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Hi everyone,

I have been extremely lucky this cycle to receive offers from multiple schools. I have one school left to hear from but I have pretty much heard from all of my top choices. The main 2 that I've decided on are U of Alberta and McMaster but I am extremely torn. I wanted to hear some opinions on what people thought about the pros and cons of each school.

To give a bit more context, I am a mature applicant with many years of experience in healthcare. I've done many research projects, worked in different medical clinics (GP, ped, opth) and work experience at a surgical skills lab for 4 summers. Hence I might have a bit more understanding of what each clinical specialties entail than perhaps an average incoming first year.

I've narrowed down to a few specialties based on previous considerations and experiences, in order of preference currently: FM+1EM, EM, Plastics, ENT, Opth, Derm

From what I gather so far pros and cons are:

 

UofA

Pro: 4 year program with time to explore different specialties, very robust (a lot of strong departments)/good rep, strong research in area of my interest (machine learning), offered me bursary, very cheap tuition compared to ONT

Con: Away from home/family (I'm from Toronto) making uncertain opportunities to make connections back to Toronto, might waste a year compared to Mac esp if seriously considering FM+1EM

 

Mac

Pro: 3 year program accelerated into practice, self-directed learning which I LOVE, closer to Toronto where I can retain and expand my connections, will be partnering with centre for excellence in AI which I'd like to be part of

Con: Very little time to experiment with specialties, more expensive, less opportunity down the road to appeal to program directors in rural or non-ONT areas, and for some reason all meds I talked to seemed to suggest I should go to Alberta?

 

Any opinions/advice would be appreciated, especially from past graduates of either programs!

 

Thank you so much!

 

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Congrats! It is evident that you have done a fair amount of career exploration and reflection.

Given this, the main outstanding question in my mind based on your post is - how far along are you in that decision?

For example, if you are 90% for FM-EM, and can see yourself being able to decide on the 3-year program versus a 5-year specialty in fairly short order once commencing the medical program, then sure, it might be a 'waste' of the extra year as you put it.

However, if you are more 50/50 at this point, then the extra year may be beneficial, especially as your shortlist essentially consists of the most competitive Royal College specialties. My understanding is that electives for fields such as ophth and derm can be challenging to obtain (they are sought after by FM students too), and deciding on a field early on will make it easier to book them.

With regards to your career-related connections in Toronto, do you anticipate you would travel back and see people on weekdays? weekends? It's not clear to me whether the concern about distance is primarily a career or family- related consideration.

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5 minutes ago, Lactic Folly said:

Congrats! It is evident that you have done a fair amount of career exploration and reflection.

Given this, the main outstanding question in my mind based on your post is - how far along are you in that decision?

For example, if you are 90% for FM-EM, and can see yourself being able to decide on the 3-year program versus a 5-year specialty in fairly short order once commencing the medical program, then sure, it might be a 'waste' of the extra year as you put it.

However, if you are more 50/50 at this point, then the extra year may be beneficial, especially as your shortlist essentially consists of the most competitive Royal College specialties. My understanding is that electives for fields such as ophth and derm can be challenging to obtain (they are sought after by FM students too), and deciding on a field early on will make it easier to book them.

With regards to your career-related connections in Toronto, do you anticipate you would travel back and see people on weekdays? weekends? It's not clear to me whether the concern about distance is primarily a career or family- related consideration.

Thanks a lot Lactic Folly!

I am getting that response a lot, that it's really a function of how sure I am on FM+1EM. I'd say I'm about 60-70% certain provided I'd be able to do AI research on it. I'm not interested in only practicing without any research component. Another factor I did think about is that fact that academic/Toronto based positions for royal college specialties are almost impossible to come by and things might be a bit easier for FM+EM who wants to do research although I'm clueless as to if this is/will be true.

Nonetheless it's difficult for me to justify that I can be any more certain on a specialty without having clinical exposure via rotations or at least extensive shadowing.

Distance is both career & family-related consideration, if I'm in Hamilton it's a quick go train ride away back to the city so I can imagine doing research projects or even shadowing remotely to build/retain those longitudinal relationships.

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5 minutes ago, plastics91 said:

Thanks a lot Lactic Folly!

I am getting that response a lot, that it's really a function of how sure I am on FM+1EM. I'd say I'm about 60-70% certain provided I'd be able to do AI research on it. I'm not interested in only practicing without any research component. Another factor I did think about is that fact that academic/Toronto based positions for royal college specialties are almost impossible to come by and things might be a bit easier for FM+EM who wants to do research although I'm clueless as to if this is/will be true.

Nonetheless it's difficult for me to justify that I can be any more certain on a specialty without having clinical exposure via rotations or at least extensive shadowing.

Distance is both career & family-related consideration, if I'm in Hamilton it's a quick go train ride away back to the city so I can imagine doing research projects or even shadowing remotely to build/retain those longitudinal relationships.

It sounds like research is important to you. Do you hold a PhD, or currently work in AI research? If not, would you pursue a program such as https://surgery.utoronto.ca/surgeon-scientist-training-program or http://www.deptmedicine.utoronto.ca/eliot-phillipson-clinician-scientist-training-program ? Do you envision yourself a clinician scientist with a research program and a collaboration with computing science? The right infrastructure is invaluable for setting up a research career - I found a family medicine-based informatics fellowship in the US but not sure if similar opportunities exist in Canada. https://wexnermedical.osu.edu/departments/family-medicine/education/fellowships/clinical-informatics-fellowship

How much time would you spend on research during the school year?

