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tere

Saudi Arabia to relocate students from Canada

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12 minutes ago, tere said:

Yeah - agree.  tried to mention that in my last post.  Guess it may not have been clear :)

No problem, just stating my opinion, you may have mentioned it as well in your previous post. I do believe that it makes sense to hire more mid-levels. Things worked well in the past because we hired more foreign attendings, we trained fewer physicians for our population and residents worked longer hours than today. However, things are changing, I think the solution could genuinely come in the form of having NPs/PAs and hospitalists running some of the surgical wards, which would alleviate some of the workload residents are tasked with. 

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15 minutes ago, Edict said:

No problem, just stating my opinion, you may have mentioned it as well in your previous post. I do believe that it makes sense to hire more mid-levels. Things worked well in the past because we hired more foreign attendings, we trained fewer physicians for our population and residents worked longer hours than today. However, things are changing, I think the solution could genuinely come in the form of having NPs/PAs and hospitalists running some of the surgical wards, which would alleviate some of the workload residents are tasked with. 

That makes sense - an interdisciplinary team would allow the work-load gap to be filled.  Obviously, it would be a relatively large outlay of money to replace the Saudi residents, but it seems like a more permanent/stable solution.  To me the question would be finding the money to make it happen - health-care budgets seem always stretched with a lot of demands.    

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2 hours ago, tere said:

That makes sense - an interdisciplinary team would allow the work-load gap to be filled.  Obviously, it would be a relatively large outlay of money to replace the Saudi residents, but it seems like a more permanent/stable solution.  To me the question would be finding the money to make it happen - health-care budgets seem always stretched with a lot of demands.    

Yes, money can be an issue, residents are probably the cheapest way, but you'd need to give them a job after and that is very expensive for the government.  The main issue would be tradition, certain services may not want to hire mid levels to run their wards due to concerns of residents losing ward skills, however this could still be learnt on medicine rotations if need be. 

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2 hours ago, Edict said:

Yes, money can be an issue, residents are probably the cheapest way, but you'd need to give them a job after and that is very expensive for the government.  The main issue would be tradition, certain services may not want to hire mid levels to run their wards due to concerns of residents losing ward skills, however this could still be learnt on medicine rotations if need be. 

While I'd hope that the government would think that far ahead when it comes to finishing residents, neither the current problems of physician underemployment nor unmatched CMGs reassure me.  I understand what you're saying regarding tradition - maybe this conservatism within services will mean a mixed solution with some added residency positions (despite saturated job markets) and some mid-level hiring.  But, since it won't be the Saudi government that's paying, I'd suppose the effective manpower on the wards will go down.    

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Are our provincial governments expecting us residents to work more for the same exact pay?

 

Yes, we are all resident trainees here to learn and to care for patients, but it is at the same time a job and our way of supporting ourselves and our families. 

So, I’m not okay with having to work more and spend even less time with my wife and kids, for the same exact pay. 

 

In no other job, would they expect you to work additional shifts for free. 

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1 hour ago, K1972 said:

Are our provincial governments expecting us residents to work more for the same exact pay?

 

Yes, we are all resident trainees here to learn and to care for patients, but it is at the same time a job and our way of supporting ourselves and our families. 

So, I’m not okay with having to work more and spend even less time with my wife and kids, for the same exact pay. 

 

In no other job, would they expect you to work additional shifts for free. 

Assumingely it will simply just be them enforcing what your contract already says? i.e. if they can make it a regular 1:x call, and you have been actually doing 1:x+1 or something, now they will just actually implement what is already in your contract that just wasn't enacted.  

That said, im sure there will be some unofficial "you should probably stay and get this done" type things in surgical specs.

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The issue with taking in more CMG residents in the upcoming year to make up for the lost Saudi residents is that it will be even more difficult than it already is to find a job as a staff. 

 

Right now, for the most power, the Saudi residents are going back home (as per their contract) after the completion of residency/fellowship. Now, a lot more of the graduates will be Canadians looking for a job in Canada.

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6 hours ago, K1972 said:

The issue with taking in more CMG residents in the upcoming year to make up for the lost Saudi residents is that it will be even more difficult than it already is to find a job as a staff. 

 

Right now, for the most power, the Saudi residents are going back home (as per their contract) after the completion of residency/fellowship. Now, a lot more of the graduates will be Canadians looking for a job in Canada.

Yeah - it's been mentioned a few times on this thread.  It doesn't mean it won't happen though :(.  Job difficulties are already occurring and the unmatched CMG problem shows that these kind of issues aren't a priority for the government(s).

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4 hours ago, K1972 said:

Are our provincial governments expecting us residents to work more for the same exact pay?

Yes, we are all resident trainees here to learn and to care for patients, but it is at the same time a job and our way of supporting ourselves and our families. 

So, I’m not okay with having to work more and spend even less time with my wife and kids, for the same exact pay. 

