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Neurosurgery vs Peds General Surgery vs Orthopedics Lifestyle

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On 2/4/2019 at 8:29 PM, yonas said:

How is orthopaedics in comparison to ENT and urology in terms of employment opportunities?

People do usually do two fellowships, but some are able to locum as well while doing them. If you really love the field, and are willing to give it your all, then do it. There's just less incentive to do it right now due to the job market.  

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10 minutes ago, Edict said:

People do usually do two fellowships, but some are able to locum as well while doing them. If you really love the field, and are willing to give it your all, then do it. There's just less incentive to do it right now due to the job market.  

The amount of years you need under your belt for a job now is insane + the poor job market in general. 

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5 minutes ago, la marzocco said:

The amount of years you need under your belt for a job now is insane + the poor job market in general. 

If you ask senior surgeons though, the job hour limitations may have also had an impact on the increasing number of years needed to practice. Truthfully though, the best way may really be to reduce the number of residency spots in these specialties.

It may also be important for trainees as a whole to lower salary expectations in general. If you are still willing to do a specialty despite a 30% pay cut, then this may be the right choice for you. I do believe that the incentives in non-surgical specialties are much better than surgical specialties if you are looking at years of training x hours worked x salary. 

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On 6/1/2018 at 2:10 PM, NLengr said:

Short answer: terrible for all. 

Neurosurg: very very bad. Expect multiple fellowships and an advanced degree before even getting looked at for a job. I think there are issues with working in the states too, so no easy outlet. 

Cardiac: Very very bad. Multiple fellowships and advanced degree required before getting looked at. Might be able to work in the US but jobs aren't that plentiful. 

Ortho: Very bad. Need 2 fellowships for a Canadian job which is hard to land. Easy to work in the US

Urology/ENT/Gen Surg/Plastics: Will need one fellowship to work in a medium/bigger community center. Fellowship plus advanced degree in academic programs. Can land a job without a fellowship in select smaller centers in crappy locations. Easy to get work in the US if you want to.

Optho: not too sure because they are a mystery to non optho people. I would expect a fellowship is needed. Advanced academic degree for academic jobs. Issues with fighting for OR time with established surgeons. 

Anything peds: No jobs. Need fellowship obviously. Probably need advanced degree since every peds hospital except one in the country is academic. Just to give an example: when I was a resident we hire a new peds specialist and it was the only peds job that had opened up for a few years in canada. Ton of people applied. 

Vascular/Thoracics: not too sure. I know some people who finished fellowships (vascular was a fellowship only thing until about 6 years ago). Couple of them got a full time job. One does locums. One bailed to the US. 

 

I agree that you shouldnt go into a specialty of you only are interested in one subspecialty area. Like was said above, fellowships are frequently decided based on market demand or requests from the hospital group where you want to work.

I think this list is broadly accurate. I'm currently Ortho staff in the US after a Canadian residency and a one year US fellowship. I think there are a few points to add to 'easy to work in the US'.  No question that it's a viable exit strategy compared to unemployment but there are a few things to consider.

The job market in the US is better without question.  However, unless you have immigration rights for another reason (you're a US citizen or married to one) you will be limited to academic jobs due to visa restrictions at this time.  This restriction has been stable for several decades and I would not plan on seeing a change even if you're currently a medical student.  All of my peers who have a green card or citizenship in the US have left to set up practice in the USA and have not looked back.  Those who do not have access to immigration status--with a few exceptions--have not and it's not just because they enjoy additional fellowships or casual employment.  If you are married to an American and are considering this route, expect it to take up to two years to get your green card. 

The US is a little inverted from Canada.  Unless you're very senior, academic jobs-- very broadly--are not desirable.  An academic job generally has lower remuneration, more obligations, and worse working hours than a community job.  The remuneration to cost-of-living ratio for most academic centers is much worse than in the community.   Most young American surgeons accept jobs in academic programs to only build their resume and maintain a clear exit strategy; unless they are stuck there due to the visa problem I mentioned above.  Or they can't live without teaching--in which case god bless.

