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Making decisions about specialty..

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Prior to clerkship, I was interested in competitive  specialty and I have built my resume for this specialty , but as I am going through clerkship I feel that I have less and less desire to pursue 5+ years of residency and sometimes I feel like I should do FM because I liked the rotation and I felt that it was very easy for me.. On my FM block, I did not have to study and I was not trying to impress and yet I ended up with really good grades... I feel that I will be able to finish FM residency with no problem and with less effort, whereas I found pursuing specialty will require more work and effort and you are always on your toes and trying to impress, and there is constantly so much you are trying to learn..

Plus i also loved how non-hierarchical FM seems like compared to other specialties... How should I make decisions about specialties? Should i just do FM because I liked rotation and I felt that it was easy, and loved learning environment, and plus I feel that I am already burn out and I dont think I can do 5+ more years of residency with constant testing/ studying/ trying to impress, etc.. In FM, I feel I will burn out less, so I will be able to provide better patient care. Are those fair points for pursing FM?? Also, what if I go into FM and realized I want to finish another residency after FM.. Is that possible?

 

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Do FM 100%

Do you want to chill in medical school with little stress not having to worry about any research/EC/etc, have the freedom to nearly guarantee where you do residency, do a chill 2 years of residency, get a job anywhere in Canada on the spot, not worry about doing graduate degrees/fellowships, have the freedom to explore many niches in family medicine, have a great work life balance, not spend gruelling years in residency, have the chance to get into many +1's if you want to (EM, Anes, Derm, etc), have a much more chill board exam, know you are actually making a difference to the number of Canadians who need a FM doc, and on top of that if you work hard are business minded and know what you are doing surpass the income of many specialists?

If the answer is yes -> do FM.

If you like stressing in medical school and scrambling for any research/resume padding you can get for CaRMS, and then further trying to impress in many years of residency/fellowship to get a job, and you like the feeling of having to likely settle for location where you do your residency since spots are more competitive, have to do 6-8+ years of residency (since you need to do a fellowship(s)/graduate degree(s) for nearly all FRCPC specialities, have to settle for living in places you really don't want to be just to get a job, like being limited to a particular body system/type of work, have a much worse work life balance (for most FRCPC specialities), like spending gruelling years in residency and fellowship while your FM friends are living life and making money, spend at least a year of life studying nonstop for the difficult FRCPC exam, and on top of that not only lose out on years of income while you are a resident?

If the answer is yes -> do a speciality 

Many smart people in medicine recognize the above, which is why FM is getting more popular recently                                                                                                   

43% of all graduating Canadian medical students in 2020 ended up in FM in the end after both rounds whether it was their first choice or not. 

(>50% of graduating medical students from the 3 French schools, 55% of Queen's grads, and 64% of NOSM's grads in particular went into FM for example)

I'm not going to lie, I feel a lot of people are ego/prestige driven and "look-down on FM" which is sad that someone would discount all the pros of FM and cons of specialities just to be called a say "interventional cardiologist" even though they have to do 9 years of very hard residency and after that be left scrambling to get a job anywhere.

Before anyone says this, I know there are people who value passion and interest for the field fist and foremost and I highly respect them, but no one can deny that at least part of why many people discount FM is because they perceive it as less "prestigious" than FRCPC. Everyone has different priorities  but what I assume is true for many people is: work-life balance, lifestyle, training time, jobs, residency lifestyle, etc > passion for the field, "prestige of the field"

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5 hours ago, offmychestplease said:

Do FM 100%

Do you want to chill in medical school with little stress not having to worry about any research/EC/etc, have the freedom to nearly guarantee where you do residency, do a chill 2 years of residency, get a job anywhere in Canada on the spot, not worry about doing graduate degrees/fellowships, have the freedom to explore many niches in family medicine, have a great work life balance, not spend gruelling years in residency, have the chance to get into many +1's  if you want to (EM, Anes, Derm, etc), know you are actually making a difference to the number of Canadians who need a FM doc, and on top of that if you work hard are business minded and know what you are doing surpass the income of many specialists?

