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ZBL last won the day on November 14 2018

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About ZBL

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  1. The American College of Mohs Surgery has recently changed their rules to make it such that only dermatologists are able to do it, not even plastics anymore. At least as far as legit Mohs fellowships go.
  2. It is a bit of a strange combo. Normally surgical people don’t want to go near IM, so I’d imagine it would potentially raise some questions. I believe ENT and Ophtho are also specialties where it’s “expected” to do most if not all your electives in that field so backing up can be tricky but other surgical folk can chime in on that. But given you like ENT and Ophtho, and also like IM, have you considered derm? I think that might give you what you’re looking for in terms of a procedural specialty (with option to be more surgical if you want), lots of clinic time and relatively low acuity - it’s very similar to Ophtho on a day to day, but slightly less procedural than Ophtho. Given derms have a bit more overlap with IM, backing up with IM would be no issue when applying to derm.
  3. I concur vaniers are rare, and not to be counted on. I also concur that that you don’t NEED a PhD to match in general; however, there are a few caveats: 1. Specialty dependent - things like NSx, Derm, Plastics absolutely do like MD/PhDs, so for those while PhD is not required, it can help quite a bit. 2. Doing your MD/PhD with clinician-scientists can have huge advantages in CaRMS. Firstly, you’ll get better letters (from them knowing you for years in the lab, plus if you do a 2 week clinical elective with them). Secondly, you gain exposure to clinicians in the area of your research. If that is also the area you want for residency, then it becomes much easier for them to check the box for “do we like this person/do we want to work with them in residency.” Familiarity goes a long way, so this can significantly increase your chances of matching at your home program, which for many people will be their top choice.
  4. Just remove option 2, that’s a bad idea. You don’t want the last year of your PhD to be in your CaRMS year, when you need clinical connections, clinical reference letters, etc. Come to think of it, I doubt any school in Canada would even allow option 2. Among the others, option 1 and 3 will almost certainly help you match if you are pursuing a highly competitive research oriented specialty. Among those, option 3 is nice because it gets it all out of the way and then you will be more efficient in research during your MD. Option 1 is nice because you get clinical exposure first so your PhD can be in an area that will relate to your desired residency specialty. Option 4 ensures your PhD is related to your clinical specialty, but is a drawback because it happens during a time where you are supposed to be developing clinical mastery and so often times the PhD is half assed and you don’t get as much out of it. Also does nothing from a matching perspective, which is important since it’s your career after all. I would think option 1 gives a nice mix of what’s important. From a financial perspective, options 1 and 3 are equivalent. Assuming 25K per year (untaxed as its scholarship) x 4 years MD and 4 years PhD = $200,000 earned. For many, this means LOC savings during med school. Then in residency you get the standard rate of the province, call it $335,000 gross for 5 years. So factoring in tax during residency, and your MD/PhD money, your earnings over 13 years is roughly $460,000 excluding any other scholarships you may get. Option 4 has zero dollars during med school, meaning you will plunge the LOC deep. Then the standard rate of residency for 5 years ($335,000 gross and taxed = $260,000 after tax) plus 4 years of residency salary for your PhD (~$280,000 gross, $220,000 after tax). So $480,000 after tax over 13 years, excluding any scholarships with the added caveat that your line of credit will have been used up significantly more initially (and this higher interest payments) because you had zero income in med school. Does a traditional MD/PhD pay less for your PhD? Usually. But in the long game you may come out ahead via LOC savings or a better match result (depending on specialty desired). Tax is the devil.
  5. So in fact you do agree! You have agreed that you need some reasonable USMLE score and then maybe you get considered at some middle of the road programs in non competitive specialties. But changing one of those things, ie. if the USMLE isn’t there, or the specialty is competitive, that same person isn’t matching. But there are two important things to consider here: 1. Most Canadians writing the USMLE do so just for a passing mark - as an entry ticket to certain fellowships or career opportunities down the road without intent of matching to the US for residency. No one is matching with just a passing mark. An “average” score is actually not that easy to obtain, and a high score is hard. 2. An average USMLE might open the door to some middle of the road IM or FM programs in the US, as you mentioned, but really who is applying to the US looking for a middle of the road FM/IM residency? Most who want to go to the US want to go for the Harvards and Stanfords, or have dreams of training at some big centre in a subspecialty. Those need stellar USMLEs, research and all the other goods. And I’m certain anyone who could match to a middle of the road IM program in the US could match somewhere in Canada.