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I agree with the above - 4 year is probably better if you're thinking something competitive. Even though the UofA is further away, if your goal is FM then realistically you should have no trouble ending up back near Toronto for residency. If you are going for something competitive, there's no guarantees where you end up, so after your 3 years at Mac you could be forced to leave anyway. Plenty of people at 3 year schools can and do match to competitive things. I guess it comes down to how set you are on FM+EM vs the others, and also what level of risk you can tolerate. Also having family around is nice. There are so few legit breaks during the year, that if you can pop over to see family on a weekend that would be a nice break. 

More importantly, even though you've had some peripheral experiences in medicine, it is very likely this could change - you really don't know what these specialties are like until you learn the med school content and experience what they are like in practice. I know many people who were dead sure about a specialty going in, and came out with something totally different. I don't mean to say your thoughts at this point won't matter, but rather I hope you keep an open mind. 

On the notion of competitiveness, your list of eligible contenders essentially is a countdown of the top 5-6 most competitive specialties that exist, and apart from a few of them (eg derm and plastics, plastics and ENT), most really don't have much in common, I guess aside from the fact that all of them deal with the face in some capacity?? I get somewhat of a perceived good lifestyle/high pay theme from your list, but in practice plastics is far from a lifestyle specialty (and ENT to some extent relative to the others), and pay for plastics is not that high without a big cosmetics business, which is not easy in terms of time or money in plastics. I'd caution you on discussing this list openly with preceptors and residents because it does stand out as suspicious motives (from a clinical interest perspective). 

As someone also interested in a research career, regarding the requirement to do research as a large component of your practice down the road, I'd say it's not possible in any surgical specialty other than ophtho unless (A) you settle for case reports and low yield chart reviews, (B) going weeks without research at times due to busy schedule issues, (C) you are willing to work part time surgery which means half salary. There are few alternate payment plans for surgeons doing research, which is why most still remain full time clinicians (because the research work is basically done for free), and why I refer you to point D, (D) you are willing to work close to 80 hrs per week or more for life.

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5 minutes ago, Lactic Folly said:

It sounds like research is important to you. Do you hold a PhD, or currently work in AI research? If not, would you pursue a program such as https://surgery.utoronto.ca/surgeon-scientist-training-program or http://www.deptmedicine.utoronto.ca/eliot-phillipson-clinician-scientist-training-program ? Do you envision yourself a clinician scientist with a research program and a collaboration with computing science? The right infrastructure is invaluable for setting up a research career - I found a family medicine-based informatics fellowship in the US but not sure if similar opportunities exist in Canada. https://wexnermedical.osu.edu/departments/family-medicine/education/fellowships/clinical-informatics-fellowship

How much time would you spend on research during the school year?

Thank you so much for your time to do research on the programs! I'll note them for future reference.

I envision myself doing clinician-scientist things but had a particular field in mind that would collaborate heavily with computing science and engineers. You're right, there isn't a lot of fam med-based interest in the field I want to go into, I guess I saw it as an opportunity to begin something anew where the field isn't so saturated. I already have a MSc, I would have to see what added benefit an additional graduate degree would be in a burgeoning field.

Amount of research I guess would depend on which school I end up going to. I've heard Mac is quite condensed as is and I wouldn't have much luck doing much research in any capacity which is a bit of a downer... But I also know that research productivity during residency is more important when it comes to job searching so I wouldn't mind holding off until residency. 

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7 minutes ago, ZBL said:

I agree with the above - 4 year is probably better if you're thinking something competitive. Even though the UofA is further away, if your goal is FM then realistically you should have no trouble ending up back near Toronto for residency. If you are going for something competitive, there's no guarantees where you end up, so after your 3 years at Mac you could be forced to leave anyway. Plenty of people at 3 year schools can and do match to competitive things. I guess it comes down to how set you are on FM+EM vs the others, and also what level of risk you can tolerate. Also having family around is nice. There are so few legit breaks during the year, that if you can pop over to see family on a weekend that would be a nice break. 

More importantly, even though you've had some peripheral experiences in medicine, it is very likely this could change - you really don't know what these specialties are like until you learn the med school content and experience what they are like in practice. I know many people who were dead sure about a specialty going in, and came out with something totally different. I don't mean to say your thoughts at this point won't matter, but rather I hope you keep an open mind. 

On the notion of competitiveness, your list of eligible contenders essentially is a countdown of the top 5-6 most competitive specialties that exist, and apart from a few of them (eg derm and plastics, plastics and ENT), most really don't have much in common, I guess aside from the fact that all of them deal with the face in some capacity?? I get somewhat of a perceived good lifestyle/high pay theme from your list, but in practice plastics is far from a lifestyle specialty (and ENT to some extent relative to the others), and pay for plastics is not that high without a big cosmetics business, which is not easy in terms of time or money in plastics. I'd caution you on discussing this list openly with preceptors and residents because it does stand out as suspicious motives (from a clinical interest perspective). 

As someone also interested in a research career, regarding the requirement to do research as a large component of your practice down the road, I'd say it's not possible in any surgical specialty other than ophtho unless (A) you settle for case reports and low yield chart reviews, (B) going weeks without research at times due to busy schedule issues, (C) you are willing to work part time surgery which means half salary. There are few alternate payment plans for surgeons doing research, which is why most still remain full time clinicians (because the research work is basically done for free), and why I refer you to point D, (D) you are willing to work close to 80 hrs per week or more for life.

