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Nirvanesthesia

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  1. Like
    Nirvanesthesia got a reaction from Meningocoele in Feeling exhausted... How do I decide on a specialty?   
    I'm coming towards the end of my pre-clerkship (I'm in a 3-year program) and I'm still feeling pretty unsure of what specialty I want. 
    To be honest, I'm mentally tired. I've been thinking about this so much lately (what with COVID impacting our clinical opportunities and the compressed timeline looming over me), on top of doing a lot of research projects and studying. It's a lot of stress and I feel so lost. I've been doing a lot of reading about specialties and discussions happening on this forum and it's cleared up some things for me, but there's nothing I've come across that feels "right" yet. I'm stuck between being practical and just building my CV towards something versus first finding something that really fits.
    I'm considering FM partly because the idea of getting out sooner is appealing right now, but I don't want to/think I should choose based on that. I'm usually a very ambitious person, but I also want to be happy. There are specialties that are more interesting to me, medically, and I enjoy research/innovation, but when I imagine doing residency and my future career, I just feel exhausted about the prospect of it. Thinking about all the stress, lack of free time, exhaustion, the constant grind of having to prove yourself... it makes me not want to do anything at all. And right now, the stress of not having it figured out, in case I do want a competitive specialty, is eating at me.
    I know there are worse things in the world going on right now and I'm fortunate to be where I am, but this is almost all that I can think about. Not sure what I'm exactly looking for, posting here, but any advice and words of wisdom on how to move forward are appreciated. 
  2. Haha
    Nirvanesthesia reacted to Egg_McMuffin in How important is it to have an online presence as a medical student?   
    LOL who told you that it's important?
    The one that I see people using predominantly for professional purposes is Twitter, that's the one where a lot of people who do advocacy congregate. Even so, the three main actions on there seem to be: 1. complain. 2. brag. 3. suck up (e.g."wow what a wonderful lecture by Dr.X!"), none of which are helpful
  3. Like
    Nirvanesthesia got a reaction from CanadianGal in How important is it to have an online presence as a medical student?   
    Depends on what you define as "important." Twitter has definitely helped me stay up to date on medical news, and also connect with people in the medical community that I wouldn't have been able to otherwise (eg. students from other schools).
  4. Like
    Nirvanesthesia reacted to Edict in Frustrated with the admissions system   
    Great point, this system is definitely not fair or equitable. I put the blame less on the medical schools themselves and more on the state of our education system in general. In high school, kids are oddly given an easy time, there is no standardized testing and your grades depend more on your individual teacher's biases than your learning as a student. Then in undergrad, the system is so laissez-faire that the smartest way to get into medical school is not to study what you are good at, but to choose the right program and the right courses to get yourself the highest GPA, interest in learning be damned. 
    Ultimately, this system screws over far too many people and people are left doing degree after degree, masters etc, all to be ultimately underemployed. Our system is failing to distribute talent well. In fact, I would argue for a limit on the number of students that should even be studying the life sciences. Its a joke that we make people spend 4 years chasing a med school dream only then to tell them that in order to get any job remotely related to their field, it'll be at least another 2 years of schooling. 
    My bias is that, the government for years has been chasing the "% of population university educated" stat as a measure of its success and while good intentioned is an incredibly flawed statistic. Just making people do 4 years of university while making the populace generally less bigoted and uninformed, also fails to address the appropriate distribution of human resources. We have way too many life science majors in Canada (The single largest group of undergrads at UofT study either Life sciences or Engineering/physical sciences), especially in Ontario and not enough jobs for them all. We have way too many university grads in general, with way too few good well paying jobs for them all. This ultimately results in the phenomenon of people with 4 yr bachelor degrees going to college for training that is practical. One could easily argue those people would have been better off financially if they had just gone straight into college instead. 
     
