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humhum

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humhum last won the day on March 4 2018

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  1. Universally you will hear that any type of academic research work as an MD will pay considerably less than if you were billing for patients. You can ask any clinician-scientist and they will confirm this for you. So in terms of absolute dollars, it is a given that researchers overall have less earning potential. However, depending on the specialty, the dollars earned per amount of time worked, can be equivalent or more. In other words, they have a lower ceiling for earnings, but at that given salary, they might be working less hours versus doing clinical work.
  2. The specialty of the husband and wife is of so little importance compared to the quality of the marriage they are in. You might as well be asking what is the best color of skin between MD couples to make their marriage work best. The answer is, it has very minor relevance. Surgical couples have the capacity to be happy or miserable as much as any other combination of professions.
  3. The rumours are false. I'm not in Alberta, but every year they tell us this is not true across Canada. The only exception are those medical schools that have made passing the LMCC a condition of your graduating and earning your MD. I don't remember what school it was (in Ontario?), but those graduates that failed did not get their MD and therefore could not register with the college.
  4. Don't overthink this, the first two years of med school are a lot like high school. They are also like the calm before the shit storm. You will see a massive shift once you hit 3rd year and above. Travels? Life experiences? Politics? Literature? Forget about it, everyone is just working their ass off. If you ever catch attending and staff outside in the real world hanging out with each other, what are they talking about? They are almost always talking about only two things: medicine and money. Well, maybe three, third being kids - if they have any. Physicians live remarkably unbalanced lives, and I'm sorry to say, they are some of the least worldly circle of people I have come across (and I include myself in this group). By the time we are in residency, and ever after that, our whole world view revolves around medicine. If we have political views, it is only because it somehow relates to how the political landscape will affect our profession, and our profession only. You can really see the contrast if you ever hang out with businessmen, lawyers, scientists, engineers, etc. It is common for other professionals to read outside of medicine, make effort to deeply understand historical and political phenomena, and are comfortable engaging in debate and discussion about things that are completely unrelated to their work. Doctors? With attending and residents alike, trying to talk about anything outside of medicine is like pulling teeth. Case in point, it is remarkable how many people entering med school could play 1-3 instruments at concert performance levels. You ask them what was the last time they played anything when they are 1st year residents, and they will tell you maybe sometime two years ago. Their hobbies and outside interests are long long dead like their soul (too dark?, JK ). Sure attendings and residents still travel and try to have fun, but next time watch for yourself: they typically schedule red eye flights because they work late that same day, and come back to get up at 6am the morning after their flight lands. Results is that if you ask them a week later how was their vacation, it is a distant memory, like a dream that might have never happened. Just something they went through the motions. Most likely they were still checking labs and making work related calls on vacation. TLDR: by the time you are in 4th year, forever after that, you will have a lot more in common with everyone else, and will spend most of your social time talking about medicine and not much else.
  5. I am not applying, so no worries there. Close family friend is ophthalmologist however, which is why I know so much about what goes on in that world. Even as slang, it is spelled ain't, and thats is not a word. Don't use either in your applications You are right though, they aren't hurting for now. But the landscape is changing, for reasons stated above. That is the point. Someone thinking of making their life's work now, by the time they finish residency and finally have a clinic and job down, it will be 7-10 years down the line. The fees have been dropping, which sets a precedence for further fee drops. Also, the fee equity pressure is not just coming from other specialists against ophthalmologists, but rather from ophthalmologists versus retinalogists. And obviously, medical retinalogists do supremely important diagnostic and therapeutic management besides just injections. The original discussion was on how the job situation in ophtho is not so bright for recent grads, and the dreams of owning yatchs is not really coming into fruition because they can't find OR time, which lead to this whole thing about injections as an alternative route to becoming an aristocrat MD. That is a crazy high number, and I highly doubt it. 40ish injections a day is coming from one of the busiest retinalogist in one of the Canada's largest metropolitan centres. A 100 injections a day is $12,000 of billing for that day. There is such a thing as maximum daily billings and volume for every procedure in every specialty. 40 injections a day is still astronomical amount of billings for a day at about $5000 for that day (more or less depending on province). Again, even doing 40 injections for a day's clinic means you are seeing about 80 patients for that day, majority of which are triaged with the basic question: bleeding or not?. Injections will be pretty much the main thing you are doing on that clinic. Supremely boring. These aren't the retinologists spending much brain power thinking about the interesting things like the weird and wonderful ocular vasculitis or uveitis presentations.
  6. One of the biggest wastes of effort and time that I immensely regret about CaRMS is the Thank You notes. Coming from the world of lawyers, and my experience being job interviews in that former life, I spent inordinate amount of time on composing dozens of Thank You notes. I figured CaRMS is like a job interview. It is not, in so many ways, it is its own beast, far more black box than anything out there in the rest of the professional world. Anyways, I later learned that Thank You cards basically mean nothing, because by the time they are recieved, the program's decision has already been made. Same with emails. In fact, most programs, especially competitive ones, already have their ranking solidified in advance of interviews, with little shuffle after the interviews. A thank you note or email will probably less positively affect your matching outcomes than a call from your elderly grandmother to the program directors.
