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Surgical specialties with good job prospects?

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1 hour ago, monocle said:

What I want to do lots of work with can only be done in large centres (robotics), and it's always been kind of the dream to be faculty in a metropolitan city. I've jumped through all the hoops so far, and I think I've got a step up on most of my peers on terms of academics. Now, if I'm being asked to be a clinical associate my opinion might change. I would be very hesitant to enter that kind of a deal which only realistically grant me a shot, and not a position, at the end of it.

It's very discouraging to hear that this kind of craziness is the new normal.

+1 definitely. Residency just slowly ate the dream. Now it's just thinking about the escape plan...

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6 hours ago, monocle said:

What I want to do lots of work with can only be done in large centres (robotics), and it's always been kind of the dream to be faculty in a metropolitan city. I've jumped through all the hoops so far, and I think I've got a step up on most of my peers on terms of academics. Now, if I'm being asked to be a clinical associate my opinion might change. I would be very hesitant to enter that kind of a deal which only realistically grant me a shot, and not a position, at the end of it.

It's very discouraging to hear that this kind of craziness is the new normal.

Perhaps you truly are a cut above your peers but chances are that you will end up competing against individuals just as accomplished as you for desirable posts. It's a simple supply/demand issue as the institutions know that people want these positions so they have the luxury of waiting for the perfect person. 

If there is one thing I want to tell medical students it's that their idea of a "perfect future" isn't always attainable and that after your training there isn't a direct elevator to the top like in medical school. You'll have to deal with the same nuances of job searching like everyone else. 

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7 hours ago, monocle said:

What I want to do lots of work with can only be done in large centres (robotics), and it's always been kind of the dream to be faculty in a metropolitan city. I've jumped through all the hoops so far, and I think I've got a step up on most of my peers on terms of academics. Now, if I'm being asked to be a clinical associate my opinion might change. I would be very hesitant to enter that kind of a deal which only realistically grant me a shot, and not a position, at the end of it.

It's very discouraging to hear that this kind of craziness is the new normal.

If you want to do robotics, go to the states. Don't stay in Canada. They will throw more robotics at you in the US than you can handle. 

 

Robotics in the US = better advertising = more patients = more cash for the hospital. 

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Definitely the incentives to practice in Canada are diminishing. This is really just a natural result of the increased competition for everything unfortunately, but CAs are definitely a thing I see CAs everywhere these days. 

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13 hours ago, ACHQ said:

I know in the department of medicine at UofT its between 20-30% depending on the specific hospital (which is still very high) and you get NONE of the practice plan benefits, AND because you submit your Billings to the practice plan, technically they get a cut of your Billings for ANY work OUTSIDE of academics (e.g. locum shifts)!!!!! 

From what I have seen, they also work the longer shifts and take worse call than actual faculty.

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13 hours ago, ACHQ said:

I learned that the hard way like most people. I still like what I do overall, but some of the things I have seen, heard and experienced are truly mind boggling and leave a sour taste in your mouth. You think that in a field where you're supposed to care for people would be devoid of these things, but that's just me being naïve.

They get a cut of 20-30% of your total billings. Meaning you get anywhere between 70-80% back

Unfortunately you CANNOT get a faculty position without doing some CA work. On rare occasions they have people come on as faculty that don't do CA work but that would constitute maybe 1% (or even less), meaning its the exception not the rule. This applies to ALL medicine specialties for sure (and it seems like surgery as well, and I wouldn't be surprised if it applied to ALL academic positions in the faculty of medicine). I've heard similar things happening at other sites across Canada (although not as brutal as UofT). These things are even being promoted by Senior admins (department and faculty heads) as necessary!

TBH why go for an academic position then when "I don't get off/orgasm over research or teaching at all". Just finish residency and start working in the community where you can make $$ and have a semblance of a life.

 

I think that the department of family medicine at UofT does not ask you to become clinical associate, and ask you to bill 70-80%; but it's an exception. 