You're right, I assume it would most likely come down to how wise it is to commit to a specialty without having a lot of hands-on exposure... Sounds risky at the moment, and I do want to keep an open mind. Thanks for reminding me!

For sure I am aware that most of the specialties I have put down are very competitive. EM is most attractive in terms of what the actual work entails and potential for research. However I do not like that I cannot have my own private practice, by the way funding is being allocated, I do not want my practice to hinge on hospitals which is why FM + EM seems perfect. Also that FM does bring its benefits that I won't get into here. Plastics I've had initial interest from when I began journey towards medicine but not for the cosmetic side. I wouldn't mind not making that much money to do reconstructive or other aspects. ENT because I am fascinated by anatomy neck up. Ophth because I have work and research experience in the field, and eye is critical to QoL. Derm only because I recently started considering having a life might not be so bad? :P But it's lowest of my choices listed. I understand that the choices at first look may be suspicious, thanks for the tip on keeping quiet where silence is helpful!

I've also heard that surgical specialties do not offer the kind of flexibility for research, and working too much is sure way to burn out. This is me transitioning drastically from all my life thinking I wanted to do surgery then slowly coming to a realization from anecdotes told by surgeon friends and supervisors. Thank you for being another voice of reason and taking my step one step farther from surgery.

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1 minute ago, plastics91 said:

You're right, I assume it would most likely come down to how wise it is to commit to a specialty without having a lot of hands-on exposure... Sounds risky at the moment, and I do want to keep an open mind. Thanks for reminding me!

For sure I am aware that most of the specialties I have put down are very competitive. EM is most attractive in terms of what the actual work entails and potential for research. However I do not like that I cannot have my own private practice, by the way funding is being allocated, I do not want my practice to hinge on hospitals which is why FM + EM seems perfect. Also that FM does bring its benefits that I won't get into here. Plastics I've had initial interest from when I began journey towards medicine but not for the cosmetic side. I wouldn't mind not making that much money to do reconstructive or other aspects. ENT because I am fascinated by anatomy neck up. Ophth because I have work and research experience in the field, and eye is critical to QoL. Derm only because I recently started considering having a life might not be so bad? :P But it's lowest of my choices listed. I understand that the choices at first look may be suspicious, thanks for the tip on keeping quiet where silence is helpful!

I've also heard that surgical specialties do not offer the kind of flexibility for research, and working too much is sure way to burn out. This is me transitioning drastically from all my life thinking I wanted to do surgery then slowly coming to a realization from anecdotes told by surgeon friends and supervisors. Thank you for being another voice of reason and taking my step one step farther from surgery.

You would not be the first, and certainly not the last! I encourage you to try some of these out at the major academic hospital at whichever school you go to - join for the day, from rounds to call and get a sense of what it's like. 

From numerous MD/PhD mentors, co-students, and pure physicians, we have concluded this: you can do research on whatever you want from whatever specialty you want, so it's far more important that you make the clinical specialty the priority and choose one that satisfies you clinically and gives the lifestyle, flexibility and such that you want. If you love the OR - great, then surgery may be for you. If you like it, but would prefer to not spend every hour there, then maybe part ways. But the specialty you do does not need to dictate the scientific research you do. So while some might say, oh there's no FMs doing research in this area - well why can't you be the first? I've seen endocrinologists do heart research, EMs do bone and joint research, derms do ID research etc. But rarely do you see a surgeon doing any research :) 

From what you've mentioned above, I say go for Mac - it'll be shorter, you'll have family close, and it seems like you're leaning FM anyway. 

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I differ on this somewhat. All the surgeons I have seen in academic centres do some research, whether it's medical education research, participating in multicentre trials, etc., and some publish quite a bit with the help of trainees. https://surgery.mcmaster.ca/research/ongoing-areas-of-research Of course, there is a significant difference between doing some research (mostly on one's own time while still maintaining a full clinical practice) and being a clinician researcher with protected time as above.

Unless someone already has a strong background in the area of research they wish to pursue (e.g. MD/PhD), I think it is much easier to establish a research program (if someone is that serious about it) if there is some infrastructure. It is invaluable to have access to a training program such as the ones listed above, which would provide access to mentors and research resources, and pave the way to further fellowships and success in obtaining grants. Not impossible without these if one is sufficiently determined of course, but more uphill.

FM(EM) is primarily clinical training. You could apply for a research-oriented FM residency, but the coursework may not be entirely relevant to your interests. You could approach computing science and engineering faculty on your own, but will you be able to convince them to devote their limited time and funding to collaborating with you? I am not sure that being a trailblazer in FM is enough of a selling point in itself, unless you are bringing something else to the table (whatever experience and connections you may have from your MSc).

I suspect that as far as non-surgical options go, general internal medicine is likely the more hospitable specialty for these kinds of research interests. More common for academic GIM to be doing fellowships in areas such as clinical informatics, and carrying that on into future practice. But developing a successful research program is also a time-consuming endeavour. It depends on how serious you are about this, like choosing surgery as a career.

When looking at specialties, I would focus less on the subject matter (because everything makes a difference to patient QoL and becomes more interesting the more you learn about it). Rather, I would focus more on the nature of the work itself. How important is it for you to work with your hands, and specifically in the OR? If you haven't read it, Brian Freeman's Ultimate Guide to Choosing a Medical Specialty is pretty good.

