do things in the community". Most of us don't end up working in big centers and you tend to get blinded in med school to a very limited way of how we do things. There is a whole world outside of academics that is worth seeing and knowing about to help you with your career choices. 
     
    GL
  24. Like
    Fresh fry got a reaction from hamham in Future Of Surgery   
    Preface: I can speak on my province and my specialty but how generaliazable that is, I have no idea. I also like making up words apparently.
     
     
    This is the major detractor for many people looking at surgical specialties; your livelihood and your ability to set your own schedule and pace are not completely in your control. OR time is an almost an absolute necessity to be a surgeon. I say almost because I am aware of a few people, in a few odd situations, who are trained surgeons who do not actually operate. These situations are definitely not the rule and probably only encompass at most 5% of trained surgeons. They also tend to be closer to the end on the retirement spectrum and are from subspecialties where they can rely on niche aspects of their profession. Examples include:
     
    Gen surgeon who strictly does ICU
    Gen surgeon who does trauma coordinator
    O&Gs who has given up gyne and only does obs
    Uro and ENT who only do outpatient (scoping) and refer surgical patients to their partners
    Various who work as assists (almost 100% people who are retiring/semi-retired)
     
    Most people who go on to become surgeons absolutely intend to operate and to be able to maintain your skills and be able to afford to be part of a practice you generally need 4-5 OR days a month (obviously variable). So a graduating surgeon, who probably owes a couple hundred grand, needs to find what we essentially call a "job" but the reality is much more complicated.
     
    1st hurdle is location and career stream. Like other aspects of medicine surgery is broken down into academic and community designations. Academics work in what we call the "ivory tower", medical school or university affiliated centers. These are big centers that offer a wide spectrum of care and for most specialties if you want to work as an academic surgeon you need a lot more training and to fill a required niche (last time I will use the word "niche" I promise). This can be surgeon-educator, surgeon-scientist, or specialist-surgeon. These are your PhDs or people with high end fellowships that bring something unique to the center. OR time is usually divided up by the academic center but the total ammount available is dependent on the province. 
     
    Aside: To put a rumor to rest it is not about the amount of physical ORs or space. Many large centers have multiple unused ORs and only operate them at a limited capacity. Building one is usually not an issue either. The hold up is always 1) operating and staffing costs 2) post op bed numbers. 
     
    Physicians are fee for service but nurses/housekeeping/techs certainly are not. The province pays these people's salary and they pay to maintain, equip, and staff the ORs. Each OR runs at a staggering operating cost per suite and it is always humbling to walk into one knowing that a measurable proportion of our country's GDP is being spent in this one room on a yearly basis. Surgical beds also cost. I have heard many different figures but it is almost certainly in the low thousands of dollars per day per bed. Each surgical bed requires staffing and equipment costs too which all get factored in. The surgeon pays for none of this and it is all provided contractually for them providing a service to the community/province. They are, without blowing up their heads even more, a community resource because they posses a capability to perform a service no one else in the community can. A surgeon is a living breathing angry and bitter MRI machine with legs in one sense.
     
    One of the ways provinces/regions control health care costs is OR time. It is a massive part of the budget and is easily controlled by allocation of resources and time. 
     
    In short: the ORs are there, there is no shortage of trained people to keep them going or surgeons to operate, the restriction is in the funding department.
     
    Back to surgeon types. A community surgeon is someone with a much broader scope of practice. They will work in community hospitals and will provide a base level of capabilities that is usually dictated by their respective colleges. They tend to be the work-a-day type of surgeons and do the bulk of the more common operations. Community Gen surge will do appy's, choley's, maybe some basic bowel work, but the transplants and heavy oncology stuff is all going to the big academic centers. Same goes in most specialties. Community surgeons are the generalists doing the general things that there is a high demand for. To get one of these "jobs" you need OR time and to either make or join a practice.
     
    As a rule almost no surgeons go solo they all join a practice. A practice means you can pool resources and more importantly: call. As part of a service a surgeon provides a community they are expected to provide a certain amount of call and support to the community site. They ma have to sit on a board or be available to perform a certain required service. Having never negotiated a contract I am not entirely sure how this works but from what I do understand you basically need to find a community that can support the surgeon with OR time and patient catchment that has an open space or retiring surgeon already filling that role.
     
    Think of it like this: OR time is like farm land, there is only so much of it and all of it is essentially spoken for. If you want to be a farmer you can take over for someone who is retiring, find someone who is farming and wants to subdivide their land and share it with you, or find some land no one is farming and set up shop. As a rule the first analogy generally applies to academic centers where OR time is tightly regulated and most services are well covered with a waiting list of potential previous surgical graduates waiting on the periphery to pounce on any openings. In my program the people who are retiring have essentially selected their replacements who are undergoing fellowships the practice has pretty much dictated to them to fill the requirements of the center. These people have traded about 95% of their decision making for an academic job with security but will be set for life. This is just becoming the reality of academic surgery. Big centers will need oncology, transplant, and other specialists. These roles have been filled and you need to project many years out to find a gap to fill and then shape your career path toward that end. 
     
    Community surgery is much more like the second and third analogies. As smaller centers grow they pick up capabilities and their populace demands better access to services so more surgeons get hired on to provide a new capability or help someone who has been doing it at a limited capacity on their own. The downsides to this is it is very difficult to forecast, the centers are smaller meaning you will have limited support, no residents, and a heavier call burden. You will also not have much choice as to where you live as you basically take a job wherever you can. OR time is usually controlled by a board and you negotiate your access before setting up shop.
     
     
    There is obviously more to it than this but this is a general overview. I would say to anyone looking at anything in medicine "get away from your med school and see how they do things in the community". Most of us don't end up working in big centers and you tend to get blinded in med school to a very limited way of how we do things. There is a whole world outside of academics that is worth seeing and knowing about to help you with your career choices. 
     
