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1D7

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Everything posted by 1D7

  1. Anecdote but I knew two people who wanted to leave. They're now in a surg specialty & radiology. If you search up programs that list their residents, you can see that there are residents from the East coast across various programs in Western Canada/Ontario. Honestly it's not any different from a BC student wanting to come to Ontario, or Ontario to BC, which happens all the time. For radiology (and most specialties), do an elective at places where you want to go and do well. Assuming no red flags and you look reasonable on paper, historically that has been sufficient express interest in a program outside your region to obtain an interview. If you have a good reason for wanting to move, even better, as it'll be easier to convince programs that you're being honest about being open to relocating (not that they should be asking... but some may indirectly ask/hint about it).
  2. It is difficult, but people are mostly speaking relatively to their 2nd year. Other specialty residency 1st years are typically even more work/stress. Internal medicine, surgery, radiology all spend essentially all of their first year doing inpatient rotations in medicine/surgery/ER. In contrast most FM programs have eliminated surgical rotations from mandatory curriculum so as long as you're comfortable with some inpatient medicine/ER/OBGYN you'll be fine. If you do end up in one of the few programs that still mandates a surgical rotation or two, it'll be a bit tougher but it's the same with what other off-service residents also have to put up with.
  3. More than half of billings disappears to overhead and taxes. Then some of the money has to be set aside from other debt acquired during residency, typically a mortgage. When you join a practice there may be some need to pay out some initial lump sum or the group may ask for some portion of your billings as a junior attending (usually in saturated academic centres). Then you'll be paying per month for things like disability, life, health insurance, and retirement. Still, all in all FM is a good career from the financial perspective. Attending positions are generally still considered well paid. I suspect most of them are complaining about residency and fellowship pay, where you're working for minimum wage per hour and often take on greater responsibility than a PA/NP. Clearly the value of resident/fellow labour is closer figures than the current 60k/yr, but it is kept depressed for cheap labour since their licenses to practice are held hostage. The length of training in cardiology can be quite extensive as well, generally residency is 6 years at a minimum (3 years IM, 3 years cardiology), with additional years of training if you want to do a fellowship (EP, interventional, etc.). That's quite a few years of working for close to minimum wage to build up some pent up frustration at the situation.
  4. The general interest levels rise in FM as students get closer to the match in M4. In the earlier years students want to keep their options open and some of the competitive mindset from premed is still winding down. Once the reality of clinical years hit, lots of the idealized sunshine and roses are wiped away and many become dissuaded with spending 5+ years of their lives training in the hospital doing q4-q7 call (or worse). Additional factors include students realizing they have to consider their SO's life/family life, learning more about the job market reality for many specialists, watching the beatdowns certain programs still give their residents, and learning that the scope of FM is reasonably wide enough that they can be happy doing what they want.
  5. Can't really lump all those cities together IMO. The situation is also less clear cut as some people can find jobs but not in things they want to do or are underemployed.
  6. There are very few dedicated NM physicians. The majority of NM programs have integrated with radiology to become a fellowship; the remainder feel academic in nature to me. As noted above, job prospects are often difficult and rely purely on word of mouth & retirees. Over the years the bread-and-butter of the specialty has been taken over by radiology (and cardiology for the heart). This does not mean nuclear medicine is becoming less important. PET/CT has or is becoming standard of care for malignancy staging (e.g. look at how recent PSMA PET/CT is and how quickly it has revolutionized screening for prostate mets). These new modalities however are controlled by radiology because the rad has the ability to compare across X-ray/US/CT/MR/PET and can stay productive in between NM cases by helping out with the general radiology workflow. Even without the 2-year fellowship, a rad can still often read the relevant nuclear medicine imaging in their subspecialty (you get a couple blocks of NM in residency plus whatever you pick up during fellowship). My honest recommendation is to pursue radiology with the 2-year fellowship. It may sound like more time, but if you end up needing to do a graduate degree or work locums/unfavourable job area, you'll ultimately take a longer path. The best people to speak to will probably be residents within the program itself. At Western it is still a separate program so there are people you can speak to. Beware speaking to attendings who may be incentivized to keep a residency program running.
  7. This is pretty inaccurate, most of the listed specialties are 1-2 years less. Lots of specialties do not need fellowships to practice or need less than what you're describing.
