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ralk

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  1. Like
    ralk got a reaction from Joshanih in Paying for medical school   
    The basic strategy for paying for med school is pretty straight-forward. Go down the following list in order until you've met your financial obligations
     
    1) Get as many scholarships/bursaries possible (it's free money)
    2) Use saved money (any saved funds cut into your OSAP, so use it up if you've got any)
    3) OSAP (part grant, so more free money; loan portion has 0% interest until graduation)
    4) LOC from a major bank (should comfortably covers any remaining expenses, has lowest interest rate you will ever get)
     
    Basic timing of this is to minimize the balance of your LOC, especially early on, to minimize interest payments until graduation. At graduation, OSAP starts charging interest, which has a higher rate than the LOC, so most people simply pay off OSAP using their LOC.
     
    There's not really a "cheaper" way to do this, since our LOCs charge interest at the prime rate, which is as good as anyone will realistically get.
     
    If you have a source of outside funding, like very rich parents, that's about the only alternative. That'll keep your debts low, but it's not an option for most of us and isn't all that necessary even for those who have it available.
  2. Like
    ralk got a reaction from hijkl in Paying for medical school   
    The basic strategy for paying for med school is pretty straight-forward. Go down the following list in order until you've met your financial obligations
     
    1) Get as many scholarships/bursaries possible (it's free money)
    2) Use saved money (any saved funds cut into your OSAP, so use it up if you've got any)
    3) OSAP (part grant, so more free money; loan portion has 0% interest until graduation)
    4) LOC from a major bank (should comfortably covers any remaining expenses, has lowest interest rate you will ever get)
     
    Basic timing of this is to minimize the balance of your LOC, especially early on, to minimize interest payments until graduation. At graduation, OSAP starts charging interest, which has a higher rate than the LOC, so most people simply pay off OSAP using their LOC.
     
    There's not really a "cheaper" way to do this, since our LOCs charge interest at the prime rate, which is as good as anyone will realistically get.
     
    If you have a source of outside funding, like very rich parents, that's about the only alternative. That'll keep your debts low, but it's not an option for most of us and isn't all that necessary even for those who have it available.
  3. Like
    ralk got a reaction from RPN-RN-MD in Is It Possible To Finish Med School Without Becoming Too Salty Or Cynical?   
    Avoiding cynicism entirely is pretty much impossible. Cynicism is mostly a defense mechanism to help deal with the BS that gets thrown around in medicine, and there is a LOT of BS.
     
    The key is to get cynical about the proper things. Some parts of medicine are bad but mostly out of your hands - most physicians can do little to improve those situations and being cynical doesn't make those situations worse. Without the ability to fix these aspects of the job, or even the time or energy to process them more maturely, being cynical is a fairly appropriate response!
     
    The trouble comes when physicians get cynical about aspects of medicine they can change for the better or, through their cynicism, they make worse. Being cynical about making a difference for patients is a big one. Most students come into medicine with rather high expectations about the potential of medicine to help others. The reality is that, while as a whole medicine does an alright job of helping most people somewhat most of the time, the marginal impact of each one of us is often fairly low. But being cynical about being able to help others only makes that situation worse. Opportunities to do some meaningful good when they do come along get missed. And the day-to-day of simply respecting and appreciating patients gets lost.
     
    To keep the cynicism pointed in the right direction, there are definitely some steps that can be taken. Make sure to take time for yourself (and your loved ones) even if it means spending a little less time on your career. Value the opportunities you have to help patients (or when you see others help patients), even if that help is as simple as being friendly with a scared person in a clinic. Lastly, best piece of advice I've gotten so far: if you want to be happy, go where the happy people are.
  4. Like
    ralk got a reaction from yonas in Family Medicine Popularity   
    FM salaries are lower overall and workload is only slightly lower when compared to royal college specialties, but there's a lot of variation. If you're willing to work in a rural or remote place, especially in a town that has FPs (without +1s) covering long Emerg shifts in rural hospitals, FPs can gross over 500k while working a very reasonable set of hours. That's a job most people don't want, but these positions do exist. Most will make ~200-225k gross while working around 50 hours a week though.
     
    As for the bigger question as to why FM is so popular, as someone who's very well set up to match to one of those higher-paying specialties, but is leaning heavily towards FM at this time, I'll give you my perspective as to why I'm likely choosing not to go into a higher-paying specialty.
     
    First, jobs. Aside from Derm, most high-paying specialties have pretty poor job markets. More importantly, jobs exist only in specific locations or in specific settings that are not always that desirable. FM has plentiful job opportunities and they're everywhere. Of equal importance, as Commons mentions, FM docs have far more latitude to tailor their practices, especially in the early stages. Specialists have some control over their schedule as well, but there are limits on that flexibility, and it can take some time to gain some flexibility, depending on the specialty. I'd like a job at the end of this. I'd also like some control over where that job is located and what my schedule looks like. FM fits the bill a lot more than most other specialties.
     
    Second, time. As LittleDaisy pointed out, it's not a 3 year difference, it's generally 4-5 years of difference before you can start full practice. Those 4-5 years additional aren't just a little bit of extra hard work, they're quite life-disrupting if you have any ambitions outside of medicine. I've got a lot of non-career life goals and the next 10 years or so are going to be critical in achieving some of them. Having a short residency that gives me some flexibility in life earlier on helps me do what I want to in life far more than a high salary that I won't realize for at least 8 years.
     