  5. Like
    Nirvanesthesia reacted to whatisgoingon in Frustrated with the admissions system   
    It's not false. We don't have the same obligations outside of school. You don't have to think about whether you can afford to re-apply or whether it's time to give up and get a job. You don't have to worry about whether you have the time or luxury to take up a 3rd volunteering opportunity or a research project because you don't have to get a job to pay for tuition. 
    I say "You" and not "people of high SES" because someone who isn't entirely clueless wouldn't have said this.
    Sure, people have to meet the same criteria. How hard it might be to achieve them is another story. Lighten up.
  6. Like
    Nirvanesthesia reacted to Aslidoctor in Frustrated with the admissions system   
    OP is catching a LOT of heat but some of what they are saying is valid imo
    For reference: Current third year resident, visible minority. Took me three application cycles to get into medical school. The most biased people I find (GENERALLY) are those who get into a Canadian school their first try. Superiority complex definitely exists. A large majority of my class looked down on IMGs and their peers who had gone abroad. Made me lose faith in the system. During CaRMS they would often say things like "that program is known to take IMG's". The bias sticks with them.
    The reality of the situation is that the whole system is broken and there is no easy fix. People lie on their applications and get extra non-academic points/fake reference letters. They are impossible to prove as fake. GPAs are highly inflated from smaller universities - I was one of them. My undergrad was relatively easy at a smaller institution (although so was Canadian medical school....60% pass. Maybe I'm just brighter than I realize and would have been OK at a bigger university - who knows). The interview selection and actual interview scoring is also a complete gongshow. I have been involved in pre-interview application review as well as MMI scoring at a major Canadian medical school. During our "teaching" for scoring of applicants there was no consistency whatsoever. Interviewer bias is very real.

    It is a broken system, without a doubt. Nepotism exists through residency, and jobs after. It really is just life. I am very thankful to have jumped through the hoops to get to where I am and I know that there are people that worked harder than me (and many others!) that never got through the boundaries. To the OP, if you are actually a frustrated applicant, try to persevere. Residency isn't easy and I think that if I hadn't struggled to get into medical school so hard I would not have been able to get through some of my training. I was extremely jaded during my third application cycle but it was necessary for my journey.

