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NLengr

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Posts posted by NLengr

  1. 5 hours ago, ChemPetE said:

    You need to learn, and they’ll need the hands on deck for teaching wards to replace the graduating docs. I imagine the pgy1’s will simply have a trial by fire. Someone has to be on call July 1, that’s never changed.

    That's what happened in 2009 with H1N1. The med students and residents just kept working. 

    This has the potential to overwhelm the hospital system in Canada, so everybody will be needed to help, residents included. 

  2. Just wanted to comment on lines since it got mentioned way up this thread. 

    Femoral lines are a great back up for both central venous access and arterial lines. They are relatively easy, can be done blind and unlike subclavian and IJ lines, there isn't a mess of important stuff in the area to hit. And unlike a radial art line, a femoral art line is a nice big pulsing vessel, making it easy to get. 

  3. On 1/16/2020 at 10:58 PM, Raptors905 said:

    It’s hard to stomach working more and being paid less for sure. 

    I don't think academic guys work more than community. Plus, they also have residents and fellows who do a ton of work for them and shield them on call. 

    My buddy is an academic IM guy, and even covering general IM call in a tertiary center, he is in there was less than I am as a community surgeon in a rural center because he has residents protecting him.

    The way I look at academic vs community is you get paid less in the academic world for a trade off of less crap cases, residents/fellows to do all your scut/call work and a large community in which to live. 

    ***just realized this convo was probably specific to FM. My comments are more general***

  4. 39 minutes ago, _gettingthere_ said:

    I have the option of a general inpatient peds elective or peds heme onc elective at SickKids. I am a visiting student and U of T peds is definitely high on my list for preferred residency programs, partly because I would really like to be home with my family. I guess this means a reference letter is very important for this elective. I've heard gen peds is better because you get to meet residents, gen peds faculty etc who are involved in the selection process. However I worry that it's harder to stand out and do well on a big team and I'm worried about having to compete with a bunch of other students if it's a CTU elective (is it CTU? Can anyone confirm?)

    Heme onc is cool because it's just one area to learn about, instead of literally everything like it would be in gen peds, but I worry the pts might be too complex for my level and it'll be harder to excel. Also worried about the fact that there are fellows, residents etc so not sure how much I'll get to do/learn.

    Has anyone done these electives? Any input would be greatly appreciated.

     

    I would try to spend time with people who are gonna be on the selection committee. Also, would general peds give you a better idea of what the program is like overall vs. a subspecialty elective?

  5. On 3/6/2020 at 12:02 AM, ellorie said:

    Ugh thanks for reminding me.

    PGY5 is the straight up worst.

    Hang in there. It's an awful year and now complicated by an awful situation. You will get through it.

    Like my grandfather used to say to my dad, my dad to me and now me to my own kids when everything looks bleak: "This too shall pass".

  6. 11 hours ago, Snowmen said:

    Here I am, stuck with about a week to decide whether or not to cancel the elective I was supposed to do in France so I don't end up without one if things go south (because France is good at shutting things down). Do you guys think I should cancel my elective so I can make sure I secure one here?

     

    City I'm going to already has a dozen confirmed cases and a death. Some events being postponed.

    Cancel. Europe is going to shit and will get worse. Plus if you get sick at all within 14 days of your return, you'll have to self quarantine.

  7. 2 hours ago, PA2021 said:

    As a midlevel PA, I'd have to sell myself to employers showing the need for a PA in order to get a job. Doesn't even mean I'll have a job in 2-3 years if funding goes away. Literally seen three PAs beg for a job since their funding got taken away and no hospital wants to create funding for them. There is barely any job stability compared to physicians and although mobility is limited, at least physicians can potentially practice all across Canada. PAs can only practice in 4, provinces so being a midlevel ain't all that good.

    NPs definitely have a much better situation than PAs right now. 

  8. 3 hours ago, PA2021 said:

     

    Also, being a PA may seem good on the surface and compensate decently in Canada but the impact and autonomy that a doctor has (combined with better job stability) outweighs everything. 

    The stability comes as a very high price of limited mobility. It is far, far easier to move jobs as a mid level than it is as a physician, especially if you are in a specialty with limited job opportunities. I frequently wonder if it is worth it.

    The autonomy is mostly for FFS physicians (I worked a salaried corporate non medicine job before I went to med school). Salaried physicians have much less autonomy than FFS.

  9. In my opinion, we have too many RNs working in the OR. LPNs could easily do the majority of the work. It's organization and planning work to a large degree (making sure proper equipment is avaliable, planning how to get the OR to run efficiently that day etc.). It's very important and doing it well is a skill but it isn't like you need core nursing skills to do it.

    Part of the overall "shortage" hype is political/union rhetoric. We could improve the shortage by more efficiently using the RNs we have (like using more LPNs in the OR and putting the RNs in other areas that need RN skills) but the union would never allow it. As far as they are concerned the solution to all problems is to hire more RNs, even if it will do nothing to help the underlying problem. Increasing RN jobs and pay is the only union motivation. For politicians, increasing RN numbers plays well with the electorate, no matter if it helps or hinders the system. Stuff that plays well with the electorate gets you reelected, which gets you that sweet retired politician pension when you retire or are voted out. 