In no other job, would they expect you to work additional shifts for free. 

In Ontario (PARO), residents can do up to 1 in 4 calls for in-hospital (or 1 in 3 for home call). Some residents have have been doing 1 in 5 or less for in-hospital calls, so now they will just have to do the maximum.

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3 hours ago, ArchEnemy said:

In Ontario (PARO), residents can do up to 1 in 4 calls for in-hospital (or 1 in 3 for home call). Some residents have have been doing 1 in 5 or less for in-hospital calls, so now they will just have to do the maximum.

And with post-call days likely discouraged ;)

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23 hours ago, Edict said:

 The main issue would be tradition, certain services may not want to hire mid levels to run their wards due to concerns of residents losing ward skills, however this could still be learnt on medicine rotations if need be. 

I don't think it would work well because managing post op patients is very different than managing medicine patients. 

What you could do is have the NP manage a portion of the inpatients. Residents still manage the other portion. And the midlevel can do the routine time consuming scut that has no educational value.

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On 8/18/2018 at 11:53 AM, K1972 said:

Are our provincial governments expecting us residents to work more for the same exact pay?

 

Yes, we are all resident trainees here to learn and to care for patients, but it is at the same time a job and our way of supporting ourselves and our families. 

So, I’m not okay with having to work more and spend even less time with my wife and kids, for the same exact pay. 

 

In no other job, would they expect you to work additional shifts for free. 

There are most certainly other jobs where you are expected to work as much as they need you to, without any additional pay.  Army officers, for instance, sometimes are on duty for weeks at a time, with no overtime pay, and maybe 3-5 hours of sleep a night when in the field or deployed.  When my husband was DCO (Deputy Commanding Officer) of a regiment, he worked 6:30AM to sometime between 8PM and 10PM weekdays, and at least one weekend day for at least 8 hours.  Didn’t earn anything extra beyond his regular salary.  The only time he earns extra money is when he deploys overseas. Otherwise, he is expected to work as long as the army needs him to, no overtime or extra pay.

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23 minutes ago, NutritionRunner said:

There are most certainly other jobs where you are expected to work as much as they need you to, without any additional pay.  Army officers, for instance, sometimes are on duty for weeks at a time, with no overtime pay, and maybe 3-5 hours of sleep a night when in the field or deployed.  When my husband was DCO (Deputy Commanding Officer) of a regiment, he worked 6:30AM to sometime between 8PM and 10PM weekdays, and at least one weekend day for at least 8 hours.  Didn’t earn anything extra beyond his regular salary.  The only time he earns extra money is when he deploys overseas. Otherwise, he is expected to work as long as the army needs him to, no overtime or extra pay.

Yes, of course there are other jobs with intermittent increases in hours for short periods of time.  Many times this is an understood nature of the career as well. But the vast majority would not require long-standing extra hours without appropriate compensation. In the case of salaried work, yes there are times of the year or periods where working extra hours for weeks may be the norm to get projects done etc. But if it suddenly becomes months or the new norm of going from 45hrs/week to 70hrs/week, without appropriate compensation, then that obviously wouldn't be fair and tolerated? That should have been negotiated and understood at the hiring phase.  This definitely happens in the corporate world, where you see a creep in responsibilities, hours etc, without appropriate compensation. Then what happens? At your performance review you either get the appropriate pay grade increase,  benefits package increase, position title change etc or the person takes their talent elsewhere and the cycle repeats itself and the company wonders why they aren't holding onto their talent.  



 

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2 hours ago, JohnGrisham said:

Yes, of course there are other jobs with intermittent increases in hours for short periods of time.  Many times this is an understood nature of the career as well. But the vast majority would not require long-standing extra hours without appropriate compensation. In the case of salaried work, yes there are times of the year or periods where working extra hours for weeks may be the norm to get projects done etc. But if it suddenly becomes months or the new norm of going from 45hrs/week to 70hrs/week, without appropriate compensation, then that obviously wouldn't be fair and tolerated? That should have been negotiated and understood at the hiring phase.  This definitely happens in the corporate world, where you see a creep in responsibilities, hours etc, without appropriate compensation. Then what happens? At your performance review you either get the appropriate pay grade increase,  benefits package increase, position title change etc or the person takes their talent elsewhere and the cycle repeats itself and the company wonders why they aren't holding onto their talent.  



 

In then the only protection here is the various provincial union contracts - and if those are applied perfectly your life would be a living hell for years. Yet we all agreed to them, because the promise of greener days in the future over pain now is the premed/med/resident moto. One in four call? with the option in the contract of in rare cases pushing it even higher in Ontario. Staying after every call shift until noon? No particular rules about when your day normally starts? When all of this is done whatever they do to the residents is exactly what they are allowed to do and what we agreed to (at least collectively). Not a big fan of workplace hour restrictions (because they are inflexible, it almost begs programs to push you to exactly the maximum, and those that they really are supposed to apply to are the one most likely to ignore them anyway - looking at you surgeons). 