    Hope this post doesn't offend anyone - its a topic I have put a lot of thought into over the years. 
  7. Like
    Nirvanesthesia reacted to TheFlyGuy in Frustrated with the admissions system   
    The slights against certain groups aside, I also resonate with the message (and anger) in OP's post. The admissions process really does contain an absurd degree of luck, subjectivity, and bias, and it will always be frustrating to see the inequities that exist play out in such an important part of all of our lives (especially when others who have been successful are oblivious to the imperfections of the system); it would be nice to see something done about it and I don't think we should stop striving for ways to improve the system just because its difficult or inconvenient. Some of the brightest and most caring people I know have been rejected from med who I think would be outstanding physicians, and it's tough to see. That said, some of the elements of the system will be here to stay and we do have to be able to accept that and either keep trying, or move on. 
    If anything what I always hope people take away from the fact that the admissions process here is so subjective is that it shouldn't change anyone's perception or their worth or abilities. Personally, it's actually encouraged me to feel less competitive and develop a better sense of comradery with those going through the pipeline. Imo, people who get in/are in should spend their time propping up the community (including those who are striving to get into medicine), and those who don't should work towards accepting that, in a way, they're casualties of a broken (or at least imperfect) system and that, after a point, it's not them. No one gets in without at least some luck. We all have to play with the hands we're dealt in life and comparison to others is a sure fire way to be unhappy. It is frustrating, but can't always change how other people think, so the best we can do is foster the kind of positive relationships with premeds and med students alike we'd like to have, and perpetuate it forward to affect a positive change that way. Until we're in a senor enough position to try to affect changes in the broader process anyways (which is a tall order as it is, in addition to the fact that most people I know who've gotten to that point are happy to just put the whose thing behind them and get on with life).
  8. Like
    Nirvanesthesia reacted to gogogo in If you like FM, is there any point in exploring other specialties?   
    I am very interested in FM and definitely recognize its benefits, but it is important to be critical of any specialty so that we can understand what we are getting into. It's important to remember that all specialties will exaggerate their pros and downplay their negatives; it's marketing just like anything else. So, for the sake of being a devil's advocate, let me give a different perspective on the benefits of FM:
    Jobs
    It's true, FM has jobs everywhere. But let's be realistic: How many job openings do you actually need? It's not as if you're going to switch your clinic every year. You'll find a clinic you like and stay there, in all likelihood. I also think that the tight job market in at least some of the other specialties might be overplayed. Speaking to people in certain specialties, they seem to be confident about the job market, even in specialties that, from the outside, I'm told have a tight job market. Of course, if you want to work downtown Toronto, then it'll be difficult to get a job. But if you're okay with working in the suburbs/community, it seems there are jobs available. I think it's important to talk to people in the field, especially residents in their final year, to get a different perspective.
    Lifestyle
    FM has the best lifestyle, but other specialties have it pretty good as well, like dermatology, ophthalmology, and outpatient IM specialties. I've also been told that you have a lot of control over your hours as a staff even in the more demanding specialties. I also check the hours of FM clinics in my area, and there definitely are FM doctors who are working 50-60 hours a week, including on weekends, and pretty late into the evening. Residency lifestyle seems awful for any specialty and is temporary, so probably not worth thinking about.
    Income
    I'm still learning about FM salaries, but it seems AB is an outlier (isn't AB in the news now for trying to unilaterally slash funding?). In ON, it seems reasonable that, on average, you'll make ~200-250k as an FM working 40-50 hours/week. Some are efficient and can do more, but some are not as efficient and work more hours for less (especially when you include the time they spend doing paperwork outside of clinic hours). And being efficient to make more money might not be enjoyable for some people because it requires faster appointments. 
    Of course, 200-250k is a good salary, but your colleagues, who only put in ~3 years more than you, are making 100-200k more (or even 2-3x more in specialties like ophthalmology or dermatology, with an equally good lifestyle). I know this shouldn't matter, but as med students with type A personalities, it's hard not to allow comparison to be thief of joy. And to elaborate, you have to be in the 80th percentile of FM in ON to make 320k after overhead (see here). It's good to be ambitious and be inspired by these numbers, but there is a reason that only 20% of FM in ON are billing that high. We can't just say that 80% of FM in ON are lazy or inefficient doctors. If so, then perhaps be prepared to be like them, because by definition, we can't all be in the top 20%.
    Scope
    There are niches in FM, but again, there is probably a reason most don't do them. For example, to be a cosmetic FM, you have to build a clientele and compete against other specialties doing cosmetics, like derm, ENT, and plastics. Splitting your time between regular FM and a niche could also prove to be difficult, because the days you spend doing the niche (e.g., cosmetics) are days that you're not giving time to your regular FM patients. The latter patients will then be angry with you. ER has a rough lifestyle, OB has a rough lifestyle and probably requires that you work outside of the city, etc.
    I also find it almost self-denial to say you want to go into FM because of the +1 opportunities. It's basically saying that you want to go into FM so that you can *not* do FM. If you are interested in a niche, perhaps it's better to just go into a specialty that does that niche?
    Matching
    I agree with this. But there are negatives to everything. Instead of sucking up to staff and residents to get research opportunities, as an FM doctor, you have to "suck up" to patients by putting up with their vague complaints and frustrations with the healthcare system (because you are their primary care provider/their first exposure to healthcare). For example, dealing with a chronic back pain patient who says nothing works for them is a very frustrating experience for everyone involved.
     