    Third, having tons of money just isn't that important to a lot of people, myself included. There's not much I could do with a household income of ~700k that I couldn't do with ~200k, at least not anything I consider overly meaningful. I certainly wouldn't say no to some extra cash, but the extra time, effort, or stress needed to achieve those higher incomes isn't a worthwhile trade-off for me. Money's a means to an end and I see some pretty steep diminishing returns from a higher income beyond the salary of a typical FM doc. You say money is an important factor so I presume you have some goals in life that require a higher income, but that's just not the case for me.
     
    Enjoying the job is also a major factor for many people - a lot of medical students simply don't want to spend their days looking at images, eyes, or skin lesions. But, even for someone looking at aspects of a specialty beyond the work itself, there are still some rather compelling reasons to go into FM instead of a traditionally high-earning specialty.
  5. Like
    ralk got a reaction from elephante in Ontario to fund new residency spots with return of service requirements   
    If all the government does with NPs is to have more of them help academic FHTs and work in underserviced areas, I'd call that a solid win. In academic FHTs they provide continuity residents simply can't (and can be decent sources of learning for those residents too). Underserviced communities need any providers they can get and while it would be ideal if FPs stepped into that void, we haven't, and neither physician groups nor governments have come up with reliable methods to get adequate FPs to those locations long-term, especially not without significant cash incentives.
    I agree about midwives, but that's also a bit of a complicated situation. Midwifery, as a concept, I think makes a lot of sense. Low-risk OB is rather simple, and have dedicated providers (rather than, say, FPs doing OB only as an adjunct to their main office-based practice) has logistical and safety advantages that are hard to ignore. Some countries, like the UK, use midwives as a mainstay of obstetrical care and their outcomes are quite good. The problem in Canada is the midwifery standards are far too low, and midwives as a whole have bought into too many non-evidence-based practices like home delivery. They're very slowly moving in the right direction, but don't have the training or skills yet to do so effectively, resulting in high rates of transfers to OBs. Better than the alternative of hanging onto patients they shouldn't, but not an efficient or effective system in the slightest.
    When it comes to public perceptions of physicians, we are definitely losing ground, but as I've said on this forum many times in the past, we have only ourselves to blame. A big part of that is our profession's collective over-estimation of its own importance and capabilities. It's a strain of arrogance that every patient has seen from a physician. That's why we're not going to get anywhere in improving our public standing by going after other health care professionals, especially NPs who are essentially filling gaps in our own coverage. Doing so only reinforces the perception of physician egotism.
  6. Like
    ralk got a reaction from Beardy in Annual Specialty Competitiveness Stats   
    For those interested, ran my version of the stats on last year's match earlier, just not in this thread. I usually look at the rate of successfully matching to a first choice discipline as my main metric - using quotas as the denominator provides a useful look, but I find it can get difficult to interpret as they're heavily impacted by people backing up and by regional mismatches in quotas vs interest, especially for middle-competitiveness specialties. Link is below.
     
  7. Like
    ralk got a reaction from Jimbo in Is It Possible To Finish Med School Without Becoming Too Salty Or Cynical?   
    Avoiding cynicism entirely is pretty much impossible. Cynicism is mostly a defense mechanism to help deal with the BS that gets thrown around in medicine, and there is a LOT of BS.
     
    The key is to get cynical about the proper things. Some parts of medicine are bad but mostly out of your hands - most physicians can do little to improve those situations and being cynical doesn't make those situations worse. Without the ability to fix these aspects of the job, or even the time or energy to process them more maturely, being cynical is a fairly appropriate response!
     
    The trouble comes when physicians get cynical about aspects of medicine they can change for the better or, through their cynicism, they make worse. Being cynical about making a difference for patients is a big one. Most students come into medicine with rather high expectations about the potential of medicine to help others. The reality is that, while as a whole medicine does an alright job of helping most people somewhat most of the time, the marginal impact of each one of us is often fairly low. But being cynical about being able to help others only makes that situation worse. Opportunities to do some meaningful good when they do come along get missed. And the day-to-day of simply respecting and appreciating patients gets lost.
     