Funny thing is in most programs even with punishing call there are still ways built in to help with that - sure in gen surg you can be hit with brutal acute service work for some time but you still have some blocks of clinic work, scoping, research or less severe types of general surgery. Internal has CTU and ICU which can be painful but there are various other blocks that are relatively lighter. Everyone knows that if you actually went indefinitely at max things would go off the rails - ha, and now more than ever having someone actually leave a program would just cascade the effect to be that much worse. 

There various ways of getting help - people have mentioned them - more residents, more mid levels, more fellows, get the staff involved somehow - but the almost universal feature of all of that is that they are expensive - or at least more expensive than now. Hospitals aren't exactly in good shape money wise right now - one of the reasons they had these other trainees in the first place.

Edited by rmorelan

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1 hour ago, rmorelan said:

In then the only protection here is the various provincial union contracts - and if those are applied perfectly your life would be a living hell for years. Yet we all agreed to them, because the promise of greener days in the future over pain now is the premed/med/resident moto. One in four call? with the option in the contract of in rare cases pushing it even higher in Ontario. Staying after every call shift until noon? No particular rules about when your day normally starts? When all of this is done whatever they do to the residents is exactly what they are allowed to do and what we agreed to (at least collectively). Not a big fan of workplace hour restrictions (because they are inflexible, it almost begs programs to push you to exactly the maximum, and those that they really are supposed to apply to are the one most likely to ignore them anyway - looking at you surgeons). 

Funny thing is in most programs even with punishing call there are still ways built in to help with that - sure in gen surg you can be hit with brutal acute service work for some time but you still have some blocks of clinic work, scoping, research or less severe types of general surgery. Internal has CTU and ICU which can be painful but there are various other blocks that are relatively lighter. Everyone knows that if you actually went indefinitely at max things would go off the rails - ha, and now more than ever having someone actually leave a program would just cascade the effect to be that much worse. 

There various ways of getting help - people have mentioned them - more residents, more mid levels, more fellows, get the staff involved somehow - but the almost universal feature of all of that is that they are expensive - or at least more expensive than now. Hospitals aren't exactly in good shape money wise right now - one of the reasons they had these other trainees in the first place.

While most programs do have periods of less intense schedules, some actually don't. General and Neurosurgery at UofT for instance have made the move to nearly entire first years that are on service. 

To answer previous questions though, there often is a clause that allows residents to take extra call in extraordinary circumstances and get paid for it, above and beyond regular PARO rules. In some cases, programs may have to rely on these caveats in order to cover service. So the answer is that you will get paid more in the form of extra call stipends, although the call stipend is rarely worth the trouble caused. 

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1 hour ago, Edict said:

While most programs do have periods of less intense schedules, some actually don't. General and Neurosurgery at UofT for instance have made the move to nearly entire first years that are on service. 

To answer previous questions though, there often is a clause that allows residents to take extra call in extraordinary circumstances and get paid for it, above and beyond regular PARO rules. In some cases, programs may have to rely on these caveats in order to cover service. So the answer is that you will get paid more in the form of extra call stipends, although the call stipend is rarely worth the trouble caused. 

even in that on service time the don't have any less busy blocks? I am in no way claiming that they aren't insanely busy (particularly neurosurg) but there are usually still some still stressful times. Not off service but not all gen surg is as bad (some blocks seem to be routinely horrible, other types of gen surg weren't as bad. Plus clinic days and scoping days seemed better - perhaps U of T is particularly nasty though ha)

Neuro and cardiac surg where the only ones I found that just went none stop endlessly at most places. Which is at least what people are expecting in them.  Cannot imagine what that will be like with say 1/2 their residents gone - nothing left in the tank. 

The PARO contract I thought actually had the rules for extra call in special cases - everything is in there no(?) Not sure how they can get around that(?)

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On 8/18/2018 at 9:17 PM, NLengr said:

I don't think it would work well because managing post op patients is very different than managing medicine patients. 

What you could do is have the NP manage a portion of the inpatients. Residents still manage the other portion. And the midlevel can do the routine time consuming scut that has no educational value.

They could hire hospitalists with extra training in surgical care to mend the surgical wards. This frees up residents so that they can spend more time in the OR. I think that would be safer for patients too.

Edited by ArchEnemy

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23 hours ago, rmorelan said:

even in that on service time the don't have any less busy blocks? I am in no way claiming that they aren't insanely busy (particularly neurosurg) but there are usually still some still stressful times. Not off service but not all gen surg is as bad (some blocks seem to be routinely horrible, other types of gen surg weren't as bad. Plus clinic days and scoping days seemed better - perhaps U of T is particularly nasty though ha)

Neuro and cardiac surg where the only ones I found that just went none stop endlessly at most places. Which is at least what people are expecting in them.  Cannot imagine what that will be like with say 1/2 their residents gone - nothing left in the tank. 