    GL
  25. Like
    Fresh fry got a reaction from Arztin in Future Of Surgery   
    Preface: I can speak on my province and my specialty but how generaliazable that is, I have no idea. I also like making up words apparently.
     
     
    This is the major detractor for many people looking at surgical specialties; your livelihood and your ability to set your own schedule and pace are not completely in your control. OR time is an almost an absolute necessity to be a surgeon. I say almost because I am aware of a few people, in a few odd situations, who are trained surgeons who do not actually operate. These situations are definitely not the rule and probably only encompass at most 5% of trained surgeons. They also tend to be closer to the end on the retirement spectrum and are from subspecialties where they can rely on niche aspects of their profession. Examples include:
     
    Gen surgeon who strictly does ICU
    Gen surgeon who does trauma coordinator
    O&Gs who has given up gyne and only does obs
    Uro and ENT who only do outpatient (scoping) and refer surgical patients to their partners
    Various who work as assists (almost 100% people who are retiring/semi-retired)
     
    Most people who go on to become surgeons absolutely intend to operate and to be able to maintain your skills and be able to afford to be part of a practice you generally need 4-5 OR days a month (obviously variable). So a graduating surgeon, who probably owes a couple hundred grand, needs to find what we essentially call a "job" but the reality is much more complicated.
     
    1st hurdle is location and career stream. Like other aspects of medicine surgery is broken down into academic and community designations. Academics work in what we call the "ivory tower", medical school or university affiliated centers. These are big centers that offer a wide spectrum of care and for most specialties if you want to work as an academic surgeon you need a lot more training and to fill a required niche (last time I will use the word "niche" I promise). This can be surgeon-educator, surgeon-scientist, or specialist-surgeon. These are your PhDs or people with high end fellowships that bring something unique to the center. OR time is usually divided up by the academic center but the total ammount available is dependent on the province. 
     
    Aside: To put a rumor to rest it is not about the amount of physical ORs or space. Many large centers have multiple unused ORs and only operate them at a limited capacity. Building one is usually not an issue either. The hold up is always 1) operating and staffing costs 2) post op bed numbers. 
     
    Physicians are fee for service but nurses/housekeeping/techs certainly are not. The province pays these people's salary and they pay to maintain, equip, and staff the ORs. Each OR runs at a staggering operating cost per suite and it is always humbling to walk into one knowing that a measurable proportion of our country's GDP is being spent in this one room on a yearly basis. Surgical beds also cost. I have heard many different figures but it is almost certainly in the low thousands of dollars per day per bed. Each surgical bed requires staffing and equipment costs too which all get factored in. The surgeon pays for none of this and it is all provided contractually for them providing a service to the community/province. They are, without blowing up their heads even more, a community resource because they posses a capability to perform a service no one else in the community can. A surgeon is a living breathing angry and bitter MRI machine with legs in one sense.
     
    One of the ways provinces/regions control health care costs is OR time. It is a massive part of the budget and is easily controlled by allocation of resources and time. 
     
    In short: the ORs are there, there is no shortage of trained people to keep them going or surgeons to operate, the restriction is in the funding department.
     
    Back to surgeon types. A community surgeon is someone with a much broader scope of practice. They will work in community hospitals and will provide a base level of capabilities that is usually dictated by their respective colleges. They tend to be the work-a-day type of surgeons and do the bulk of the more common operations. Community Gen surge will do appy's, choley's, maybe some basic bowel work, but the transplants and heavy oncology stuff is all going to the big academic centers. Same goes in most specialties. Community surgeons are the generalists doing the general things that there is a high demand for. To get one of these "jobs" you need OR time and to either make or join a practice.
     
    As a rule almost no surgeons go solo they all join a practice. A practice means you can pool resources and more importantly: call. As part of a service a surgeon provides a community they are expected to provide a certain amount of call and support to the community site. They ma have to sit on a board or be available to perform a certain required service. Having never negotiated a contract I am not entirely sure how this works but from what I do understand you basically need to find a community that can support the surgeon with OR time and patient catchment that has an open space or retiring surgeon already filling that role.
     
    Think of it like this: OR time is like farm land, there is only so much of it and all of it is essentially spoken for. If you want to be a farmer you can take over for someone who is retiring, find someone who is farming and wants to subdivide their land and share it with you, or find some land no one is farming and set up shop. As a rule the first analogy generally applies to academic centers where OR time is tightly regulated and most services are well covered with a waiting list of potential previous surgical graduates waiting on the periphery to pounce on any openings. In my program the people who are retiring have essentially selected their replacements who are undergoing fellowships the practice has pretty much dictated to them to fill the requirements of the center. These people have traded about 95% of their decision making for an academic job with security but will be set for life. This is just becoming the reality of academic surgery. Big centers will need oncology, transplant, and other specialists. These roles have been filled and you need to project many years out to find a gap to fill and then shape your career path toward that end. 
     
    Community surgery is much more like the second and third analogies. As smaller centers grow they pick up capabilities and their populace demands better access to services so more surgeons get hired on to provide a new capability or help someone who has been doing it at a limited capacity on their own. The downsides to this is it is very difficult to forecast, the centers are smaller meaning you will have limited support, no residents, and a heavier call burden. You will also not have much choice as to where you live as you basically take a job wherever you can. OR time is usually controlled by a board and you negotiate your access before setting up shop.
     
     
    There is obviously more to it than this but this is a general overview. I would say to anyone looking at anything in medicine "get away from your med school and see how they do things in the community". Most of us don't end up working in big centers and you tend to get blinded in med school to a very limited way of how we do things. There is a whole world outside of academics that is worth seeing and knowing about to help you with your career choices. 
     
    GL
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