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ZBL

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ZBL last won the day on January 20

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About ZBL

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  1. There are very few dermatologists or plastic surgeons outside of big cities. Yes they exist in smaller locations but not often. Anyway, I think it’s clear that most dermatologists are non academic, by which I mean they are fee for service with their own clinic and not paid by the university. However many of them still affiliate with the university by taking residents and doing teaching. Doesn’t make them true academic staff, but they get to call themselves clinical assistant professors - something to signify their involvement. Part of that is call. I don’t know if it’s a university or health authority thing, but I do know that most community dermatologists in my province still do occasional city wide call. The minority who don’t are the ones that don’t work with residents and don’t participate in any university or health authority related matters. Plastics is a bit different because none have a 100% private practice, so most end up doing call at their hospital site as well.
  2. In addition to the above, often there will be requirements by the university as well. For plastics and derm as you mentioned, which tend to really only work in bigger cities with a university, doing call is part of the deal if you want to be affiliated with the university, which most plastic surgeons and dermatologists do. This is different from being a full academic staff - they still bill separately and can do private clinics, but if you want to say you are a clinical assistant professor, you will be doing call. The only way to get out of call is to go 100% private, which for plastics is near impossible, and for derm is actually quite rare - most will maintain some small connection to the university and cover call a few times per year. FM is the only one I can think of that maybe wouldn’t have true call, but technically you should be available for your patients still. It’s part of the job regardless of specialty in some sense.
  3. The question of whether a clerk slows down a resident or staff is irrelevant to the question of whether clerks should be paid or not. At an academic centre, teaching is a part of the game and if that bothers staff then said staff should not be entitled to be at the academic centre. But in regards to pay, Undergrads get 5K for four months of summer research, and for sure they slow down the grad student or supervisor too. Engineering students doing co-op get paid. A new hire at any government or industry job also needs teaching and is not super productive at first, yet they still receive a salary. Same for any high school student learning to use the cash register. Clerks are working 60-90 hrs per week, and while yes they need teaching and are students, (a) said teaching is part of the staffs job description, and (b) the clerk is still contributing to patient care, even if it’s just wheeling in a stretcher post-OR, writing a note or dabbing a wound, let alone fielding CTU call over night - this is not unlike the engineering co-op model where they are a learner, but still getting a bit of financial support for their efforts. We pay people minimum wage for far less in other disciplines, so I think pitching a bit of money towards the clerk for the year, even just a small amount, would be justified.
  4. I’m not sure what this has to do with appropriate compensation. Is your argument that because clerks are receiving teaching (taking away time from the team), that negates any positive work they contribute? Staff get paid more than senior residents, senior residents more than JRs, JRs more than clerks and with that pay grade comes different administrative and teaching duty. Doesn’t mean the person at the bottom should be paid nothing. And relative to the amount of work you do as a clerk, it’s a bit odd that you are net negative thousands for that - rounding, doing consults, writing notes, dictating etc. Yes you are receiving teaching and learning, but you aren’t (or shouldn’t be) useless.
  5. Excuse my bluntness, but writing USMLEs for the possibility of “keeping options open” to a US residency does not seem like a good idea, when you have 3 very different specialties of interest currently. I think you are better off putting time towards figuring out which of those 3 you want to do, then go for it in Canada - that is where your best chance of matching will be. FYI, unlike IM and obgyn, Derm is even more competitive in the US so regardless of your USMLE score (it’s just one of many factors), this would not be a backup option and more like a primary option if you feel you are competitive enough.
  6. Relative to the amount of school needed for the job, the type of work being done, and the number of hours worked, absolutely Resident’s are underpaid. So are clerks - I remember the nightmare it was to think that in clerkship I was actually paying someone thousands of dollars to allow me work 90 hr weeks....
  7. ZBL

    Family Medicine VS Dermatology

    Shadow and you’ll find out. You’re literally asking for every detail that differs between two entirely different specialties.
  8. I had a post some time back on this if you sift through. In a nutshell, in Canada you will need a fellowship, you will likely not get to choose where you work or in what subdiscipline you primarily work but there likely will be work, you will likely not have a 100% cosmetic practice, a cosmetic practice is extremely expensive overhead wise and not easy to build, income for plastics on the CMA site is the conglomerate of all plastic surgeons not doing cosmetic work so has some who do zero cosmetics and some who do at least some cosmetics - in general plastics is a low paying specialty outside of cosmetics. After factoring cosmetics (if you do any) plastics gross income is probably in the 500-1.2mill range but the higher the number the more hours you’re working which is already high as a surgical specialist and also way higher overhead (and no guarantee you can achieve that higher gross income number). Situation is a bit different in the US. Moral of of the story: don’t do it if you exclusively want cosmetics.
  9. ZBL

