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medisforme

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medisforme last won the day on August 31 2019

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About medisforme

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    British Columbia
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    RN

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  1. To clarify my point, it was in reference to residency interviews, nothing more, and I clearly said it doesn't reflect my personal opinion. There is nothing wrong with voicing interests in areas of family medicine during a residency interview. The only point I was making is that certain applicants were docked points when they ONLY discussed interest in one area of family medicine and did not touch on the longitudinal aspects of the specialty.
  2. EM is the obvious one, I think most people know better than to do that. The couple of times it happened during our interviews, it was applicants discussing wanting to be a hospitalist or a sports med clinician.
  3. There are very few people who would have done both exams, so you probably won't get any answers from personal experience. I think it is pretty well acknowledged the Royal College exams are much more difficult for a variety of obvious reasons. For context, I studied about 3 hours/day for 3 months for the combined CFPC oral/written exam and probably could have studied a little less. My understanding is that a lot of R5+ residents are studying 4-8hrs everyday for a year to prepare for the Royal College exam.
  4. Re: Derm residency. My understanding is that it is heavily IM based for first 1-2 years and you work like a dog until you actually start your derm rotations.
  5. One other note, that doesn't reflect my personal opinion but I noted from a couple of local site leads whom I interviewed beside. Applicants were docked points if they solely expressed interest in a niche/subspecialty area of family medicine (sports med, ER, hospitalist, obstetrics are the 4 that come to mind) during the interview without discussing concurrent interest in longitudinal care (though given the enormous number of applicants, I really don't think this would make or break your application).
  6. 1) PBL/CBL preceptor (with UBC at least) pays decent given how relaxing the work is, though if you don't live near campus, there would be a lot of travel involved which can affect other potential work duties that same day. From my experience, it was mostly docs close or at retirement doing these gigs. 2) Botox/skin cosmetics 3) pharmaceutical company (i met a few docs doing this, though I personally don't see how this would be in any way rewarding aside from the financial aspect). 4) From a family med perspective, there really isn't any money to be made from being an interviewer, examiner etc... You sometimes get a small "honorarium" but your main reward will be CME credits. Most of it is essentially volunteer work. There is more money to be made (can't remember how much) creating questions and marking written licensing exams. 5) One of my colleagues runs obesity education groups out of his practice (all MSP billable) and makes quite a bit of money doing this.
  7. I purposely did 90% of clerkship and residency outside of vancouver, and I never met an FM+1 COE anywhere. I am not even clear what their role is compared to a "regular" GP with an interest in elderly care. I am guessing jobs for them are confined to larger cities. Outside of Vancouver, they are screaming for docs for residential care, it is very easy to find work. In Vancouver, it is obviously more difficult to find work/jobs in niche areas of family medicine.
  8. The other thing no one has mentioned is being completely up to date or your province's billing codes. It is worthwhile to take a mini course or memorize the billing codes so you can maximize your billings. A couple of local GP's here recently hired a company to review their billings and it was found they were underbilling up to 50k/year. Never assume your MOA/manager is maximizing your billing, you have to check it yourself (at least initially until you have them trained how to bill).
  9. Agree with this, In BC at least, lumps and bumps for GP's is remunerated extremely poorly, and that doesn't take into consideration the money GP's have to pay for equipment, sterilization etc... Prior to covid, I had slowly been decreasing the amount of lumps and bumps, it is just so much easier to refer to plastics/derm.
  10. The other reason its hard to fail a clerkship block is that its not like you show up at your final clinical evaluation and are suddenly told "you failed, sorry." There are requirements for mid rotation evaluations and preceptors are obligated to tell you if you are not meeting clerkship requirements so you can make appropriate adjustments etc... Most med students who struggle are able to take this feedback and improve their clinical performance, hence, usually fairly difficult to fail the clinical portion. There was a well known incident at UBC probably around 10 years ago, where two med students failed their surgical block but were able to successfully appeal it as they were able to show that there was no documented feedback on their performance nor suggestions for improvement from their preceptor, throughout the clinical block.
  11. At our local program, those that have done ICU electives in the past are being credited with call shifts for "helping out" for 18-24 hour shifts in the ICU, starting lines, handling labs etc...
  12. Just a word of advice for everyone asking about billing. You should indicate what province you are in/want to practice in so appropriate advice can be given, as billing info is DRASTICALLY different from province to province (ie. 1) there are no time codes for billing in BC, 2) in response to a previous poster who indicated that mental health visits pay more, mental health visits in BC (termed counselling appointments) pay less per 10min then a typical office appointment )