    Overall, despite everything I said above, based on my limited training thus far, I think FM is great. But I think it's important to critical. FM is not an easy waltz into a 300k salary and requires sacrifices just like any specialty. 
  9. Like
    Nirvanesthesia reacted to insomnias in If you like FM, is there any point in exploring other specialties?   
    I guess this is a corollary of the whole "if you enjoy anything other than surgery do that." I like family medicine overall and am confident I could find a niche I'd enjoy spending the rest of my life doing. I also like various aspects of various other specialties, and I could enjoy doing those specialties for the rest of my life as well. Given the training time difference and flexibility in hours, location and scope of practice that's pretty much unparalleled by any other specialty, why pursue the RC specialties over family medicine? Financially, it doesn't seem to make sense. From a mental health perspective (call sucks) it doesn't seem to make sense. Am I missing something?
  10. Thanks
    Nirvanesthesia reacted to rmorelan in Radiology lifestyle & job market in comparison to other specialties   
    I don't think it ever was a lifestyle speciality in terms of residency (maybe someone would disagree with me there ha). Right now call is still variable between institutions but I will say as a resident the call was quite hard where I trained - they are constantly changing things in an attempt improve both coverage and keep residents sane but I was lucky to get an hour of sleep on any of the call shifts I had which in the beginning was 1/5. It was hard, busy and exhausting and really took a toll on me. For most programs you are still done by 8am on the call day though - unlike some other fields which can go to noon (it is a balance - usually, but not always, in internal for instance you would expect some rest overnight - and non CTU/ICU rotations would be lighter - you have to look at the overall situation. In rads every call shift is the same. In many other fields they have various rotations where it is different). 
    In rads in the beginning it is hard to get part time work and be permanent staff - that just isn't how it is done in most places. Few grads want part time work, so the system isn't set up for it. There are locums which you can do - and many people do some of those. 
    Staff jobs do have a bunch of vacation time - basically when you are on you are on, but you do have times when you are not on at all. 
    I have always found the jobs to be hit and miss - you pick a fellowship in something, but you do that 2+ years prior to graduating and thus 3 years prior to actually starting as staff. No one really has any idea what the particular job market will be in a particular area that far out so you are guessing. If you are very lucky you can get on as staff at a major centre right way - I was very lucky that way. On the other hand most graduates I know even from good schools and great fellowships are in community positions in less urban areas (sometimes that was their choice all along to be clear - there are a lot of benefits in those jobs). It all appears to be hit and miss but there are things you can do to improve - works hard, learn lots, network, do an excellent fellowship and be flexible in the site you are hoping to work (even if it is among different urban centres - and what exactly is urban for that matter). 
     
