Working in the Middle East

[aeromed]

Me too, I just don't think they'd be on p101 bringing others down.

 

well i am sorry. Just needs to be said some times to bring people back to reality. I apologize for the personal attacks

[Cnussey]

well i am sorry. Just needs to be said some times to bring people back to reality. I apologize for the personal attacks

 

Not sure she meant you specifically, but apologies are always nice to see.

[Jochi1543]

well i am sorry. Just needs to be said some times to bring people back to reality. I apologize for the personal attacks

 

I wasn't referring to you, actually, I pretty much agree with your POV.

[leviathan]

If I won $100 million tomorrow I'd still be a doctor. I probably wouldn't work as many hours though.

[bnface]

HAHA...you guys are great. I am not talking from a moral high-horse; it may seem that way because you recognize that a viewpoint that you possibly agree with (i.e. moving to Dubai to avoid taxes) is unjustifiable morally and probably have gone into defensive mode as a result. Your arguments have become centred on a) attacking me or arguing for practicality over doing what’s right.

 

I am not telling anyone to live their lives against their individual wishes. What I am trying to do is put forth an argument that your individual wishes should probably incorporate some degree of respect for your local community and country in a forum that seems to increasingly be headed towards the ways of the SDN forums (i.e. becoming dominated by people who have forgotten the meaning of professionalism). Apparently we all “bull****ed” our ways through medical school interviews. It doesn’t have to be that way though. Every so often, we can try to actually uphold some of the ideals that we convinced the admissions committees that we believe in. As physicians, we will be fortunate enough to be able to achieve these ideals while earning a 6-figure salary. Brooksbane will say I’m crazy, naive, and that I should let my bank account guide me. My response is I think about my potential earnings everytime I consider my future specialty, but not as an exclusive factor. Will I change once I start working? I’ve seen enough physicians to know that it is possible to be extremely pleased with a career helping people while being able to pay the bills and buy a house. Others will say that I can't live by what I am writing, so that I shouldn't be making the argument. To them, I say: read about logical fallacies, then we can chat.

 

If you don’t care, then ignore me please. Hopefully you go into cosmetic derm or something.

 

P.S. I really have an issue with people who claim to speak from the “real world” and come across with all these cynical pseudo-realities. The world really is not that scary if you can be disciplined about your spending habits, do something you love, and have with certain guiding principles in mind that you can live with at the end of the day.

 

P.P.S. I am neither perfect nor claim to be so. I am offering my personal view on the matter. If you agree, or have changed your mind to agree, I’m happy. If you’d like to attack my intelligence, go ahead, because it doesn’t really phase me. If you have a valid counterpoint to provide, I’d be happy to hear it.

 

Anyways, I'm done with this thread. As I have presented my view, there's not much else that I can add to this discussion.

[utmed13]

After reading all this army stuff, I'm sort of wondering if anyone would consider going to saudi arabia or dubai for a year after you're done? The pay is ridiculous, tax free, they give you a car, place to live, pay for your kids education, give you 6 weeks education; plus, Dubai is supposed to be beautiful! Seems like a better alternative to me if you're going into the army for the money thing. Anyone?

 

I probably wouldn't mind doing a rotation in the middleeast and maybe working after. I grew up in the middle east with parents working as doctors, so if you really have qs about what its like here, send me a pm.

[aeromed]

HAHA...you guys are great. I am not talking from a moral high-horse; it may seem that way because you recognize that a viewpoint that you possibly agree with (i.e. moving to Dubai to avoid taxes) is unjustifiable morally and probably have gone into defensive mode as a result. Your arguments have become centred on a) attacking me or arguing for practicality over doing what’s right.

 

I am not telling anyone to live their lives against their individual wishes. What I am trying to do is put forth an argument that your individual wishes should probably incorporate some degree of respect for your local community and country in a forum that seems to increasingly be headed towards the ways of the SDN forums (i.e. becoming dominated by people who have forgotten the meaning of professionalism). Apparently we all “bull****ed” our ways through medical school interviews. It doesn’t have to be that way though. Every so often, we can try to actually uphold some of the ideals that we convinced the admissions committees that we believe in. As physicians, we will be fortunate enough to be able to achieve these ideals while earning a 6-figure salary. Brooksbane will say I’m crazy, naive, and that I should let my bank account guide me. My response is I think about my potential earnings everytime I consider my future specialty, but not as an exclusive factor. Will I change once I start working? I’ve seen enough physicians to know that it is possible to be extremely pleased with a career helping people while being able to pay the bills and buy a house. Others will say that I can't live by what I am writing, so that I shouldn't be making the argument. To them, I say: read about logical fallacies, then we can chat.

