Carms 2016 Match Data Out

[Edict]

http://www.carms.ca/en/data-and-reports/r-1/reports-2016/

 

Any comments? Mac, Queens and Ottawa seemed to have matched pretty well. 

[JohnGrisham]

1013/1203 that matched Family in 1st iteration, were 1st choice disciplines.

[Fresh fry]

3 people had emerge as a 2nd choice and matched to it!

[ralk]

Whipped up a rundown of match success by 1st choice of specialty - available here. Will follow-up with impressions soon!

[Fresh fry]

med micro???

[ralk]

med micro???

 

Small specialty, subject to extreme statistical variation, safe to ignore

[rmorelan]

http://www.carms.ca/en/data-and-reports/r-1/reports-2016/

 

Any comments? Mac, Queens and Ottawa seemed to have matched pretty well. 

 

not bad - probably within the usual random noise effects I woulds still say.

 

Overall in first round there was roughly a 6% unmatched rate country wide in first round. Roughly 50% of people from the prior year unmatched pool made it in the first round  match this time around.  

[ralk]

Ok, initial thoughts...

 

1) PM&R had good reason to get more competitive and it did! Not a huge surprise with hindsight, but the degree of change over the last few years has been impressive.

2) Rumors of Anesthesiology being uber-competitive this year were grossly exaggerated, it was a pretty typical year

3) Rumors of Rads being notably non-competitive this year were bang on

4) Rumors of IM having a competitive year were also pretty accurate

5) Surgical specialties bucked the recent trend and seemed to be more competitive overall, particularly Urology. Bit of a surprise to be honest.

6) The top 3 of Derm, Plastics and EM doesn't look like it'll stop anytime soon. All three hit lows in terms of match percentage when compared to the last 5 years.

[rmorelan]

Ok, initial thoughts...

 

1) PM&R had good reason to get more competitive and it did! Not a huge surprise with hindsight, but the degree of change over the last few years has been impressive.

2) Rumors of Anesthesiology being uber-competitive this year were grossly exaggerated, it was a pretty typical year

3) Rumors of Rads being notably non-competitive this year were bang on

4) Rumors of IM having a competitive year were also pretty accurate

5) Surgical specialties bucked the recent trend and seemed to be more competitive overall, particularly Urology. Bit of a surprise to be honest.

6) The top 3 of Derm, Plastics and EM doesn't look like it'll stop anytime soon. All three hit lows in terms of match percentage when compared to the last 5 years.

 

ha at fewer applicants to rads than actual positions you could say the luster is off Not exactly a surprise I think when you know what is going on.

 

top three probably aren't going anywhere any time soon I agree - well paid, good lifestyle, available jobs in suitable amounts in places people want to be.....

[NeuroD]

ha at fewer applicants to rads than actual positions you could say the luster is off Not exactly a surprise I think when you know what is going on.

What's going on?

[rmorelan]

What's going on?

 

well don't take this as complaints as I really do obviously like radiology and don't regret my choice. That being said radiology in most places is not or soon will not be a lifestyle specialty or far from it. In the community where most radiologists work call has been increasing workload wise just like in academic centres - however there are no residents there to shield anyone. Some places are 1-4 to 1-6 call with late nights (quite common - plus overnight calls, and you just have to work the next day). The daily work volume has exploded - it is extremely long and busy days (for instance some of our grads report back that they are starting working 8-9pm days plus coming in over the weekend just to keep up with what is considered a "typical week".

 

Basically now no one in the hospital can move it seems without imaging. There is a never ending pile of work - truly at times it is hard to get across exactly how busy radiology is. Something like 250 plain films a day, or 50 cross sectional studies - all with intense concentration to avoid a mistake or missing some subtle finding (easily twice what it was a relatively short time ago). On top of that is the procedures you are asked to do all in the same day.  

 

and yet the fees have been slashed and continue to do so. There are questions that on a per hour basis whether it is that much better than other fields (and if it isn't then what will it be moving forward). The field is getting trashed a bit in the media.