If the answer is yes -> do FM.

If you like stressing in medical school and scrambling for any research/resume padding you can get for CaRMS, and then further trying to impress in many years of residency/fellowship to get a job, and you like the feeling of having to likely settle for location where you do your residency since spots are more competitive, have to do 6-8+ years of residency (since you need to do a fellowship(s)/graduate degree(s) for nearly all FRCPC specialities, have to settle for living in places you really don't want to be just to get a job, like being limited to a particular body system/type of work, have a much worse work life balance (for most FRCPC specialities), like spending gruelling years in residency and fellowship while your FM friends are living life and making money, and on top of that not only lose out on years of income while you are a resident?

If the answer is yes -> do a speciality

While, I get that you are passionate about family medicine, and I agree, its a great speciality for many reasons, I feel you are painting a bit of an unfair picture of most specialties and grouping many into a single category when thats not in fact the reality. Despite the positive elements of FM that you presented here, I personally would not find any job satisfaction in doing that day to day. Even with a good lifestyle and work-life balance (which some might argue is even better in some specialities), it is important to be happy with the work you do day to do and not just get by because its an easier path.

More than half of graduates still pursue a field that is not family medicine, and majority of those do not do so for the "prestige" or "income potential". Feeling the need to impress tends to subside with time, and while the path to practice is certainly longer for other specialties, it's important to ultimately do something you are happy doing. If that is FM then great, but if not, it's important to know that it's not all bad as presented above.

I am in a 5-year speciality that likely wont REQUIRE a fellowship for a job down the road, and I can say I don't feel limited to ANY of what the response above has mentioned (limited to one body system, working in a place I don't want to, bad work-life balance, need to impress attendings, scrambling for research, etc.)

Important to have a balanced opinion when making a decision.

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^This

Everything I said above applies for:

Neurosurgery, Cardiac Surgery, Vascular Surgery, Plastic Surgery, Orthopaedic Surgery, General Surgery, ENT, Urology, OB-GYN (except for limited jobs part),  Ophthalmology (except for attending lifestyle), Anatomical Pathology, Haematological Path, Neuropath, med microbio, Rad Onc, Public Health, Neurology, Radiology, Nuclear Med, Internal Med (except for the low payed "life style" sub-specs, or general IM). Everything except work-life balance for anything lab med mentioned.

Specialities that don't fit most of what I said above (besides FM):

IM Lifestyle fields like endo/rhem/geriatrics,

General IM

Derm

EM

Psych

General Peds

Physical Med

In the above FRCPC fields jobs are much more plentiful, lifestyle is good to great for most except general IM, compensation is ok (IM sub specs) to amazing (Derm), no need for fellowship/graduate degrees in any of the above, but you also have to do 5 years of residency vs 2 which is a big drawback and need to work hard to impress for longer.

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11 hours ago, health&wellness&balance said:

Prior to clerkship, I was interested in competitive  specialty and I have built my resume for this specialty , but as I am going through clerkship I feel that I have less and less desire to pursue 5+ years of residency and sometimes I feel like I should do FM because I liked the rotation and I felt that it was very easy for me.. On my FM block, I did not have to study and I was not trying to impress and yet I ended up with really good grades... I feel that I will be able to finish FM residency with no problem and with less effort, whereas I found pursuing specialty will require more work and effort and you are always on your toes and trying to impress, and there is constantly so much you are trying to learn..

Plus i also loved how non-hierarchical FM seems like compared to other specialties... How should I make decisions about specialties? Should i just do FM because I liked rotation and I felt that it was easy, and loved learning environment, and plus I feel that I am already burn out and I dont think I can do 5+ more years of residency with constant testing/ studying/ trying to impress, etc.. In FM, I feel I will burn out less, so I will be able to provide better patient care. Are those fair points for pursing FM?? Also, what if I go into FM and realized I want to finish another residency after FM.. Is that possible?