  10. On 3/1/2020 at 6:54 PM, Zuk said:

    For instance? I'm not doubting you, I just want to learn some more. 

    Quick and simple example:

    Severe shortage of OR nurses in our facility due to recent injuries, unplanned leaves and short notice retirements. We are at the point where surgeries may be getting cancelled for lack of staff. We have several nurses with some OR experience and have completed the specific OR nursing course who are interested in coming to the OR to fill the vacancies. Easy fit, you can drop them in to the position and they are ready to perform their job at full capacity within a short period.

    Union somehow got it put in the contract that OR nursing positions are "teachable" which means that the position goes automatically to the most senior nurse who applies, even if they have no OR experience and have no formal OR course. Those nurses can take up to a year before they are ready to work as an independent fully functional OR nurse. During that year they are still in the OR, just filling the position and unable to fulfill all it's duties. 

    It was pointed out that the current rules will make it extremely difficult to run the OR at full capacity for the coming year and surgeries will likely be cancelled, resulting in more patient suffering and delay of care. Union gives zero shits. Not to mention the fact that each "teachable" nurse will cost the system an extra 80k or so because we are paying someone to do a job that they can't fully do. Plus having a nurse who has to be actively trained for a year while working in the OR means the entire OR efficiency goes down.

    Drives me insane because it's such a waste of resources and impacts our patients in a negative way. Also, the logic the union uses is stupid because technically, anything is a trainable position. Should we be naming the most senior nurse in the building the new general surgeon? That is "teachable", we weren't born instinctual surgeons. What about making them an astronaut, lawyer or F1 driver? All those people are "taught" to do what they do.

  11. 1 hour ago, 1D7 said:

    For small/moderate differences in residency lifestyle I agree it's not worth basing your decision of residency off of.

    For absolutely massive differences like pathology/psychiatry vs general surgery, then it's worth thinking about. The difference is putting your life on hold x5 years vs being able to live some of it freely (e.g. being able to start a family vs putting it on hold).

    I started a family during a surgical residency. Added a second during fellowship. I'm a dude so the whole carrying the child/breastfeeding was a non issue. It's do-able. Your spouse has to shoulder a lot of work and be amazing though. 

  12. If you are debating between the specialties, I would strongly consider attending lifestyle and try not to sweat residency lifestyle. Residency will suck no matter what you do for 5 years. But you need to work your attending job for 30 years.

    All residency sucks. Any surgical specialty will be horrible (maybe not optho?). I imagine IM residency also sucks the big one much of the time.

  13. In the community IM is the worst of the three for after hours work. The IMs at my center seem pretty busy on call but we are a rural secondary center so we don't have most subspecialties. So for MI's, AKI needing dialysis, ICU admits etc. general IM is handling those instead of cardiology, critical care, nephro etc. And the patients are not easy patients a lot of the time (grandma with mild dementia, pneumonia and CHF). Gen Surg seems tolerable at our center than IM but milage may vary.  Urology is almost as busy as gen surg when it comes to volume of on call cases (we recently reviewed all the after hours add on volume for the OR) but no urologist is doing a routine stone patient at 2 am (by far the most common add on case for them), where-as it's not unheard of for gen surg to have to take a bowel to the OR at 2 am. So the urologists here have better hours for add ons because they can put more off till the next day. 

    Also, poop is gross. 

  14. 1 hour ago, rmorelan said:

    ha I would have to agree to large part with that. 

    putting it another way - as a doctor in Canada you are basically in a union, and unions only really work if they are united and willing to push back in some fashion (in other words not afraid to actually piss people off from time to time). Doesn't mean say we would go on strike but does mean you take steps when attacked, or avoid the attack from coming in the first place. 

    I always find it odd that doctors seem to be super independent in outlook, and yet at the core are in the most collective form of employment typically there is. 

    Nurses, teacher, police, firefighters......none of those groups seem to have that form of cognitive separation from reality. They are all united and act so quite often. 

    We may have been trying to avoid making waves but that certainly hasn't helped regardless on the PR front. Doctors well really suck at the PR side, and that is sad because we really do work our asses off, take the same risks other health care professionals take and make a lot of sacrifices along the way (and so do our families). We could position ourselves much better as the true patient advocate, and even pushing against the government when it hurts patient care to save money. There is nothing any of those nurse PR campaigns are doing that we couldn't do as well. 

     

    What drives me nuts from an admin point of view is the nursing union promotes themselves as guardians of healthcare and very interested in saving the public system, but the minute we try to improve the system in any way that isn't simply adding more nursing jobs, they act as a roadblock. In my experience, the union is a massive barrier to improving the system. Probably the biggest internal barrier we have. 

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