 

Despite the work, due to projected fee cuts jobs are not easy to get in many areas or sub-specialties. Locum after locum is the norm in many places (TO for instance has roughly a 50 to 1 ratio of applicants to positions according to our last career talk - and there are now extended period of what boils down to probation before you truly are working etc). Like other areas it may be possible to get hired in small centres but the thought of 70 hour weeks/call/weekends in such a place forever may not be what many people want.

 

So we have a tight job market, no jobs in many popular centres at all, and massively more work for less pay. Everything is getting squeezed - and the media makes it sound like we are robbing the system blind. Many staff aren't exactly shy about pointing all of this out either. Doesn't look like it will get better anytime soon.

 

Looking forward there is the possibility of shift work going 24/7 just to keep up with the emerg/inpatient demands for rapid imaging turn around. There are also some weird global cuts to imagining (say do only 3000 CTs this week) which are immediately followed by why is the waitlist for cancer workup this long! (ok for march you can do 2000 extra MRIs to catch up, but you have to do them all in March - watch everyone's schedule for March now go to hell).

 

hehehehe and of course no one else really seems to know any of this is going on. Radiology just sits in the background like it should - not exactly high profile. Behind the scenes there are some big issues.

 

oh and lastly the residency program itself is very demanding ha.

[NLengr]

Urology has always been pretty competative if you look at long term trends.

[GrouchoMarx]

well don't take this as complaints as I really do obviously like radiology and don't regret my choice. That being said radiology in most places is not or soon will not be a lifestyle specialty or far from it. In the community where most radiologists work call has been increasing workload wise just like in academic centres - however there are no residents there to shield anyone. Some places are 1-4 to 1-6 call with late nights (quite common - plus overnight calls, and you just have to work the next day). The daily work volume has exploded - it is extremely long and busy days (for instance some of our grads report back that they are starting working 8-9pm days plus coming in over the weekend just to keep up with what is considered a "typical week".

 

Basically now no one in the hospital can move it seems without imaging. There is a never ending pile of work - truly at times it is hard to get across exactly how busy radiology is. Something like 250 plain films a day, or 50 cross sectional studies - all with intense concentration to avoid a mistake or missing some subtle finding (easily twice what it was a relatively short time ago). On top of that is the procedures you are asked to do all in the same day.  

 

and yet the fees have been slashed and continue to do so. There are questions that on a per hour basis whether it is that much better than other fields (and if it isn't then what will it be moving forward). The field is getting trashed a bit in the media.

 

Despite the work, due to projected fee cuts jobs are not easy to get in many areas or sub-specialties. Locum after locum is the norm in many places (TO for instance has roughly a 50 to 1 ratio of applicants to positions according to our last career talk - and there are now extended period of what boils down to probation before you truly are working etc). Like other areas it may be possible to get hired in small centres but the thought of 70 hour weeks/call/weekends in such a place forever may not be what many people want.

 

So we have a tight job market, no jobs in many popular centres at all, and massively more work for less pay. Everything is getting squeezed - and the media makes it sound like we are robbing the system blind. Many staff aren't exactly shy about pointing all of this out either. Doesn't look like it will get better anytime soon.

 

Looking forward there is the possibility of shift work going 24/7 just to keep up with the emerg/inpatient demands for rapid imaging turn around. There are also some weird global cuts to imagining (say do only 3000 CTs this week) which are immediately followed by why is the waitlist for cancer workup this long! (ok for march you can do 2000 extra MRIs to catch up, but you have to do them all in March - watch everyone's schedule for March now go to hell).

 

hehehehe and of course no one else really seems to know any of this is going on. Radiology just sits in the background like it should - not exactly high profile. Behind the scenes there are some big issues.

 

oh and lastly the residency program itself is very demanding ha.

 

 

At least radiologists get paid for your work. More work, more remuneration. the slashing of fees is something that is happening to all fields, even family medicine. and its something that doesnt significantly reduce in one fell swoop. its more death by a thousand cuts. not only that, but radiologists on the whole are more professionally respected than pathologists, who might be the least respected physicians.

