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ZBL

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ZBL last won the day on January 20

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  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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?
  6. 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.
  7. 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.
  8. 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.
  9. If you want ortho, you don’t do research. It’s not competitive. Use your free time to shadow and become bros with the residents instead.
  10. The 3 you listed (gen surg, ortho and NSx) are arguably the worst for lifestyle, with CV also up there and plastics coming up close behind. There’s minimal point comparing lifestyles of these, but I agree with the above that NSx is he worst followed close by ortho. The fact you listed lifestyle style as a priority this early (ie before M1) tells me you should be looking more at ophtho, urology or ENT if you really want a surgical specialty, or consider a procedural specialty like cardiology, gastroenterology, anesthesia, dermatology or interventional radiology instead. You have to live for the OR, as in love it more than any other hobby you have if you want to pursue a surgical specialty like NSx, ortho, gen surg, CV, plastics because if not residency will do you in.
  11. In general, I would not base your med school selection on match lists in Canada. The reason is that unlike the US, where the quality of school varies from incredible to incredibly bad and match lists can help see what your future might be like, Canadian schools and residency programs are all about the same in quality so apart from some regional differences in the %matching to FM, it’s not like we have any particular school that’s routinely matching more people (by %) to things like plastics or derm. So in my opinion you are better off selecting your school on other factors. But it if you seek an answer, I think CaRMS has that info on their web page.
  12. In general, I wouldn’t take time off unless it was to do a PhD through the MD/PhD program. Otherwise, save any dedicated research years for a Masters or PhD for residency, where you get paid a resident salary plus are eligible for other awards to supplement. If you want to show dedication to research as part of your medical career, then residency is where you do it if you haven’t already done an MD/PhD. Otherwise it looks like it’s done only for the sake of matching like in the US (and is not common in Canada).
  13. Usually more slack or slightly less hours, usually fewer patients per day, usually much less acuity/stress, usually group practices so vacation is a bit easier, usually minimal call, and more likely to be salaried positions through a university so less need to worry about billing. However, like every specialty, there’s a ton of variability in everything I just listed. Some earn more than FM, some earn less, some work more hours, some work less and same goes for FM. Truly the best way to see what they’re all like is to just get some clinical experience in these specialties and chat with residents/staff as the CMA data only goes so far (though I’d doubt you actually have clinical interest in all of them, as they’re pretty different). To that end, based on your recent posts about various specialties, I think your best bet is to do some soul searching as to what it is you really want in a specialty. There’s no shortage of specialties with good lifestyles, and really most specialties can be tailored to some extent to get you close to the lifestyle and salary you want (either scaled up or down), so I think rather than wondering about the average lifestyle/salary ratio for everything you should focus on what you actually want to be doing clinically with your time, then narrow in from that.
  14. Lifestyle better than FM, salary about the same.
  15. I fully agree that many if not most surgeons at academic centres will participate in research, but I guess I was referring more to the scenario of the surgeon taking a lead role in a large project that is not necessarily clinical, i.e. computer science, engineering etc. It all comes down to whether we are talking about a surgeon who does research or a true surgeon-scientist. The later is quite rare and difficult to achieve on a surgeons schedule, and comes with large income cuts compared to the former. To be honest, I don't think it's realistic to learn all the math and computer science during med school, regardless of whether you are at a 3 or 4 year school. The reason is that these are really your only 3-4 years you have to set yourself up for the rest of your life - you need to figure out what specialty you want, learn all of medicine, pass courses and regular exams, not to mention being very busy during clinical rotations. The CaRMS match is a real pain as it is, and you do not want make it worse or risk going unmatched as a consequence of prioritizing non-medical knowledge during med school. Unfortunately, learning those skills during your MD won't count for much at CaRMS, so I really think your best approach is focus on medicine during med school so you get into the specialty you want, and then during residency or afterwards there will be time to dedicate towards your research goals. If you have an MSc, certainly doing a PhD would be a great way of doing this that would set you up as an expert in the field no matter what clinical specialty you choose. There are plenty of options for one year research fellowships as well, which I think are fine for those who just want to dabble in research down the road, but I personally don't think it's good enough for those who want more of a leading role in applied/basic science types of work. Having done grad school as well, I can't imagine doing research in my area well had I done just one year as opposed to the whole degree. These types of clinician-scientist programs are available all over the place and not just surgery. There are dedicated research tracks for certain specialties in CaRMS, like the surgeon-scientist one posted above, but a resident in ANY royal college discipline (i.e. not FM, but yes to 5-year EM) can can join the Clinician Investigator Program during their residency: https://fhs.mcmaster.ca/cip/ Maybe FM has something similar, but you'd have to check. Anecdotally, a lot of the CaRMS direct entry surgeon-scientist spots, and surgeon CIP spots seem to be used more for just getting the extra few letters by your name, as in surgical fields it helps for hiring in larger centers; however most have no intention, and never do end up actually running a research lab later on, and instead default to the typical surgeon who does some research role. I agree that if the plan is to do research down the road, that basically means academic centre, so 5 year EM is something to think about, OR a PhD in computer science etc so you are cross appointed.
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