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A-Stark

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  1. I'm not sure any of this shows the essentialness of clerks let alone that they're doing work that should be compensated like a job. In community centres, nurses will often enter "routine" bloodwork themselves without any MD input (imagine!) because they're used to things working like that. Assessments and rounding takes no time at all; the only stuff that I never feel quick at are the note-writing and, of course, patient/family counselling.
  2. I assume you're just starting CC3, so give it time! Generally speaking it's most efficient to review the chart first, especially the PMHx and Meds and such. You can even start your note ahead of time with that. I will say that while taking notes is fine, make sure you're not writing a "rough copy" of your note. I've seen a number of clerks do that and does it ever slow things down. Eventually you'll just remember what was said well enough that writing all the stuff down won't be needed. It's better to listen.
  3. Clerks should not overrate their importance to the system. They are students - very junior apprentices at most - and are doing all that work to learn how to do the job. Residents work still harder. But they still have a union and post-call days and, well, a salary with paid vacation and sick leave. I didn't think I was particularly underpaid as a resident - even despite the hours at times - but our call stipends sucked and still do because of bad outcomes with prior negotiations. Staff pay is almost inconceivably better, but you're now responsible for everything. And if you end up being up all night on a Friday you still might be on call Saturday, Sunday, Monday... but is 5pm Monday ever awesome! (Those days may or may not be coincidence.) Indeed. Teaching requires time and you can't - as a resident or staff - simply go by a clerk's assessment without questions or your own assessment. It's helpful to have someone around to write painstakingly detailed notes from time to time but I can't think of many instances where having a med student didn't just slow me down (at least after PGY1).
  4. I switched to RBC in PGY5 because of the lower rate and two year grace period. But my mortgage is only $210k... I know tuition fees have really gotten out of control in some places (e.g. Ontario) but $325k is at least $100k more debt than anyone should ever consider taking on. In retrospect I would have ate out a lot less and been more frugal over the last 9-10 years.
  5. A-Stark

    Looking at ROS/Incentive Options

    They provided me a list but it wasn't actually helpful at all. One of them never returned me call and the other was apparently too busy. Any that have experience in employment contracts will do.
  6. A-Stark

    Speciality Closest to Derm

    Outpatient consults do not take 60 minutes except apart from some slow academic GIM staff. All patients are complex, but just because you get a consult as an internist does not mean you're going to be exhaustively counselling someone about every last issue. A lot of community internists (and, really, any FFS staff in an academic centre) do fairly high volume clinics. Meh. Rashes are boring.
  7. A-Stark

    Looking at ROS/Incentive Options

    These contracts take the form of explicit ROS agreements or somewhat looser bursaries. Either way, they're largely the same and simply prescribe a certain term of service in exchange for X dollars. Variations will be about the specifics of the position (e.g. just working in a particular region or a particular hospital?). Note these generally are NOT contracts insofar as they don't generally define a position description or specifics of what you might be doing. You can be honest with recruiter types about other places you are considering. The ROS side of things is not a negotiation, however, and the amounts involved are set by provincial health departments, often varying with region. When it comes to negotiating around a position description, you will have more leeway, but that's at the stage near the end of training when you're defining a specific position. PGME is not the place to go with this. You can talk to your MDM advisor, but CMPA may be a better (free) resource. Provincial associations will not review any contract but can comment on items that would typically be included. Otherwise talk to a lawyer. Cost will be in the range of $1000.
  8. I always have coffee with me apart from when I can't. But I'm APP so I don't get to bill as such. It is helpful when GIM does much of the overnight admitting, but I always go and see the patient myself - I don't think it's appropriate to rely on someone else's assessment when I'm assuming care, but then this whole "independent practice" thing is kinda new. And it is lonely! But there's something to be said for doing everything yourself. And when Thursday afternoon comes you get to peace out and avoid the place for a while (provided there's no IM call coming up soon...).
  9. Wasn't too long ago that staying a bit late was the norm in most programs. When I was an R1 it was fairly usual to be in the hospital at least til mid-morning post-call, and sometimes until early afternoon. We'd just started night float that year so that might have something to do with the "it's 8am cya" mentality that subsequently developed.
  10. A-Stark

    YouTube/Social Media

    I think it's inappropriate to share detailed patient accounts over social media, particularly in relative real time. And the more exciting it is, the stricter you need to be.
  11. Do you have another slot for a home school elective? Alternatively, could that one be after CaRMS and pre-interview (as in, do you already have home school letters?).
  12. True but NL is dealing with a more dispersed "remote" population. NS absolutely has a lot of little towns that are fairly close together each with its own little "emerg" (well, actually a lot less than in the past). You're really never more than an hour away from (at least) a regional centre, at least three of which are within two hours of Halifax. I don't know what the solution is to the rural/remote issue, but in NS there's already been a lot of consolidation of services and this will undoubtedly continue. I can't understand why industrial Cape Breton alone has four hospitals when Halifax alone gets by with three (if you include the IWK and ignore the NSH). But then Nova Scotians think driving an hour into the City is a "long way". What Newfoundlander hasn't driven across the island to Costco/PriceClub? What NS does have going for it is a fairly well organized EMS/air ambulance system. NL has a patchwork of private/public services and way too much reliance and fixed wing transfers.
  13. To play devil's advocate, "OHIP coverage details" are not typical aspects of prescriptions. This seems more like an insurance issue. All the same, pharmacies almost always get a hold of me through switchboard.
  14. I've done a lot of call in the last week (5/7 nights) and miss having minions. Although really they'd just slow me down... I don't understand why supposedly serious people like Chrystia Freeland think that Twitter is the place for any serious messages or diplomacy. This is an unmitigated disaster. I don't much like the kleptocratic authoritarian Saudi government, but their ridiculous overreaction cannot be taken as that unexpected. Freeland absolutely should resign. Contracts can be cancelled. Especially by new governments.
  15. I've always thought the Saudi training programs in Canada represented something of a racket. After all, nothing beats having residents and fellows who will essentially work for nothing and let academic staff stay in their beds all night. Okay maybe that was a bit cynical... But I would feel a lot better about this "moral stand" if this same government hadn't already vigorously defended selling weapons and military equipment to the Saudis. Because they did. Was this the hill to die on?
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