     
  11. Like
    Nirvanesthesia reacted to dooogs in Radiology lifestyle & job market in comparison to other specialties   
    Hope you dont mind I add one more question:
    Is a fellowship or more necessary for a good job ?
  12. Like
    Nirvanesthesia got a reaction from honeymoon in Feeling exhausted... How do I decide on a specialty?   
    I'm coming towards the end of my pre-clerkship (I'm in a 3-year program) and I'm still feeling pretty unsure of what specialty I want. 
    To be honest, I'm mentally tired. I've been thinking about this so much lately (what with COVID impacting our clinical opportunities and the compressed timeline looming over me), on top of doing a lot of research projects and studying. It's a lot of stress and I feel so lost. I've been doing a lot of reading about specialties and discussions happening on this forum and it's cleared up some things for me, but there's nothing I've come across that feels "right" yet. I'm stuck between being practical and just building my CV towards something versus first finding something that really fits.
    I'm considering FM partly because the idea of getting out sooner is appealing right now, but I don't want to/think I should choose based on that. I'm usually a very ambitious person, but I also want to be happy. There are specialties that are more interesting to me, medically, and I enjoy research/innovation, but when I imagine doing residency and my future career, I just feel exhausted about the prospect of it. Thinking about all the stress, lack of free time, exhaustion, the constant grind of having to prove yourself... it makes me not want to do anything at all. And right now, the stress of not having it figured out, in case I do want a competitive specialty, is eating at me.
    I know there are worse things in the world going on right now and I'm fortunate to be where I am, but this is almost all that I can think about. Not sure what I'm exactly looking for, posting here, but any advice and words of wisdom on how to move forward are appreciated. 
  13. Like
    Nirvanesthesia reacted to katakari in Challenges of Family Medicine   
    I don't find any of these to be challenging aspects of family medicine. Most of my management is based on history, if you have a concerning undifferentiated finding, you can always get an echo, get a chest x-ray, or do a biopsy.
    In a community family medicine site, often you don't have the opportunity to refer due to limited resources. This gives you the opportunity and impetus to manage a lot on your own. In all the patient's I see in a week, I would say I refer less than 5% of the time, and even then would be a likely overestimate.
    Often the longitudinal relationship can benefit you in high stakes situations. I remember one patient walked in on 9L of O2 and looked terrible. I sent him home because he had a restrictive lung disease and no further management could be offered him. I was able to say this comfortably because of the longitudinal relationship we had with him. His family disagreed with me and sent him to the hospital. Well of course, someone who doesn't know this guy, is going to admit him to the ICU, begin workup of this idiopathic disease and he found himself with 3 organs severely damaged due to iatrogenic investigations/management, transported inbetween several hospitals for different management of the varying iatrogenic comorbidities, and I saw him in rehab a few weeks later with no difference to his management or diagnosis.
    Patients seem to not mind that I look things up, especially when I am open about it.
    Now, for the challenges I face in family medicine:
    1) Being the coordinator of care. You are responsible for everything and often have to tie together poor communication from various health fields, records, notes etc. You also can't turf your patient back to family medicine when you're at a loss for what to do or when it doesn't fit your specialty's area of expertise
    2) Diversity of knowledge required. The specialists I work with often have reductionist views of disease because they see things that are already worked up. You have to begin from the ground and consider so many various possiblities, choose the right tests without choosing too many, etc. You're often admonished for not having specialist expertise in every specialty. It takes a lot of work to find a balance
    3) Chronic disease. Chronic disease can often be frustrating when patient's don't get better and you have to manage their investigations, tell them why they can't have another MRI or more opioids, and this can upset people
    4) Benign disease. On the same spectrum, having to tell people why they don't need antibiotics for a small cough. It's also really easy to miss something severe at the same time. Anyone can manage a STEMI - there's a basic protocol for it. But that low risk chest pain that comes into your office with a few almost-red flags, deciding what to do there is where medicine gets very nuanced.
    That being said, you need to shadow some family doctors. It's a great field, but it's not for everyone.
  14. Like
    Nirvanesthesia reacted to Mithril in Challenges of Family Medicine   
    Well, that entirely depends upon your practice. A good chunk of my patients I would consider to be not healthy. Obesity and obesity-related conditions plague the general population. I can agree with you though that most of my patients are of minimal acuity, i.e., they are not on the verge of serious complications and death at that instant in time, but I still see 10-20 patients a week I would consider high acuity, and many patients who are just a Big Mac away from an MI. Physical procedures I am not entirely sure what you mean, but I still do a lot of procedures such as intra-articular injections, suturing, biopsies, wedge resections, and cautery.
     
    You have to recognise murmurs and pathological lung sounds, sure, but you don't necessarily need to know what specific disease entity correlates with a particular abnormal finding. If you can recognise that something is abnormal, then read up on what it could be or talk to a colleague. You have lots of tools, such as imaging, lab tests, or specialists to narrow down the specific diagnosis, but by the time you are done residency you should know when a finding is bad and warrants further investigation and when a finding is innocuous or inconsequential.
    You could refer them to a specialist, but like I said above you also have other things at your disposal such as imaging or other tests. An abnormal heart sound could always be checked with an echo or an ECG. A skin lesion can always be sent for a biopsy. These are things that you can do as a family physician and residency programs should be training you to be relatively autonomous within the scope of family medicine. It is important to recognise the limits of your knowledge and there's no shame in that, but I would say I am comfortable handling 95% of what comes through my office without needing to refer to a specialist.
    This can be challenging and not always obvious, that's true. I had an elderly patient once who came in with vague bilateral calf pain after hiking a few days prior, thought it was muscle strain, but ordered a d-dimer anyway because he had a prior history of clots. His Well's score was low. A few hours later he ended up in the ER with a PE. Seems like he did have a clot in one of his legs whereas the other leg was just a muscle strain. Sometimes you just can't know what is truly high acuity, but residency programs in family medicine do train you to recognise obvious high emergency situations.
    I still look things up a lot. I can't possibly know what to treat with for a guy who drank a bunch of dirty water in Nicaragua and ended up with a Blastocystis hominis infection. I mean, I know now, but for the most part my patients have appreciated after I told them I need to research more about their condition, or more about how to properly manage their kid's catch-up schedule for vaccines, than trying to fake knowledge you don't have, which is both dangerous and unethical.
  15. Like
    Nirvanesthesia reacted to coastalslacker in Interested in family medicine and something surgical?   
    I was 100% rural family medicine, loved my family medicine rotation, and am now in Ortho......
     