  8. Not true. For most hospital-based specialties at a minimum you will be dealing with hospital admin. Moreover in general you will be working amongst partners/equals where at minimum you will share office space, divide up day time scheduling (e.g. OR time, clinic time), and partake in the responsibility of call. I don't think OP would function well in a lengthy residency setting which is innately hierarchical, especially those that deal with acuity (as those situations are driven by hierarchy and roles). Basically OP is best off with an outpatient specialty, preferably one that deals with lower acuity. Really this means FM. After that if he/she can tolerate residency, then psych, IM, PMR, and neurology can be reasonable choices as they can subspecialize or work in relaxed outpatient settings (e.g. endo, movement disorders).
  9. What do you mean by fit? Traditionally most people did electives at 4+ locations within the same specialty (some people would load up on 6+ electives, depending on the specialty) which gave you a reasonable idea of what the atmosphere was like for all the locations around you. You won't have this luxury with COVID so all you can do is ask around.
  10. Top 5-10% is defined very differently when it comes to book knowledge vs clinical skills vs evaluating someone for elective performance. It is different again when evaluating someone for an interview and it is different again when it comes time to rank the applicant. No one is at the top in every single definable parameter. When it comes to the interview stage and beyond, personality and reliability matter a lot. The stuff on paper is usually most important when it comes to obtaining an interview in the first place. If it works out it works out. Have a backup in case.
  11. It's difficult to find something that fits all of that. What fits best is 'general' radiology in a community hospital handling a mix of ER, inpatient medical/surgical, and outpatient cases with a few biopsy/drain cases here and there. You'll work with the whole body handling mostly adult but with some paediatric cases as well. It's technological with constant advances and shifts in technology. IR in an academic setting can also tick many of these boxes, but you will work with high acuity, sick patients relatively often (life & death situations with bleeders at a minimum and in some centres you are in the call pool to handle EVARs and cold limbs). If you have a particular interest in any body part, the various disease entities can feel somewhat varied. Otherwise neurology and the IM subspecialties probably aren't what you're looking for. I also don't think most surgical specialties fit what you're asking for. If you want variety often it means working further away from academic centres, which also means you'll be on call more often and have to be comfortable handling high acuity cases without immediate backup. Plus residency/fellowship will challenge your work-life balance.
  12. I don't put down outright negative comments (unless it was for something flagrant, which I've never had to do) because I don't want comments from a 2 week elective to affect a medical student's future CaRMS match in case somehow it ends up on their MSPR . For me generally vague comments mean you're average, mildly below average, or just someone I haven't worked with closely but have to help evaluate.
  13. Head shot, good photo, more professional than less. It should look at least somewhat like what you'll look like on interview day.
  14. It's a realistic take on things given how things are moving. For family medicine residency education has moved away from that (and is moving further). Many programs no longer have any surgical exposure during residency, and a part of that is because most FM residents and attendings don't feel there is commensurate value in learning how to mostly do surgical floor work/consults in exchange for an exceptionally bad lifestyle for 1-2 months. I believe this is in part due to the personality various specialties attract and also because modern medicine has reduced the autonomy of residents. E.g. In the old days a pathology resident rotating through OB for whatever reason was expected to catch babies. Nowadays the nurses won't even bother calling you even when you leave your pager # up on the board. If you want to be first assist, or deliver babies, or put in chest tubes, you have to be highly self-directed because there are plenty of other people who are eager to learn and are easier to teach.
  15. I agree! But the 'option' of being a bit less pleasant or more assertive is generally more accepted coming from a surgeon than family doctor for example, just how it is.
  16. Sounds reasonable. I don't really know how stable being a vet is, but with the current down turn everyone was hit hard. Though I agree typical outpatient FM is one of the most stable jobs, it's hard to beat it in that respect. Sure in some specialties maybe you can take on a more assertive demeanor, but not in family medicine. Aside from the ER (which are often manned by family docs), family medicine probably has the highest proportion of people who treat you like you're serving a burger. There is no end to overly demanding patients with inappropriate expectations. Plus in general while you don't have to be nice to survive, you need to develop a therapeutic alliance with the patient to do your job. Medicine is very competitive. I know veterinary school is competitive, but there's some self-selection at play. You may not be able to enter into the medical schools close to you unless you're already an exceptional candidate (in terms of grades/MCAT/other entrance reqs).
  17. Schools that still use(d) grades have a competitive environment. In my time I believe the only schools that use grades instead of P/F were Quebec schools. I would say a hypercompetitive environment is rare in P/F schools, though a few people here and there may have some issues in clerkship.
