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guy30

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  1. This would be similar to the timing of the USMLE for US med students where they do their step 2 CK and step 2 CS exams during the first half of MS4 between Aug-Dec of 4th year.
  2. guy30

    FM + 1 EM ... where to start

    I've seen some +1 EM docs hold faculty positions and do EM research through the Department of Family Medicine at my school. Not sure how common this is though.
  3. I don't think it's that unusual to have CCFP-EM docs work in Level 1 trauma centers. In fact, I think at the very least a large minority of the docs in the departments I've worked in have their CCFP-EM. I also don't think they did a trauma fellowship year either. Usually when you're working with a staff you won't know anyways unless you ask around cause it doesn't really matter from a practical or clinical standpoint in the end. The situation might be a bit different in terms of hiring nowadays though. Not sure how many new jobs are available at Level 1 centers and when there are, not sure what the hiring patterns are. I would imagine these jobs are more limited now and FRCPC docs would usually get first pick at hiring though things like experience etc. can play a role too.
  4. guy30

    CCFP(EM) in the US?

    Yeah I've heard of the LMCC being considered equivalent in some states too but I couldn't find anything specific to back that up in my quick search so maybe someone else has more info on that? In terms of doing ER in the US, I think it's important to differentiate between being able to do it and actually getting hired to do it. As a CCFP(EM), you'd be able to become board certified in family medicine which has a scope that allows you to practice emergency medicine. However, to be hired in any major center (and to have insurance companies be willing to pay you) it will be difficult and just like in Canada as a family doc, you'd be more likely to be hired in a peripheral community or rural center.
  5. guy30

    CCFP(EM) in the US?

    I believe the answer is generally yes, you need to have all 3 steps of the USMLE done in order to have a license to practice medicine in the US. In addition, each state puts requirements on the minimum amount of post-graduate residency training an individual must have obtained in order to obtain licensure. I think it needs to be ACGME accredited training but they don't always explicitly say that. I'm also pretty sure all Canadian residency is considered equivalent to ACGME so both the FRCP and CCFP(EM) training should count this should count. The minimum number of years for residency required may differ between US grads and IMG's with IMG's often requiring more. I would think CMG would be considered in the US grad category here but they only state that for one state (Maine). Generally the US grad requirement is at least 1-2 years and IMG requirement is about 3 years. Again, both FRCP and CCFP(EM) fit the bill here. This table outlines it pretty nicely: https://www.fsmb.org/licensure/usmle-step-3/state_specific
  6. Yeah agreed that a fractured collarbone alone would not merit urgent attention. Apparently the label of being the worst hospital in the western world was based on a host of other factors though. "A report on the hospital by Quebec's health watchdog unrelated to the coroner's report said it underperforms compared to other Quebec hospitals, which that same watchdog ranks as the worst in Canada and the western world. The health watchdog report gave the Gatineau Hospital a D- for emergency care. And since no other hospital in Quebec has ever received a D- score before, "we are forced to conclude that the statistics indicate that this hospital is among the worst in the western world for health care possible," the watchdog's report concludes in French. That comment was then echoed in the coroner's report into Gauthier's death."
  7. Just read this article and thought it was quite shocking for a Quebec hospital to get this label from both the coroner and Quebec's health watchdog. Anyone ever rotate through Gatineau hospital? I wonder if it's a manning issue in their emergency department. "Gatineau Hospital among worst in western world for ER care, report finds Man with ALS waited more than 10 hours to see a doctor for fractured collar bone" http://www.cbc.ca/news/canada/ottawa/gatineau-hospital-coroners-report-1.3736927 (edit to fix link)
  8. This is quite interesting! I'm a bit of a geek for this stuff but I have some more specific numbers to add for Canada, the US, Australia, New Zealand, and the UK I just quickly googled if anyone was curious. So comparing the number of medical students, population size, and the med student/population size in millions ratio: Canadian med student intake (2014): 2921, population size 35 million, 83.45 USA med student intake (2015): 20,631, population size 319 million, 64.7 Australian med student intake (2015): 3210 domestic (3777 total), population size 23 million, 139.5 for domestic students NZ med student intake (2015): 583 domestic, population size 4.5 million, 129.6 UK med student intake (2010, domestic numbers?): 8085, population size 64.1 million, 126.1 The ratio for Canada about 2/3 that of Aus, NZ, and the UK but the US is about half that of Aus, NZ, and the UK when looking just at domestic students. This means that for domestic students in their respective countries, it is much easier for students in Aus, NZ, and the UK to get into medical school compared to Canada because there are about over 1/3 more spots comparatively based on population. The numbers for the US makes it look like the US is crazy competitive but it's important to note this is just for MD schools and doesn't include DO numbers so I imagine including DO schools would bring it similar to the ratios for the other countries? Oddly enough, the countries with higher ratios have more public funding for education compared to the US. I wonder why there aren't more med student positions in the US if it's such a private market? Another interesting point to note is the OECD physician to population ratio in each country which is: Canada: 2.6 USA: 2.6 Australia: 3.5 NZ: 2.8 UK: 2.8 OECD average: 3.3 If anyone is interested in looking into the numbers further, these are the sites I used. Also, it would be useful to get a more recent UK med student numbers if anyone has it! https://www.afmc.ca/publications/canadian-medical-education-statistics-cmes https://www.aamc.org/data/facts/applicantmatriculant/ http://www.medicaldeans.org.au/statistics/annualtables/ http://www.kingsfund.org.uk/time-to-think-differently/trends/professional-attitudes-and-workforce/medical-workforce http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm
  9. Agreed, the only jurisdictions with cross-recognition/certification for family medicine are the USA, Australia, UK, and Ireland. I don't know how we'd be having a massive importation of Libian, Nigerian, and Egyptian family docs unless it's a super rural location and even then, they wouldn't be squeezing other docs out of the job market then..
  10. guy30