    To keep the cynicism pointed in the right direction, there are definitely some steps that can be taken. Make sure to take time for yourself (and your loved ones) even if it means spending a little less time on your career. Value the opportunities you have to help patients (or when you see others help patients), even if that help is as simple as being friendly with a scared person in a clinic. Lastly, best piece of advice I've gotten so far: if you want to be happy, go where the happy people are.
  8. Like
    ralk got a reaction from ana_safavi in 2019 CaRMS unfilled spots   
    For those who went unmatched (and are still reading this thread despite the directions the conversation has turned), please reach out to any and all supports that are available to you, when you're in the mindset to do so.
    This year's 2nd round is different than in previous years, which provides both some challenges as well as some opportunities. For CMGs, there are now a lot of dedicated CMG spots in the 2nd round, many of which I know would have typically been filled by IMGs in the 2nd round in the past. This means a CMG flexible about location and/or specialty probably has a much better chance of matching in the 2nd round than in previous years, but as others have noted, the unfilled spots are mostly in less competitive locations or specialties. These locations and specialties are typically less competitive for valid reasons, but can still be excellent fits for many students. Please take the time to look into as many of these as possible before writing them off as poor options, especially for FM residencies that are a (relatively) short 2 years in duration. Many CMGs who look at their options, their preferences, and weigh the pros and cons will choose to wait until next year rather than try to match in the 2nd round to an available spot, and that can be the right choice in many cases. Still, it's worth exploring as many of the available 2nd round spots as possible, especially with the reduced competition for CMG spots this year.
    Anyone who's unmatched and needs to write out their frustrations or bounce ideas off someone, my inbox's open. There are many paths forward from going unmatched, and while none of them perfect, yesterday's result should never be viewed as a dead-end.
  9. Like
    ralk got a reaction from vascular in 2019 CaRMS unfilled spots   
    For those who went unmatched (and are still reading this thread despite the directions the conversation has turned), please reach out to any and all supports that are available to you, when you're in the mindset to do so.
    This year's 2nd round is different than in previous years, which provides both some challenges as well as some opportunities. For CMGs, there are now a lot of dedicated CMG spots in the 2nd round, many of which I know would have typically been filled by IMGs in the 2nd round in the past. This means a CMG flexible about location and/or specialty probably has a much better chance of matching in the 2nd round than in previous years, but as others have noted, the unfilled spots are mostly in less competitive locations or specialties. These locations and specialties are typically less competitive for valid reasons, but can still be excellent fits for many students. Please take the time to look into as many of these as possible before writing them off as poor options, especially for FM residencies that are a (relatively) short 2 years in duration. Many CMGs who look at their options, their preferences, and weigh the pros and cons will choose to wait until next year rather than try to match in the 2nd round to an available spot, and that can be the right choice in many cases. Still, it's worth exploring as many of the available 2nd round spots as possible, especially with the reduced competition for CMG spots this year.
    Anyone who's unmatched and needs to write out their frustrations or bounce ideas off someone, my inbox's open. There are many paths forward from going unmatched, and while none of them perfect, yesterday's result should never be viewed as a dead-end.
  10. Like
    ralk got a reaction from Heisencat in 2019 CaRMS unfilled spots   
    For those who went unmatched (and are still reading this thread despite the directions the conversation has turned), please reach out to any and all supports that are available to you, when you're in the mindset to do so.
    This year's 2nd round is different than in previous years, which provides both some challenges as well as some opportunities. For CMGs, there are now a lot of dedicated CMG spots in the 2nd round, many of which I know would have typically been filled by IMGs in the 2nd round in the past. This means a CMG flexible about location and/or specialty probably has a much better chance of matching in the 2nd round than in previous years, but as others have noted, the unfilled spots are mostly in less competitive locations or specialties. These locations and specialties are typically less competitive for valid reasons, but can still be excellent fits for many students. Please take the time to look into as many of these as possible before writing them off as poor options, especially for FM residencies that are a (relatively) short 2 years in duration. Many CMGs who look at their options, their preferences, and weigh the pros and cons will choose to wait until next year rather than try to match in the 2nd round to an available spot, and that can be the right choice in many cases. Still, it's worth exploring as many of the available 2nd round spots as possible, especially with the reduced competition for CMG spots this year.
    Anyone who's unmatched and needs to write out their frustrations or bounce ideas off someone, my inbox's open. There are many paths forward from going unmatched, and while none of them perfect, yesterday's result should never be viewed as a dead-end.
  11. Like
    ralk reacted to indefatigable in ON changes CaRMS second round for IMG/CMG   
    I've never seen a province-by-province breakdown.  
    The most useful Table I could see on the CaRMS website suggested there were 20 IMG quota positions left-over across Canada after the first round in 2018 (with 12/20 in FM):
    https://www.carms.ca/wp-content/uploads/2018/06/r1_tbl14e_2018.pdf

    I'd speculate the move was made since it was i) both a recommendation by the AFMC and ii) wouldn't mean more spending by the ON government.  
     
    I'd hope there is more ON specific data to support the change.  
  12. Like
    ralk got a reaction from blueciel in Performed Poorly In All 5 Interviews... Please Help!   
    When it comes to candidates underperforming on interviews across the board, there are a few common culprits.
     
    First and foremost is simply a failure to answer the question being asked. It doesn't matter if you gave the most insightful, passionate reply that showcases all of your unique talents and accomplishments if it doesn't address the question at hand. Some candidates fall into the trap of thinking they have to show off in the interview, making every question about how they are an especially-capable person and miss giving an actual response to the question. Others end up giving great replies, just to a different question than what was asked. In this second case, I find candidates have a really strong anecdote that tangentially applies to the question and is, of course, more comfortable for the candidate to talk about, but misses the point entirely. In both cases the candidates can come out thinking they gave great, substantive answers because they've shown what they want to show about themselves, but they've failed to show what the interviewers wanted to see with their question.
     
    Second is being over-rehearsed. The best candidates can think on their feet and while they may have some strategies, they don't have a clear script. Their answers are fluid and adaptable to the question (see point #1). Candidates who have spent too much time coming up with the "perfect" answers either miss touching on relevant details specific to the question or get obviously rattled when they have to go off-script (which tends to lead to content-poor rambling).
     
    Lastly, there are those with unprofessional communication styles. The odd "um" and "like" aren't a problem, but when they're every other word, that's a problem. Use of idioms or phrases that might not be familiar to older interviewers (or just those not in undergrad anymore) can be a barrier as well. A lot of words get said, but few of it meaningful to the interviewers.
     
