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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. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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?
  7. 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.
  8. 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.
  9. Anesthesia is shift work. They clock in and out then someone takes over, unlike surgery where you have a lone surgeon plowing through 18 hours of work.
  10. The rule of thumb for going to the US is that the years of residency training needs to match. This means for any Canadian residency other than FM, it is allowable in the US (FM needs an extra year of training to go to the US). USMLEs and Visa’s are a separate issue which I won’t get into. Ot is hard to nail down exactly what is in demand and what isn’t as there’s some regional variation, but here are my thoughts from my experience and discussions with staff and classmates: Surgical specialties are are very difficult to find jobs in Canada. The worst are CV, neuro and ortho - you are basically required to have 2 fellowships +/- grad school and even then there is absolutely no guarantees on where or if you work. Many orthos are forced to the US and I think neuro is to some extent as well. CV sucks everywhere. For plastics fellowship is required. There are jobs, but you can’t just pick a city - you go where the job is. Starting a cosmetics practice is very challenging for plastics. Not sure where vascular fits For Urology, gen surg, ENT and for sure ophtho, I think job opportunities are better but I don’t know enough to say for sure or to what extent. Pretty sure obgyn can work wherever they want For non-surgical specialties, ones with a heavy procedure focus are tough for jobs. This includes GI, interventional cardiology. Things like ICU, resp, nephro, heme have jobs available, but not as easy to pick your practice spot. Some easier than others. Things with the most job flexibility in terms of location are rheumatology, Endo, derm, FM, geriatrics - outpatient things. EM also probably has reasonable flexibility. For the lab/imaging based specialties, and other rare things like genetics, I have no idea. EDIT: forgot psychiatry and anesthesia. These are also good for jobs in my experience.
  11. After discussing with the CRA, this is not entirely correct. You do not need to be self-employed to claim work expenses - for instance, if you are an employee and you do not receive mileage reimbursements from your employer, you can claim that. You are correct that you cannot claim expenses to and from your primary place of business, but the wording regarding rotations in different location is not so clear. From the CRA: "1. You were normally required to work away from your employer's place of business or in different places." As a resident, you work in different places - yes it's part of the employment agreement but that doesn't matter if your employer is not the one paying for the expenses. After talking to the CRA, they are not sure whether simply rotating at different sites would qualify or not for claiming expenses. One thing they seemed agreeable about though, is if you are a resident and you travel to different sites in the same day - eg hospital in the morning, clinic afternoon, or hospital in the morning, half-day in the afternoon at a different site, these are things you definitely can claim as you are travelling between multiple sites in the same day, which is not the same as simply driving to and from work.
  12. Does anyone know if residents can claim a tax deduction on a portion of car lease/finance payments? For example, CRA says that to do that as an employee (of a provincial or municipal health system for example), you have to (a) be required to work away from your employers place of business or in different places, (b) had to pay your own car expenses (ie employer doesn’t cover it). They also consider driving back and forth to your main place of work to be personal use So so my interpretation of that is this: If for example you are a senior path resident, employed by your health system, and you go back and forth to the lab, that doesn’t count since the lab is your primary place of employment as a path resident. But on your R1 year, where you travel to other locations for all sorts of off service rotations, that to me seems like it would count as car use that is tax deductible. As an example, that path resident while on obgyn at one hospital might have to leave back to their lab headquarters for their academic half day, so travel back to their main work place, thereby making the obgyn location different from their primary headquarters. They will also be at a totally new location every 4 weeks. Does anyone have any experience or thoughts on this?
  13. That’s true, but on the other hand I admired her willingness to stick to her guns and know what she likes and doesn’t like. If it was between IM or nothing, a lot of people would choose nothing and that’s reflected in the current unmatched rate (whatever top choice specialty vs no back up). People aren’t willing to compromise and I don’t blame them for being choosy, so long as they enter the game knowing you can’t always get what you want.
  14. Thanks for posting - an interesting read for sure. My take aways are two things: 1) Shadow shadow shadow so you know what you want to go into because the system is too unforgiving to allow you to waiver and decide when it's too late. Do not gamble on being able to transfer into something down the road CaRMS is a one shot deal for most. Bottom line: not everyone will get the medical specialty they want (a topic for a different discussion). 2) An MD is not useless - she set up her own business after leaving her program, which is great. Maybe not everything in the MD directly translates, but critical thinking, work ethic and people skills go a long way and that's what medicine gives you.
  15. It has been that way for many years in Canada Probably related to some combination between: - few or no ortho jobs in canada - need to do 2 fellowships to get a job in canada +/- masters/PhD to get a job in a big city in canada - compensation is not terribly high relative to many other procedural and surgical specialties - garbage hours and work/life balance in residency, moderately improved but amongst the worst for surgical specialties as a staff in the US, there is still the need for many fellowships, and the hours still suck but there are more jobs available and the pay can be very high (private system). A lot of Canadian grads are “forced” to the US because of lack of jobs in Canada For a specialty like ortho, research in itself is really not critical. It is a tool to getting closer to residents/staff and that’s it, and there can be other ways of doing this if research isn’t your thing. Basically, having no research in ortho will not penalize you. This is in contrast to specialties like ENT, NeuroSx, Derm where research output is usually expected.
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