I think that if being close to family is more important in the long run, and you can see yourself being satisfied working in family medicine in Toronto (as the +1 EM is also competitive - 60-something percent match rate in recent years), then go for Mac. If you need more time for specialty exploration, the 4 year program may be advantageous for that reason, but certainly students have matched well coming from Mac - you'll just need to hit the ground running.

Often reading or talking to people in the field about their careers can be equally or more high-yield than observing, since those further along in their careers are familiar with the range of practices out there and can distill what's most relevant to specialty choice and career satisfaction, whereas although there is also no substitute for firsthand experience as a student, it is only a small slice of a particular practice rather than of the possibilities available in an entire field.

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Also, not sure what you mean by funding hinging on a hospital - both hospital-based EM and traditional fee-for-service clinic-based FM bill the government directly for their services. The emergency medicine physician holds hospital privileges, but provides services as an independent contractor, as does the FM physician. It's the surgical specialties which are more constrained by availability of hospital resources (in particular OR time).

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1 hour ago, Lactic Folly said:

I differ on this somewhat. All the surgeons I have seen in academic centres do some research, whether it's medical education research, participating in multicentre trials, etc., and some publish quite a bit with the help of trainees. https://surgery.mcmaster.ca/research/ongoing-areas-of-research Of course, there is a significant difference between doing some research (mostly on one's own time while still maintaining a full clinical practice) and being a clinician researcher with protected time as above.

Unless someone already has a strong background in the area of research they wish to pursue (e.g. MD/PhD), I think it is much easier to establish a research program (if someone is that serious about it) if there is some infrastructure. It is invaluable to have access to a training program such as the ones listed above, which would provide access to mentors and research resources, and pave the way to further fellowships and success in obtaining grants. Not impossible without these if one is sufficiently determined of course, but more uphill.

FM(EM) is primarily clinical training. You could apply for a research-oriented FM residency, but the coursework may not be entirely relevant to your interests. You could approach computing science and engineering faculty on your own, but will you be able to convince them to devote their limited time and funding to collaborating with you? I am not sure that being a trailblazer in FM is enough of a selling point in itself, unless you are bringing something else to the table (whatever experience and connections you may have from your MSc).

Yes surgeons in academic centres definitely do a fair bit of research, but I guess in realms that are already narrowed down to their respective fields. I'm interested in basically applying already developed machine learning techniques with available data sets to help guide policy and clinical decision making. More interested the process rather than specific application into any particular clinical field. For training programs you mentioned it seems they are provided at resident level not at undergraduate medical school level and both are at UofT, so could you shed a light on how I should factor this into my decision to attend an undergraduate institution? I'm thinking of covering the basics of what I need to learn (Math, comp sci) during MD (Mac is good that it's self directed) while getting relevant research projects (already have potential ones lined up at UofT.. But trying to decide if proximity by being in Hamilton will help OR having summers off in Alberta would help)

I have also heard FM/EM is primarily practice hence was the reason why I also considered just going full EM where people tend to do more research from what I hear and also has not that many clinical hours in a month and no calls. However also trying to figure out if FM/EM is prohibiting busy that I CAN'T do any research? And

1 hour ago, Lactic Folly said:

Also, not sure what you mean by funding hinging on a hospital - both hospital-based EM and traditional fee-for-service clinic-based FM bill the government directly for their services. The emergency medicine physician holds hospital privileges, but provides services as an independent contractor, as does the FM physician. It's the surgical specialties which are more constrained by availability of hospital resources (in particular OR time).

I guess i was thinking that EM still need a hospital to work in even though it bills the government. The thing I like best about FM is that you can set up shop anywhere and scope of practice is less defined.

1 hour ago, Lactic Folly said:

I suspect that as far as non-surgical options go, general internal medicine is likely the more hospitable specialty for these kinds of research interests. More common for academic GIM to be doing fellowships in areas such as clinical informatics, and carrying that on into future practice. But developing a successful research program is also a time-consuming endeavour. It depends on how serious you are about this, like choosing surgery as a career.

When looking at specialties, I would focus less on the subject matter (because everything makes a difference to patient QoL and becomes more interesting the more you learn about it). Rather, I would focus more on the nature of the work itself. How important is it for you to work with your hands, and specifically in the OR? If you haven't read it, Brian Freeman's Ultimate Guide to Choosing a Medical Specialty is pretty good.

Academic GIM is great in subject matter but as you mentioned I think it could be quite time consuming, not only in practice but in training (multiple fellowships..). This is why I was leaning more towards EM where things are a bit more fast paced. I like fast pace :) I've picked up the book and starting to read it! Thanks for the suggestion!

Thank you so much for your detailed response, and for sure, at this point the best thing would be to talk to staff at different specialties. Trying to set that up now.... If you know anyone in any of the fields I've mentioned I'd love the opportunity for a quick chat! Thank you so much!

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10 hours ago, plastics91 said:

For sure I am aware that most of the specialties I have put down are very competitive. EM is most attractive in terms of what the actual work entails and potential for research. However I do not like that I cannot have my own private practice, by the way funding is being allocated, I do not want my practice to hinge on hospitals which is why FM + EM seems perfect. Also that FM does bring its benefits that I won't get into here.

As people have mentioned in other EM (5 years) vs. FM+ EM threads, it's not entirely practical to split your work between both family medicine and emerg at the same time. Instead, it sounds like most FM+EMs will work in emergency medicine for a given time, while having the option to practice FM down the road (if you become tired of the shift-work, if you're feeling burnt-out etc.) 