    Irish/australia

    I don't think any schools in Aus start in Sept. Different seasons in the southern hemisphere so their Feb/Mar start date is equivalent to the northern hemisphere's September start date (ie just after the summer holidays for both hemispheres)
  11. This is definitely something people looking to do EM in the US shouldn't bank on but I'm curious if the number of years required for Royal College certification will change with the move to competency based models for residency? Probably something nobody will really know for some time but it'll be interesting to see in the future..
  12. guy30

    Caribean Medical Schools

    Interesting read and it really is sad... I guess people need to keep in mind you're ultimately going to a 3rd world country and to a university who's main purpose is not world class research, education, or creating a medical workforce for their own country etc., but rather one that was created for the purpose of using people as cash cows, relying on a foreign country for half your education during clerkship, and with no possible resources or infrastructure to fall back on and support you post med school in the home country if things don't work out. As such, they're ultimately not going to be very invested in you. That and though the US is probably more merit based across applicants compared to Canada for residency selection, it clearly is not completely objective if a person of this caliber and marks had so much trouble even getting interviews. I can't believe how smart this guy is though. Those are some pretty high USMLE and shelf scores and a lot of US MD/DO students he would have beat out on in a standardized way. This all despite the stress of constantly having his life uprooted from city to city at the last minute and being seperated from family etc. It does seem odd though that he struggled so much getting interviews for MD schools though, I really wouldn't think the spelling of his name would be that big of a factor but who knows.. especially with all the bigotry coming out of the US lately :S
  13. Out of curiosity, are students at schools that use a grading system (ie French schools), disadvantaged when applying to residency/CARMS compared to P/F schools if your grade is not that great? For example: Someone with a 51% at a French school may be looked at more negatively compared to a student with a Pass grade at an English school (even though theoretically both students may of had the same grade if both schools used a graded system but a PD would not see that).
  14. guy30

    Ont Gov Capping Physician Pay

    I don't know much about Germany's healthcare system but from reading the Wikipedia page you posted, it seems like it's more of a multi-tier system and actually a bit more like what Obamacare is trying to achieve in the end for the US with universal health insurance coverage but multiple funds in the private and public sector? It seems like in Germany, there are around 130 public health insurances for people to choose from and many more in the private sector whereas in Canada, it is a single payer provincial public insurance system, and in Australia, it is a single payer national public system with various private insurances you can then choose from. I personally think that a single payer system within the public sector is better in the end since it helps increase not-for-profit focused purchasing power, increases accountability for governments, and helps standardize what people are getting from their public health care in the end.
  15. guy30