    I've seen people with rambling answers fall into each of these categories, and the big thing from my perspective is that it's not the rambling that's the problem. Sure, a concise, complete answer is best, but interviewers get that you're nervous and could ramble a bit. I don't think rambling answers alone explains going 0 for 5 in interviews, especially if you weren't running over your time. Given what information you've given so far, I can see you falling into any one of these three common pitfalls, or perhaps a combination of several. Despite what interview prep companies say, there's no secret or trick to interviewing - schools are looking for honest, relevant answers that you can back up with some degree of personal experience and present in a warm, professional manner. That's about it.
  13. Like
    ralk got a reaction from targaryen in Ontario to fund new residency spots with return of service requirements   
    Let's talk about bias. Many in this thread are quick to call out the published studies for potential bias. That's fair, and as I said earlier, it's important to take these studies with a grain of salt, as well as to recognize their limitations. As most of these studies address NP performance in collaboration with physicians, I do think it's reasonable to push back against things like NP-led clinics in favour of those better-studied collaborative models, again with the caveat that we as physicians make a concerted effort to address the underlying reason for those NP-led clinics coming to be created in the first place, which is a lack of availability to adequate primary care.
    But bias runs both ways. In completely dismissing peer-reviewed literature, you and other posters in this thread have put anecdotes and personal observations as the basis for your opinion. So when talking about the "standards of our profession", let me ask you - in the hierarchy of evidence, where to systematic reviews and RCTs stand in comparison to anecdotes or expert opinion? Which is more prone to bias?
    That's part of my point here. Physicians are quick to blame, attack, denigrate, or malign other actors in the healthcare system for lowering the standards of medical care, but we don't hold ourselves accountable. FPs (and specialists) order unnecessary tests, over-prescribe, misdiagnose, and over-refer all the time and we as physicians don't lift a finger to stop that. But when an NP does it suddenly we should take swift and decisive action not just to correct that behaviour, but to limit the very notion of NPs. I've seen physicians bill inappropriately, practice outside of their training, prescribe medications that they shouldn't to people they shouldn't in non-clinical settings when they shouldn't. And when any group try to address these problems - the CPSO, the Ministry of Health, local hospitals, even patient advocacy groups - sure enough physicians rise up in anger at this horrible affront to their autonomy to enforce what should be basic ethical principles of our profession. I see medical students and residents get promoted through various stages of training and eventually graduating despite struggling to manage those complex patients everyone here seems to be worried about landing in an NP's lap, and I've been told that I'm qualified to do a procedure independently that I've seen - not done, seen - once, because that's considered acceptable for some reason.
    We do have a duty to uphold the standards of our profession, but that starts with us. And on that front, we have been failing, and failing for quite some time. All the ways in which the profession has been degraded - the loss of admiration from our patients, the loss of respect from the public, the loss of clout within the healthcare system - all this stems from our profession's own actions. I agree, allowing NPs to do what physicians do is our failure. It's our failure because we held ourselves as the ultimate authority in medical care, and when medical care stopped living up to expectations, we failed to close that gap. That opened the door for others to fill it for us. Yet, by attacking NPs, all we'd be proposing to do is open that gap back up. That's not going to work. If the goal really is to push NPs or other mid-levels out, we need to close those gaps ourselves. We can do this by strengthening both our standards as well as physicians' adherence to those standards. We can do it by making much more of an effort to get physicians into the communities that are lacking appropriate care, even if that means getting physicians to work in settings they'd prefer not to. We can do it by raising our education standards to take better advantage of our longer training times, so that we someone goes to study the differences between physician competency and those of other providers, there's no ambiguity - we would be clearly superior.
    But these actions take a degree of humility, a willingness to admit fault, and an acceptance of certain sacrifices to improve the profession. I have yet to see that sentiment from anything but a small minority of physicians. Instead, we get vocal physician groups proclaiming that our profession is under siege by countless external forces. This misdiagnosis the problem, and so gets the solution wrong. The problems of the physician profession are internal. The external stressors on medicine as a profession are simply reactions to those internal problems - to be sure, some of those stressors are opportunistic, some are malicious, but all are reactions to our own failings. We can knock down groups like NPs, but that's just going to open the door for other changes we don't like to be enforced upon us - and those other changes might not be as benign as accepting a group of practitioners that at least have some evidence to support their merits to practice...
    You can't be held liable for another independent practitioner's actions. If an NP refers to you for a second opinion, you're responsible for that second opinion, but not for the actions of the NP unless there is a previously agreed upon supervisory role. This is no different than if another FP referred to you for a second opinion. This is a major part of the reason I'm much more comfortable with NPs than PAs. NPs work off their own license, while PAs work off their supervising physician's license. 
  14. Like
    ralk got a reaction from Windcalibur in What They Don't Tell You Before Getting Into Medicine.   
    I think you've missed my point. It's not your tone I'm objecting to, it's your message.
     
    It doesn't matter what specialty they chose - the kind of things Regrettingitall described are unacceptable in any specialty.
     
    It doesn't matter that other professions also experience harshness - mistreatment on the scale Regrettingitall describes is unacceptable in any profession. Plus, this isn't law or business, which are fundamentally antagonistic, top-down fields, this is medicine, where we're supposed to work together to help patients. There is zero benefit to treating each other terribly or expecting each other to endure hardships without complaint.
     
    You are right, the culture is changing, slowly, but even that doesn't matter - the ones who are not changing are often able to continue on with impunity. Even if 90% of currently practicing physicians are fine - and I'd even agree that the percentage could be higher than that - that doesn't excuse the remaining 10% who are behaving inappropriately. And it's not just older individuals, my worst experiences have been with faculty and residents well under 50. There are systemic factors at play too - when our systems don't provide enough support, autonomy, or respect to learners and practitioners, it creates a terrible situation for those involved even if no one is actively causing harm. Apathy towards suffering is more a problem these days than outright abuse, but that doesn't make it any less concerning.
     