It also sounds like you have the desire to work/live one day in Toronto. As a FM+EM working in emergency, there may be less opportunity for future work in Toronto, especially in downtown academic centres. Would you be okay with working at a community site, or even 1-2 hours outside of Toronto? Would these community locations hinder your ability to conduct the research that you're interested in?  And as others have mentioned, FM+ EM has become very competitive. If you were not able to get into this stream, would you be satisfied working entirely as a family physician?

 

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1 hour ago, plastics91 said:

Yes surgeons in academic centres definitely do a fair bit of research, but I guess in realms that are already narrowed down to their respective fields. I'm interested in basically applying already developed machine learning techniques with available data sets to help guide policy and clinical decision making. More interested the process rather than specific application into any particular clinical field. For training programs you mentioned it seems they are provided at resident level not at undergraduate medical school level and both are at UofT, so could you shed a light on how I should factor this into my decision to attend an undergraduate institution? I'm thinking of covering the basics of what I need to learn (Math, comp sci) during MD (Mac is good that it's self directed) while getting relevant research projects (already have potential ones lined up at UofT.. But trying to decide if proximity by being in Hamilton will help OR having summers off in Alberta would help)

I have also heard FM/EM is primarily practice hence was the reason why I also considered just going full EM where people tend to do more research from what I hear and also has not that many clinical hours in a month and no calls. However also trying to figure out if FM/EM is prohibiting busy that I CAN'T do any research? And

I guess i was thinking that EM still need a hospital to work in even though it bills the government. The thing I like best about FM is that you can set up shop anywhere and scope of practice is less defined.

Academic GIM is great in subject matter but as you mentioned I think it could be quite time consuming, not only in practice but in training (multiple fellowships..). This is why I was leaning more towards EM where things are a bit more fast paced. I like fast pace :) I've picked up the book and starting to read it! Thanks for the suggestion!

Thank you so much for your detailed response, and for sure, at this point the best thing would be to talk to staff at different specialties. Trying to set that up now.... If you know anyone in any of the fields I've mentioned I'd love the opportunity for a quick chat! Thank you so much!

There are established linkages between surgery and research in a broad range of fields including machine learning, probably more so than with emergency medicine in Canada if I had to guess, though I could be wrong on that. https://www.ncbi.nlm.nih.gov/pubmed/27119951 

A search reveals a scientist at McMaster who is doing research in machine learning and trains surgical residents/fellows in research. https://rhpcs.mcmaster.ca/who-we-are/ranil

The McMaster Surgeon Scientist program has biotechnology/innovation as one of its areas of focus. https://fhs.mcmaster.ca/ssp/ 

I provided links to UofT residency programs since you expressed an interest in returning to Toronto. There are Clinician Investigator Programs at other schools as well, which are designed for residents interested in research careers. Your undergraduate program will primarily serve to get you into the residency program of your choice. Some research during your MD years would help, but I don't know how much time you would have for learning additional subjects like math/comp sci during Mac's program. Your time would likely be better spent learning medicine and working on strengthening your application for highly competitive fields such as the ones you are considering. With summers off in Alberta, you could set up months-long research projects in Toronto if you wish.

When I meant that research could be time consuming, I meant in general, not with reference to GIM in particular which should not be longer than pursuing research through other Royal College specialties. Again, it depends if you see yourself building a career as a clinician researcher (PI), or being a clinician who simply participates in some research. You would want support from your department to apply for grants, etc. more than simply going down in clinical hours and pay, although your group scheduling would need to accommodate that as well.

Again, it's easier if you're working somewhere that already has dedicated research personnel to support these activities. That's why I am unsure of your emphasis on FM being able to set up shop anywhere, as you will want to be close to a university performing research in machine learning/AI if you are seriously pursuing this path. This will determine your practice location more than needing to work in a hospital ER. I don't have firsthand knowledge of the EM job market, but any hospital with an emergency department needs it to be staffed, and it's flexible for anyone with privileges to pick up ER shifts, as long as the hospital and ER group are willing. 

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3 hours ago, Lactic Folly said:

I differ on this somewhat. All the surgeons I have seen in academic centres do some research, whether it's medical education research, participating in multicentre trials, etc., and some publish quite a bit with the help of trainees. https://surgery.mcmaster.ca/research/ongoing-areas-of-research Of course, there is a significant difference between doing some research (mostly on one's own time while still maintaining a full clinical practice) and being a clinician researcher with protected time as above.

I fully agree that many if not most surgeons at academic centres will participate in research, but I guess I was referring more to the scenario of the surgeon taking a lead role in a large project that is not necessarily clinical, i.e. computer science, engineering etc. It all comes down to whether we are talking about a surgeon who does research or a true surgeon-scientist. The later is quite rare and difficult to achieve on a surgeons schedule, and comes with large income cuts compared to the former. 