    I did observerships in Gen Surg, Urology and ENT in pre-clerkship and none of these appealed to me. I liked being in the OR, but hadn't actually gotten to do anything in any of these observerships. Coupled with family medicine's great lifestyle and the variety available if working in a rural setting, I didn't give surgical specialties a second thought.
     
    Like I said, I loved my family medicine rotation in which I worked with a guy who took two hour lunches every day to either go to the gym or play hockey. He had a great life, lots of variety (OB, Gyne assists, ER, clinic one or two patients in hospital) and made excellent money. I was sold. However, I had two weeks of electives with nothing scheduled and thought I would give ortho a try because I didn't have it in my core surgical block and thought it might be cool (I had chosen Urology instead....figured it would be easier and the "slacker" in my nom de plume is not incidental). Bottomline I got onto the arthroplasty service, occasionally got to do stuff, and thought ortho was pretty much the best thing ever. I was kind of tired, but got used to it pretty quickly. I switched the rest of my electives around, used up summer vacation for more, and matched to my first choice. Very lucky.
     
    A few things attracted me to the field: 1. doing stuff (true of any surgical field); 2. Orthopedic surgeries in particular-I later had my gen surg block and it wasn't nearly as interesting to me; 3. A difficult to define but immediate feeling that I "fit" in the field; I got along with the guys and thought the way they thought (incidentally, I've done some research on what motivates med students to choose particular fields and this vague "sense of fit" seems to be the most important, if most poorly defined, factor).
     
    So, what would I recommend to decide between family and surgery (and I don't mean having a family...)?
     
    1. Observerships in surgery don't count if you don't get the opportunity to actually do stuff. It is the DOING that makes it great. If you ask a surgeon what she likes about her job, the answer will likely be "operating". Try to find someplace where you will actually be able to get right in there. Surgeons in smaller centres are probably more likely to let you do stuff; go someplace without residents. Go to Africa (or someplace similar). And, do this stuff before clerkship so you don't have to go through the all the anxiety I did regarding CaRMS because I switched late.
     
    2. Know how much you are willing to work. If you hate getting up early it ain't for you. However, keep in mind that attendings generally have much better lifestyles than residents (if they want-many of them are so old school all they seem to know how to do is work). Working alot isn't bad if you love your job. Working even a little can be painful if you chosoe not to do something you love just to have less hours.
     
    3. Think about what kind of family doctor you would want to be. There are lots of options out there. Similarly, if surgery, what kind appeals?
     
    4. Do you like to know alot about something or a little about everything. I thought I was the latter but have realized I was kidding myself.
     
    5. Someone may mention the option of doing surgical assists as a family doctor. This is monkey-work. I can't imagine it being satisfying for someone who actually wanted to be a surgeon. Plus, MDs assisting may eventually be phased out in favour of RNs or someone else equally qualified to do surgical assists (ie 2 hands, 1/2 a brain, ability to follow instructions and tolerate occasional abuse from the occasional a-hole surgeon).
     