 

I think it's so great that you're re-evaluating what you want instead of convincing yourself to keep pursuing that competitive specialty because of sunk-costs!

What you've listed are very fair points for pursuing FM. However, although previous responses outlined some advantages of FM (albeit a unbalanced) I don't think one size fits all answers are helpful because they don't take into account what's important to YOU. Some wise advice I've been given about choosing a specialty: it's like choosing a spouse. No one is perfect, but ultimately can you see yourself enjoying the day to day bread and butter stuff while tolerating the negative aspects of that specialty? you've mentioned a lot of probably valid negative points about that competitive specialty, but are those actually deal breakers to you? what are your deal-breakers? if you're not able to mitigate them by say, choosing a sub-specialty or practice setting you'd want by going into that specialty, maybe you're just incompatible. Those same questions apply to FM.

I'm pretty set on not pursuing a specialty for the exact reasons you mentioned. I admire that plenty of others are willing to sacrifice their personal life/other interests a bit more to pursue a more intense training/job and that's cool too--their priorities are just different than mine.

disclaimer: I'm behind you in training (MS3) but gets told "wow I love that you know what you want and not afraid to own it!" a lot.

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27 minutes ago, Egg_McMuffin said:

I think it's so great that you're re-evaluating what you want instead of convincing yourself to keep pursuing that competitive specialty because of sunk-costs!

What you've listed are very fair points for pursuing FM. However, although previous responses outlined some advantages of FM (albeit a unbalanced) I don't think one size fits all answers are helpful because they don't take into account what's important to YOU. Some wise advice I've been given about choosing a specialty: it's like choosing a spouse. No one is perfect, but ultimately can you see yourself enjoying the day to day bread and butter stuff while tolerating the negative aspects of that specialty? you've mentioned a lot of probably valid negative points about that competitive specialty, but are those actually deal breakers to you? what are your deal-breakers? if you're not able to mitigate them by say, choosing a sub-specialty or practice setting you'd want by going into that specialty, maybe you're just incompatible. Those same questions apply to FM.

I'm pretty set on not pursuing a specialty for the exact reasons you mentioned. I admire that plenty of others are willing to sacrifice their personal life/other interests a bit more to pursue a more intense training/job and that's cool too--their priorities are just different than mine.

disclaimer: I'm behind you in training (MS3) but gets told "wow I love that you know what you want and not afraid to own it!" a lot.

I'm pretty sure OP just got into med school this year.

But I, too, am impressed with their certainty to pursue FM. I'm sure they will find med school a lot more relaxing than many of their classmates. 

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19 hours ago, offmychestplease said:

^This

Everything I said above applies for:

Neurosurgery, Cardiac Surgery, Vascular Surgery, Plastic Surgery, Orthopaedic Surgery, General Surgery, ENT, Urology, OB-GYN (except for limited jobs part),  Ophthalmology (except for attending lifestyle), Anatomical Pathology, Haematological Path, Neuropath, med microbio, Rad Onc, Public Health, Neurology, Radiology, Nuclear Med, Internal Med (except for the low payed "life style" sub-specs, or general IM). Everything except work-life balance for anything lab med mentioned.

Specialities that don't fit most of what I said above (besides FM):

IM Lifestyle fields like endo/rhem/geriatrics,

General IM

Derm

EM

Psych

General Peds

Physical Med

In the above FRCPC fields jobs are much more plentiful, lifestyle is good to great for most except general IM, compensation is ok (IM sub specs) to amazing (Derm), no need for fellowship/graduate degrees in any of the above, but you also have to do 5 years of residency vs 2 which is a big drawback and need to work hard to impress for longer.

Not to mention the royal college exam for some of these is brutalm (i.e derm)

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Family med is also really boring, unrewarding, and not well-compensated. Sometimes I feel like I'm smarter than my staff and wish I was doing something better. I also miss being able to answer a single question as a specialist, instead of being forced to deal with 2-3 issues and be compensated $36 for it. 