 

1 hour ago, plastics91 said:

Yes surgeons in academic centres definitely do a fair bit of research, but I guess in realms that are already narrowed down to their respective fields. I'm interested in basically applying already developed machine learning techniques with available data sets to help guide policy and clinical decision making. More interested the process rather than specific application into any particular clinical field. For training programs you mentioned it seems they are provided at resident level not at undergraduate medical school level and both are at UofT, so could you shed a light on how I should factor this into my decision to attend an undergraduate institution? I'm thinking of covering the basics of what I need to learn (Math, comp sci) during MD (Mac is good that it's self directed) while getting relevant research projects (already have potential ones lined up at UofT.. But trying to decide if proximity by being in Hamilton will help OR having summers off in Alberta would help)

To be honest, I don't think it's realistic to learn all the math and computer science during med school, regardless of whether you are at a 3 or 4 year school. The reason is that these are really your only 3-4 years you have to set yourself up for the rest of your life - you need to figure out what specialty you want, learn all of medicine, pass courses and regular exams, not to mention being very busy during clinical rotations. The CaRMS match is a real pain as it is, and you do not want make it worse or risk going unmatched as a consequence of prioritizing non-medical knowledge during med school. Unfortunately, learning those skills during your MD won't count for much at CaRMS, so I really think your best approach is focus on medicine during med school so you get into the specialty you want, and then during residency or afterwards there will be time to dedicate towards your research goals. If you have an MSc, certainly doing a PhD would be a great way of doing this that would set you up as an expert in the field no matter what clinical specialty you choose. There are plenty of options for one year research fellowships as well, which I think are fine for those who just want to dabble in research down the road, but I personally don't think it's good enough for those who want more of a leading role in applied/basic science types of work. Having done grad school as well, I can't imagine doing research in my area well had I done just one year as opposed to the whole degree. 

 

27 minutes ago, Lactic Folly said:

The McMaster Surgeon Scientist program has biotechnology/innovation as one of its areas of focus. https://fhs.mcmaster.ca/ssp/ .....

I provided links to UofT residency programs since you expressed an interest in returning to Toronto. There are Clinician Investigator Programs at other schools as well, which are designed for residents interested in research careers. Your undergraduate program will primarily serve to get you into the residency program of your choice. Some research during your MD years would help, but I don't know how much time you would have for learning additional subjects like math/comp sci during Mac's program. Your time would likely be better spent learning medicine and working on strengthening your application for highly competitive fields such as the ones you are considering. With summers off in Alberta, you could set up months-long research projects in Toronto if you wish....

Again, it's easier if you're working somewhere that already has dedicated research personnel to support these activities. That's why I am unsure of your emphasis on FM being able to set up shop anywhere, as you will want to be close to a university performing research in machine learning/AI if you are seriously pursuing this path. This will determine your practice location more than needing to work in a hospital ER. I don't have firsthand knowledge of the EM job market, but any hospital with an emergency department needs it to be staffed, and it's flexible for anyone with privileges to pick up ER shifts, as long as the hospital and ER group are willing. 

These types of clinician-scientist programs are available all over the place and not just surgery. There are dedicated research tracks for certain specialties in CaRMS, like the surgeon-scientist one posted above, but a resident in ANY royal college discipline (i.e. not FM, but yes to 5-year EM) can can join the Clinician Investigator Program during their residency: https://fhs.mcmaster.ca/cip/ Maybe FM has something similar, but you'd have to check. Anecdotally, a lot of the CaRMS direct entry surgeon-scientist spots, and surgeon CIP spots seem to be used more for just getting the extra few letters by your name, as in surgical fields it helps for hiring in larger centers; however most have no intention, and never do end up actually running a research lab later on, and instead default to the typical surgeon who does some research role. 

I agree that if the plan is to do research down the road, that basically means academic centre, so 5 year EM is something to think about, OR a PhD in computer science etc so you are cross appointed.

 

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Thank you guys so much @Lactic Folly @ZBL and @yup. This has been really enlightening and gave me a lot to think about.

To distill it simply and without considering too much of the intricacies and uncertainties in the future, it seems it is unrealistic to really think about the research portion at this stage. It seems that it's more important that I know for sure where I would want to practice, as a FM with EM shifts in the community, or a EM with research in academic facilities.

Because of the passion I have for the topic, I am inclined towards EM in academic facilities, preferably in Toronto as I have family there, and the research is really taking off in that field with a lot of investments. Also I have already made meaningful connections in the city. With that in mind, would Mac or UofA offer a significant advantage that one or the other would have, thinking EM at Toronto specifically? 

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If I had my family and friends in Toronto I would go to Mac.

If not, all else being equal, I would do the 4-year just for the added time, especially if gunning for something.  You can still gun at Mac, but it will be helpful if you decide what you want to gun for EARLY.  Like get in those clinics/ORs and see if you decide in the first month or 2.  

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Just now, goleafsgochris said:

If I had my family and friends in Toronto I would go to Mac.

If not, all else being equal, I would do the 4-year just for the added time, especially if gunning for something.  You can still gun at Mac, but it will be helpful if you decide what you want to gun for EARLY.  Like get in those clinics/ORs and see if you decide in the first month or 2.  

I've heard this over and over again about Mac, but I think it's actually just the opposite. If you want to gun, or you want more time to figure things out, I think Mac should be at the top of your list. You can turn it into a 4 year program and spend that extra year doing as many electives/research projects as you want! It's like a 4 year program but you get one whole year dedicated to gunning or exploring. I don't know why more people don't take advantage of that.

Side note on competitiveness at Mac (and this isn't very scientific): Mac has been over represented in ophtho the last couple of years. It's not the most scientific data point, but I I really don't buy that competitiveness varies reliably between schools.

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9 minutes ago, PhD2MD said:

I've heard this over and over again about Mac, but I think it's actually just the opposite. If you want to gun, or you want more time to figure things out, I think Mac should be at the top of your list. You can turn it into a 4 year program and spend that extra year doing as many electives/research projects as you want! It's like a 4 year program but you get one whole year dedicated to gunning or exploring. I don't know why more people don't take advantage of that.