 

If you don’t care, then ignore me please. Hopefully you go into cosmetic derm or something.

 

P.S. I really have an issue with people who claim to speak from the “real world” and come across with all these cynical pseudo-realities. The world really is not that scary if you can be disciplined about your spending habits, do something you love, and have with certain guiding principles in mind that you can live with at the end of the day.

 

P.P.S. I am neither perfect nor claim to be so. I am offering my personal view on the matter. If you agree, or have changed your mind to agree, I’m happy. If you’d like to attack my intelligence, go ahead, because it doesn’t really phase me. If you have a valid counterpoint to provide, I’d be happy to hear it.

 

 

Anyways, I'm done with this thread. As I have presented my view, there's not much else that I can add to this discussion.

 

Again, the crusader who will make his/her six figure salary.

I think you are trying to convince yourself. You keep telling yourself you are in medicine because you have burning desire to help humanity at any cost.

 

I personally really respect people who are true humanitarians, not posers like yourself who have their whole future financially secured. Put your money when your mouth is and forfeit the high salary and set an example for the rest of the "professionals". Its people like you who lie to themselves about their true motivations that are an embarrassment and joke.

 

Happy with career with paying bills and able to buy a house you say? Ok. well you can do that on 45,000 easy. You know what take the big salary till you pay off your education debt and then work for $40,000.

 

Let me know how that goes. You are truly inspiring. Here is something you should think about: Actions speak louder then words. So show us and tell us about your amazing selfless life, I am very interested. Until then you have nothing to preach about.

[Cnussey]

If I won $100 million tomorrow I'd still be a doctor. I probably wouldn't work as many hours though.

 

I'd be able to find a wonderful nanny rather than a "doable" day care. Lol. And my "power" suits wouldn't be from Sears. LOL.

[Guest BluePin]

Why not split the difference?...

 

Taking subsidized medical education in Canada + leaving to work in a tax-haven such as Dubai at higher salary rate + avoiding Canadian taxes + returning to Canada once retired to take advantage of subsidized health care = a bit of a violation of the spirit of the system & profession.

 

Working overseas for a few years after school to pay off debt = prudent financial planning.

[Cnussey]

Why not split the difference?...

 

Taking subsidized medical education in Canada + leaving to work in a tax-haven such as Dubai at higher salary rate + avoiding Canadian taxes + returning to Canada once retired to take advantage of subsidized health care = a bit of a violation of the spirit of the system & profession.

 

Working overseas for a few years after school to pay off debt = prudent financial planning.

 

I warn you all...if you come back, you will pay the tax!

[Everlast]

I lived in the Middle East - would highly recommend it. There are a lot of misconceptions about the area but overall the people are very welcoming and the countries are just beautiful. And you can't beat the weather or cost of living! Also, from a medical perspective you can rest assured that you will have access to any piece of equipment that money can buy.

[boodog]

where are some links with info on this?

[Mamie]

I reject the idea that as Canadian physicians, we owe a debt to our society.

 

Yes, our education is heavily subsidized. But in our 1.5-2 years as clinical clerks, we are exceptionally underpaid in the form of a 'bursary', which amounts to less than one quarter of minimum wage. And as clinical clerks, we work HARD. Generally, working leads to appropriate financial compensation. Apparently in medicine, this does not follow. All of this means that by the time we are done medical school, we have already contributed fairly skilled labour to the betterment of our society almost for free.

 

Then we move on to residency, where we are paid. However, we are absolutely underpaid considering the level of education that we have acheived and the unique skill set that we have. And we continue to be underpaid for 2-7 years while providing medical care to our communities.

 

Of course we are still learners while we are clerks and residents. However, service makes up a large part of our day to day work and we are not reasonably compensated for it.

 

By the end of our training, I think that we have more than repaid our debt to the society that subsidized our medical education. So, I can't object to someone who wants to go abroad and be better compensated than he/ she would be in Canada. The argument that we have an ongoing obligation to our own country once we have spent so many years being unpaid/ underpaid is entirely false.

[bayervillager]

Hey everone! I agree with many of the posters above such as Jochi, Cnussey etc. about the points that they are making, and I also agree that bnface did come off as holier-than-thou.