    CaRMS statistics

    All you need is one. For competitive things, it’s not so much about applying broadly and hoping for the best - it’s more about targeting a program early and gunning so that you are considered top for that program. Competitive specialties are usually small and will be biased in favour of not only strong applicants but also people they know.
  10. Then you'd be incorrect, and you will see this once you actually start med school and eventually interact with MDs and med students from across Canada. You are no more likely to be a superstar doctor going to UofT vs Sask. Match rates don't reflect school prestige in Canada, unlike the US - in Canada there's far more regional bias. For example, most people going to NOSM have no intention of being a plastic surgeon - they want to be a rural family doctor, so consequently few will match to plastics by design. I think you are unnecessarily differentiating what you know and who you know. Sometimes, you get to know the right people by knowing the right things. Do well on a surgical rotation, and I'll bet your staff will happily introduce you to the program director and just like that, suddenly you're "known" by the program. The situations you are describing where person X is relatively unaccomplished and matched to Y specialty just because their parents or neighbor is in specialty Y are extremely few. Yes, we do not put as much emphasis on your absolute score in med school like the US does, but at a certain point maybe it doesn't matter if you were 90th percentile or 80th percentile - you still know what you need to know to start residency, and probably other factors like how you fit with the program, what other skills you bring to the table besides reading and memorizing are important. Again, those just squeezing by at the bottom of the class likely will have deficiencies elsewhere and not be matching to things like plastics/derm/ENT anyways. Bottom line: don't put so much faith in a single number from a single test. That's just bad statistics.
  11. Some, probably. But having a test doesn’t make sure the student/resident is good. In the US there is grades, USMLEs, AOA, research, elective performance but at the end of the day who you know is still huge. Canada doesn’t have grades or USMLEs, but you can still do research and know your stuff cold on electives to make a good impression. The other thing that id say is that in the US, these exams and grades are necessary to standardize medical education. There are obviously some world class schools in the US, but there are also some really really bad ones. So having standardized national exams allows those students in the low tier schools the chance to show they still know what they’re doing even if they’re school isn’t known to produce good doctors if they want to match to something competitive. This is irrelevant in Canada since the medical education quality is so equivalent across schools. While Canadas system seems less standardized, it is still standardized. Everyone has the same opportunity to do research, everyone can do electives, everyone can get through med school without red flags and everyone can get to know and impress the department they want to match to. Whether you actually do or not makes the difference, and that’s on you - I can guarantee that if you coast in electives, don’t do any research, don’t get to know the department, have red flags from med school/clerkship, or are just not enjoyable/useful to have on service, 99/100 will not be matching to derm/plastics/ENT etc. Yes there are occasional outliers, but I think you will find that the majority matching to super competitive specialties in Canada are deserving and very competitive applicants. PS, ortho isn’t competitive in Canada. Like not at all.
  12. ZBL

    Worried About Debt

    For perspective, as a staff physician you will bill 30K from just 2-4 weeks of work depending on your specialty. I know you’re risk averse, but realistically you could travel, buy clothes, go out to dinners, buy a nice car or house etc without worrying about debt too much because you will pay it off so fast down the road.
  13. Yeah that’s what I was thinking - at least for all the sites that are not my program’s home base. So basically if I keep track of mileage used for work vs personal, as well as costs like car payments, gas, maintenance, I figure out the total cost of the car for the year that was for work purposes? Did you need a letter or anything from your employer to say we don’t get any vehicle allowances?
  14. I’m going to start calling dogs “bears” and see if it catches on. If enough dogs identify as such and if breeders call them that too then it’ll gain traction. You cant reinvent the definition of a word. It’s use and definition can broaden, but the base definition remains. So when it’s use goes against how it’s defined altogether (like MD Candidate), it’s not a matter of language evolution, it’s a matter of people not understanding the definition. Moral of the story, it’s MD Student. Just like it’s BSc Student, and how residents are residents and not “neurosurgery candidate”. Even in PhD, it’s student until you become a candidate by passing your CANDIDACY exam.
  15. Poor lifestyle is in the eye of the beholder. For EM and anesthesia, yes it’s shift work but usually that’s at the trade of fewer overall hours per week. For some people, that’s preferred over 65 hours M-F. For others, like myself, I’d rather work longer hours overall by day than do shifts. Anesthesia is more slack for shifts than EM though - you need a few EMs available at 3am whereas you don’t need many anesthesiologists at that time. Same deal for weekends (where ORs are closed except for on call cases). So between the two, anesthesia is probably the better lifestyle from a shift work perspective (usually less busy and usually fewer evening/weekend shifts) - all irrelevant if you don’t enjoy the content though.
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