An allergist or GIM doc can see half the patients in the same clinic day, make double the amount of a family doc, and not be forced to do longitudinal care and paperwork. Something you don't get exposure to in med school is the bloodwork, specialist notes, etc you need to follow up on - it ends up being several hours of unpaid work. 

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On 9/15/2020 at 11:25 AM, offmychestplease said:

^This

Everything I said above applies for:

Neurosurgery, Cardiac Surgery, Vascular Surgery, Plastic Surgery, Orthopaedic Surgery, General Surgery, ENT, Urology, OB-GYN (except for limited jobs part),  Ophthalmology (except for attending lifestyle), Anatomical Pathology, Haematological Path, Neuropath, med microbio, Rad Onc, Public Health, Neurology, Radiology, Nuclear Med, Internal Med (except for the low payed "life style" sub-specs, or general IM). Everything except work-life balance for anything lab med mentioned.

Specialities that don't fit most of what I said above (besides FM):

IM Lifestyle fields like endo/rhem/geriatrics,

General IM

Derm

EM

Psych

General Peds

Physical Med

In the above FRCPC fields jobs are much more plentiful, lifestyle is good to great for most except general IM, compensation is ok (IM sub specs) to amazing (Derm), no need for fellowship/graduate degrees in any of the above, but you also have to do 5 years of residency vs 2 which is a big drawback and need to work hard to impress for longer.

Where does anesthesiology fall in your opinion?

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Anesthesia grads I know don't have problem at all finding jobs, even in large hospitals in urban areas, without fellowship. Although I have no first hand experience, they mention they really like that you can pick and choose your shift, and if you want to make more, you can pick those overnight shifts, if you want to take it easy, you can do less.

Some people in FM also did a +1 year in anesthesia and now works in rural hospital OR part time, they love that they can blend FM with some OR time to add to the variety of work they do. Rural hospitals seem to employ a lot of FM to do the anesthesia on smaller cases so the demand is certainly there.

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To answer OP's original question, I think FM is a great choice. People tend to think of FM as the prototypical office based practice that mainly does mundane tasks, but there is a huge variety of things you can do as family doc, such as hospitalist, ER, anesthesia, surgical assist, minor procedure, routine delivery etc. Unless you are extremely limited in geography, you should be able to find a niche that makes you happy.

Anecdotally I can assure you 5 years of residency does make you burn out, not to mention the mess with RC exam. I can't image what it feels like for my classmates that are doing 6 year residencies or PhD during the residency or 2 fellowships just to have a chance at a job.

If you really like a specialty, try to shadow the MOST DIFFICULT part of that specialty that can make or break your residency/career. For example, shadow those 5am rounds or 1 in 2 calls with no post call day, and see if you can take it. I think sometimes medical students are underexposed to the "ugly" side of a residency.

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2 hours ago, unmatch said:

Family med is also really boring, unrewarding, and not well-compensated. Sometimes I feel like I'm smarter than my staff and wish I was doing something better. I also miss being able to answer a single question as a specialist, instead of being forced to deal with 2-3 issues and be compensated $36 for it. 

An allergist or GIM doc can see half the patients in the same clinic day, make double the amount of a family doc, and not be forced to do longitudinal care and paperwork. Something you don't get exposure to in med school is the bloodwork, specialist notes, etc you need to follow up on - it ends up being several hours of unpaid work. 

There are over 750 FM doctors in AB that are making $400,000+ AFTER overhead, 250 of which that are making $550,000+ on average AFTER overhead, about 40 of which that are making $1,100,000 on average AFTER overhead, and the top 3 of which that are making $2,000,000+ on average AFTER overhead. This is from government billings alone and does not include any private billings and/or business ventures like getting profit from the overhead that other doctors pay you if you decide to buy a clinic etc. The numbers are all here:

https://nationalpost.com/health/leaked-report-offers-window-into-the-medical-one-percenters-and-growing-concern-over-md-pay-inequity/

It's quite funny the level of misinformation that a lot of people have regarding their perceived notion of "low fm" pay. Pretty good for a 2 year residency..