    You talk about the choice that we all made to go into medicine, or to go into one particular field. It's true, we all consciously put ourselves on these paths. However, these are rarely fully-informed decisions. Medical students are frequently surprised by what they find in medical school, many residents are surprised by what's asked of them in residency, and attendings are often surprised by what their life is like once they finally land that coveted job. The OP, who has successfully been through it all, gives a compelling narrative of all three. And once you're far enough into each step, you often loose the choice to step away. Medical students get trapped by debt. Residents get trapped by a lack of transfer opportunities. Attendings get trapped by the job market. Even people who do everything they can to find out about the next step in the process get blindsided once they're on the other side and have no choice but to keep going forward. 
     
    My main point is that when people react to others' struggles like you did, by criticizing their decisions first and foremost, it reinforces the negative aspects of the medical culture. I'm glad you've had good experiences so far and hope those continue as you move forward, but I'm asking you - pleading with you - to adjust how you respond to those who have not had as positive an experience as you have. It is still so difficult for people in medicine to open up about their struggles. When these disclosures are met with criticism, it encourages everyone else who may be unhappy with their situation to continue to suffer in silence. That makes it so much harder to help these individuals, and to prevent others from going through similarly negative experiences. Even at your (our) early stage of training, your actions and attitudes help to shape the culture in medicine. Please, help move it in the right direction, away from blaming the victim and towards fixing the problems that caused the harm in the first place.
  15. Like
    ralk got a reaction from futuredoc123 in Extracurriculars   
    ECs don't have much direct value to CaRMS matching. They're considered, and it's important to show you've done something in medical school besides simply showing up and doing the bare minimum, but since most people have some ECs and very few are meaningful or overly impressive to programs, it's unlikely to move the needle much in convincing a program to take you.
    ECs can help though in overall career development and determining your path through medicine. They can help you get contacts which do become useful for CaRMS. They let you explore various specialties and aspects to working in medicine that can clarify what your goals are. They can also help improve your knowledge base and functional abilities for when clerkship comes around. So, while you shouldn't be fighting hard for opportunities just to make your CV look better, it's definitely worthwhile to pick up some activities which hold some interest and have personal value to your potential career. Basically, whatever you do, do it for yourself.
    When it comes to programs differentiating applicants, the main consideration is clinical performance, either directly through electives, core rotations and (rarely) observerships, or indirectly through LORs. Research can matter, depending on the program, but often doesn't make much of a difference. As a pre-clerk, since there are no grades and no clinical opportunities, the ECs and research become really the only ways to directly improve your CaRMS application, even though neither is going to make a huge difference directly. Alternatively and additionally, you can be taking the extra time to improve your likely performance in a clinical setting. Studying for higher grades doesn't matter, but studying to improve your clinical performance certainly can.
  16. Like
    ralk reacted to NLengr in "One possible fix for Nova Scotia's ER closure problem — fewer ERs"   
    I support this. Every province I have ever worked in has too many little ERs scattered around that probably dont really contribute much to overall patient outcomes. For example, around me we have 2 fully staffed ERs and 2 ERs with a physician on call 24 hours a day. That's all within an hour of each other.
  17. Like
    ralk reacted to la marzocco in Working as a FM Doc vs owning a FM practice?   
    Credits have the same value regardless of income level. A dollar today is worth more than a dollar tomorrow. Better to use it as soon as possible.
     
  18. Like
    ralk reacted to rmorelan in Working as a FM Doc vs owning a FM practice?   
    yeah on a year to year bases it doesn't change anything. Excellent summary (I would just add the children are already out - and the spouse is greatly reduced as well)
     
