rmorelan

sigh - I haven't gotten this may moderate requests in a while.

So today it appears we have a court case coming for medical resident that is taking NOMS to the human rights tribunal, claiming she was punished for filing for harassment while she was a resident there. As far as I know this is the first time someone has done that - its a public hearing so the zoom details are above. Supposed to last the rest of the week.

You have the right idea with some how sometime family medicine financially is a stronger choice than many give it credit for - you have to factor in the taxes on that 220K (which due marginal taxation matters as the average tax rate on that 80K is not the same as the 300K - although if you have a corporation that effect is blunted). You also quite often need an additional fellowship year for many non-family medicine fields so it is 4 years of "extra" trainee time often or even more (it was 5 for me). People love comparing the incomes of FM vs whatever ignoring the power of potentially a 3-4 year head start. Also in many specialities your ramp up to full salary is not a quick as family medicine - for instance for me as a staff radiologists my first year of practise was at 60%, and the following year was 80% of base salary - and then I got the group practise pay. It just further stretches things out. Plus again the marginal tax rates bumping at higher rates blunts things a bit. There are obviously some specialities that earn quite a bit - that blow this math out of the water but they are relatively few in number. Plus all the FM advantages are always going to be there (many fields don't have the same career length, and are harder to go part time later one with - if you can gracefully slow down at late stages it really impacts the need for retirement savings). I am still not sure all of this should be a major factor in selecting a career - only because being bored or frustrated for 50+ hours a week sounds worse that any cost difference.

even in academic medicine people stop caring quickly. Oh this guy thinks less of this guy.....who cares? Most people are just trying to get through the day doing good work and then going home. There are a few doctors that can never get out that superiority mind set - those people are not much fun at parties.

medicine has this strange and pointless self inflicted punishment system - everywhere really - where doing less than the maximum is looked down on in some fashion until medicine is your entire life. I think they may have some cognitive dissonance related to it - "I am doing something hard and painful so it must be for a logical reason, therefore I should keep going. Anyone that isn't doing something that hard and painful must be inferior to me" - it never ends by the way - you see that within different fields, and between them all over the place forever. Probably almost necessary mindset at times to keep people going in some fields but it is not wise. So in this case that breaks down into FM must be horrible because I decided not to do it and my longer and more stressful chose is just better .... because it just has to be. The thing is......not all pain is gain. Sometimes it just hurts for no reason. It is a hard lesson for many in medicine that in many cases you just have to stop doing hurtful things to yourself. That extends as well across your entire career, where there are an infinite number of stupidly painful things you can decide to do. Medicine also has this deep root fear of losing out problem too - particularly in picking a specialty. As if that one decision can somehow complete your life, and if you get it wrong you will be tortured for your entire career. Truth is people are vastly more adaptive than that and field has good and bad things. Other than radiology - radiology is clearly the best - particularly emergency radiology You do have to of course really make sure you have explored things - and not care ultimately too much about what other doctors think about what you are doing. Prestige really does wear out very quickly - because no one really cares in the end, and that too is an endless hollow pursuit because it is all external validation. For the record the smartest doctor I know from my class - phd and everything - went into family medicine and she wasn't alone because it was a smart move, and how can a very broad area of medicine be anything other than challenging in many ways. The people you really need to be talking to is people in family medicine.

that is always hard to answer - the value to the contract I find varys based on the specialty and the city combination more than the province at times I think. Also seems to depend on when in the contract cycle you are at - as the contract feed off of each other a bit - sometimes the most current one has the best rates but that changes when the others update. With the duration of the contracts they will be updated commonly at some point in the longer residency programs. I did find the out of ontario call stipends a bit better last time I checked - but I wouldn't be basing any actual decisions on those sorts of relatively minor differences.

A lot of the time periods for residencies anyway are a bit arbitrary - why are almost all of them exactly 5 years? Is there some magic there that all programs are equally difficult, and take exactly the same amount of time to train someone? That seems logically unlikely - and worse compared to other training in other countries you find differences all over the place in the length of training just further suggesting the duration is not really based on anything particularly solid. As some fields get more and more complex the training still doesn't change - for instance radiology is still 5 years but it was 5 years when we had plain films, barium fluro and maybe US studies and that is about it - now we have CT, MRI, US, Nuc med, IR, way more procedures.........still 5 years. So 4 vs 5 years? You would think with more training then if someone was a bit behind it would ensure they reach the needed level by the end. Otherwise if there was a reason difference in skill you would like to think it would be obvious by now. It isn't.

you will always have variability unfortunately - I hope programs take it into consideration but I know sometimes it is not easy - when you are already flooded with applicants, and they are already quite good, then there is a natural tendency to not go around and seek out more. It is one of those frustrating aspects of CARMS. The advice they give to do as many as possible just makes sense - easier to have them in hand then have to explain why you don't. Even if they are as you say community placements that is still something to talk about. I won't worry as much about their engagement on selection committees - for one thing that is going to just trace back to a single school anyway, and more over we take steps to prevent "interference" in the selection process to blunt another effects.

Derm is annoying that way - it truly is one of the very few cases where they may be a home school advantage that is relatively important. Very few electives, relatively few schools doing them. The programs are very aware of the problems mind you so that is factored into their processes. They don't want to lose out on good candidates either.

also doesn't help a lot with specific disciplines either. Although obviously getting interviews at every site you applied at isn't exactly a bad sign.

This is one of those stupid issues in examinations. If such resources existed then everyone - the test takers, and the test givers and so on - would be fully aware that they did. The test makers could easily enough create an exam where the resources would be useless - it wouldn't be hard at all to do that (major exam format changes have from time to time for instance - for rads in the US the test changed in part to specifically eliminate the usefulness of any such materials) . If they didn't change things under those circumstances then they would logically not doing so for a reason (you don't have to agree with the reason, but nothing about these exams is in any way an accident). They also wouldn't have doing anything for generations and generations of test takers. I have heard of possible explanations there but one of the best I have heard was simply it is an amazing way to get people to learn a particular subset of things extremely well. You want to have a student learn 5000 core things? Tell them that 50-100 of them will be an super important exam that will dedicate their future. Then just sit back and watch.

this does come up from time to time - I think for the most part all the grading for residency spots is done basically right away (there may be some exceptions) - schools know you are going to start forgetting things fast, and there are many people applying - you don't want to miss anything or confuse anyone with anyone else. The point of all that is it pointless simply because they are already done the process.

Ha, and since we don't want them to realize it later on we likely to make sure that is out there sooner. The argument is when you join a practice that group has already built up capital in a variety of ways and you need to "buy in" in some fashion. Since you don't have any money yet having started off as staff that is generally done with "sweat equity" - you just don't get paid at the full rate. It is not a small difference - I started off at 60% for instance, and then the following year went to 80%, before finally hitting at the start of year 3 100% plus then a share of the group's profit. In the community you actually unlikely to be fast enough to be truly a fully time rad at the start - so you effectively have a pay cut another way - either you start at a lower rate or you end up working late/weekends all the time until you slowly get faster. The idea that you leave residency or even fellowships fully ready to go is just....false. Truly the first 5 years of any practice are really where you develop fully. That isn't just for radiology. You have to manage expectations buy being blunt about the truth. The problem is when anything is unexpected.

Generally not a good idea - the schools are looking for you to complete a standardized block of courses of 5.0 credits per year. Some places will let you do 4 standard courses in one term and 6 in another and have it count. I keep saying standardized courses as some courses are worth more or less than normal. All this is supposed to promote some version of standardization and therefore fairness (of course you can argue that all the courses are not the same so this breaks down at some point, but you have to do something).