Arztin

Work life balance really just depends on your workload and your practice setting. A GIM working in a small hospital might be on call 1:4. In a larger setting, they will take less calls, and frequently have senior residents who will take calls. Call structure really depends on the location, the setup, how well is the hospital staffed. In my hospital, the FM hospitalists do 7 days in a row 24/24. They do almost always have FM residents at night. 2 GIM cover consults and the wards each week. They split the calls overnight calls.

Hi there. 4th year attending here. Plain CCFP in my case, working in a large urban hospital where everyone else is FR or EM. You must really be laughing at me now. From my experience, residents, nurses, consultants all can't tell unless they ask. I've seen a lot of new docs at this point. FRCPs take about 3-6 months to become "ripe". CCFP-EM grads take about a year, and typically during their first year will ask more questions. After 2-3 years, they become "comfortable junior" attendings. I once saw a FRCP EM PGY-5 who already wrote and passed the RC exam who assessed a patient dying of a cardiac issue and rightfully put the patient in palliative care. Patient was already unconscious. However, they put the orders of : give O2 to keep O2 sat above 92 percent. I've never seen any other person in anyother pathway of training do that, esp at the PGY5 level. Lack of common sense? or lack of training in that area? Who knows. During training, I've worked with a super good FRCP not knowing what to do for a T2 diabetes patient with suboptimal control with only metformin, not in DKA nor HHS. Pt doesn't have a FM anymore, and endo consult would take months. You can argue that the patient doesn't have an emergency and hence is not an EM problem. Being FM trained, I knew what to do. I've worked with FRCP docs (with an S), who, even when they suspect a cancer in a patient, won't scan because they consider the patient to not have an acute emergency. Point being, If you use anecdotes like these, you can support any kind of narrative (toxic and damaging in your case) you want. That being said, either pathway has its pros and cons. At the end of the day, with the right attitude, with hard work, both produce great EM docs. Real life EM isn't what you see in the Ivory towers.

Perhaps program dependant? I've seen multiple ICU docs who have done 3 yrs of IM+ICU. They typically don't feel comfortable enough to do IM and hence only do ICU. GIM and ICU integration in 3 years, yes it's possible. With the EPAs nowadays, I don't know how feasible it still is. Maybe someone chime in? 3 year resp+GIM doesn't exist anymore. I was told that You become a mediocre ICU doc and mediocre respirologist at the same time. You can always finish resp, and then do ICU after.

Erm... she sounds like a lot of work... and a major energy drain. Only interact with her only if strictly necessary. Set clear and strict boundaries. Ignore her for the rest. Do your project alone or with someone else. And if needed, don't hesitate to talk to your PD.

I'll just add one more thing. If you think getting in med school (or being a MD) will make you happy - nope it doesn't.

C'est pas mal la même chose dans toutes les banques. Dépendemment de la personne qui t'es attitré, ça se peut que les choses se fassent plus facilement. Si t'es insatisfait, juste signe avec une autre banque.

The previous posted answered perfectly. Now, I'd like you to think about the following. You don't need to type the answer, but rather actually think about the following: why do you want to work in the academic setting instead of the community, and most importantly, do you really want to work in an academic setting.