The PARO contract I thought actually had the rules for extra call in special cases - everything is in there no(?) Not sure how they can get around that(?)

Not sure actually, maybe PARO does have that in the rules. All i know is that UofT surgery has a rule saying that their own surgical residents are not post-call until noon haha. 

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1 hour ago, Edict said:

Not sure actually, maybe PARO does have that in the rules. All i know is that UofT surgery has a rule saying that their own surgical residents are not post-call until noon haha. 

Yeah that is in the PARO rules. It was the same for other blocks I took at Ottawa as well. 

For the extra call shifts

  1. As an exception to Articles 16.1(b) and 16.9, residents in a hospital department, division or service may be required to work up to an additional three (3) call periods over a six month block period (July 1 to December 31 and January 1 to June 30), but only if needed to replace a resident who is forced to miss scheduled call days due to unexpected, short-term sickness, being on a vacation for a period of two (2) consecutive weeks or more, or being absent in other circumstances beyond his/her control or due to emergency.

For the staying to noon:

Where a service provides PARO with advance notice that the service cannot relieve residents of their responsibilities within the time set out in Article 16.4(b)(ii) below, residents working on that service shall be relieved of their responsibilities by no later than 1200 hours on the day following their in-hospital call, and Article 16.4(b)(ii) does not apply. A service’s decision that Article 16.4(b)(ii) does not apply cannot be the subject of a grievance or arbitration, but will be addressed through the committee process set out in Article 16.4(b)(iii) below

I mean my point of bring out the fine print is just that even the fine print for call, even as much as we have made it better over the past 30 years still sucks even as it already is. Other than the people just flat out ignoring the rules everything at least on paper is following the contract. The problem is they are trying to combine a crap load of different specialties all with different requirements, all with different call experiences under the same simple to understand rule list. It is a huge problem. Some people call on average is relatively light - and you can be destroyed but the expectation is you would actually have some sleep during the night. Others have systems where the juniors are protecting the seniors even though they are on paper doing similar call shifts (because the seniors have to prepare for exams and are supposed to do say ORs pretty independently and thus cannot be permanent zombies). Others tamper call down, and those with almost for sure brutal nights tend to let out earlier (like CTU, ICU which have rules for that in terms max handover time, and in my case radiology which is almost always no stop at my centre at least - in 150 call shifts I had one where I had 3 hours sleep ha. It was glorious :)

If they want to schedule more than the rules in Ontario they will hit the contract limits hard quickly - and at least on paper they have to follow those rules. It will be interesting to see what comes out of it. 

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1 hour ago, Edict said:

Not sure actually, maybe PARO does have that in the rules. All i know is that UofT surgery has a rule saying that their own surgical residents are not post-call until noon haha. 

Humm... I am off service resident, and I stayed until noon post-call in surgery.

For general surgery residents at UofT, the expectation is that you stay beyond noon to help out, hence, you are never post-call lol 

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57 minutes ago, LittleDaisy said:

Humm... I am off service resident, and I stayed until noon post-call in surgery.

For general surgery residents at UofT, the expectation is that you stay beyond noon to help out, hence, you are never post-call lol 

just stating the official rules, how it is actually done is a different story ;) As in, at UofT, you aren't even allowed to leave until 12pm

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Just now, Edict said:

just stating the official rules, how it is actually done is a different story ;) As in, at UofT, you aren't even allowed to leave until 12pm

True I feel ya. One of the general surgeon staff with whom I worked with was pretty cunny, and asked me to go home past noon, as he said that I wasn't paid overtime lol 

Tough residency lives to all of those doing surgical specialties, stay strong!

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Interesting rebuttal to a previous Ottawa Citizen article by Dr. John Stewart.

https://ottawacitizen.com/opinion/columnists/padmos-saudi-medical-trainees-arent-taking-training-spots-from-canadian

Apparently the deadline for Saudi Residents to leave the country has been moved to September 22nd:

https://globalnews.ca/news/4400538/saudi-medical-students/

 

 

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On 8/20/2018 at 9:57 PM, LittleDaisy said:

Humm... I am off service resident, and I stayed until noon post-call in surgery.

For general surgery residents at UofT, the expectation is that you stay beyond noon to help out, hence, you are never post-call lol 

I was amazed at how many surgical residents I heard say some variation of "The great thing about being post call is that I can stay in the hospital and operate!"

They're a different breed, God bless 'em.

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6 hours ago, ploughboy said:

I was amazed at how many surgical residents I heard say some variation of "The great thing about being post call is that I can stay in the hospital and operate!"

They're a different breed, God bless 'em.

Stockholm syndrome. 

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