 

again i have to recommend students take a hard look at pathologys history. in ontario pathologists were prohibited from billing by a simple line put in place in the health insurance act, "other than a hospital laboratory". this happened in the 80s because pathologists were considered automatons not deserving of professional standing, making them an easy target for cost cutting. the oma did not do much to prevent this from happening either. apparently they tried this with radiology at that time but the radiologists, having bigger cojones and more professional respect, kept billing OHIP despite the regulations and managed to stave off any negativity.

 

source:

https://curve.carleton.ca/system/files/etd/fa8e0a95-8ca3-4816-bb7b-103d55eea17a/etd_pdf/c8154b3de4cda56e8bcbdc384665b819/sutherland-bitingthehandthatfeedsyouthepoliticaleconomy.pdf

 

another source:

https://www.ontario.ca/laws/regulation/900552

 

pathologists are entirely dependent on hospital contracts for their work, so theyre guaranteed to be overworked and underpaid. the decision to take on pathologists is entirely dependent not on the volume but on hospital administration. not only that, if a pathologist is paid below the "minimum level of compensation", which they always are, they get a "top up" from the government. however if the pathologists hospital has extra fulltime equivalents available, the pathologists already working there cannot use them above and beyond their agreement because it will cut into their "top up". not only that the whole concept of a "top up" is a late payment with opportunity costs associated with it.

 

no other physician specialty is so marginalized. take a good look at it before you dive in because of interest. if it bothers you to be marginalized dont do pathology. youll quickly lose the interest that got you here. 

[ralk]

At least radiologists get paid for your work. More work, more remuneration. the slashing of fees is something that is happening to all fields, even family medicine. and its something that doesnt significantly reduce in one fell swoop. its more death by a thousand cuts. not only that, but radiologists on the whole are more professionally respected than pathologists, who might be the least respected physicians.

 

again i have to recommend students take a hard look at pathologys history. in ontario pathologists were prohibited from billing by a simple line put in place in the health insurance act, "other than a hospital laboratory". this happened in the 80s because pathologists were considered automatons not deserving of professional standing, making them an easy target for cost cutting. the oma did not do much to prevent this from happening either. apparently they tried this with radiology at that time but the radiologists, having bigger cojones and more professional respect, kept billing OHIP despite the regulations and managed to stave off any negativity.

 

source:

https://curve.carleton.ca/system/files/etd/fa8e0a95-8ca3-4816-bb7b-103d55eea17a/etd_pdf/c8154b3de4cda56e8bcbdc384665b819/sutherland-bitingthehandthatfeedsyouthepoliticaleconomy.pdf

 

another source:

https://www.ontario.ca/laws/regulation/900552

 

pathologists are entirely dependent on hospital contracts for their work, so theyre guaranteed to be overworked and underpaid. the decision to take on pathologists is entirely dependent not on the volume but on hospital administration. not only that, if a pathologist is paid below the "minimum level of compensation", which they always are, they get a "top up" from the government. however if the pathologists hospital has extra fulltime equivalents available, the pathologists already working there cannot use them above and beyond their agreement because it will cut into their "top up". not only that the whole concept of a "top up" is a late payment with opportunity costs associated with it.

 

no other physician specialty is so marginalized. take a good look at it before you dive in because of interest. if it bothers you to be marginalized dont do pathology. youll quickly lose the interest that got you here. 

 

Something I could use some clarification on - in Ontario, Path salaries are pretty easy to determine because of the sunshine list and the typical compensation really doesn't seem that bad at all, something I've heard repeated from the Pathologists themselves at my site. They're nowhere near the top earners, but it's nothing to scoff at. Pathologists' workloads don't seem abnormally higher either when compared to other specialties and the few surveys done on work hours put Pathologists on the lower end of the spectrum in terms of overall workweek hours.

 

I'm not a pathologist or particularly interested in pathology, but I'm trying to square what I've seen and heard about the specialty so far with what you're saying, because it's fairly contradictory.

[rmorelan]

At least radiologists get paid for your work. More work, more remuneration. the slashing of fees is something that is happening to all fields, even family medicine. and its something that doesnt significantly reduce in one fell swoop. its more death by a thousand cuts. not only that, but radiologists on the whole are more professionally respected than pathologists, who might be the least respected physicians.