There are some other less firm barriers to consider: 

You must pass the USMLEs. Though it is technically possible to work in some states with your MCC, at some point the credentialing hospital or one of the many insurance companies will require you to be fully certified and past all 3 Steps.  Negotiated workarounds are always possible, I guess, but why shoot yourself in the foot.  Get these done as soon as possible while the knowledge is fresh in your brain.  As hard as it is to imagine, there are surgeons locuming, or worse, in Canada because they can't face the USMLEs.

You must repeat your Board certification with an accredited US specialty board.  In Orthopaedics this is a headache but not the end of the world.  It hasn't been the end of the world but there may be more or fewer problems for other specialties. 

Strongly consider a US fellowship.  Canadians are IMGs in American's brains.  A US fellowship takes the edge off of that stigma.  A US fellowship will also give you insight and experience within the US system.  I'd be drowning without that experience.   In orthopaedics, this is a match process  (SFmatch) that requires some planning starting in R2.

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22 hours ago, member_225 said:

how many fellowships do urologists do on average before finding a job in a major city? 

At least one. There are also unemployed urologists because they want a major city. Such is the life of surgery now a days, unless you got some major connections,  the job market is tight as sheet. We’ll see again in 10 years what it is, hopefully better hah.

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On 7/18/2019 at 7:30 PM, IMislove said:

At least one. There are also unemployed urologists because they want a major city. Such is the life of surgery now a days, unless you got some major connections,  the job market is tight as sheet. We’ll see again in 10 years what it is, hopefully better hah.

Honestly, I doubt it will get better. If you actually look solely at numbers, we are training more surgeons than are retiring and inevitably, competition for jobs in the city is great. 

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10 hours ago, Edict said:

Honestly, I doubt it will get better. If you actually look solely at numbers, we are training more surgeons than are retiring and inevitably, competition for jobs in the city is great. 

Sorry for the confusion, I meant in general I hope it gets better, so like small to medium sized cities. The large cities/metropolis areas I have no illusion it will always be tight. No interest in going there anyways :lol:

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On 7/18/2019 at 7:30 PM, IMislove said:

At least one. There are also unemployed urologists because they want a major city. Such is the life of surgery now a days, unless you got some major connections,  the job market is tight as sheet. We’ll see again in 10 years what it is, hopefully better hah.

The job market isnt getting better.  The Staff interviewing me for CaRMS 10 years ago told me it would get better and look where we are now. The factors creating this situation are structural not market driven. 

I was personally very lucky that the SCOTUS changed a certain law during my residency otherwise I would have been up shit creek at this point in my career. 

To any medical student reading this, unless you have a very viable fall back plan in another jurisdiction, my advice is to not start surgical training. 

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2 hours ago, Monkey D. Luffy said:

How doable is it to just open up a clinic in a small/medium sized city as a urologist and just do clinic work until you can get OR time locally?

I’d venture to guess that no one in their right mind would do 5+ years of surgical residency/fellowship only to work clinic (which is very expensive to open up, and a separate limiting factor altogether). Not to mention that killing time in a clinic does absolutely nothing to improve your chances at getting hired for OR time, and in fact it may be a negative as you’ll be out of touch with key players in hiring and your skills will decline. If clinic is the plan, and you’d be happy with it, don’t do a surgical residency. Simple as that. 

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19 hours ago, Monkey D. Luffy said:

How doable is it to just open up a clinic in a small/medium sized city as a urologist and just do clinic work until you can get OR time locally?

Your surgical skills would rapidly atrophy. Very rapidly.

Also, why on earth would you spend 5 years training to do surgery if you aren't going to be able to cut once you start working?

And unless you buy a whole set up of cystoscopes, I don't think you would be able to provide much care (considering a ton of urology work ups seems to include a cysto). 

 

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On 8/2/2019 at 6:34 PM, Monkey D. Luffy said:

How doable is it to just open up a clinic in a small/medium sized city as a urologist and just do clinic work until you can get OR time locally?

Also, it may be tough to get OR time, if there are more and more graduates coming year on year. 