    Hope this is helpful. Good luck!
  16. Like
    Nirvanesthesia reacted to bloh in GP side projects/supplemental income   
    The first post in this thread is not my personal experience over the last 2 years of practice. My main place of work is a large city in Alberta but I've done everything except obstetrics. In order of best paid to least:
    -Emergency/Urgent care on a weekend, evening or statutory holiday
    -Efficient LTC, ~10 patients/hr (although the added billing crap you have to do afterhours ruins the experience)
    -Busy walk in clinic
    -ARP hospitalist, ARP LTC, ARP anything (it's a set hourly rate). Anecdotally, hospitalists often "bill" for more hours then they normally work.
    -Efficient clinic booking 4 patients an hour
    -Emergency/Urgent care on a weekday
    -Extenders, surgical assists
     
    Obstetrics is a bit tricky because they often have different shifts. Some do 24 hours shifts, others 12 hours, some are nights which screw your following day, some are on weekend, etc.. so I don't know how it washes out in the end. On a per shift basis, it certainly is good but you have to look at the complete picture.
    With cosmetics there's a huge variation in income. For it to really be profitable, you almost have to do it 100% and have a constant referral base.
    Even then, the difference between best paid and least paid on above scale is barely 100%, so do what you like and mix it up.
  17. Like
    Nirvanesthesia reacted to youngdad in GP side projects/supplemental income   
    I work Mon to Thursday in the office.  See about 25-30 pts per day on Mon/Tues/Wed, and about 15 per Thursday with the afternoon for paperwork (disability pension applications, lawyer requests, workplace forms etc.- you get paid for these!)  I have 1 hour booked off for lunch but I use most of that to catch up from the morning notes and errands.   That leaves about 20 mins of relaxing, eating and socializing with other docs in my clinic which is just right. 
    I'm a new grad so it has taken quite some time to get more efficient.  I am doing now in 8.5 hours of work what took me 12-15 hours of work for the first 4 months.  (Expect late nights doing labs and notes!)  I probably should have just taken less pts and less money...
    No hospital work.  Every 7th week I do a Friday and Saturday "doctor of the day" walk in clinic for patients of our group. Same day appts only.  I see maybe 15-20 pts over 3-4 hours those days, typically quick and easy appts with less "baggage".  No Sundays.  The week that I do the Friday Saturday clinic I am "on call" for the group which really only means I have to take calls for urgent labs that come in for our group after hours.  I have been on call a few times now and have only been called once and it was for a high INR that came in at 7pm.  Cake.
    2-3 Fridays per month I work at an urgent care centre.
    The other Fridays I either take off, get caught up on admin stuff (banking, paperwork etc).
    This is enough for me.  I have kids and I am very busy in my church community volunteering.  I am spent by the end of most work days and weeks.  A bad day can run you over, a bad week can really run you over.  But I am finding as time passes I am getting much more efficient and sane at the end of the day.  The other thing I have noticed is that if I take a few less patients per day I am more efficient and accurate with my billing and my bottom line does not suffer at all.
    I estimate I will bill around 240,000 from the office over 12 months, with an additional 8000-12000 in private fees for paperwork and 18,000-24000 in urgent care shifts.
    But remember its not what you bill, its what you take home...
     
    Example 1:
    Doc 1 loves his life, works 40 hrs per week and bills 250,000.  He pays 20% overhead, so = 200,000 pretax income
    Doc 2 works his bag off and his wife leaves him, bills 350,000.  He pays 40% overhead, so = 210,000 pretax income  oops
     
    Example 2:
    Doc 1 checks out 2 clinics knowing he will bill 250,000 in a year
    Clinic 1 has 25% overhead so 187,500 pretax income
    Clinic 2 has 30% overhead so 175,000 pretax income
    A 5% difference in overhead might not sound like a lot, but I bet 12,500 does.  (Over 1000 bucks a month!)
    Same work, more pay.
     
    Overhead is a big deal and it doesn't stop when you take a vacation... Find a clinic that is well managed.  Look for under 30% overhead.
     