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On 6/26/2019 at 10:17 AM, monocle said:

 

Does this apply to most specialties in Toronto (the whole clinical associate thing)? I've done my fair share of academic slavery, but I wasn't planning on doing any more beyond a fellowship (already have a Masters) to at least have a shot at an academic position. If I'm asked to CA, I don't know what I'd do as I've been working towards this goal for several years now. I think that's very unfair and akin to daylight robbery considering you could be losing anywhere from 150-300K a year while going through it.

I don't get off/orgasm over research or teaching at all, but I'm willing to do it if it secures me a spot. This is some real bullsh**, incredibly discouraging!

If you are asked to do a CA and *don't* do it, you might as well start looking for a community job. 

In general at U of T, you will need to compete to become a CA,  do that for ~3 years, accept that there will be a significant tithe on your billings during that time, work the weeks that the established staff don't want to work, produce something significant with your research, hope that you don't cheese off the wrong senior person in the department, and hope that your mentors/champions within the department continue to hold their positions and influence so that they can advocate for you.  Oh, and maybe do another fellowship at a different institution so that you can "bring something back" to UT.

I know several people who are flat-out brilliant, insanely hard working, don't need to sleep, are clinically solid and socially normal-to-above-average who have started on this pathway and have fallen or gotten knocked off it for reasons they couldn't control. 

The investment::payoff ratio is currently skewed the wrong way.

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5 hours ago, ploughboy said:

If you are asked to do a CA and *don't* do it, you might as well start looking for a community job. 

In general at U of T, you will need to compete to become a CA,  do that for ~3 years, accept that there will be a significant tithe on your billings during that time, work the weeks that the established staff don't want to work, produce something significant with your research, hope that you don't cheese off the wrong senior person in the department, and hope that your mentors/champions within the department continue to hold their positions and influence so that they can advocate for you.  Oh, and maybe do another fellowship at a different institution so that you can "bring something back" to UT.

Or if you are sensible: Get community job. Print cash. Love life.

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20 hours ago, NLengr said:

Or if you are sensible: Get community job. Print cash. Love life.

By community job does this refer to rural areas in Canada? Are surgical jobs at hospitals in the Toronto suburbs and GTA also just as difficult to get as the big centres downtown?

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On 6/29/2019 at 2:20 PM, Aurelius said:

By community job does this refer to rural areas in Canada? Are surgical jobs at hospitals in the Toronto suburbs and GTA also just as difficult to get as the big centres downtown?

I mean any non academic job. That's what is meant by community job. A community job can be anything from a job in Toronto to a job in Nunavut. 

From what I understand jobs in the GTA are harder to get just because more people want them. 

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6 hours ago, NLengr said:

I mean any non academic job. That's what is meant by community job. A community job can be anything from a job in Toronto to a job in Nunavut. 

From what I understand jobs in the GTA are harder to get just because more people want them. 

 

Oh okay thank you for clarifying! This thread is disheartening as I'm interested in surgery and want to practice in the GTA at a community job but hopefully things improve in the future. Do you recommend students interested in surgery write their USMLEs in case the job market in Canada doesn't improve, so they can at least go to the states?

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18 hours ago, Aurelius said:

 

Oh okay thank you for clarifying! This thread is disheartening as I'm interested in surgery and want to practice in the GTA at a community job but hopefully things improve in the future. Do you recommend students interested in surgery write their USMLEs in case the job market in Canada doesn't improve, so they can at least go to the states?

Tbh i'm not sure if community jobs are actually any easier to get when you are talking about the GTA. Plenty of people want to work in the community around the GTA. With that being said, the community will value different things compared to academics so you probably won't need to get a masters or phd for most specialties. 

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20 hours ago, Aurelius said:

 

Oh okay thank you for clarifying! This thread is disheartening as I'm interested in surgery and want to practice in the GTA at a community job but hopefully things improve in the future. Do you recommend students interested in surgery write their USMLEs in case the job market in Canada doesn't improve, so they can at least go to the states?