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On 5/7/2019 at 10:07 AM, jnuts said:

I think this list is broadly accurate. I'm currently Ortho staff in the US after a Canadian residency and a one year US fellowship. I think there are a few points to add to 'easy to work in the US'.  No question that it's a viable exit strategy compared to unemployment but there are a few things to consider.

The job market in the US is better without question.  However, unless you have immigration rights for another reason (you're a US citizen or married to one) you will be limited to academic jobs due to visa restrictions at this time.  This restriction has been stable for several decades and I would not plan on seeing a change even if you're currently a medical student.  All of my peers who have a green card or citizenship in the US have left to set up practice in the USA and have not looked back.  Those who do not have access to immigration status--with a few exceptions--have not and it's not just because they enjoy additional fellowships or casual employment.  If you are married to an American and are considering this route, expect it to take up to two years to get your green card. 

The US is a little inverted from Canada.  Unless you're very senior, academic jobs-- very broadly--are not desirable.  An academic job generally has lower remuneration, more obligations, and worse working hours than a community job.  The remuneration to cost-of-living ratio for most academic centers is much worse than in the community.   Most young American surgeons accept jobs in academic programs to only build their resume and maintain a clear exit strategy; unless they are stuck there due to the visa problem I mentioned above.  Or they can't live without teaching--in which case god bless.

There are some other less firm barriers to consider: 

You must pass the USMLEs. Though it is technically possible to work in some states with your MCC, at some point the credentialing hospital or one of the many insurance companies will require you to be fully certified and past all 3 Steps.  Negotiated workarounds are always possible, I guess, but why shoot yourself in the foot.  Get these done as soon as possible while the knowledge is fresh in your brain.  As hard as it is to imagine, there are surgeons locuming, or worse, in Canada because they can't face the USMLEs.

You must repeat your Board certification with an accredited US specialty board.  In Orthopaedics this is a headache but not the end of the world.  It hasn't been the end of the world but there may be more or fewer problems for other specialties. 

Strongly consider a US fellowship.  Canadians are IMGs in American's brains.  A US fellowship takes the edge off of that stigma.  A US fellowship will also give you insight and experience within the US system.  I'd be drowning without that experience.   In orthopaedics, this is a match process  (SFmatch) that requires some planning starting in R2.

Hey, @jnuts. I know I’m bumping an old thread but I was wondering for how long would a Canadian trained ortho (who did fellowship in the US) be stuck in an academic job in the US? Is it until they are a full citizen, green card, certain # of years? 
 

 

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2 hours ago, bruh said:

Hey, @jnuts. I know I’m bumping an old thread but I was wondering for how long would a Canadian trained ortho (who did fellowship in the US) be stuck in an academic job in the US? Is it until they are a full citizen, green card, certain # of years? 
 

 

In US, academic centers can sponsor H1Bs or O-visa and you can maintain that status until you get green card (which depends on which country you were born in or your marriage status, if born in Canada, it wont take long, just ~ 2 years). To be honest, from what I heard/seen (so take this as a VERY small grain of salt), even academic orthopaedic surgeons make A LOT of money relative to Canadian surgeons especially if you do spinal surgery/fellowship. Not to mention, much better location (this cannot be stressed enough), more OR time and better employment opportunities. Definitely worth doing the USMLEs and move. To add, if you are a new med student and want to become a surgeon, DO THE USMLES!! DO NOT HESITATE. Also, some surgical speciality residencies are NOT interchangeable in US and Canada (e.g. neurosurgery), so consider US residencies as well. 

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On 8/5/2020 at 7:53 PM, bruh said:

Hey, @jnuts. I know I’m bumping an old thread but I was wondering for how long would a Canadian trained ortho (who did fellowship in the US) be stuck in an academic job in the US? Is it until they are a full citizen, green card, certain # of years? 
 

 

With a green card there are no further employment restrictions.  @peace2014 I think you're broadly right.  I'm a little skeptical about the 2 year processing time--and being able to convert off a work visa easily -- especially a J1 if you're on one for residency. I'm basing that off of observed experiences not direct expertise however.  Definitely agree that doing the USMLEs as early as possible can't but help.

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