  7. The CaRMS CV is a very frustrating and redundant process, unless they have recently changed it. Most programs but not all want you to upload a custom CV. At the same time, CaRMS itself has a CV that you individually put in entries, with some sections very little control over the ordering. With the custom CV you can tailor your experiences to a specific specialty, but at the same time, the CaRMS CV cannot be tailored to specific programs, making it a complex process of how you can make it generic enough to appeal to every program you apply to.
  8. So you think. This is prime example of survival bias. For everyone that got matched to where they wanted, there is another person who did the exact same things, perhaps even better, and didn't match. If we had a random generator that could somehow transform you into, let's say a aboriginal overwright female, everything else being equal, you might not be here writing that paragraph. Important to realize that.
  9. So you are telling us: 4 years of medical school, 5 years of residency, and 2 years of retina subspecialty to bet everything on injecting Anti-VEGF all day long? The billings for each injection has already been cut in the past four years in most provinces across the country, and more is sure to come. Even general ophthalmologists are picking up pitchforks in protest of how much out of whack retinalogist billings for anti-vegf injections are. So if you are going to bet everything on that, probably not a good gamble. Also, how boring. In our mandatory ophtho rotation I sat in a retina clinic once, and watched a retinalogist inject 40 eyes in a day. Starting an IV is more exciting, and frankly, at times more technically challenging. Edit: You are absolutely right about the lifestyle/work hours though, they have it REALLY good. Even the residents were telling me they don't do any overnight call. Then again, optho is kind of rad onc. It is a "surgical" specialty by tradition, but it is now much more procedural than surgical. Microscopes and lasers. At the end of 5 years of residency, they learn cataracts, strabismus, and some other small surgeries here and there. That is about it. You compare that to the hard core surgical specialties like gen surg and ortho, those residents operate all day and night on every conceivable body part, and learn so many surgical approaches during their 5 years that would be too long to list here. That is why the actual surgical residencies so brutally crushing. There is so much technique to learn that they make you use every possible waking hour (and sleeping hour) to operate as much as possible and learn as much as possible for when they are out there independent.
  10. This is the right answer. Edit: the shifting demographics part is huge in terms of what makes the most competitive specialties competitive. There are more girls than guys in med schools now, and if there is a specialty that females don't find attractive, right there you have 40-60% less applicants than you would have otherwise. I think rad is one of the only remaining specialties where the male to female ratio is 5:1. This is likely to change though... in the US radiology made a come back in the past couple of years, back into the top 5 most competitive after some lull years.
  11. Showing up at ground rounds is not being annoying. There are a thousand reasons why people go unmatched, and this is not one of them.
  12. It is no internal medicine or radiology. You just listed all the hyper competitive specialities.
  13. You are first year and shadowed all specialties and this is what it has come down for you? You have a long ways to go. It is baffling when there is a vast ocean of life choices out there, and people get obsessed with one specialty in their first year, and one that is the most competitive by a huge margin, with tragic stories of the best people going unmatched year after year. It is almost sadistic. Give it time. Open yourself up to the vast ocean of possibilities out there. Ask some emerg docs if they could go back what speciality would they choose? A good chunk of them will tell you not emerg. This is in no way to out down this amazing speciality. But rather, it just too early to be this myopic about all that is possible for you. Wait until at least the end of your ER rotation in clerkship before you start worrying about these things. If you truly like medicine, there is so much more you are bound to fall in love with. To answer your question, doing primary care electives will get you in family medicine, and they all overlap with EM. After all, EM is primary care. As for 2+1 CCFP, take account, it is extremely competitive to get in to.
  14. You want ortho? Look at the competitiveness stats from CaRMS. It is hyper-competitive, and ortho is not a broad speciality like, say Neurology or even Gen Surg. Do all the electives you can in it, and supplement only with other specialty electives that directly relate. For example: neurosurg spine, plastics hand, physiatry trauma rehab if you must. But remember, being SEEN on ortho electives by people who are on the CaRMS selection committee for that program is far more valuable than a note on your CV that you did some elective in another specialty that you might not even apply to.
  15. Actually, it would not be odd to show up, as long as you use the opportunity to introduce yourself, and explain your presence. For small programs, you want to be SEEN. Seen to the point of being annoying. Some people that match to the ultra-competitive small specialities are basically like constant fixtures in the program by the time they come in for the CaRMS interview. They have hung around, shadowed so many people, done so much research, etc. that the interviewers don't have to look at the CV to recognize them. Who do you think is going to have a better chance to match? The constant ever-present sycophantic above average med student, or the random top medical student from a far flung province with pretty much the same resume, and maybe a few more publications and here, who only a handful of preceptors and residents met over a 2-week period. It will always be the former.
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