If you would consider working in the states then it makes sense to do them.

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On 6/30/2019 at 9:40 PM, Aurelius said:

 

Oh okay thank you for clarifying! This thread is disheartening as I'm interested in surgery and want to practice in the GTA at a community job but hopefully things improve in the future. Do you recommend students interested in surgery write their USMLEs in case the job market in Canada doesn't improve, so they can at least go to the states?

do them anyway even if you dont plan on going

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On 7/1/2019 at 11:14 PM, GrouchoMarx said:

do them anyway even if you dont plan on going

Will I need a competitive (i.e high) step 1/2 score or will just a pass in both do? I definitely want to do my residency in Canada.

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20 hours ago, Aurelius said:

Will I need a competitive (i.e high) step 1/2 score or will just a pass in both do? I definitely want to do my residency in Canada.

Then it mostly doesnt matter.  USMLE scores are used for residency matching not really beyond.  It's a bit like a residency program asking for your MCAT scores for the match. 

A couple of fellowships that are highly competitive MIGHT look at your USMLE scores but most will just want you to have passed them (with a few exceptions for the odd state AND hospital combo that will honour the MCC in lieu of the USMLE for Fellows). 

That said I've heard residency programs are looking at undergrad grades these days so who knows what the next 5 years will bring for competitive fellowships.  But it's hard to imagine a world where something like USMLEs will matter for fellowships more than the usual known-person-recommendations and research. 

For credentials in the US later in your career, you just need to have passed them. No one will ask for your score. 

Invest your time accordingly, but remember that the Canadian medical system doesnt teach to the USMLE material at all, so additional prep is definitely required. If you get 70% consistently on Uworld you'll likely pass.  

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On 6/28/2019 at 9:08 AM, ploughboy said:

If you are asked to do a CA and *don't* do it, you might as well start looking for a community job. 

In general at U of T, you will need to compete to become a CA,  do that for ~3 years, accept that there will be a significant tithe on your billings during that time, work the weeks that the established staff don't want to work, produce something significant with your research, hope that you don't cheese off the wrong senior person in the department, and hope that your mentors/champions within the department continue to hold their positions and influence so that they can advocate for you.  Oh, and maybe do another fellowship at a different institution so that you can "bring something back" to UT.

I know several people who are flat-out brilliant, insanely hard working, don't need to sleep, are clinically solid and socially normal-to-above-average who have started on this pathway and have fallen or gotten knocked off it for reasons they couldn't control. 

The investment::payoff ratio is currently skewed the wrong way.

Is this true for Emerg academic positions as well?

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17 hours ago, Redpill said:

Is this true for Emerg academic positions as well?

It's not as bad in Emerg because right now the demand is still there, I know of several CCFP+1 ER who are working in GTA and academic centres downtown as staff. In surgery the job market is tighter hence why some are doing CAs

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2 hours ago, mononoke said:

It's not as bad in Emerg because right now the demand is still there, I know of several CCFP+1 ER who are working in GTA and academic centres downtown as staff. In surgery the job market is tighter hence why some are doing CAs

I think beside St Michael's Hospital and Sunnybrook Hospital who are tertiary trauma hospitals, they prefer to hire FRCPC, although there are a few CCFP-EM who work there.

The majority of other Toronto academic and community hospitals' chiefs are CCFP-EM and don't cherry pick over FRCPC or CCFP-EM. After all, 70-80% of emergency physicians in Canada are family physicians. 

It depends mostly how you network and impress your future colleagues during your residency/fellowship, if you are a good fit, they will advocate a job position for you. There is not too much point to hire a FRCPC in a community hospital, unless the hiring person is very keen on credentials. At the end of the day, you just need to find someone who will get along with the rest of the group and provides good service to the patients. A lot of soft skills can't be taught in medical school/residency. We tend to think that the most brilliant people get hired in coveted academic positions, but actually they tend to have strong interpersonal skills and connect well with the department. 

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