 

again i have to recommend students take a hard look at pathologys history. in ontario pathologists were prohibited from billing by a simple line put in place in the health insurance act, "other than a hospital laboratory". this happened in the 80s because pathologists were considered automatons not deserving of professional standing, making them an easy target for cost cutting. the oma did not do much to prevent this from happening either. apparently they tried this with radiology at that time but the radiologists, having bigger cojones and more professional respect, kept billing OHIP despite the regulations and managed to stave off any negativity.

 

source:

https://curve.carleton.ca/system/files/etd/fa8e0a95-8ca3-4816-bb7b-103d55eea17a/etd_pdf/c8154b3de4cda56e8bcbdc384665b819/sutherland-bitingthehandthatfeedsyouthepoliticaleconomy.pdf

 

another source:

https://www.ontario.ca/laws/regulation/900552

 

pathologists are entirely dependent on hospital contracts for their work, so theyre guaranteed to be overworked and underpaid. the decision to take on pathologists is entirely dependent not on the volume but on hospital administration. not only that, if a pathologist is paid below the "minimum level of compensation", which they always are, they get a "top up" from the government. however if the pathologists hospital has extra fulltime equivalents available, the pathologists already working there cannot use them above and beyond their agreement because it will cut into their "top up". not only that the whole concept of a "top up" is a late payment with opportunity costs associated with it.

 

no other physician specialty is so marginalized. take a good look at it before you dive in because of interest. if it bothers you to be marginalized dont do pathology. youll quickly lose the interest that got you here. 

 

everyone has been cut of course (and the fee cuts where really only one factor - and not the most important one at that - in my comments.) Radiology has been cut more proportionally (not even saying that shouldn't happen - just that it has - and that has an impact on the number of applicants).

[GrouchoMarx]

everyone has been cut of course (and the fee cuts where really only one factor - and not the most important one at that - in my comments.) Radiology has been cut more proportionally (not even saying that shouldn't happen - just that it has - and that has an impact on the number of applicants).

 

i totally see that and really appreciate your take on the situation in radiology. an inside view of the challenges a profession faces is both valuable and difficult to find. i hope to provide similar information for those considering pathology so theyre not surprised by the situation.

[Lactic Folly]

Something I could use some clarification on - in Ontario, Path salaries are pretty easy to determine because of the sunshine list and the typical compensation really doesn't seem that bad at all, something I've heard repeated from the Pathologists themselves at my site. They're nowhere near the top earners, but it's nothing to scoff at. Pathologists' workloads don't seem abnormally higher either when compared to other specialties and the few surveys done on work hours put Pathologists on the lower end of the spectrum in terms of overall workweek hours.

 

I'm not a pathologist or particularly interested in pathology, but I'm trying to square what I've seen and heard about the specialty so far with what you're saying, because it's fairly contradictory.

I think the deeper issue being referred to is the perceived lack of autonomy, which is something I heard from pathologists when I was a medical student.

[shikimate]

At least radiologists get paid for your work. More work, more remuneration. the slashing of fees is something that is happening to all fields, even family medicine. and its something that doesnt significantly reduce in one fell swoop. its more death by a thousand cuts. not only that, but radiologists on the whole are more professionally respected than pathologists, who might be the least respected physicians.

 

again i have to recommend students take a hard look at pathologys history. in ontario pathologists were prohibited from billing by a simple line put in place in the health insurance act, "other than a hospital laboratory". this happened in the 80s because pathologists were considered automatons not deserving of professional standing, making them an easy target for cost cutting. the oma did not do much to prevent this from happening either. apparently they tried this with radiology at that time but the radiologists, having bigger cojones and more professional respect, kept billing OHIP despite the regulations and managed to stave off any negativity.