Side note on competitiveness at Mac (and this isn't very scientific): Mac has been over represented in ophtho the last couple of years. It's not the most scientific data point, but I I really don't buy that competitiveness varies reliably between schools.

Youre right that you CAN take an extra year.  But it would be odd.  Its certainly not encouraged, and I would bet residency programs would find it strange, unless you maybe were very productive that year in terms of research.  You also wouldn't graduate with your class.  This doesn't matter to you now, but it will!  

The real Mac advantage for gunning IMO was that in pre-clerkship, you have way more free time.  If you are efficient with it, you can easily fit in more research and observerships than you can in other schools.

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1 hour ago, goleafsgochris said:

If I had my family and friends in Toronto I would go to Mac.

If not, all else being equal, I would do the 4-year just for the added time, especially if gunning for something.  You can still gun at Mac, but it will be helpful if you decide what you want to gun for EARLY.  Like get in those clinics/ORs and see if you decide in the first month or 2.  

I agree with this. Regarding the enrichment year, doing one essentially negates the main advantage of a 3-year program. In addition, as it does not start until after the pre-clerkship phase is completed, its timing is less advantageous CaRMS-wise than doing research during the summer between 1st and 2nd year in a 4-year school.

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On 5/9/2018 at 12:55 PM, PhD2MD said:

I've heard this over and over again about Mac, but I think it's actually just the opposite. If you want to gun, or you want more time to figure things out, I think Mac should be at the top of your list. You can turn it into a 4 year program and spend that extra year doing as many electives/research projects as you want! It's like a 4 year program but you get one whole year dedicated to gunning or exploring. I don't know why more people don't take advantage of that.

Side note on competitiveness at Mac (and this isn't very scientific): Mac has been over represented in ophtho the last couple of years. It's not the most scientific data point, but I I really don't buy that competitiveness varies reliably between schools.

I used to think about the enrichment year like you do. However, the issue is, it remains a pretty niche program, you go out of sync with your friends in your class, you kind of set yourself on your own and you ultimately are responsible for explaining why you needed that extra year when you apply to CaRMS. Some people have great outcomes, others don't, the issue is, you have to declare relatively early on that you want to take an enrichment year, you can't be midway through CaRMS, change your specialty of interest and get an enrichment year to gun for it.

Mac may be over-represented in ophthalmology (truthfully don't know the data on this), but we are also under-represented in many of the specialties listed above including plastics, ENT, derm. Mac just doesn't send many people to these specialties and much has to do with the fact that these specialties are so competitive, that they are asking for the absolute maximum of applicants and McMaster as a 3 year school and with its curriculum doesn't give you the appropriate elective time and training to really succeed or excel.

To OP: Congrats first of all! I think if you can genuinely see yourself being happy as a FM/EM in the GTHA with or maybe without research, despite potentially liking plastics or ENT or ophtho, choose McMaster. I really do think McMaster provides you with the advantages that help you achieve the 2+1 goals you mentioned. If you do choose McMaster, you will have the first year to really explore those competitive specialties you listed, but please please hit the ground running with this kind of stuff. You may end up liking some of these competitive specialties, but not fall in love with them, the issue with McMaster here is that it doesn't give you as much time to explore them and crucially, the clerkship experience to really understand them, so you may end up with a foot on two boats that are heading in opposite directions. This happens to a lot of people and many make the decision to drop one and continue with the other. The one thing you can try to do at McMaster is, pick one highly competitive specialty, gun for that specialty like your life depends on it, back up with FM and perhaps do some ER shifts on the side. You will probably burn out, but it is doable. If the things I said don't seem to appeal to you, you may want to choose UofA. UofA can still give you a FM/EM match, but you may have to delay a lot of the start of that stuff until you hit residency in Toronto, however, UofA would give you time and preparation to succeed in those competitive specialties, but also understand these competitive specialties come with a lot of sacrifices, including the fact that you are more likely to match at UofA or other west coast schools in those specialties rather than come back to Ontario. 

 

 

 

 

 

 

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Thank a lot @goleafsgochris @PhD2MD @Lactic Folly and @Edict! (Not sure why tagging is not working...)

There are so many factors to consider and many of which are uncertain that it's difficult for me to establish a priority.

As of now, it seems going to Mac and being super proactive about pursuing horizontal electives at all potential pathways, and quickly eliminating them seems most appropriate. Because of the good point by Lactic Folly (that even if I did FM/EM, if I want to do research, academic centres will likely be preferred place of employment), and because I can't really imagine just doing urban family, I think I have tentatively narrowed down to EM and backing up with FM. In which case, as Edict suggested, Mac could be a better option considering life factors (early graduation, family/friends nearby).

Still having ongoing discussions with a lot of people regarding this decision, but I'm very grateful for the lively conversation here! I've learned so much!

One question: For Mac graduates, would you say your horizontal electives were enlightening enough to counter the electives before core rotations issue? Or was enlightening enough to eliminate specialties prior to formal clerkships?

 

 

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46 minutes ago, plastics91 said:

 

One question: For Mac graduates, would you say your horizontal electives were enlightening enough to counter the electives before core rotations issue? Or was enlightening enough to eliminate specialties prior to formal clerkships?