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38 minutes ago, shikimate said:

To answer OP's original question, I think FM is a great choice. People tend to think of FM as the prototypical office based practice that mainly does mundane tasks, but there is a huge variety of things you can do as family doc, such as hospitalist, ER, anesthesia, surgical assist, minor procedure, routine delivery etc. Unless you are extremely limited in geography, you should be able to find a niche that makes you happy.

Anecdotally I can assure you 5 years of residency does make you burn out, not to mention the mess with RC exam. I can't image what it feels like for my classmates that are doing 6 year residencies or PhD during the residency or 2 fellowships just to have a chance at a job.

If you really like a specialty, try to shadow the MOST DIFFICULT part of that specialty that can make or break your residency/career. For example, shadow those 5am rounds or 1 in 2 calls with no post call day, and see if you can take it. I think sometimes medical students are underexposed to the "ugly" side of a residency.

The bolded can not be understated. 

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1 hour ago, offmychestplease said:

There are over 750 FM doctors in AB that are making $400,000+ AFTER overhead, 250 of which that are making $550,000+ on average AFTER overhead, about 40 of which that are making $1,100,000 on average AFTER overhead, and the top 3 of which that are making $2,000,000+ on average after overhead. This is from government billings alone and does not include any private billings and/or business ventures like getting profit from the overhead that other doctors pay you if you decide to buy a clinic etc. The numbers are all here:

https://nationalpost.com/health/leaked-report-offers-window-into-the-medical-one-percenters-and-growing-concern-over-md-pay-inequity/

It's quite funny the level of misinformation that a lot of people have regarding their perceived notion of "low fm" pay. Pretty good for a 2 year residency..

https://www.cma.ca/sites/default/files/pdf/Physician Data/01-physicians-by-specialty-province-e.pdf

So you cherrypicked the top 10% billing from the province which pays their family docs the highest. We have no idea if they're working 24/7 or doing sketchy stuff with their billings.

Also the billings aspect doesn't change the fact that the career is boring and unrewarding. I can't wait to go back to clinic and see my five patients with mechanical low back pain again...

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I chose AB because that is where I am based. It is not too difficult being part of "that 10%" since half of FM doctors work part-time <30 hours/week...and many of the ones that work full-time don't know/don't care to maximize their billings. Even then, the hours needed to get into that top 10% are not comparable to the call and work hours of many surgeons etc. And this is not even taking into account many years of lost-income in residency/fellowship/etc. 

Your posts indicate that YOU think "the career is boring and unrewarding". That is your opinion. Many others don't think so + found a niche they love to practice.  

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4 hours ago, offmychestplease said:

I chose AB because that is where I am based. It is not too difficult being part of "that 10%" since half of FM doctors work part-time <30 hours/week...and many of the ones that work full-time don't know/don't care to maximize their billings. Even then, the hours needed to get into that top 10% are not comparable to the call and work hours of many surgeons etc. And this is not even taking into account many years of lost-income in residency/fellowship/etc. 

Your posts indicate that YOU think "the career is boring and unrewarding". That is your opinion. Many others don't think so + found a niche they love to practice.  

 

[Edited to be less of an ass]

I'm not even a resident yet, so if any AB docs could substantiate these claims that would also be helpful, but I have doubts that a their workload isn't approaching the level of a surgeon. There was a previous post about an Ontario FM doc who worked rurally and made I think ~650k I think averaging 75 hours a week, (generally not sustainable for most people). That was with rural locuming in ERs and adding additional hours to the standard practice. Yes AB pays more than Ontario, but that will come down after the AMA cuts come through.

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The best specialty is the specialty that you enjoy imo. You can have a rewarding career as a GP, a surgeon, an anesthesiologist, a pathologist etc. I am only a PGY-3 so my view may be a bit naive, but at the end of my 20th hour of my call shift, I want to have a good reason/justification of why I am doing this while I could be at home enjoying life and sleep like most (normal) people. And you know what? Every time I reflect on my journey and my choices, I can’t see myself anywhere else but where I am today, and in my current specialty. I still get excited about going to work when I am on service (despite sometimes brutal hours) and get miserable when I have to go to work on off service rotation where the hours are much more chill and it’s because I love the work I do. So ultimately, don’t worry about the compensation, the job prospect etc. All residency is brutal, doctors will be well compensated, and you will eventually be employed. The career you choose is going to last 30+ years, so find what you enjoy. 
 

