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shematoma

Physician on 'hands and knees' trying to transfer to Family

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http://www.cbc.ca/news/canada/nova-scotia/why-n-s-physician-couldn-t-become-rural-family-doctor-1.4703055

The short story - she matched to IM (her first choice) because she was advised it would be easier to do a specialty and switch into family than vice versa. She has failed repeatedly to transfer into family both internally at Dalhousie and through the CaRMS second iteration.

This year 43 people applied in the second iteration for transfer and only 13 succeeded. That's 30%. Dalhousie reports that internally, 40% of transfer requests succeed.

This is chilling news for anyone who was hoping for a chance at a transfer. It's more competitive than getting into dermatology!

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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.

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This article is really frustrating.  First--she's right, theres no way it should be THAT difficult to transfer into family.

But second--why didn't she just finish IM?  Her reasoning seems really dumb and makes no sense.  I really don't buy that you couldn't set up a family med-like practice in rural Canada after finishing a GIM residency, even if its not EXACTLY family med.  I think she is trapped in a grass-is-greener fallacy.  She says ""I've had a lot of people call me selfish and question, 'Why didn't you return to internal medicine and finish it?' That's easy to say, but it's really not what I wanted out of my life."--at least to me it really comes off as "things aren't 100% perfect and I cant accept that."  Its her choice of course, but it doesn't sit well with me.

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2 minutes ago, goleafsgochris said:

This article is really frustrating.  First--she's right, theres no way it should be THAT difficult to transfer into family.

But second--why didn't she just finish IM?  Her reasoning seems really dumb and makes no sense.  I really don't buy that you couldn't set up a family med-like practice in rural Canada after finishing a GIM residency, even if its not EXACTLY family med.  I think she is trapped in a grass-is-greener fallacy.  She says ""I've had a lot of people call me selfish and question, 'Why didn't you return to internal medicine and finish it?' That's easy to say, but it's really not what I wanted out of my life."--at least to me it really comes off as "things aren't 100% perfect and I cant accept that."  Its her choice of course, but it doesn't sit well with me.

Agreed. On one hand, I am skeptical as to why it was so particular challenging to go from IM to FM and I feel for her on some of that frustration. On the other hand, sometimes things do not work out 100% - we don't always get what we want in life, but that doesn't mean you just flip the table and walk away. That's not necessarily responsible either..

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Not sure if others have read this article, but this article touches on some of these topics too: 

https://www.theglobeandmail.com/opinion/article-is-every-medical-school-graduate-entitled-to-become-a-doctor/

This raises some difficult questions, including:

  • Is every medical school graduate entitled to become a practising physician?
  • Do we have an adequate number of residency spots and, just as importantly, the right kind of residency spots?
  • Is there a better way of aligning the desires of medical students and the needs of society?

But this is not simply a numbers game. We have more doctors, in absolute numbers and per capita, than ever before. But we have a growing problem of maldistribution. Everyone wants to be a specialist and everyone wants to practice in a big city – largely because our pay scales tell us that is what is valued.

We don’t need more doctors, we need more more general practitioners, especially in rural and remote areas. If medical students don’t want those jobs, then perhaps we’re not attracting the right people to medical school.

Becoming a doctor is hard. It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not one where personal desires can trump societal needs.

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39 minutes ago, goleafsgochris said:

This article is really frustrating.  First--she's right, theres no way it should be THAT difficult to transfer into family.

But second--why didn't she just finish IM?  Her reasoning seems really dumb and makes no sense.  I really don't buy that you couldn't set up a family med-like practice in rural Canada after finishing a GIM residency, even if its not EXACTLY family med.  I think she is trapped in a grass-is-greener fallacy.  She says ""I've had a lot of people call me selfish and question, 'Why didn't you return to internal medicine and finish it?' That's easy to say, but it's really not what I wanted out of my life."--at least to me it really comes off as "things aren't 100% perfect and I cant accept that."  Its her choice of course, but it doesn't sit well with me.

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. 

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This is the thing though... she wants to be a rural FM doctor. She wants it so badly she offered to sign a 10-year return of service, even do the training without pay. She's that set that this is what she wants. And after walking away from medicine she moved to a small town in BC. She has figured out what she wants, which turns out to be what many parts of this country are so desperate for - rural family doctors. Governments across the country have been bending over backwards throwing hundreds of millions of dollars at this problem, recruiting doctors from around the world and showering doctors with money to stay rural, but they can't seem to find funding for local graduates like this young doctor to train and practice in her own community. It would cost peanuts relatively to train her.

