blah1234

Is our training that portable? Outside of the US, I've only ever heard of people trying to go to the UK, Australia, and New Zealand. A common theme was how awful the paperwork was and the hoops they had to jump through. If that's the case for commonwealth countries I can't begin to imagine how much worse it would be for a non-commonwealth destination.

I've heard of some IMGs (not Canadian students) get a ND because they couldn't port over their residency training and couldn't get a residency spot. I have to imagine that's another way to "practice medicine" as I think you can prescribe, inject, etc. in many provinces. I wonder if those naturopaths just practice evidence based medicine but with the convenience of time and private pay.

Yea, poor consults are a great way to destroy a relationship with your local consultants.

Credential creep is all it is in my opinion. Not sure if it really drives any material outcomes unless you do something niche. You still learn as staff and I feel the learning sticks as you're the one making the final call with the burden of MRP. This fellowship/grad degree nonsense is pretty much free labor for academics and older people pulling the ladder up behind them.

I think moving south to the US can be heavily dependent on your specialty area. I think some fields are difficult because our training isn't transferable (e.g., neurosurgery last I heard), some fields have worse job markets (e.g. ER market just collapsed when I caught up with a US friend 2 weeks ago), and some fields just pay less than Canada (e.g., FM based off that same friend). Additionally, the visa situation complicates things unless you're a dual citizen or permanent resident. I suspect the only institutions willing to sponsor your visa are larger centers where the pay is less compare

I think if policy makers take a pure resource allocation approach than I agree the scope creep will be limited. However based on what I've seen during my career, the lobbying ability of mid-level providers is just much stronger than our associations. Also, the public seems to trust them more even if they may be less efficient or accurate. Frankly, I believe that the public is okay with many people making "less" money than a few physicians making "a lot" of money even if we are cheaper as an aggregate. I have rarely heard of people complaining about overpaid nurses while the opposite is true fo

Yea, I think private work for forensics does very well for that reason. People who are in high demand for IMEs (Neuro, ortho, psych, PMR, etc.) also can have a steady private pipeline of work that pays above OHIP rates. But it's not for everyone for a variety of reasons...

Can you elaborate more on your monthly expenditures? Is there no way at all to reduce your cash outflow?

I don't think undergrad marks are correlated with how you good would you be as a clinician in certain specialties. However, I do understand why programs would try to find additional data points in a era where medical students have functionally identical CVs.

Yea, "professionalism" is such a general term that it can be used to punish residents if there is any evidence of slip up (and no resident I know is perfect or has not cut some sort of corner). Honestly, it's a big reason I used to tell my residents to just keep their head down and fake their smiles until they finished. Too many unsympathetic academic staff out there that can really make your life hell while residents have little to no recourse.

I almost feel like it would've been easier just to find her a transfer or if we still had General Licensure maybe she would've moved on. I don't want to automatically cast judgement on her either as I've also seen how unfair the system & process can be for residents. This is just another unfortunate outcome of the rigid training path we have in Canada.

Agreed. The billing schedule is public info so you just need a sense of the daily workflow after seeing it in clerkship/residency to ballpark how hard you'll have to work.

Money/Lifestyle isn't enough for everyone as FM isn't appealing from a practice pattern or a subject matter perspective to everyone. Some people actually enjoy the patient population and cases in their field and/or feel more comfort with specialization. Also, in a FFS environment it's a grind to be a high biller in any specialty. In my opinion you would really have to enjoy the work to see the number of patients or work the number of hours needed. Some people do have unique setups where they take home a lot while working reasonable hours but that is not really the norm. I think it's much sa

Yea, I've heard that the institutions that will typically sponsor a H1B are larger centers like academic hospitals. However, the positions that pay the significantly higher salaries are often community positions that you may not have access to as a Canadian. I have a friend at Sick Kids (who are already underpaid in my opinion) that told me that they turned down a role at Boston Children's Hospital because it would pay even less than Sick Kids.

Yep, that's basically a template for someone else I know. I don't think money is enough to convince some people to go to the US and I almost feel like some fields have enough of these people waiting on the sidelines to fill any vacant hospital spots in Canada.