    Ont Gov Capping Physician Pay

    I've often struggled with settling the internal debate in my head with whether a parallel system is better, or a fully public single-payer system is better for healthcare. It's a tough call to make and there's no perfect system out there obviously. On the one hand, there seems to be something fundamentally wrong with someone being able to pay and get faster access, 'better treatment' etc. But on the other hand, the rate with which we're funding healthcare in Canada is increasingly becoming unsustainable each year and slowly eroding the government's ability to provide other public services (along with paying physicians and other health workers adequately which forms the bulk of public health care costs). Also on some rational level to me, it seems that in a cash strapped system where there are people willing to pay and take pressure off the public system, why not and if anything, you would think it would improve the public system. Having experienced the Australian healthcare system which is a 2 tiered parallel system, there's a couple key features to note (more details in the link I googled below). Based on 2011 OECD data, Australia's health expenditure as a share of GDP is lower (8.9% which is about 14th out of 34 countries looked at and below the OECD average of 9.3% of GDP) compared to Canada's (11.2% which is 30th out of 34 countries looked at and above the OECD average). However, interestingly enough and as ralk mentioned, despite Canada being a single payer public model and Australia being a 2 tiered parallel model, the public vs private expenditures are remarkably similar with Canada having a 70/30 split in public/private health spending and Australia having a 68/32 split (2014 OECD data). I would possibly interpret this to mean that Australian's are spending proportionately the same on private health care compared to Canadians but more of this private spending is probably off-loaded to wealthier Australians who can afford it and more of the public spending is off-loaded on those with lower incomes who can't afford health care whereas in Canada, the public spending covers everyone whether they are wealthier or of lower income and the private spending is also probably spread more evenly among income classes (particularly with people paying for prescription medications etc. which is not publicly covered in Canada). Also of note in the Australian system is that their medicare health insurance scheme is a national system which is really nice because you have easy access to healthcare no matter where in the country you live or travel to but health care delivery is still a state/provincial responsibility (whereas in Canada, health insurance and health care are both exclusively provincial and you can end up paying out of pocket quite a bit if you're travelling between provinces). They also have a national pharmacare program (the Pharmaceutical Benefits Scheme) that covers everyone for medications with a small co-pay you have to pay (I think it's like a standard $13 fee regardless of the actual cost of the medication). Overall between the two countries, I think the health outcomes are quite similar (I think even slightly better in Australia), and most importantly, everyone has ACCESS to health care though the type and speed of access you have may be different. People may perceive the quality in private to be better than public but it's important to note that all the major teaching and research hospitals are in the public sector so quality is actually quite high in public hospitals. I'm not completely sure but I think wait times in general are also similar (possibly slightly longer in Australia depending on the procedure) and I think physician salaries are similar if not higher in Australia (definitely higher in the private sector) but someone could perhaps look that up. The nice thing about having a private sector as well is that I guess it keeps government's in check with how much they pay doctors since doctors working in the public sector can easily threaten to move into the private sector instead (most doctors in Australia work in both Public and Private I believe). The key difference though is that I think the Australian system of 2 tiered health care, though not perfect and still has a lot of issues, is probably a lot more sustainable in the long run compared to in Canada (and we don't even have a national pharmacare program!). The other aspect is that having a private system has not eroded the public system as some people may fear and I think it has actually improved it including in terms of access for people who need it most. The link for some of the OECD figures is below or you can just google OECD Health Data + country name. What do people think is an ideal system? http://www.sbs.com.au/news/article/2014/02/20/how-does-australias-medicare-compare A brief crude synopsis of the Australian and Canadian healthcare system is also below for anyone interested: http://www.theguardian.com/healthcare-network/2011/jun/07/healthcare-systems-australia-medicare-canada-saskatchewan Australia Medicare is controlled by the Australian government's Department for Health and Ageing (DHA). But each state is responsible for public hospitals under the Medicare scheme, which dates from 1984 (the same year Canada's system was implemented). Blood transfusion services are provided by the Red Cross and dentistry, optometry and ambulance services are outside Medicare. There is a separate government-run pharmaceutical benefits scheme that subsidises prescription medication and allied treatment, but patients are expected to pay the excess at the point of dispensing. Medicare is financed by a 1.5% income tax levy, plus an additional 1% levy on higher rate taxpayers who do not take out private insurance. The government encourages all citizens to take out private healthcare to top up the Medicare co-payment system - which offers 100% subsidies (in other words, free) treatment for in-patient stays, 85% for specialist services and 75% for GP treatments. Patients are expected to pay at the point of care for the 'excess' unless they have insurance or exemption. However, there is also a low earners card allowing totally free government-funded healthcare. Private insurance is complex, with citizens choosing between a mutual or the government-run Medibank service. There are incentives for young working people to sign up for private insurance, with premiums being government subsidised on a mean-tested rebate basis of between 30 and 40%. However, citizens over 30 are premium surcharged on private insurance at the rate of 2% per year, up to a cap of 20%. Private insurance also operates on a community basis, with premiums not wholly based on age or previous medical history. Canada With its Commonwealth links, Canada has paralleled the UK in developing universal health coverage. In 1944, the province of Saskatchewan introduced universal hospital insurance, four years before Britain introduced the NHS. In 1956, the federal government offered an open-ended 50-50 cost sharing arrangement between itself and the provinces, and within two years all provinces had introduced universal hospital coverage. In 1962, despite medical strikes against the plan, Saskatchewan introduced full universal medical coverage. By 1965, the federal government had launched a national programme with 50-50 cost sharing, with national implementation in place by 1971. But the scheme started to fall apart by the late 1970s, with many GPs - reportedly eyeing the wealth of their US colleagues - opting out of the state programme. This resulted in a complete revamp in 1984 to a Medicare scheme, implemented along the lines of the Australian scheme of the same name. However, unlike Australia virtually all Canadian healthcare is delivered free at the point of care. Most services are provided privately under the Canada Health Act, which lays down strict standards and administrative simplicity. This simplicity involves a GP-centric organisation - a single payer system which bears more than a passing resemblance to the planned GP commissioning model for England - with no billing involvement for the patient. Most hospitals are publicly-funded, though each unit operates on an independent basis, a factor which is acknowledged as potentially increasing overall healthcare costs. Each citizen is issued a health card, which acts as their passport to healthcare, in a similar fashion to many European countries including France. Dentistry and optometry are not always covered – it depends on the province – but if not, people are usually insured through employer-funded schemes. Prescription medicines are chargeable, but subject to very strict price controls.
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