It would be different if she wanted dermatology, but it's rural FM. Come on. This should be a no brainer. Our system is bonkers.

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10 hours ago, ZBL said:

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.

We need to work to try and change the system. Yes, CaRMS is becoming a one shot deal for most people but it shouldn't have to be that way. We let people change jobs when they discover it's not right for them. We let people get divorced when they marry the wrong person (which is almost 50% of the time!) Why should we spend hundreds of thousands on residency training only to trap a lot of people in careers where they're unhappy, to the point where they'd rather leave medicine? What a waste of talent and taxpayer money. It's time we started fighting back. It shouldn't have to be this way.

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4 hours ago, goleafsgochris said:

This article is really frustrating.  First--she's right, theres no way it should be THAT difficult to transfer into family.

But second--why didn't she just finish IM?  Her reasoning seems really dumb and makes no sense.  I really don't buy that you couldn't set up a family med-like practice in rural Canada after finishing a GIM residency, even if its not EXACTLY family med.  I think she is trapped in a grass-is-greener fallacy.  She says ""I've had a lot of people call me selfish and question, 'Why didn't you return to internal medicine and finish it?' That's easy to say, but it's really not what I wanted out of my life."--at least to me it really comes off as "things aren't 100% perfect and I cant accept that."  Its her choice of course, but it doesn't sit well with me.

My disclaimer here is that I know her, though haven't talked to her in person in years. I probably know more details thanks to social media, but I generally agree with what you're saying. I'm not sure why she took a leave and moved across the country. I also don't know why she couldn't find something in IM that would have worked. Missing working with "babies and children" doesn't seem like a very strong motivation. There's more to it, I know, but I'm not sure CBC was the right venue to talk about it (as ever).

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20 minutes ago, A-Stark said:

My disclaimer here is that I know her, though haven't talked to her in person in years. I probably know more details thanks to social media, but I generally agree with what you're saying. I'm not sure why she took a leave and moved across the country. I also don't know why she couldn't find something in IM that would have worked. Missing working with "babies and children" doesn't seem like a very strong motivation. There's more to it, I know, but I'm not sure CBC was the right venue to talk about it (as ever).

How else would we get the attention of politicians, who with the stroke of a pen can suddenly make residency positions out of thin air?

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18 hours ago, shematoma said:

http://www.cbc.ca/news/canada/nova-scotia/why-n-s-physician-couldn-t-become-rural-family-doctor-1.4703055

The short story - she matched to IM (her first choice) because she was advised it would be easier to do a specialty and switch into family than vice versa. She has failed repeatedly to transfer into family both internally at Dalhousie and through the CaRMS second iteration.

This year 43 people applied in the second iteration for transfer and only 13 succeeded. That's 30%. Dalhousie reports that internally, 40% of transfer requests succeed.

This is chilling news for anyone who was hoping for a chance at a transfer. It's more competitive than getting into dermatology!

Hum...I am sure that there is more back story to the transfer into family medicine.

At UofT at least, I know quite a few people in their PGY-4 & 5s into surgical specialties & internal medicine, who transferred successfully into family medicine without any elective nor family physician LORS. I don't think that Family Medicine PDs in Canada are picky when it comes to accepting transfer residents from other specialties since there is a high need..

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I'm guessing there is more to the story. She left her program then decided to transfer. It doesn't sound like her IM residency went to bat for her. Based on the trouble she had finding a new residency is possible she had an issue during her residency and couldn't get a recommendation from her program or there was some red flag that programs turned her down. If there wasn't a red flag she shot herself in the foot for not transferring while still in residency as it would have been much easier if she could have done electives etc. and got her own program on board, as programs are usually pretty supportive of their residents trying to transfer out.

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I don’t think this example necessarily says something about transfers in general. I know at least one person that transferred from a surgical specialty to FM at Dal and can think of several more transfers (oftentimes people escaping surgery!). I know not everyone gets what they want, but I don’t know that any took an extended leave from a program to accomplish it. 

You can’t have big gaps in training and the longer it is, the more likely no program will ever look at you. I don’t think IM is so drastically different from types of FM practice that a motivation simply to work with “babies and children” is sufficient. Don’t get me wrong - I really think transfers should be relatively easy, with training aimed more at creating basic generalists who can flexibly figure out the right fit. There will always be constraints on time and money but the system has gone too far down the road of treating postgrad training like permanent paths. 