 

source:

https://curve.carleton.ca/system/files/etd/fa8e0a95-8ca3-4816-bb7b-103d55eea17a/etd_pdf/c8154b3de4cda56e8bcbdc384665b819/sutherland-bitingthehandthatfeedsyouthepoliticaleconomy.pdf

 

another source:

https://www.ontario.ca/laws/regulation/900552

 

pathologists are entirely dependent on hospital contracts for their work, so theyre guaranteed to be overworked and underpaid. the decision to take on pathologists is entirely dependent not on the volume but on hospital administration. not only that, if a pathologist is paid below the "minimum level of compensation", which they always are, they get a "top up" from the government. however if the pathologists hospital has extra fulltime equivalents available, the pathologists already working there cannot use them above and beyond their agreement because it will cut into their "top up". not only that the whole concept of a "top up" is a late payment with opportunity costs associated with it.

 

no other physician specialty is so marginalized. take a good look at it before you dive in because of interest. if it bothers you to be marginalized dont do pathology. youll quickly lose the interest that got you here. 

 

Fantastic insights, I will just highlight one quote from one of the quoted reports, and something for pre-meds, med students, residents and beyond to think about 

 

"This doctor blaming is the corollary of biomedicine's focus on individual physicians as the arbiters of good health care and the system's gatekeepers. When something goes wrong it has to be a problem with physicians.

[ralk]

I think the deeper issue being referred to is the perceived lack of autonomy, which is something I heard from pathologists when I was a medical student.

 

That's fair, but I'll point out that most hospital employees - most employees in general - have a perceived lack of autonomy. I guess I'm missing how that perceived lack of autonomy is leading to egregious outcomes, specifically those mentioned in terms of pay and hours. Province-reported Pathologist pay is far from being terrible when compared to many other specialties and physician-reported hours worked is on the lower end of the spectrum. I'm failing to see where the "guaranteed to be overworked and underpaid" statement comes from - mapping out my own career path, in FM I'm expecting to work more hours for significantly less money than the typical Pathologist based on the data I've seen thus far - admittedly with less training time, but there are 5 year specialties in roughly the same boat.

[seeking1]

Ok, initial thoughts...

 

1) PM&R had good reason to get more competitive and it did! Not a huge surprise with hindsight, but the degree of change over the last few years has been impressive.

2) Rumors of Anesthesiology being uber-competitive this year were grossly exaggerated, it was a pretty typical year

3) Rumors of Rads being notably non-competitive this year were bang on

4) Rumors of IM having a competitive year were also pretty accurate

5) Surgical specialties bucked the recent trend and seemed to be more competitive overall, particularly Urology. Bit of a surprise to be honest.

6) The top 3 of Derm, Plastics and EM doesn't look like it'll stop anytime soon. All three hit lows in terms of match percentage when compared to the last 5 years.

 

Why's PM&R so competitive this time around?

[btdubs]

Why's PM&R so competitive this time around?

Just a guess here, but I'm assuming that the job prospects are looking pretty good in the next few decades... lots of stroke rehab and the like.

 

I could be completely wrong though. Maybe it's a more "pleasant" residency than others?

[ralk]

Just a guess here, but I'm assuming that the job prospects are looking pretty good in the next few decades... lots of stroke rehab and the like.

I could be completely wrong though. Maybe it's a more "pleasant" residency than others?

I think that's a decent part of it. It's a pretty diverse field with plenty of variety, decent pay, decent job market, generally good lifestyle after residency and I hear that it's one of the better ones during residency too. It's always been a bit of a hidden gem, it's just now a little less hidden as the current poor job market in many specialties forces students to consider fields with more reliable job opportunities.

 

It's also a small field, which comes with year-to-year variation in competitiveness, though the change from this year to last is still fairly dramatic.

[GrouchoMarx]

That's fair, but I'll point out that most hospital employees - most employees in general - have a perceived lack of autonomy. I guess I'm missing how that perceived lack of autonomy is leading to egregious outcomes, specifically those mentioned in terms of pay and hours. Province-reported Pathologist pay is far from being terrible when compared to many other specialties and physician-reported hours worked is on the lower end of the spectrum. I'm failing to see where the "guaranteed to be overworked and underpaid" statement comes from - mapping out my own career path, in FM I'm expecting to work more hours for significantly less money than the typical Pathologist based on the data I've seen thus far - admittedly with less training time, but there are 5 year specialties in roughly the same boat.