  19. Like
    ralk got a reaction from strawberryjams in Working as a FM Doc vs owning a FM practice?   
    Owning a clinic vs working for a clinic doesn't change your tax burden in any way. Owning a clinic means you are in charge of your own overhead, whereas working for a clinic owned by others usually involves some sort of arrangement for the clinic to cover your overhead for you, typically by taking a share of your billings. You get taxed on whatever is left after overhead either way. If you're a particularly good manager of your own clinic, you might be able to pay less overhead than if you worked for a clinic you don't own, but any savings are likely to be very small.
    Physicians can save money on taxes in various ways by incorporating, but this can be done without owning your own clinic. The net earnings pre-tax are unchanged, while the amount saved in tax is going to be variable and depends on what corporate taxation laws are taken advantage of, and how. Using the $230k figure as an example, taxes would take about $85k in Ontario (which is about middle-of-the-pack in taxation rate). Various deductions available to everyone - such as charitable donations, RRSP, childcare or medical expenses - can reduce this a fair bit on their own. RRSP contributions alone can reduce overall tax burden by at least $10k per year. Holding money in a corporation can allow for income deferment, which over time could reduce the overall tax burden somewhat. Income splitting with a spouse or child is also a fairly common practice to reduce overall tax burden, but is almost certainly being phased out by the current federal government. In any case, none of this has anything to do with owning - or not owning - the clinic where an FP works.
  20. Like
    ralk got a reaction from JohnGrisham in Saudi Arabia to relocate students from Canada   
    We'll see if they carry through with this threat. It would be more disruptive for them and their citizens than it would be for us, so it seems like a very strong reaction for how this situation started. If they do go through with it, the effect on our system will likely be mixed, though probably negative in the short term.
    Call and duty schedules could go very crazy, especially in some programs with many of these learners. Some residents may unexpectedly find themselves working extra call shifts, particularly in the short term when there isn't as much time to plan around these disruptions. Programs and hospitals also get a fair bit of money from Saudi Arabia for this training and that could see some very real reverberations through the medical education system, resulting in some cuts to certain voluntary hospital- or program-provided perks. Smaller, less competitive fields that rely heavily on these learners will likely see the greatest changes.
    Over the long term, there could be some benefits. This could open up capacity in some programs to take on new residents, as despite programs' protestations to the contrary, foreign-sponsored students do take up learning opportunities that could be directly elsewhere, especially with the new pressure to open up additional CMG spots. From a quality perspective, while Saudi-sponsored trainees had a wide range of capabilities (as with any larger group of individuals), I generally have found them to be on the below-average end of the spectrum when it comes to residents of equivalent training levels, at least in a Canadian practice setting.
    On the balance of things, I imagine programs and hospitals will view this as a decided negative - after all, they took on these learners for a reason. The healthcare system overall will probably see changes closer to neutral once the dust has settled. For other residents, I'd argue there will be short term pain, but some rather modest benefits over time in the way of less crowded clinical teaching centres.
    One element I came across that I believe may be a negative from a broader perspective is that these residents spent years, typically half a decade or more, immersed in Canadian culture. Their kids - and most have kids - grew up around Canadian children. That imparts certain values which are hard to shake, even when they return to Saudi Arabia. Saudi Arabia is, if only very tentatively, starting to make some moves towards a more progressive, open society, and the more people who see the benefits that come with a more Canadian mindset, the faster such changes might happen. Medical residents from Saudi Arabia are universally from a more privileged class than the vast majority of the country, and in many ways have directly or indirectly profited from the oppression of wide swathes of their citizens, but as most successful revolutions - peaceful or otherwise - only occur with the support of at least part of the privileged classes, the more individuals in that echelon of society open to reform, the better the prospects for reform get. Sounds like most of these students and residents will be transferred to other western nations, so it's likely they get the same general exposure to more liberal societies. Still, the chaos of this announcement could lead to some missed opportunities to inch Saudi culture closer to the west, and reduce the frequency of events like the one that started this whole diplomatic row.
  21. Like
    ralk got a reaction from JohnGrisham in Saudi Arabia to relocate students from Canada   
    Well, Yemen might not be the best example here, seeing as Saudi Arabia is a major reason as to why that country is so volatile these days...
  22. Thanks
    ralk got a reaction from indefatigable in Saudi Arabia to relocate students from Canada   
    We'll see if they carry through with this threat. It would be more disruptive for them and their citizens than it would be for us, so it seems like a very strong reaction for how this situation started. If they do go through with it, the effect on our system will likely be mixed, though probably negative in the short term.
    Call and duty schedules could go very crazy, especially in some programs with many of these learners. Some residents may unexpectedly find themselves working extra call shifts, particularly in the short term when there isn't as much time to plan around these disruptions. Programs and hospitals also get a fair bit of money from Saudi Arabia for this training and that could see some very real reverberations through the medical education system, resulting in some cuts to certain voluntary hospital- or program-provided perks. Smaller, less competitive fields that rely heavily on these learners will likely see the greatest changes.
    Over the long term, there could be some benefits. This could open up capacity in some programs to take on new residents, as despite programs' protestations to the contrary, foreign-sponsored students do take up learning opportunities that could be directly elsewhere, especially with the new pressure to open up additional CMG spots. From a quality perspective, while Saudi-sponsored trainees had a wide range of capabilities (as with any larger group of individuals), I generally have found them to be on the below-average end of the spectrum when it comes to residents of equivalent training levels, at least in a Canadian practice setting.
    On the balance of things, I imagine programs and hospitals will view this as a decided negative - after all, they took on these learners for a reason. The healthcare system overall will probably see changes closer to neutral once the dust has settled. For other residents, I'd argue there will be short term pain, but some rather modest benefits over time in the way of less crowded clinical teaching centres.
    One element I came across that I believe may be a negative from a broader perspective is that these residents spent years, typically half a decade or more, immersed in Canadian culture. Their kids - and most have kids - grew up around Canadian children. That imparts certain values which are hard to shake, even when they return to Saudi Arabia. Saudi Arabia is, if only very tentatively, starting to make some moves towards a more progressive, open society, and the more people who see the benefits that come with a more Canadian mindset, the faster such changes might happen. Medical residents from Saudi Arabia are universally from a more privileged class than the vast majority of the country, and in many ways have directly or indirectly profited from the oppression of wide swathes of their citizens, but as most successful revolutions - peaceful or otherwise - only occur with the support of at least part of the privileged classes, the more individuals in that echelon of society open to reform, the better the prospects for reform get. Sounds like most of these students and residents will be transferred to other western nations, so it's likely they get the same general exposure to more liberal societies. Still, the chaos of this announcement could lead to some missed opportunities to inch Saudi culture closer to the west, and reduce the frequency of events like the one that started this whole diplomatic row.
  23. Like
    ralk got a reaction from lark22 in Why not family med?   
    Starting my PGY-1 in FM in just a few days - here's where FM gave me pause:
    1) Minimal opportunities for research or education. Some specialties are focused on the academic side of medicine, sometimes to a point where you can't avoid it even if you want to. Most others have ample opportunities to get involved in research and/or education. Not Family Medicine. Don't get me wrong, there are still opportunities to get involved in these aspects of medicine, but the default is to be in clinical practice only and so the options in FM-based research or education are less apparent and usually less-well compensated compared to clinical practice. This is something I was hoping to keep in my practice moving forward and may have to give up or lessen in FM.
    2) Time constraints. Current standard in FM is 4-6 patients per hour, leaving only 10-15 minutes per patient. That can turn off a lot of people, especially as other specialties can have an hour or more per patient, depending on the setting. Now, more is demanded of specialists during their visits, so I'll say that with the exception of pediatrics, I felt at least as rushed on rotations in other specialties as I did in FM, but it's hard to say that time is plentiful in FM.
    3) Pay. Income for FM is better in Canada than pretty much anywhere in the world, while hours are better both in quantity and quality than most other specialties in Canada and training times are shorter. Yet, total take-home is less that most specialties. I likely could have doubled my expected income doing something else, at least how things currently stand. I'll still make more than enough for my own needs and that of my family, but it's still hard to pass that kind of money up.
    There are other aspects that I know classmates have felt to be drawbacks - lots of paperwork, significant routine care, lack of acuity - that I should mention as well. However, I either didn't mind these aspects or felt them to be over-stated (every specialty has paperwork and work that becomes routine, for example).
    So why did I go into FM despite these drawbacks? In a word: flexibility.
    Going for FM, I got to choose the electives I wanted to in medical school, without worrying whether they were the right choices. I got a lot more say about where I ended up for residency, because it's a less competitive field. I'll get to choose whether or not to do a +1 and can choose that +1 without having to worry about the job market much. Once I start working, I should be able to get work fairly easily and get a lot more choice over where I get to work. With some small restrictions depending on practice type, I'll get to work the hours I want to work, at the pace I want to work. If I want to take longer with patients - while it would cost me money to do so - I can. Since my scope of practice is whatever I have the training, comfort level, and tools for, I get to decide whether it's best to refer a patient or handle their issues on my own. In short, I have a lot of latitude to decide my own mix of personal and professional priorities. There are restrictions and trade-offs on these choices, of course, but it's a degree of freedom that's hard to duplicate in medicine outside of Family practice.
  24. Like
    ralk got a reaction from ThatCanadianGuy in 2018 CaRMS Match Results - 1st Iteration CMG Competitiveness Statistical Breakdown   
    Didn't see that the CaRMS stats were out until now, a few weeks after the fact, but wanted to get a competitiveness breakdown out there, particularly given the difficulties experienced with this year's match. I've attached the full data set, but wanted to highlight the larger specialties directly here as well as offer a few comments. As always, my preferred metric for competitiveness is the percentage of individuals who rank a specialty first overall who match to that specialty. Those matching to an alternative discipline are also listed, as it provides a sense of how easy it is to back-up to another specialty when shooting for a particular first choice specialty. This metric is not a perfect representation of competitiveness, nor is it the only one available, but given available stats I believe it has the most value to those approaching the match and deciding on their CaRMS strategies. All stats are for the 1st iteration and for CMGs only.
     