 

However, I disagree with the all-or-nothing view that some seem to be proposing. I think that while there's nobody here who can be Mother Theresa, St. Nicholas, Buddha... (insert other selfless people here), our choice shouldn't be about complete altruism or zero altruism. There is a middle way here.

 

And Mamie, yes, we work incredibly hard during clerkship. However, just to point out what's going on in other health professions: PT and OT students do their placements where they also work hard and are responsible for a lot of patient care, but receive no compensation (at least at Queen's). Queen's-affiliated Resp Therapy and Radiation Tech students get nothing too. And correct me if I'm wrong, but I'm pretty sure Nursing students also get zero compensation.

 

And remember those student teachers we all had in elementary/middle/high school who basically did everything while your real teacher sat back and watched? Education students don't get any money during their placements even though they essentially teach the class.

 

So in my opinion, the stipend that we get for clerkship when we are still very much awkward learners is amazing, and many kudos to the folks at OMSA for arranging us that tidy little raise too.

[marshan]

Ditto. I lived in Saudi and the Middle East is a fantastic place to experience a new culture and a new way to practice medicine. You don't have to do it for life, just get a little taste and enjoy the benefits (and I'm talking about the wonderful food, not the salary!)

 

I enjoyed it so much, that I say it may in fact be worth the moral brow beating you could get from some of your high-horse colleagues.

 

I lived in the Middle East - would highly recommend it. There are a lot of misconceptions about the area but overall the people are very welcoming and the countries are just beautiful. And you can't beat the weather or cost of living! Also, from a medical perspective you can rest assured that you will have access to any piece of equipment that money can buy.

[Wolvenstar]

I won't bash people who feel the need to work abroad, indeed the idea of spending a couple of years in europe or australia/new zealand while making good money is very appealing to myself. The middle east not so much but everyone has their cliches.

 

At the same time I can completely understand what some people say about feeling a need to give back to their country. I love Canada, have applied to the military reserves for part time work during my undergraduate and plan to go through the military to finance my medical education and then serve my four years proudly. I think very highly of others who decide to give back to the country that has given us so much.

 

It is not that I look down upon those who don't feel the desire to give back to their country, only that I have increased respect for those who do.

[covarubious]

didn't you just apologise for making personal attacks just a few posts ago and now you are making personal attacks again while going on about hypocrisy?? i guess actions do speak louder then words...

 

Again, the crusader who will make his/her six figure salary.

I think you are trying to convince yourself. You keep telling yourself you are in medicine because you have burning desire to help humanity at any cost.

 

I personally really respect people who are true humanitarians, not posers like yourself who have their whole future financially secured. Put your money when your mouth is and forfeit the high salary and set an example for the rest of the "professionals". Its people like you who lie to themselves about their true motivations that are an embarrassment and joke.

 

Happy with career with paying bills and able to buy a house you say? Ok. well you can do that on 45,000 easy. You know what take the big salary till you pay off your education debt and then work for $40,000.

 

Let me know how that goes. You are truly inspiring. Here is something you should think about: Actions speak louder then words. So show us and tell us about your amazing selfless life, I am very interested. Until then you have nothing to preach about.

[Rock*]

I reject the idea that as Canadian physicians, we owe a debt to our society.

 

Yes, our education is heavily subsidized. But in our 1.5-2 years as clinical clerks, we are exceptionally underpaid in the form of a 'bursary', which amounts to less than one quarter of minimum wage. And as clinical clerks, we work HARD. Generally, working leads to appropriate financial compensation. Apparently in medicine, this does not follow. All of this means that by the time we are done medical school, we have already contributed fairly skilled labour to the betterment of our society almost for free.

 

Then we move on to residency, where we are paid. However, we are absolutely underpaid considering the level of education that we have acheived and the unique skill set that we have. And we continue to be underpaid for 2-7 years while providing medical care to our communities.

 

Of course we are still learners while we are clerks and residents. However, service makes up a large part of our day to day work and we are not reasonably compensated for it.

 

By the end of our training, I think that we have more than repaid our debt to the society that subsidized our medical education. So, I can't object to someone who wants to go abroad and be better compensated than he/ she would be in Canada. The argument that we have an ongoing obligation to our own country once we have spent so many years being unpaid/ underpaid is entirely false.

