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About skyuppercutt

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  1. If you want to set up an outpatient office, for sure you'll be good. General cardiology you won't have trouble finding a job, especially in the community, but the volume is lower. If you want to do other stuff like caths or EP, the job market is a bit tighter at the moment. I think doing echos or cardiac imaging is still okay. Keep in mind that cardiology is a 3 year fellowship (6 years in total including the 3 years of IM that you do first). Also fellowships like cath, EP, cardiac imaging are an additional 2 years on top of that (cardiac imaging may also just be 1 additional year if you want to focus on echos, although I may be wrong about that. That's what the cardio fellow told me when I spoke to him about it when I was on call. As a side note, welcome to medical school at western! If you want to do some shadowing in internal, reach out to your IM mentorship group or something. I've had a couple of your upper year classmates do observerships with me and I may be your senior at some point during your training
  2. As an IM resident my understanding is: GI - really bad Endocrinology - Good if you set up your own office Geriatrics - Good if you set up your own office Hematology - somewhere in the middle ID - somewhere in the middle Nephro - absolute shit I'll add GIM - Really fucking good
  3. Wow, I was always under the impression that the ABIM was more difficult than the royal college (purely based on the fact that the steps are more difficult than the USMLE). Are any of you aware of people finishing residency in Canada and then moving to the states? Would you have to do the ABIM in that case? My understanding is that the USMLEs would be optional depending on which state you want to practice in if you have the LMCC, but please correct me if I'm wrong
  4. In terms of the pay, I consistently hear people say that in the community you would make significantly more than at an academic centre. I'm having some difficulty understanding that, because at an academic centre you always have a handful of residents seeing your patients and I imagine that because of this you're able to see and bill for more patients on a daily basis? I heard that in a community the MRP would have a team of 10-15 patients, while at an average academic centre it would be anywhere from 20-30. The attendings also get to bill premiums for all the overnight admissions codes and all those things. Is the %amount that the medicine departments take from the MRP's billing so much that they end up making less money than they would in the community or am I missing something here? Is it reasonable as an MRP in the community to see and manage a ward of 30 patients without residents? (Maybe it's because I just started R2 that I'm finding it a bit difficult, but it'll be easier as an attending?)
  5. I guess my main question would be, is it realistic to have a set up like this in or around the GTA? No paid vacation/pension if you set up your own outpatient clinic. Even if you work in the hospital, I've rarely heard about that being the case, but if others know differently please chime in
  6. Wow, thank you so much for such an informative post. Really did not know about a lot of things you mentioned, especially this: One thing that many people have told me is that endo and rheum (even attending rheumatologist) usually bill less than GIM. Is that because on average someone in GIM would still be able to see more patients per hour despite the 50% bonus that the subspecialists can bill for? Can anyone speak to how easy/difficult it would be for someone in GIM to pick up ER consult shifts at a community hospital in Ontario e.g. Mississauga, Brampton, Windsor, Scarborough? How would the volume be/expected income be for a shift from midnight to 8am? I've heard some people say that young attendings can pick up call shifts in places like Sue St Mary where they also run the ICU and end up billing something riduculous like 15k in a weekend (Friday evening, Sat, and Sunday). Is that realistic or an exaggeration? Thanks! R1 going into R2 internal and leaning towards GIM
  7. That's bullshit, I don't know why any resident would say that, especially a senior. Stuff like that should absolutely not happen. I'm sorry that you had to go through this
  8. Any idea how much a purely outpatient GIM staff would make if they worked 8am-5pm with 1-hour lunch (8 hour day) assuming they completed all their paperwork so they literally leave at 5pm? Assuming they work 4-5 days per week? I hear people say that you'd average 400k per year for 4 days per week. Is that a realistic estimate?
  9. While what you are saying is true, there are a couple of caveats that I kept in mind when making a decision. When I made calculations as well, I also found that OMA was cheaper than RBC when I was younger, but when I get older the step rate for OMA would surpass the cost of RBC which would remain the same. That being said, OMA was much much cheaper than RBC was, so when I calculated how many years I would have to be with OMA until it's cost supassed that of RBC I found that it would be something like a decade or so until I just broke even. I decided that financially for me it would make sense to stick with OMA, because the money that I would save from paying into my RBC premium, I could instead use to pay off my student loans (save on interest) OR invest for it to grow. So, in the long run I may even continue to profit from this difference because it would grow with compound interest. Another thing I thought about is that, after 10 years or so when the cost of being with OMA rises I will be making signigicantly more money as an attending and would financially be in a better place that the difference wouldn't really matter at that point, because I'd have more money anyway. While it's true that you'll never be as young or healthy as you are today, when you decide to increase your premiums, because you're making more money, they will use your age at the time when you increase your premiums NOT the age you used to sign up for the insurance plan, which is something none of the insurance brokers mentioned unless I specifically asked for it and pressed them. I'll just briefly explain this since it's a bit complicated: If RBC offers you $1,000 of disability insurance for $10 per month when you're 25, but it costs $50 per month when you're 35, some people will be like okay sign me up at age 25. Now you finish residency at age 35 and are working and wanna get another $1,000 coverage so you have $2,000 in total and you call up you're friendly broker and be like hey, hook me up with some more coverage, they will then say that you will now have to pay $60 per month ($10 from when you're 25 and $50 because you're 35 now), you won't get it for $20 in total, which is what they make it seem like. So ya, just my $0.02
  10. That's right. Rebates have been lower, but at the same time they actually have rebates. When comparing OMA vs RBC I find that OMA is cheaper anyways, so even if there weren't any rebates you'd still be paying less by going with OMA (assuming your situation is identical to mine). A lot of the insurance brokers used the rebate argument as a reason to not go with OMA saying that the rebate has been decreasing over time. I always took that as a moot point because the other options don't even have a rebate as a possibility (at least the ones I've researched)
  11. I feel that I researched all of them really well before starting residency. Now I'm not an expert obviously, but all the advantages that people say about RBC (personalized and unchangeable) I didn't feel were really big advantages. Especially given that for OMA if it does get changed it'll be by physicians who are current insurance holders. I ended up just going with OMA they have a discount so you'll be paying less during residency. Near the end of when I finish, I will reassess and decide if I want to stay or change. That way I'll also know if I'll still be in Ontario or not. So we'll see. Stay tuned!
  12. Show up on time. Really the only way I felt that helped prepare me for clerkship was shadowing lots of doctors. I did a lot of surgery shadowing and by the time I started, I was very very comfortable in the OR whereas some of my classmates had never stepped in the OR. Just an example in surg, but if you do it in other specialities it'll be good too
  13. I've thought about that a lot too. I'm not sure if there is evidence for it, but from my experience, I can say that if the patient looks like they're in pain from their facial expressions and they get morphine their expression changes. I have also thought about, what if all these things we do that are commonly found on a palliative care order set are just things we do to make ourselves and the patient's family feel better. Who knows right? How would one study something like this too? When patients are in their last moments of life when you would use stuff like scopolamine etc they tend to be nonverbal anyways...
  14. While I heard that they tend to be more informal compared to the rest of medicine too; that was definitely not my experience when I interviewed for family med last year. When I interviewed, almost everyone wore a suit and tie (for men) or formal wear for women. There were a couple of people who were more casual, but for the vast majority of people >95% were dressed formally. I would not recommend dressing casually to the interview, YOU WILL STAND OUT For the social, I wore dark pants and a cardigan. It would be okay to wear jeans for the social too and some people did, which was fine. I prefer dressing a little more formal and so stuck with dark pants (or dark wash jeans). Definitely try to go to the queens family med social if you get an interview there. It was amazing!
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