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Its not surprising how people assume there are redflags if someone can't transfer, but it is lamentable.

We dont know her story. We do know that she look leave, maybe for mental health. That leave got her blacklisted. A reaction like that does nothing to advance the cause of physician wellness, in fact it does the opposite.

The smaller the school, the bigger the old boys club. Maybe that's part of it too.

Without any objective measure of skill there is no way to determine who is cut out for what. 

If she was such a bad doctor why did dal graduate her?

Im tired of the inflexible system. We should be arguing for complete flexibility. Instead, true to form, we shoot ourselves in the foot being concerned about macro issues we have no domain over.  If a doc is competent to graduate they should be assumed competent for any field, including rural ramily med

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14 hours ago, LittleDaisy said:

Hum...I am sure that there is more back story to the transfer into family medicine.

At UofT at least, I know quite a few people in their PGY-4 & 5s into surgical specialties & internal medicine, who transferred successfully into family medicine without any elective nor family physician LORS. I don't think that Family Medicine PDs in Canada are picky when it comes to accepting transfer residents from other specialties since there is a high need..

Uoft is the best school for this as they are heavily funded

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1 hour ago, GrouchoMarx said:

Its not surprising how people assume there are redflags if someone can't transfer, but it is lamentable.

We dont know her story. We do know that she look leave, maybe for mental health. That leave got her blacklisted. A reaction like that does nothing to advance the cause of physician wellness, in fact it does the opposite.

The smaller the school, the bigger the old boys club. Maybe that's part of it too.

Without any objective measure of skill there is no way to determine who is cut out for what. 

If she was such a bad doctor why did dal graduate her?

Im tired of the inflexible system. We should be arguing for complete flexibility. Instead, true to form, we shoot ourselves in the foot being concerned about macro issues we have no domain over.  If a doc is competent to graduate they should be assumed competent for any field, including rural ramily med

I don’t think there were any true red flags initially. A leave of several months is not at all unreasonable. But not returning to the program at all, moving across the country, and being out of clinical practice for more than a year become problematic in themselves. 

I’ve known numerous people that transferred but they all continued on in their program and finished rotations until it happened. And I do think that there’s a world of difference between being unhappy in something like ortho or neurosurg vs IM as compared to FM.

I know that transfer processes are kinda fraught at the best of times. I know this personally. 

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If anyone knows Dr. Alison Fines, please let her know that if she has done at least 1 year of postgraduate training, she can get an unrestricted medical license in many of the States in the USA (she just has to pass the USMLE Step 1, Step 2 CK and CS exams which should be more than doable for an IM resident). She can be a cash-based private practice physician, or work in the prison system I believe. If anybody has her email address, could you please PM me or ask her to msg me via premed101? I am in a similar situation...

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On 6/15/2018 at 11:24 AM, GrouchoMarx said:

Its not surprising how people assume there are redflags if someone can't transfer, but it is lamentable.

We dont know her story. We do know that she look leave, maybe for mental health. That leave got her blacklisted. A reaction like that does nothing to advance the cause of physician wellness, in fact it does the opposite.

The smaller the school, the bigger the old boys club. Maybe that's part of it too.

Without any objective measure of skill there is no way to determine who is cut out for what. 

If she was such a bad doctor why did dal graduate her?

Im tired of the inflexible system. We should be arguing for complete flexibility. Instead, true to form, we shoot ourselves in the foot being concerned about macro issues we have no domain over.  If a doc is competent to graduate they should be assumed competent for any field, including rural ramily med

That was not my intention to say that if someone can't transfer that means the residents have red flags.

I do think that that there are taboos around mental health in medicine. For CPSO PG license application, your file will go to the registration committee if you are known for depression & anxiety or any mental health that comes into mind, and you will need to be evaluated by a physician annually. We are in fact targeting our own fellow colleagues with mental illnesses & burnouts secondary to intensive workload, and judge if they are competent to practice medicine, which is in fact ridiculous when there are so much effort into ensuring residents wellness (all put in for a show??!!)

I do agree that if you graduate successfully from medical schools, you are competent to practice in any field, especially for rural family medicine when there is a high need. 

I am sorry for this physician's case, Dal family medicine should not be limiting her transfer when there is a high need for rural family physicians

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