Take everyone's take with a grain of salt, including mine. I do EM full time in a large urban setting. It's intense. Every shift is intense. You have to give it your 100% every single shift. Yes it's fun. It's fast paced. You see different pathologies. Most of the time, you diagnose or come close to diagnosing the problem. You need to think. You do procedures. You have to know a bit of everything. You deal with younglings, with the elderly, healthy patients, critically ill patients. You are overall a very ''well rounded'' clinician. You will constantly learn, and will be constantly challenged to improve. You will see all sorts of funky, or interesting cases. You work with a a great team, and usually the environment is very friendly between EM docs and ED nurses. Now, some of the downsides as you probably guessed: - shifts are grueling, and extremely demanding. Doing a shift as an attending is no the same as a trainee. - shift work takes a toll. Talk to EM attendings who are starting, who are in their mid 30s, mid 40s, and 50+. They will all tell you how evenings are hard, and nights are even harder as they age. Some people only work nights. I could never. There's a reason many emerg docs stop after a couple of years. - you will deal with really traumatic things. I've lost count of how many died a long time ago. I've seen patients who were victims of violent crimes reported on the news. I've seen dead children. - it's a great lifestyle when you are young, healthy, and have no dependants, not in an understaffed department (working a reasonable number of shifts), and are able to recover from these shifts. As you age, you will be annoyed by working so many weekeends, so many evenings. (BTW shift schedule is a recognized hazard for cancer) - the health care system in Canada makes it that you will never have enough time nor ressources to do as much as you'd like for your patients. You will feel rushed by the endless waves of patients, trying to admit patients, discharge patients, not having enough time to do things as well as you'd like, while the hospital is bed blocked (same story basically all over the country). Talk to any ''old-timer'' emerg doc. They will all tell you that everything is much worse since they started. I love what I do, at least for now, but don't expect me to still be in the ED by the time I'm 55-60. For radiology, depending on where you work, calls can be absolutely brutal. I've seen radiologists reading non stop from 8 AM till 2 AM Saturday and Sunday in the community setting while on call (it was at another large urban hospital). Hope it helps. My 2 cents.

If you do this, be aware that people have run into a lot of bureaucratic issues trying to apply for the FRCP examination afterwards since the duration of training is not the same (3-4 in the USA vs 5 in Can). https://cmajblogs.com/we-want-to-come-home/

In Quebec, FRCP have a completely different set of billing codes. CCFP-EM or CCFP bill another set of codes. FRCPs bill (anecdotally) about 30% more. From what I understand, there is no difference for other provinces, at least, in BC and ON. (other than the consult fees mentionned above for Ontario)

It's kind of what Rmorelan said. It's important to note is that the job market is cyclical. If you are a student now, the landscape might be quite different in a couple of years when you graduate, depending on the location, and the type of practice.

Yup. normal. Even as an attending, I learn something new almost every shift. it will get better with time. Keep up the good work. It is a lifelong learning journey.

If this is a serious question I will say the following. Asking such a question means you probably don't have enough knowledge nor experience with procedural sedation to perform it safely without supervision, especially in a setting with no backup nor RT. Therefore, I think you shouldn't be doing procedural sedations in such a setting, with your current knowledge. Any common medication used can be safe and unsafe depending on a bunch of factors: experience with the drug, dose, age and comorbidities, duration of sedation, clinical state of the patient, the procedure itself etc... It can be a risky procedure that can lead to severe complications that you should be ready to deal with. As someone who does it pretty much on a weekly basis, I still sometimes ask a colleague of mine to sedate while I do a procedure for higher risk patients, and I'm ready to call the anesthesiologist if it's a very high risk situation. The airway is no joke. If it's absolutely something you need to do in your practice, please do a rotation in anesthesia and rotations in ED where you will learn how to do it. If you are an attending, take CME classes, and if you can, do some extra training as a resident.

This is the problem with the current medical education system. Many clinicians don't know how to do it, so they don't see the benifit of it, and therefore they don't teach it. Training should include some sort of basics. To answer your question, I've done a POCUS+EM rotation as a trainee, and took multiple courses. Regarding courses, look up the courses available on CPOCUS. They're mainly given by emergency physicians in Canada. https://www.cpocus.ca/training-exams/courses-and-workshops/ Look if you can do a POCUS rotation as an elective. It's usually given by EM physicians where you do a mix of POCUS shifts with clinical shifts. And something important to note: ultrasound is not there to replace physical exams. It's more of an extension of the physical exam. EDIT: Nothing to dislose. For books, I would suggest for beginners: https://books.apple.com/ca/book/essentials-of-point-of-care-ultrasound/id841572764 Pretty cheap and basic. It has most of the POCUS applications you'll realistically use. Very good buy, especially for the price. For free, you can also download if you have an Apple device the following: Introduction to Bediside: volume 1 and 2 by Matthew Dawson and Mike Mallin