 

Having just come off a week of working just shy of 100 hours in surgery yet getting paid only $2.50 for 40 "official" hours and getting a quarter of that amount deducted in parking fees, I cannot agree with you more.

[Microbiodude]

I reject the idea that as Canadian physicians, we owe a debt to our society.

 

Yes, our education is heavily subsidized. But in our 1.5-2 years as clinical clerks, we are exceptionally underpaid in the form of a 'bursary', which amounts to less than one quarter of minimum wage. And as clinical clerks, we work HARD. Generally, working leads to appropriate financial compensation. Apparently in medicine, this does not follow. All of this means that by the time we are done medical school, we have already contributed fairly skilled labour to the betterment of our society almost for free.

 

Then we move on to residency, where we are paid. However, we are absolutely underpaid considering the level of education that we have acheived and the unique skill set that we have. And we continue to be underpaid for 2-7 years while providing medical care to our communities.

 

Of course we are still learners while we are clerks and residents. However, service makes up a large part of our day to day work and we are not reasonably compensated for it.

 

By the end of our training, I think that we have more than repaid our debt to the society that subsidized our medical education. So, I can't object to someone who wants to go abroad and be better compensated than he/ she would be in Canada. The argument that we have an ongoing obligation to our own country once we have spent so many years being unpaid/ underpaid is entirely false.

 

I guess the thing with debates is you can always put the twist you desire. Clerks definitely do work hard but you're there to learn and the government is paying a physician/ resident/ supervisor to watch over your every step. I mean at the end of the day, why do you have clerkships? So that you can practice the clinical skills you learned in class and get exposure to the different areas within medicine.

 

As an employer a clerk is someone who has no license to practice, has no relevant work experience since this is their first intensive experience in a clinical setting and on top of that a huge liability because they are learners and are bound to make mistakes.

 

Take this as an analogy (I apologize if it is a little crude):

 

You are a head mechanic with a trainee under your wing. They've never really worked with cars before just studied a lot of diagrams and read up on them. They also have some experience working with non-functioning cars which they studied to learn more about the mechanisms, etc. Car rolls in and you ask your trainee to do an oil change. Of course, since they've never done one before you have to watch over them when you could be dealing with another repair (opportunity cost). After the oil change is done, you realize they accidentally nicked the radiator and there is a leak and now you have to fix it (more opportunity cost in repairs for the time spent on correcting the nick). If there are more complications, the onus is on your since the trainee is free of liability (after all they are still a trainee and we need to be understanding). After all this your trainee feels they have been overworked and is asking for compensation for the time spent? What do you say to him/ her?

[interleukin]

Can someone please shed some insight into how to get involved in this? Maybe some numerical figures would be informative and interesting to hear also.

[Mamie]

Sure. In clerkship and residency you are still a learner. I agree. You're also providing service. On many of your rotations as a clerk and more and more as a resident, you are primarily providing service and getting less an less in the way of teaching.

 

In the end, this means that you are a highly educated, highly skilled person being paid very little in relation to your level of training. This fact, to me, means that you have paid back your debt to the society that educated you.

 

I'm all for people staying in their own country and because I hail from a highly underserviced area of northern Ontario, I really appreciate physicians going to underserviced areas to practice. However, I don't think that these people should do this because of some misplaced sense of obligation. That isn't sustainable for the communities in need and certainly won't result in a content physician work force.

[Mei_Mei_girl]

I wrote a post here before but deleted it...I don't want to "prove a point" in this conversation which alot of people seem to be taking personally...but for perspective's sake logically right now Canada needs more physicians. Its a matter of health care (particularly in rural/northern areas) being in dire need. I know this too personally since my dad died from being on a waitlist to see a specialist for too long -- just didn't make it with the crazy wait required. Some people who are living in large centres just as Toronto don't even have a family doctor. Draining out doctors from Canada (for whatever reason, such as the enticement of moving abroad to work) seems to pose a major risk. A few here there wouldn't seem to matter, and only going for a few years probably wouldn't make much of a difference. But to those who want to train here and then leave permanently consider the people you leave behind who are counting on you.

[aeromed]

I wrote a post here before but deleted it...I don't want to "prove a point" in this conversation which alot of people seem to be taking personally...but for perspective's sake logically right now Canada needs more physicians. Its a matter of health care (particularly in rural/northern areas) being in dire need. I know this too personally since my dad died from being on a waitlist to see a specialist for too long -- just didn't make it with the crazy wait required. Some people who are living in large centres just as Toronto don't even have a family doctor. Draining out doctors from Canada (for whatever reason, such as the enticement of moving abroad to work) seems to pose a major risk. A few here there wouldn't seem to matter, and only going for a few years probably wouldn't make much of a difference. But to those who want to train here and then leave permanently consider the people you leave behind who are counting on you.