 

i will start by saying that family doctors are incredibly undervalued. the thirty dollars they receive for seeing a patient is dangerously low and encourages assembly line medicine. in pathology you see the aftereffects of rushed medical practice in some of the autopsies, like missed posterior MIs, missed mesenteric ischemia, and others. but if you dont rush, your practice goes belly up. the government's solution is to give practice privileges to naturopaths and nurses instead of paying fair value for the work of our family doctors. the oma fights to prevent cataract fees from being slashed instead of at least acknowledging the huge disparity between certain fields. i foresee more deaths from simple diagnoses.

 

ralk, if you havent already, i advise you to really think about what kind of practice you want in family. then find a doctor who practices similarly and learn about the possibilities. try not to get blindsided by the more mundane but very important administrative and financial things. in other words, try to look before you leap. 

 

---

 

being the only physician specialty that is predominantly salaried brings with it a reduction in professionalism and autonomy, which is the biggest issue. money is also an issue but less so.

 

the numbers look like a lot but salaries are generally worse than corporations because of the tax burdens and absence of control of workplace factors like ancillary staff recruitment. any supposed extras like benefits and rrsp never offset the tax losses. ive not heard, in ontario at least, of salaried pathologists getting overtime, something that salaried employees generally get, for having to stay after hours, which at some high volume institutions is the norm. in ontario the sunshine list makes you and your family a public target. i can tell you the name of half o the pathologists in ontario and their earnings, which sound like a lot to most people, but i cant tell you the names of any of the ophthalmologists billing over a million. being on the sunshine lists supports that pathologists are not physicians but are overtrained technical workers. its not fair. no physician should have their incomes out in the open like that. all things considered, the take home for a salaried pathologist is less than the 180k that an average family doctor would take home after overhead. this would make them one of the lowest paid specialties in medicine.

 

i am very disappointed in how marginalized pathologists have become, in a very arbitrary fashion. from my readings i gathered that back in the 80s the automated lab work was getting too expensive so the government just decided to stop paying for it. unfortunately, since surgical pathology was also considered "lab" it was cut along with it, even though it is non-technical consultation and not automated. doesnt seem like pathologists have had any luck, or have even tried, to get this misunderstanding fixed. i totally agree with not paying fees for automated work, but lumping surgpath in with it is a mistake thats not been rectified. the oma has also not been effective in this matter and doesnt seem to represent pathologists at all. 

 

 

 

------

 

ralk asked how lack of autonomy leads to egregious outcomes. here is my take. control of the practice rests with the payor. the payor wants to find the perfect employee: quiet, cheap and does what theyre told. know that zero medicolegal liability falls on the administrators that hire. if there are two pathologists, one has good training, and one does not, the one with the bad training would be more willing to take a smaller salary, less vacation time, fewer benefits. more importantly because they know they have fewer opportunities, they are  less likely to rock the boat and will go along with whatever theyre told. they might also not have the insight or experience to know when there is a problem. if there are problems with 'quality' the poorly trained person will be quiet = a better employee. the lack of departmental quality will spill over to the other pathologists who will need to play along as well, otherwise they get replaced by another quiet employee. if there is a dangerous problem with the technical side of the department, the pathologists are powerless to fix it. these are how mistakes happen. 

 

none of this sounds good, which is why few cmgs go into pathology. with the low recruitment of talent and the challenging practice environment both resulting in mistakes, the government's solution is not to improve these things but to expand residency programs to recruit more imgs and to over-regulate the practice of pathology. 

to add to that, cancer care ontario is currently partnered with the CPSO to police pathologists. this was decided unilaterally without consultation with the ontario association of pathologists. the college now has direct oversight of pathologists daily practice. this makes me very uncomfortable and marginalizes the field even more. the self-regulating nature of a profession does not exist in pathology.

 

for anyone that values autonomy, pathology should not even be considered as a career. admittedly the income is average for physicians if you find a non-salaried position, and is below average for salaried, and there is a definite ceiling that has been arbitrarily determined and your practice will be dictated and policed by external organizations.