  13. The income number i quoted is gross (not net) billings, but is after overhead. 1) I attended a couple day workshops and taught myself. I also do %100 my own billings so I know how to maximize them, the only billings the MOA's do for me is billing chronic care fees on due dates. 2) I only pay 20% overhead (vs 30-40% in big cities). 3) I charge for all forms (ie. every patient over 80 needs drivers physicals every 2 years, I charge $150/form) 4) I spent countless hours (and was paid by GPSC for a big portion of it) reviewing my charts to maximize who qualifies for chronic care and complex care billings 5) Nursing home "call" ($250 from 0800-1700) - and is as chill as you can get (ie. maybe 1 non-urgent phone/call a day) 6) addictions medicine (ie. panel of 10 OAT patients nets around $10,000 extra/year) 7) I am one of 2 physicians in our town who does out of office clinics at the local semi assistant care living retirement homes (higher visit fees and virtually every patient there qualifies for complex care billings. 8) I don't work in the hospital (covering inpatients as a non-hospitalist pay relatively poorly in BC). #2 would be the biggest factor though. For new FM docs, i would just say a lot of new clinics are so desperate to attract docs you can have a little bit of say in your overhead (of course, the trade off is that you are guaranteeing to see x amount of patients/day etc.. that pressure isn't for everyone.
  14. I am 1.5 years out of residency and don't understand all the doom and gloom around family medicine. As a disclaimer, I neither love nor hate family medicine. It provides a great income so I can provide for my family and enjoy the time I spend with them. The other disclaimer, is that I quickly gave up on trying to be an agent for change in our health care system, it is too inefficient and bureaucratic and not amenable to change. I am much happier just putting my head down and working within the parameters we have. 1) My personal opinion is that the NP/PA encroachment is almost irrelevant (at least in BC). There is such a dire lack of primary care that there will always be work for family doctors (outside of large cities at least). The city I work in, has at least 3 new NP's to help ease the fact that there is a 5 year wait to obtain a family doctor (i do have a problem with how much NP's earn per patient seen, which is a bit of a separate argument). 2) I also don't understand the paperwork argument - don't refill Rx by fax - charge patients for all private forms - you bill for all simple communications with nursing homes, home health etc... It's a non-issue if you follow the above 3 rules 3) Memorize your province's billing codes to help you maximize your income (I already outearn most of my colleagues who have no idea about all the billing codes available to them.) I earned >350K last year, with zero hospital work, zero evening work, and a minutiae of weekend work. I typically see about 30 patients on a full office day. ie. psychosocial issues can easily be converted to counselling and mental health planning appointments, filter charts to see who qualifies for chronic disease management codes (ie. anyone who has ever had an Ha1c of 6.5 or above qualifies for CC diabetes codes regardless of their complexity) etc... Negatives would be: that certainly, there is a lot of frustration with certain patients who are demanding, neurotic etc... It doesn't provide a lot of job satisfaction. A lot of the office based work involves listening and counselling on mental health issues (the medicine is just validating their feelings and providing simple advice, which is actually often quite helpful). That is not for everyone Dealing with chronic pain (especially chronic back pain). Very difficult to convince patients there is little indication for medications, procedures etc... vs physio, tai chi, weight loss, stretches (as an aside see February 18 issue of the economist for a crazy story on how much is spent treating back pain in the US, it is nearly 80% of what is spend on all cancer treatments). This also doesn't lead to much job satisfaction. I would just say speak to a variety of family docs about their experiences before making a decision as you will find a wide variety of opinions.
  15. Obviously no one has up to date information on all the sites but as a past UBC resident with many friends in the program. - most call- Kelowna (St. Paul's would be second) - least call- Abbotsford - family medicine in general does tend to be more learning (vs service) based. A lot of the community sites residents are supernumery for call. Even sites that call themselves service based call (ie. chilliwack), there is always a family doc back up on call (before the residency program started, these docs just took call from home; most issues a resident gets called to see on night shift, a home call doc probably wouldn't come in for). A lot of the learning vs service isn't program specific, but preceptor specific. I recall, a call shift on an off service rotation where the preceptor stayed home and we reviewed by phone every 30min, new consults, test results ect.. he just told me what to order as a lot of the medicine was way out of my comfort zone; and of course he made sure I compiled a patient list (with PHN) of all the patients "we" saw. Obviously, there is very little learning on a shift like that. - I did residency at a community program, i recall almost no scut work. The few electives I did in the city, there tended to be WAY more of this, especially for off service rotations. - Re: nightlife, there is Vancouver and then everywhere else. I have lived in most cities in the lower mainland at one time or another and none compare to vancouver for restaurants, bars etc... - hiking, outdoor activities are everywhere, even vancouver. I wouldn't say one site is necessarily better than another in this regard. - vacations- I think that is more UBC vs individual site specific. basically you have to attend 75% of every rotation. So you can't take vacation on two week core rotations. If you want to take a two week vacation it has to span the end and then the beginning of 2 different 4 week core rotations. Obviously, in second year when you are doing a lot of electives, there is more leeway with booking vacations. - flex days, education days etc.. are a part of every site Hope that helps
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