 

 

OK. Point taken. But I hope you plan on going into family medicine (even though it pays less) to help with that shortage.

 

Also, another idea why don't we take a poll and ask the doctors of Canada to take a pay cut so more physicians can be trained in order to deal with the shortage. The reality is physicians are human; and humans are ultimately about self preservation. The system should be setup to harness that fact. I care about people a great deal as i believe all of us do on here. However, I care about my family much more then anyone else.

 

And yes I care about myself a great deal as well. If i did not, i would not be well educated, hardworking, and ambitious. All qualities that ALL doctors have. So you see, i believe its simply a matter of providing the right incentives, instead of arguing about what may or may be morally/socially right or wrong. Because i guarantee you in the end, financial security wins. Because even the best people look out for themselves and their families.

 

I am truly sorry about your father that is terrible.

 

However, If you want to discuss waiting lists maybe we should consider incorporating private medicine with public medicine on a larger scale.

[A-Stark]

And yes I care about myself a great deal as well. If i did not, i would not be well educated, hardworking, and ambitious. All qualities that ALL doctors have. So you see, i believe its simply a matter of providing the right incentives, instead of arguing about what may or may be morally/socially right or wrong. Because i guarantee you in the end, financial security wins. Because even the best people look out for themselves and their families.

 

On the contrary, reducing everything to "incentive" and "rational choices" takes an appallingly cynical view. Medicine is not a profession that can be divorced from moral or, indeed, social questions, particularly when conflicts of interest arise between incentives (fee-for-service for, say, operating) and what's best for the patients. Indeed, the adage that "more medicine is not better medicine" ought to be thought of as a small example of these issues.

 

However, If you want to discuss waiting lists maybe we should consider incorporating private medicine with public medicine on a larger scale.

 

Blah, blah, blah, vague generalities, private this, private that. Three questions for any kind of "incorporation" of fully private medicine: 1) Which patients, if any, will benefit and how? 2) Which physicians will benefit and why? 3) What has been the experience elsewhere?

 

(And if the phrase "European style public/private mix" comes up, let's here some specific examples, along with the fact that just about any European system has more comprehensive public care and higher public system spending as a proportion of total spending than does Canada.)

 

But that's somewhat off topic.

[AdamP]

Hmm...where to take this. There are obviously a lot of complex forces at play but a few things that come to mind, in terms of the obligation of a physician.

 

On repaying a debt to society...

 

A lot of comments have been based around well what I see as two separate but perhaps connected ideas. One being that as a physician you re-pay your debt during the long and underpaid hours spend as a clerk/resident. Another is that the qualities which make a doctor successful i.e. work ethic and ambition etc. will inherently perhaps cause us to want to find the best opportunities for ourselves.

 

I reject as false the concept of a 'self-made' person, weather or not you become a doctor the fact is your so called 'training' for it began when you were very young. You owe a debt to the institutions that have taught you, the schools etc. you owe a debt to the community groups, the sports teams, the volunteer organizations that have made you who you are. You owe a debt to your friends, your family, your neighbors, your coaches, teachers the list is never ending. You can't put some tangible price on this debt, and can't pay it off with 5 years of long hours and low pay.

 

That being said I'll be the first to say physicians should be given freedom of movement, wherever that movement may be. When you begin medschool (unless it's being paid by the military) you don't sign a contract saying that you for sure won't move to the US or the UAE or any other place. Adcoms, and subsequently the society at large has made the decision, I think correctly, that they don't want a profession of essentially 'slaves' forced to work where they are told. Not only would a system like that stifle creation, but I think if given the choice you'd prefer to be taken care of by a doc who actually wants to be where they are.

 

As far as solving the access problem, a parallel private system isn't going to help access in rural areas, what private company would open a clinic in any part of rural canada where the margins are so small? All we would see is some posh operating/mri suites in Toronto/Vancouver/Montreal where the people already have the best access. All that can be done is to consistently increase the spots available, as I understand it the real bottleneck isn't that med school spots are hard to open it's that there aren't enough attendings to train the graduates.