Well first off, you can't diagnose these with physical exam. You aren't the only one with those problems. The sensitivity specificity of a physical exam vs a bedside POCUS is just not comparable for many things. I don't ever look for the JVP. I have my pocket US machine. I just look at the LVEF to have a rough idea instead. I can easily look at the IVC which is equivalent to the JVP. You can see consolidations on POCUS as well. Here are just a few example of why POCUS is very important, way more than a stethoscope. There are all true patients I've seen recently, that changed the management entirely. I can go on and on. - a lady in her 70s came with a presentation fairly classic for decompensated CHF, but not known for CHF. I POCUS her, and realized that she was actually in tamponnade. She had 600 cc of liquid drained. Her JVP would have been high either way and would not have helped. The fact that I couldn't hear her heart properly in a noisy ED wouldn't have helped. Not identifying the problem, and giving lasix and having her seen by cardio next day assuming she had a CHF could have been deadly. - I saw a man recently who came to the ED hypotensive and had a couple of episodes of syncope. My bedside POCUS reveals RV dysfunction and fixed and dilated IVC. Especially with the clinical context, I knew the patient almost certainly had a massive or submassive PE, which was later confirmed by a scan. - A very obese elderly lady comes in for delirium and fever. I do all sorts of investigations, including a CT chest and abdomen. There is nothing. She seemed to have some pain when I moved her legs. I then POCUS her knees and she had a large effusion bilaterally. I asked for a joint tap which confirmed inflammatory arthritis. IM saw and admitted the patient with prompt treatment. There was no way you could palpate and ''milk'' the effusion on a physical exam. - A lady came in with general weakness, only known for a DVT diagnosed recently on DOAC. Nothing specific on history and physical exam. I POCUS her and see a HUGE vegetation of mitral valve of like 3 cm. I also scanned her and she ended up having a cancer and bilateral PEs, but that large vegetation would not have been identified at all if I didn't POCUS. Cervical dilation takes a bit of time. You need to do quite a few before starting to be good. Unless you do OB, you can forget about it. If you hear a murmur, you'll ask for formal echo anyways. Now, the problem is that for physical exams, they teach completely useless things: especially the following: Traube space and castell sign? (can't even remember those). 99 and whatever else for effusions (whispered pectoriloquy?) while a POCUS tells you right there if there is an effusion, and if there's a consolidation that touches the pleura. Then there are urban legends such as: thyroid bruits, abdominal bruits, 1/6 diastolic murmurs. When I was in med school, I've had a RC IM examiner giving us a lecture. I asked her how can you differentiate a thyroid bruit vs a carotid stenosis. She told me she didn't know and she never heard a thyroid bruit. But it is part of the physical exam that you need to mention for the RC. Yup... Now there are truly very important things regarding physical exam, including those: - doing a good MSK exam is of the uttermost importance. It is not taught properly usually - same goes with the Neuro exam. People do it very poorly in general. Go shadow neurologists and see how they perform a complete neurological exam. - derm obviously. Many clinicians (including me) do not feel comfortable in derm at all. - knowing how to recognize an acute abdomen - if you do trauma, knowing how to do a good primary survey - eyeballing, quick glance and recognizing a sick patient. This one just takes time and practice. Very difficult. Often not obvious. I still don't find this always easy. Often, we fail to turn the patient and look at the patient's back and perianal area. I've seen countless times big surprises such as a big infection that you wouldn't have seen otherwise. Undressing the patient is often overlooked but it actually important. That being said, I still need a stethoscope. I can't entirely work without it. When patients come in for SOB, I still auscultate. You do need to hear what a normal lung auscultation sounds like. You need to identify wheezing and crackles. And go read what Samy suggested. You'll realize that very often, many physical exam manoeuvers have a LR that don't ultimately doesn't matter, like less than 5, or sensitivity/specificity that is way too low to be of any use. And a caveat, POCUS takes a lot of time and training to master. You always need to recognize your limits. Finally you are precisely at that stage where learning physical exams is part of the curriculum. Don't be afraid of asking your senior or your staff to show you how to do it properly!