I work with surgeons and other specialists very closely, and I am sure they are well compensated, have a prestigious reputation etc. But looking at their residency and life, I would never pursue that career... ever. I also know they fee the same way about my specialty. So honestly, pursue what you love.

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22 minutes ago, piperacillin said:

Just lol.

Considering you took 4 tries to get into medical school and ~50% of the class gets in after an interview, I would be a little more humble and think about how hard it is to reach the top 10%.

ouchhhh, that was a low blow... (and this is coming from someone who disagrees with offmychestplease a whole lot)

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35 minutes ago, piperacillin said:

Considering you took 4 tries to get into medical school and ~50% of the class gets in after an interview, I would be a little more humble and think about how hard it is to reach the top 10%.

Probably one of the silliest things I’ve heard. Everyone has their story, 50% of those may very well be privileged people (like my class), it’s hilarious how unrelatable most med students are to the common Canadian. You may not agree with off my chest, but I’ll be damned before someone calls someone else out after multiple tries to medicine. Also your point makes 0 sense, they are not at all related. Use actually well formed arguments and not personal attacks thanks. 

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25 minutes ago, petitmonstre111 said:

ouchhhh, that was a low blow... (and this is coming from someone who disagrees with offmychestplease a whole lot)

 

27 minutes ago, offmychestplease said:

I began typing something but I stopped. This shows more about them than me is all I will say. 

Yea alright, that was me being an ass, shouldn't have made it personal, sorry. Just frustrating to read repeated posts that imply how easy it is to reach that level and how guaranteed it is. Don't think I'm gonna convince you anyway, good luck with everything

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On 9/14/2020 at 11:30 PM, health&wellness&balance said:

Prior to clerkship, I was interested in competitive  specialty and I have built my resume for this specialty , but as I am going through clerkship I feel that I have less and less desire to pursue 5+ years of residency and sometimes I feel like I should do FM because I liked the rotation and I felt that it was very easy for me.. On my FM block, I did not have to study and I was not trying to impress and yet I ended up with really good grades... I feel that I will be able to finish FM residency with no problem and with less effort, whereas I found pursuing specialty will require more work and effort and you are always on your toes and trying to impress, and there is constantly so much you are trying to learn..

Plus i also loved how non-hierarchical FM seems like compared to other specialties... How should I make decisions about specialties? Should i just do FM because I liked rotation and I felt that it was easy, and loved learning environment, and plus I feel that I am already burn out and I dont think I can do 5+ more years of residency with constant testing/ studying/ trying to impress, etc.. In FM, I feel I will burn out less, so I will be able to provide better patient care. Are those fair points for pursing FM?? Also, what if I go into FM and realized I want to finish another residency after FM.. Is that possible?

 

What specialty were you originally considering? I'm wondering if it is one that is relatively common for FM docs to "specialize" in (e.g. low risk OB, anesthesia, psych, derm) as it might make it easier to make the decision easier if you didn't feel like you were "losing" that specialty entirely. Even if it isn't one with a traditional plus 1 program, is is something that could still include a tailored practice? Not sure where you're located/hoping to practice eventually, but there are programs like Project ECHO (See Arora et al, 2011, NEJM and https://www.echoontario.ca/Join-an-ECHO/Programs) which are looking to expand FM doc roles to include management of some of the simpler patients who were traditionally treated by specialists/subspecialists. Another resource I've found helpful is Northern Exposure (northernexposurepodcast.ca) which has profiled a few physicians who have done different +1 years or tailored their practice. It isn't exhaustive though, so hopefully they will release more episodes with different +1's.

 

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