    PS. Incorporate.
  18. Like
    Nirvanesthesia reacted to RPN-RN-MD in McMaster Waitlist Party   
    Accepted to Hamilton off of the waitlist!
    Timestamp: 1924, June 13th
    Thank you guys for waiting with me, we suffered together, and the more fortunate ones of us will now study together.
    And for all who didn't make it (yet, there are still a couple weeks left!) stay strong and have pride in the fact that you were among the strongest applicants of the entire year.
    See you in August,
    Cheers
    (P.S. Wendy Edge told me that they have just dealt with the deferral requests, and that had free up a couple spots)
  19. Like
    Nirvanesthesia got a reaction from hihello in Waitlist Support Thread - 2019   
    Just declined my offer for the English stream today—I hope this makes someone happy!
     
  20. Like
    Nirvanesthesia got a reaction from MD_endgame in Waitlist Support Thread - 2019   
    Just declined my offer for the English stream today—I hope this makes someone happy!
     
  21. Like
    Nirvanesthesia got a reaction from Persephone in Can upper years/graduates of Mac med comment on the condensed program/lack of summers?   
    Amazing, thank you for such a detailed and helpful response! This makes me feel much more confident about the decision I'll be making. 
  22. Like
    Nirvanesthesia reacted to claypot in Can upper years/graduates of Mac med comment on the condensed program/lack of summers?   
    One thing that I forgot to mention is that they revamped the med school curriculum so the schedule is a lot better too for the incoming first years. I don’t know the details but apparently it addresses a lot of the concerns we the upper years voices (like electives/rotations schedule) and increased the amount of break time you get! 
  23. Thanks
    Nirvanesthesia reacted to claypot in Can upper years/graduates of Mac med comment on the condensed program/lack of summers?   
    Hey I’m entering my third year at Mac :)
    Made this account just to post this since there seems to be some worries for this year’s incoming class.
     
    You’re right on that the three year program is still super conducive to developing a solid CV, I’d say that Mac might even have an upper hand at letting students develop their CV in ways that really pertains to their personal interests because you have more consistent free time during preclerkship (instead of a really busy school term and two months off in the summer). This means more time to establish and continue connections for the long term right from the beginning of first year which can be invaluable for your entire med school career (and afterwards too).
     
    When it comes to burn out, every medical school will have students who feel more burnt out and every medical student will probably feel some degree of burn out at times. It really depends on each individual’s needs and what type of work schedule they prefer. There was still enough time throughout the years for my classmates and myself to go on 2-3 trips/year or go home and relax if we wanted. My peers who go to other 4-year programs probably travelled a similar amount as myself since most of them end up picking up some sort of full time research position throughout their summers anyways (no one really has true ‘summers off’ in med school anymore). 
     
    Clerkship is different and definitely a lot more work but overall has been an incredible experience. Everyone has been really supportive and HHS is a major hospital network that sees a large variety of cases (including interesting rare ones) like most academic centres but still manages to maintain a type of community feel. Lots of great hands on experience and clinical exposure throughout the years. Yes, at times I’ve felt burnt out and tired but again, there likely aren’t a lot of clerks at any school who haven’t felt this way. And having started med school just under two years ago and knowing that I’ll be done this next year is a nice little (read: major) perk too. 
     
    I’m sure there’s many peers in my cohort who feel that the three year program placed a lot more stress on them. Especially those who have been considering competitive surgical specialities (but from my experience it seems gunners will feel more pressure regardless of the school). I do recognize that this is potentially a major con for choosing Mac and I was really lucky since I had a good idea of what I wanted to go into (internal) and it didn’t change. Side note: if you’re interested in internal medicine, Mac is amazing with renowned staff and residency program.
     
    Sorry if that felt disjointed, I wrote it up during my break. But I hope that helps!
  24. Like
    Nirvanesthesia reacted to duckduckgoose18 in McMaster Waitlist Party   
    Accepted to Hamilton! Fell out of my chair when I got the news!
    Timestamp: 10:05AM
    Thanks to everyone here for your support and fingers crossed for anyone still waiting.
     
  25. Like
    Nirvanesthesia reacted to Inittowinit in Waitlist Support Thread - 2019   
    Accepted off waitlist today! Email was around 1130AM. I’ll be accepting my offer!
    3.99 wGPA, 7:18:59 timestamp
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