 

 

---

 

Why's PM&R so competitive this time around?

 

PMR: one of my friends is a PMR and he tells me that there are two big monetary draws to PMR practice: private insurance consultations to catch fakers, and interventional pain. both of these things are said to be very lucrative. PMR is a great field for students who enjoy the mechanical aspects of MSK but dont enjoy the more immunological aspects (rheum would be a better choice there) and dont like ortho surgery. the secret might be out.

[Thunderbirds]

This is going to be a somewhat strange question, but how do people manage to match to alternative disciplines? For eg. 43.8% of people who had Dermatology as their 1st choice discipline matched to an alternative one. Now, I am probably making a big assumption, but these people probably did majority of their electives in Dermatology. How does the other program still take those people despite knowing it isn't their #1 choice? These days, people talk about how FM doesn't want you if they see 6 weeks of electives in one specialty.

 

TL;DR: how do you manage to be competitive for your "back-up" option while competing with people who have it as their #1? I guess it isn't that bad. One of the biggest dilemmas is how much backing up should one do, or go all-in for one specialty. 

[ralk]

i will start by saying that family doctors are incredibly undervalued. the thirty dollars they receive for seeing a patient is dangerously low and encourages assembly line medicine. in pathology you see the aftereffects of rushed medical practice in some of the autopsies, like missed posterior MIs, missed mesenteric ischemia, and others. but if you dont rush, your practice goes belly up. the government's solution is to give practice privileges to naturopaths and nurses instead of paying fair value for the work of our family doctors. the oma fights to i foresee more deaths from simple diagnoses.

 

ralk, if you havent already, i advise you to really think about what kind of practice you want in family. then find a doctor who practices similarly and learn about the possibilities. try not to get blindsided by the more mundane but very important administrative and financial things. in other words, try to look before you leap. 

 

---

 

being the only physician specialty that is predominantly salaried brings with it a reduction in professionalism and autonomy, which is the biggest issue. money is also an issue but less so.

 

the numbers look like a lot but salaries are generally worse than corporations because of the tax burdens and absence of control of workplace factors like ancillary staff recruitment. any supposed extras like benefits and rrsp never offset the tax losses. ive not heard, in ontario at least, of salaried pathologists getting overtime, something that salaried employees generally get, for having to stay after hours, which at some high volume institutions is the norm. in ontario the sunshine list makes you and your family a public target. i can tell you the name of half o the pathologists in ontario and their earnings, which sound like a lot to most people, but i cant tell you the names of any of the ophthalmologists billing over a million. being on the sunshine lists supports that pathologists are not physicians but are overtrained technical workers. its not fair. no physician should have their incomes out in the open like that. all things considered, the take home for a salaried pathologist is less than the 180k that an average family doctor would take home after overhead. this would make them one of the lowest paid specialties in medicine.

 

i am very disappointed in how marginalized pathologists have become, in a very arbitrary fashion. from my readings i gathered that back in the 80s the automated lab work was getting too expensive so the government just decided to stop paying for it. unfortunately, since surgical pathology was also considered "lab" it was cut along with it, even though it is non-technical consultation and not automated. doesnt seem like pathologists have had any luck, or have even tried, to get this misunderstanding fixed. i totally agree with not paying fees for automated work, but lumping surgpath in with it is a mistake thats not been rectified. the oma has also not been effective in this matter and doesnt seem to represent pathologists at all. 

 

 

 

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ralk asked how lack of autonomy leads to egregious outcomes. here is my take. control of the practice rests with the payor. the payor wants to find the perfect employee: quiet, cheap and does what theyre told. know that zero medicolegal liability falls on the administrators that hire. if there are two pathologists, one has good training, and one does not, the one with the bad training would be more willing to take a smaller salary, less vacation time, fewer benefits. more importantly because they know they have fewer opportunities, they are  less likely to rock the boat and will go along with whatever theyre told. they might also not have the insight or experience to know when there is a problem. if there are problems with 'quality' the poorly trained person will be quiet = a better employee. the lack of departmental quality will spill over to the other pathologists who will need to play along as well, otherwise they get replaced by another quiet employee. if there is a dangerous problem with the technical side of the department, the pathologists are powerless to fix it. these are how mistakes happen. 