    First Choice Discipline                                     Percent Matching to Discipline                                    Percent Match to Alternative Discipline                                    Percent Unmatched
    Family Medicine                                               96.4%                                                                                 1.0%                                                                                                 2.6%
    Internal Medicine                                             88.9%                                                                                 9.1%                                                                                                 1.9%
    Diagnostic Radiology                                      88.9%                                                                                 6.2%                                                                                                 4.9%
    Psychiatry                                                         85.8%                                                                                 9.0%                                                                                                 5.3%
    Anatomical Pathology                                    84.2%                                                                                 7.9%                                                                                                 7.9%
    Physical Medicine & Rehabilitation              83.9%                                                                                 12.9%                                                                                               3.2%
    Orthopedic Surgery                                         80.4%                                                                                 3.6%                                                                                                 16.1%
    Radiation Oncology                                         77.8%                                                                                 14.8%                                                                                               7.4%
    Pediatrics                                                          77.6%                                                                                 19.9%                                                                                               2.6%
    Neurology                                                          76.4%                                                                                 16.4%                                                                                              7.3%
    Neurosurgery                                                    69.2%                                                                                 11.5%                                                                                              19.2%
    Anesthesiology                                                 68.5%                                                                                 21.2%                                                                                              10.3%
    General Surgery                                                63.6%                                                                                 10.8%                                                                                              25.6%
    Obstetrics and Gynecology                            63.4%                                                                                 28.6%                                                                                               8.0%
    Urology                                                              58.3%                                                                                 25.0%                                                                                               16.7%
    Ophthalmology                                                52.1%                                                                                 29.6%                                                                                               18.3%
    Emergency Medicine                                      50.4%                                                                                 37.4%                                                                                               12.2%
    Otolaryngology                                                47.2%                                                                                 22.6%                                                                                                30.2%
    Dermatology                                                    43.3%                                                                                 48.3%                                                                                                8.3%
    Plastic Surgery                                                34.6%                                                                                 23.1%                                                                                                42.3%
     