  6. The question of Canadian match rate to the US is irrelevant as the number of confounding factors here are huge. USMLE score (massively important factor), reference letters from big names in the field, MD/PhD (often with lab connections), desired specialty (also massively important factor), availability of J-1 visa for your specialty, availability of H1-B visa for your desired residency, if you have US citizenship etc all have a much bigger influence than the mere fact of being from a Canadian school. Without a strong USMLE and at least one or ideally more of the others in check, the match rate from a Canadian school to the US is essentially zero.
  7. Most often they will take call during their PhD. Most surgical residents doing a PhD are doing it because they have to for job related reasons rather than actually wanting to do research down the road, so the PhD ends up being rushed, and filled with call. In the end if all it is is a means to a job then it is what it is, but it’s not what I’d recommend for surgical residents wanting a career with a significant amount of research, which on its own is hard in surgery.
  8. Anyone “finishing” a PhD in 2 years, let alone 3 years does not deserve the degree. Again, I’m just playing devils advocate, but there is not and should not be a single correct answer to whether to do a PhD before or after residency. Someone below mentioned going elsewhere like to the US for your phd during residency - yes you can, but with that comes cost that near negates any financial advantage of doing your PhD in residency.
  9. Keen on research and undergrad research background is not equivalent to capability in leading an entirely new research program
  10. I’ll also add that doing a PhD in residency can have some issues in terms of content translation, just as it can pre-residency. For example, say you are in a cardiac surgery residency, and for your PhD you want to do health services research on valve replacement. Well what if your institution doesn’t do research in that area and the only person doing health services stuff does mental health, and all that is available in heart related stuff is cardiac physiology research? Either you do a PhD in cardiac related stuff but in a research field that is not exactly what you want to be doing, or you do research in the field you want but might not be related to your medical specialty. Same as pre-residency. Yes you can always try and build your own research path and have various mentors advising on some new area that suits your needs, but for someone just starting a PhD without much research background while in the middle of residency that is risky to say the least.
  11. Valid, there’s no one universally correct answer. Unless someone is going for something like derm/plastics, and they know they want to do a PhD at some point, then I’d universally say to do the PhD first - yes funding is greater in residency, but the opportunity cost of not matching to derm/plastics if that’s what you want is worth far more than any funding discrepancy, so better to maximize all aspects you can control pre-CaRMS.
  12. Devils advocate here. Doing a PhD before residency will *usually* result in a higher quality PhD by virtue of the fact that most PhD trainees in residency are pushed through way too fast and end up not being able to do substantial independent research. Doing it before residency may also help improve your chances of landing a highly competitive residency or one that greatly values research like Derm, Plastics, NeuroSx/Neurology etc. The above posters mentioned some important alternative thoughts. Pay is the most significant one, in the end we’re talking maybe a $120,000 difference in after tax career earnings all else being constant, though not necessarily depending on your funding situation. That’s either a lot, or not a lot depending on your viewpoint. The other point about how if you do your PhD first, the research might not relate to your specialty, I think is actually not an issue. The point is to learn good science first and foremost, and that’s translatable across fields even if you take up a new field of research every 5 years. If it relates to your residency then great, but many do not, and it doesn’t matter - I encourage MD/PhDs to keep their mind wide open during their clinical training so their residency choice isn’t biased by their research, and the reverse should also apply. You could also see it as a positive, as in brining a new perspective to a new field. In the end you will probably have to do a fellowship/post-doc for an academic job and that’s where you’ll be judged for hiring purposes, not your PhD.
  13. ZBL

    Unhappy in medicine?

    - don’t want to stick around in the hospital all day everyday? - hate the algorithmic nature of medicine? - feel too drained from the continuous patient interaction? - feel like you are not being intellectually stimulated enough? - strong CV? You my friend will make an excellent MD/PhD. I presume you entered into medicine with at least some related interest, and an MD/PhD may allow you to channel that through a different output than strictly clinical medicine while still being connected to the field. Here, the MD would be helpful to finish even if you never practice again.
  14. 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.
  15. 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.