 

none of this sounds good, which is why few cmgs go into pathology. with the low recruitment of talent and the challenging practice environment both resulting in mistakes, the government's solution is not to improve these things but to expand residency programs to recruit more imgs and to over-regulate the practice of pathology. 

to add to that, cancer care ontario is currently partnered with the CPSO to police pathologists. this was decided unilaterally without consultation with the ontario association of pathologists. the college now has direct oversight of pathologists daily practice. this makes me very uncomfortable and marginalizes the field even more. the self-regulating nature of a profession does not exist in pathology.

 

for anyone that values autonomy, pathology should not even be considered as a career. admittedly the income is average for physicians if you find a non-salaried position, and is below average for salaried, and there is a definite ceiling that has been arbitrarily determined and your practice will be dictated and policed by external organizations.

 

 

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PMR: one of my friends is a PMR and he tells me that there are two big monetary draws to PMR practice: private insurance consultations to catch fakers, and interventional pain. both of these things are said to be very lucrative. PMR is a great field for students who enjoy the mechanical aspects of MSK but dont enjoy the more immunological aspects (rheum would be a better choice there) and dont like ortho surgery. the secret might be out.

 

Of course, I'm exploring multiple practice types and locations. I've been asking preceptors as much as I can about the business side of things - how much administrative work they do, impacts on free time and family life, ability to adjust practice, as well as compensation for various activities. I've had a chance to work at several different clinics and while all seem busy, none seem particularly rushed seeing ~25 patients a day and I can see myself - with a fair bit more knowledge and familiarity - being able to keep up. Most other specialties seem to move at an even faster pace when considering severity and acuity of the conditions involved. I agree that there are FPs who churn through far too many patients, but from what I've seen, that's not a necessity for FPs that bill appropriately, work efficiently, and put a higher priority on good patient care than maximizing income.

 

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I think I'm still missing something when it comes to Pathologists. Being salaried does provide some bad incentives for employers, but that's not unique to pathologists (public health is also often salaried) and I'm not seeing evidence of those bad incentives in play. Pathologists on the Sunshine List (which I generally agree shouldn't be publicizing salaries the way it does) are clustered around the same level of compensation, particularly within individual institutions, so undercutting does not appear to be having much of an effect. Compensation appears have declined marginally, but no more than what other physicians have experienced in Ontario. I'm also failing to see how this is leading to overworked pathologists considering the fairly reasonable hours pathologists themselves are reporting and the near-lack of call requirements. I really fail to see how the salaries reported will fall below the FM standard pre-tax amount of around $180k - with just RRSP deductions, total take-home income will fall near or above $180k. Incorporating helps, but it doesn't come close to eliminating tax burdens entirely!

 

A number of your complaints just don't make sense to me as a way to single out Pathology as being in a uniquely bad situation. The OMA hasn't been effective in promoting any specialty's interests lately. The CPSO is the regulator for all specialties, not just Pathology - the Ontario Association of Pathologists has no legal authority and neither do any of the other provincial specialty associations. Salaried positions generally don't receive overtime pay in any field, and physicians of all backgrounds do a ton of uncompensated work.

 

I do understand the value of autonomy, since I'm choosing FM because it allows me an autonomy most other specialties won't. However, I feel like you're saying the sky is falling when it comes to Pathology, yet all I see are some dark-ish clouds. Aside from autonomy and the mediocre job market, there's a disconnect to me between what you're saying and what I'm seeing. I'd like to clarify where that disconnect lies, because right now I'm clearly not getting it.

A number of your complaints just don't make sense to me as a way to single out Pathology as being in a uniquely bad situation. The OMA hasn't been effective in promoting any specialty's interests lately. The CPSO is the regulator for all specialties, not just Pathology - the Ontario Association of Pathologists has no legal authority and neither do any of the other provincial specialty associations. Salaried positions generally don't receive overtime pay in any field, and physicians of all backgrounds do a ton of uncompensated work.