  18. Research is definitely advantageous for IM. Sure you probably will match without it, but most people care a lot about where they end up, whereas in the most competitive specialties some people are happy just to match at all. It may sound melodramatic to you now, but the difference between matching to your #1 vs #3 program or #2 vs #5 program will feel vast (other than for program/ego reasons, you may live much further from your family/SO than expected). Spending a bit of time working in your summer can mean the difference between getting an extra interview or not, which ultimately may affect where you end up. For FM it definitely matters less. Though as a M1, maybe you'll end up wanting to do a specialty where research is traditionally considered a part of the application or even if you don't want to do the most competitive specialties, it definitely helps for the specialties in the 'mid' competitiveness range. I've gone through CaRMS (the above 2 posters are still medical students) and have seen my old classmates go through it. IMO it's worth working a bit harder to maximize your chances to match where you want.
  19. Talk with your school's faculty (the people who usually meet with students and give advice) and upper years. Usually they will give you advice on establishing a working relationship with someone, or put you in contact with someone that does.
  20. It's only important if you plan to work in the States or if you pursue a few certain surgical subspecialties which have exceedingly poor Canadian job prospects. The vast majority of specialties do not have any need to do USMLEs for the purpose of finding a job. For fellowship, a few fellowships require the USMLEs but most do not. If you want to keep every possible option open, then you should write it. There are many good/prestigious ones that do not require it though.
  21. Depends on the school. At my medical school and residency (different institutions) students help round & do consults. Someone late or missing for a while would definitely be noticed and it would affect their evaluation... enough absences would definitely affect someone's ability to pass the rotation.
  22. IMO it's personality dependent. I would lean towards not doing medicine because of the heavy upfront investment needed (aside from financials, you need 4 years of medical school and 2 years of residency training, during which you may have to relocate and may want to relocate again as an attending). Plus it sounds like you want to avoid stress, death, and responsibility, which are to some extent unavoidable with medicine. You hear very split opinions on family medicine because there are very varied experiences. Some people get hired right away in a good practice where they did residency and are able to be efficient, making good money as others are alluding to here. Most move around, locum for a while, or maybe even take a bit of time off for kids (reducing their income). A few have horrible experiences where got sued in residency/as a junior attending or just hate their job. There was a recent poster who seemed to really dislike it (quoted below). While I don't think the quote below is representative of the average family physician (or even a good argument against doing FM since other specialties have higher rates of being sued), it does show that some people end up disliking what they do because of the anxiety/stress that comes with working with patients.
  23. I wouldn't bother changing floors/specialties for the sake of medicine. Interviews: I doubt nursing experience in one area vs another will be more valuable than another for medical school adcoms unless there was some personal/deep underlying reason to it. It might help a tiny bit for residency interviews if you can talk up your nursing experiences... but that 3-5 minute spiel is probably the extent that it could be useful for residency interviews. Networking: It's unlikely you're going to meet with the PD of the residency program. Even if you make it a goal to do so, in the time you meet anyone and interview for residency, that's going to be ~4 years. The PD may have changed by then and most residents you've met have graduated. Even some of the nurses you work alongside may be gone by then. It's a longshot that it would be helpful here. Clinical: It might be a bit useful in terms of knowing common medications in that specialty while you are in clerkship or shared procedures between medicine & nursing. I know sometimes pharmacy->medicine students look pretty sharp when they know everything about the medications we want to give. I doubt it will be helpful for residency and beyond. In all the situations where it could be a bit helpful, that assumes you end up pursuing the specialty you work in.
  24. For in-house call, it will be 24-26 hours (i.e. start of your day, which is around usually 7-8 to the next day around 7-8 plus handover taking 1-2 hours). On some services you will work a few more hours handling busywork, typically until noon, meaning ~28 hours. If you are doing home call like I said you may just continue to work, or you may get a post-call day depending on how much you worked overnight and the culture. Rarely there may be some sort of special evening shift for some services which is also referred to as call but does not last nearly as long as a typical 24+ hr shift. If you are doing nightfloat usually you get blocks of X hour shifts overnight.
  25. I made a math mistake in my post above in terms of how many call shifts/month (1 in 4 looks like 7 or 8 call shifts per full block). Friday+Sunday is a combination that happens frequently, but other than that it's fairly random, meaning it may be spaced out or may be grouped together. In terms of scheduling, you're at the mercy of whoever is making it (usually the chief residents or designated staff). Usually call switches are arranged between residents, though sometimes they will send out preliminary drafts for you to request for a switch from the scheduler directly.
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