    A few thoughts on these numbers:
    1) Across the board, a competitive year for surgical disciplines. These specialties have slowly been losing residency spots due to their generally poor job markets, but demand seems to have largely stayed put despite this, driving competition up. With over a quarter of people applying to Gen Sx, ENT, and Plastics going outright unmatched in the first round, and over 15% in pretty much all other surgical disciplines speaks to the risks involved going down that career path. To be a surgeon these days, you've got to really want it, and fight for your spot.
    2) By contrast, certain moderate and high competitiveness specialties can be rather safe with an appropriate back-up plan. Derm and OBGYN have overall combined match rates (first choice + alternative) close to the weighted average of all specialties. More people who picked Derm first ended up in a back-up specialty than in Derm itself, a figure fairly consistent with previous years. Part of this may be driven by those with weak interest in the field - say a person who is essentially going for FM but taking a long-shot on a Derm program on the off-chance it works out - but considering that obtaining a Derm interview in the first place isn't a guarantee, I think there's something to be taken away by those specific numbers.
    3) Likewise, two specialties this year had a combined match rate better than FM, generally considered the safe specialty to apply to - namely, IM and Peds. Here I do think individual circumstances play a role that prevents a simple interpretation of these numbers, as those who pick FM first tend to apply less broadly than those going for specialties, and most of those backing up from IM and Peds will end up in FM. Still, there was a growing inclination that Peds and increasingly IM were competitive enough that you had to gun for them like you would a surgical specialty, ignoring a back-up entirely, and I don't think that's true at all. Back-ups remain viable, especially in these specialties, if approached correctly.
    4) Rads continues on the pathway towards non-competitiveness, a journey it's been on in fits and spurts for half a decade now. As someone who gave Rads a good hard look in pre-clerkship without ever really coming around to the field, I'd be very interested in exploring what's driving this trend. My guess is a combination of increasing work requirements, slowly declining incomes (though still exceptionally high, even by doctor standards), and a growing medical student preference for patient contact are the main drivers, but even that seems like it's missing something.
    5) As was already apparent, this was a rough match overall. Too many left without a residency position after the first round and as is now being exposed, medical schools and provincial governments had no real plan to address this. Now that the dust has settled, the last-minute efforts to provide emergency residency spots in Ontario, plus the military opening up additional spots after the match, have helped improve the immediate crisis. Yet, the underlying math of the situation has yet to really change. As we approach the time when the final residency numbers get set, here's hoping some more wiggle room enters the system. While the vast majority of graduating CMGs will have a good outcome, even if nothing changes, that bad outcomes for a small subset are now virtually assured is very concerning. For all those reading, please remember that unmatched CMGs are more than ever victims of circumstance and should not automatically be considered weaker or flawed candidates.
    One mildly frustrating change with the reported stats this year is that CaRMS has not provided the numbers for people who match to a given specialty when it is not their first choice. That makes it harder to identify specialties that are good options to back-up into, though I strongly suspect this continues to be FM and IM.
    Lastly, a few caveats on the data above. First, this works off of first choice rankings, which are not always straight-forward. Some individuals will put a single program in one specialty followed by a ton in a second. Some will want a particular specialty but get no interviews and be left with only their back-up options to rank first. Many will apply in a limited geographic area, or generally utilize a bad match strategy which results in them going unmatched for reasons that have little to do with their chosen specialty's competitiveness. Second, while I have listed all specialties in the excel spreadsheet attached, please interpret the smaller ones with caution. Lots of variability in these specialties year-to-year that make definitive conclusions almost impossible. Finally, some specialties have chosen to offer streams with slight differences from the standard program - such as those with an academic or research focus - that appear as a completely separate CaRMS discipline in the stats. This makes interpretation of these specialties much more complex, as these slightly different streams undoubtedly share the main applicant pool as their main streams. This means if someone wants, say, a Clinician Investigator Program as their first choice but would be perfectly happy with just the normal stream, if they end up matching to that normal stream, they're automatically shown as falling into a "second choice" program, even when they really didn't. This is particularly bothersome for the Public Health programs, which are split between "Public Health and Preventive Medicine" and "Public Health and Preventive Medicine including Family Medicine", but are essentially the same specialty. Same could be said of the lab-based programs, which are shades of the same thing under different names. There's not nearly enough transparency in residency matching and these shenanigans make what little data we have even worse.
    If I've gotten anything wrong with the numbers, please let me know and I'll correct it ASAP. I try to double-check things but something can always slip through and sometimes the source material gets things wrong too.
    CaRMS stats 2018 First Round.xlsx
  25. Like
    ralk got a reaction from SYoung in sexual assault and "stigma" in med school apps   
    If you come across a relevant question where bringing up what you went through would be a meaningful part of honest and thorough answer, I'd say you shouldn't feel the need to shy away from telling this part of your personal journey towards a career in medicine. Especially considering the growth you've shown in response to it, I would be very surprised (and deeply disappointed) if it were in any way held against you.
    By the same token, however, don't feel that not talking about this part of your life is somehow deceptive towards interviewers. I'd go even further and suggest that you not go out of your way to disclose what you went through, not because I think it'll stigmatize you, but rather because doing so can land you into a bit of classic trap interviewees frequently fall into - drawing attention to aspects of your story important to you, rather than the aspects important to their interviewers. The key part of your story to sell is that you proactively took on an advocacy role and provided support for a group of victims. As an interviewer, while I do care about the motivation behind those actions, it's by far a secondary consideration - I would still think highly of what you've done if you hadn't been assaulted, even while acknowledging the strength it takes to turn such a negative experience into positive action.
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