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Everything posted by medigeek

  1. Yeah it was an example of little things that need auto-consults. A lot of the protocols are there to up the billing and keep the specialty services busy. Even small rural hospitals in USA often have pretty decent subspecialty availability (state dependent) and advanced imaging available. The rural patient population isn't as big so these consult services essentially will be consulted whenever possible.
  2. The shift from academic center/metro center hospitals in Canada to smaller community and rural is pretty drastic compared to USA. I'd say scope of practice is USA is somewhat consistent across the board until you get very rural. Open ICUs are fairly common in busy metro areas (not just small community/rural) so IM/FM hospitalists can be managing vented patients, placing lines, intubating etc as needed. Of course many hospitals also have closed ICUs (especially academic centers) so ICU doctors have full control and hospitalists only do general floor medicine. And IM/FM would always be on shared
  3. I think most canadian IM docs come out of residency able to do things like paras/thoras, lines, and maybe chest tubes/pigtails. Intubation is a huge plus/minus and I'd say the solid majority will not be highly skilled at airway management, though I'm sure many do it anyway later on. Lines aren't hard to get good at if you've done some already. Maybe take a course to supplement? Chest tubes are easy. And yes you will not have nearly as much subspecialty support in most Canadian hospitals. In many hospitals, you're the actually consultant and the specialty support. Filling the role fo
  4. You learn a lot more medicine in-depth while inpatient and it is definitely heavily applicable to clinic. You also get much better context to evaluate a clinic patient's condition and how bad it can become. It also broads your differential, among other things. So I would say heavy inpatient is of major benefit to docs who want to do clinic only. Also, people change their minds. Especially in FM. You may like X in med school then like Y in residency. Better to be somewhere that trains you better. And honestly programs that are heavily outpatient-only oriented tend to have weaker preceptor
  5. But you know these are exceptional circumstances. I just meant that in general, going somewhere more rigorous for family medicine specifically is a better idea. Even if you just want to do bread and butter outpatient only.
  6. It's 2 years. Go somewhere more rigorous to become as competent as you can.
  7. Busy community with few residents is always best. Optimal ratio of pathology and procedures to learners.
  8. How about true rural ERs? Quite a few of these, all are mostly FM staffed and none have any back up available (no ortho or anesthesia or essentially anyone lol).
  9. Yeah I meant informally like if you've heard if they provide assistance on certain procedures (ex. complex reductions with sedation). Less so on medical management as I think you should be very competent on the cognitive aspects (including running codes) if you're working in the ED. But some procedures are just tough to get enough experience in during residency.
  10. Do you know if they're offering mentoring to those new hires as well? And the 4 year practice route makes you more eligible for large community hospitals jobs within GTA perimeter/just outside of it I'd assume?
  11. 1. Don't train them. By far the most important part. At the beginning, they're just learning. 5 years later, they're lobbying for independent practice and will claim to be at minimum equal to you or better. 2. Don't hire them. Sure they'll work for you initially and do as told. Then go down the street and become a direct competitor. 3. Raise awareness. So many people in the field are barely aware of this issue or think superficially it's a good thing. 4. Aggressively lobby against proliferation.
  12. It is very likely we will have the same issues in Canada. Biggest mistake in your post is training midlevels to go rural. The US is concrete proof that it does the opposite. A lot of rural ERs in USA are staffed by just a midlevel and no one else. CRNAs delivery anesthesia all alone too, 0 supervision. And this is for stuff like ex laps etc. ICUs are run by midlevels all alone overnight all over USA. Even in academic centers. PA and NP "hospitalists" are also rampant everywhere.
  13. There's a lot of shadow billing and other fees you can accumulate. It would be way over 150k. Consider that not everyone will be honest on their earnings as well. Or that they may tell you their post corp tax income, or their net or whatever else. There are so many ways to frame physician income in Canada that the numbers are not clear ever. And 1k is a somewhat smaller roster. And the large X variable is how frequently your patients need follow up. If you have people coming in for refills of routine meds - you lose time (as an example). The people making a lot from FHOs have 2.5k ish pa
  14. This is both true and false. FM in canada may be hospitalists more often in Canada than in USA, but they can be hospitalists in USA at most hospitals aside from the main large academic centers - and they're considered equal to IM in terms of competency at hospital medicine. Them being hospitalists less frequently in USA is due to personal choice largely. IM does a lot of primary care in USA and Peds does the bulk of primary care for kids. There's also more emphasis on use of specialists in USA (region dependent). FM also isn't in as many settings as they are in Canada (a
  15. If often means you're doing just fine and they're probably not paying super close attention. Picking up that a med student is doing super well is kind of tough in all honesty.
  16. I agree and this is a universal issue. Only a minority of programs truly maximize resident training. But I don't think we should willingly just give things up. You can learn stuff on the fly, same as how midlevels do. And I don't think committing a profession to managing algorithmic hypertension and diabetes is the best way to go in the era of technology and proliferating non-physicians. Easy tasks are much easier to replace.
  17. How about instead of letting non physicians take over our role, like they do in the US, we keep our current duties?
  18. We're slowly losing everything, why give up another role?
  19. Maybe if it's X number of weeks per year where X is not 7 on 7 off lol. In that case, unavailability could be justified to a degree. Though I do know one guy doing 7 on 7 off with 2 days of clinic on off days. Haven't asked about the continuity aspect of it but he sees very complex patients.
  20. Yeah I think having a dual or even a triple approach can be nice. Outpatient setup with your own panel (not a walk in) + integrated outpatient niche and then having a significant portion of time spent in the hospital too. This is of course for those looking to do more than just regular clinic.
  21. I would still recommend having something longitudinal with patients to fall back on. Niches can be great but long term may fall part after x number of years (defunding, etc.).
  22. USA residency and lots of inpatient call all 3 years. Lots of ICU 24 hour call. And 6 weeks of nights per year.
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