 

 

Personally, yes, but individual mileage may vary. I was able systematically ruled in/out specialties in plenty of time. If you are systematic about it, it is not too difficult. Some horizontals are very very good at getting exposure both to the breadth and to procedures that might exist (emerg, psych, and anesthesia come to mind from my personal experiences) – especially emerg which is great for consolidating clinical skills knowledge. If you have an interest in EM I would also encourage you to also set them up at community sites for post-MF4s and horizontals as they can also be great learning experiences. You do need to be proactive though –as you would at U of A– and I would encourage you to also try and experience as many aspects of a discipline as possible  – as an example, I found joining IM residents on night float to be a very good learning experience. Don't be afraid to reach out to upper years if you do decide to come to Mac for preceptor recommendations etc. everyone is very collaborative here. 

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4 hours ago, plastics91 said:

 

One question: For Mac graduates, would you say your horizontal electives were enlightening enough to counter the electives before core rotations issue? Or was enlightening enough to eliminate specialties prior to formal clerkships?

 

 

I personally felt horizontal electives were useful to rule out specialties that I wasn't interested in but it couldn't give me enough information to rule in a specialty.

I certainly learned a lot more about certain specialties by doing 2 week electives or core rotations in them. Additionally, the context and knowledge you gain by being in clerkship helps a lot in deciding.

For example, if you shadow a surgical specialty, you most likely will end up doing a day in the OR or maybe clinic, which is mostly, you watching and not doing much, a far cry from what it will actually be like as a resident, actually being able to use your hands, having insanely long hours and dealing with ward/emerg issues. In this context, some might rule out surgery because they stood around for hours doing nothing, which truthfully you still probably do to some degree as a junior resident, but eventually fades. At the same time, some might love the OR, but not really get a feel for the 6am starts, the on calls or the emergencies. In that case, they might falsely like the specialty. The closest emulation I can think of if you want to know if you really like surgery would be to volunteer to do on calls/shifts with residents often and see if you still like it.

Another example, if you shadow emerg as a junior medical student, you might love it because you are spending your time doing quick H&Ps, formulating a plan and seeing a lot of "cool" cases. That kind of experience gives a medical student a lot of responsibility, and you will feel like you are really a doctor, vs. lets say standing in the OR like the Queen's Guard trying to avoid the wrath of the OR nurses. However, with time and experience, you might find that you don't enjoy the undifferentiated case as much as you did as a junior student, or that you want to follow up your patient's eventual outcomes.

The post MF4 elective period (7 weeks after 1st yr summer) at Mac, help, but truthfully, they end up being glorified shadowing experiences in many cases, so they end up being better than a horizontal but not as good as an actual elective.

At Mac, most people go into clerkship with a shortlist of 2 or 3 specialties they are interested in, and they usually try to narrow that list down as soon as they can which is where the challenge lies.

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5 hours ago, Edict said:

I personally felt horizontal electives were useful to rule out specialties that I wasn't interested in but it couldn't give me enough information to rule in a specialty.

I certainly learned a lot more about certain specialties by doing 2 week electives or core rotations in them. Additionally, the context and knowledge you gain by being in clerkship helps a lot in deciding.

For example, if you shadow a surgical specialty, you most likely will end up doing a day in the OR or maybe clinic, which is mostly, you watching and not doing much, a far cry from what it will actually be like as a resident, actually being able to use your hands, having insanely long hours and dealing with ward/emerg issues. In this context, some might rule out surgery because they stood around for hours doing nothing, which truthfully you still probably do to some degree as a junior resident, but eventually fades. At the same time, some might love the OR, but not really get a feel for the 6am starts, the on calls or the emergencies. In that case, they might falsely like the specialty. The closest emulation I can think of if you want to know if you really like surgery would be to volunteer to do on calls/shifts with residents often and see if you still like it.

Another example, if you shadow emerg as a junior medical student, you might love it because you are spending your time doing quick H&Ps, formulating a plan and seeing a lot of "cool" cases. That kind of experience gives a medical student a lot of responsibility, and you will feel like you are really a doctor, vs. lets say standing in the OR like the Queen's Guard trying to avoid the wrath of the OR nurses. However, with time and experience, you might find that you don't enjoy the undifferentiated case as much as you did as a junior student, or that you want to follow up your patient's eventual outcomes.

The post MF4 elective period (7 weeks after 1st yr summer) at Mac, help, but truthfully, they end up being glorified shadowing experiences in many cases, so they end up being better than a horizontal but not as good as an actual elective.

At Mac, most people go into clerkship with a shortlist of 2 or 3 specialties they are interested in, and they usually try to narrow that list down as soon as they can which is where the challenge lies.

Thanks for the detailed explanation @Edict and @a7x!

It seems that based on what you say, what's really important is when you have to sign up for electives. It seems for most competitive specialties that they like it if you "commit" to one for all your electives, so if I have 2 competitive specialties in mind then it's less favourable to split them AND back up with family. 

From what I gather, at Mac requires you to choose your electives 7 months into preclerkship vs. other schools that let's you choose.. when? I'm not sure, but I gather months in to clerkship. Is that true? =

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5 hours ago, Edict said:

 

The post MF4 elective period (7 weeks after 1st yr summer) at Mac, help, but truthfully, they end up being glorified shadowing experiences in many cases, so they end up being better than a horizontal but not as good as an actual elective.

 

This hits the nail on the head.  IMO an ideal use of the summer elective period after first year is to have your list of potential specialties down to 1 if youre gunning, or 2 if you want something non-competitive.  That summer is about learning/exposure, NOT about reference letters.  Consider doing electives in the community where you will see a lot of stuff without being evaluated by a potential school you want to apply to.  Read around all the stuff you see, and youll have a solid knowledge base for clerkship once you start doing electives.

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