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Lactic Folly

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  1. Like
    Lactic Folly got a reaction from NeuroD in How bad is it if I forgot to shake their hands at the end?   
    Don't read too much into what the interviewers are doing... they are not the ones being interviewed, so they won't be paying as much attention to how they are coming across. I doubt there is any correlation between the amount of writing and their thoughts about you. If you felt your answers were fine, then I would not overthink too much...
  2. Like
    Lactic Folly got a reaction from Let'sGo1990 in Salaries of specialists adjusted for overhead expenses   
    Just a friendly reminder that this is a public thread and if I'm not mistaken, any of the posts on here (esp. on billing practices) could be quoted by media, government, etc. regardless of original context/intent/accuracy.
  3. Like
    Lactic Folly got a reaction from LostLamb in Salaries of specialists adjusted for overhead expenses   
    Just a friendly reminder that this is a public thread and if I'm not mistaken, any of the posts on here (esp. on billing practices) could be quoted by media, government, etc. regardless of original context/intent/accuracy.
  4. Like
    Lactic Folly got a reaction from GrouchoMarx in Salaries of specialists adjusted for overhead expenses   
    Just a friendly reminder that this is a public thread and if I'm not mistaken, any of the posts on here (esp. on billing practices) could be quoted by media, government, etc. regardless of original context/intent/accuracy.
  5. Like
    Lactic Folly got a reaction from Edict in Salaries of specialists adjusted for overhead expenses   
    Just a friendly reminder that this is a public thread and if I'm not mistaken, any of the posts on here (esp. on billing practices) could be quoted by media, government, etc. regardless of original context/intent/accuracy.
  6. Like
    Lactic Folly got a reaction from LostLamb in Should I put my fast food job on my application?   
    Some people like to see such jobs on applications - the thought is less sense of entitlement.
  7. Like
    Lactic Folly got a reaction from SunAndMoon in Should I put my fast food job on my application?   
    Some people like to see such jobs on applications - the thought is less sense of entitlement.
  8. Like
    Lactic Folly got a reaction from End Poverty in Phd during Residency   
    Do a search for Clinician Investigator Program - available at many schools.
  9. Like
    Lactic Folly reacted to Mithril in Challenges of Family Medicine   
    Well, that entirely depends upon your practice. A good chunk of my patients I would consider to be not healthy. Obesity and obesity-related conditions plague the general population. I can agree with you though that most of my patients are of minimal acuity, i.e., they are not on the verge of serious complications and death at that instant in time, but I still see 10-20 patients a week I would consider high acuity, and many patients who are just a Big Mac away from an MI. Physical procedures I am not entirely sure what you mean, but I still do a lot of procedures such as intra-articular injections, suturing, biopsies, wedge resections, and cautery.
     
    You have to recognise murmurs and pathological lung sounds, sure, but you don't necessarily need to know what specific disease entity correlates with a particular abnormal finding. If you can recognise that something is abnormal, then read up on what it could be or talk to a colleague. You have lots of tools, such as imaging, lab tests, or specialists to narrow down the specific diagnosis, but by the time you are done residency you should know when a finding is bad and warrants further investigation and when a finding is innocuous or inconsequential.
    You could refer them to a specialist, but like I said above you also have other things at your disposal such as imaging or other tests. An abnormal heart sound could always be checked with an echo or an ECG. A skin lesion can always be sent for a biopsy. These are things that you can do as a family physician and residency programs should be training you to be relatively autonomous within the scope of family medicine. It is important to recognise the limits of your knowledge and there's no shame in that, but I would say I am comfortable handling 95% of what comes through my office without needing to refer to a specialist.
    This can be challenging and not always obvious, that's true. I had an elderly patient once who came in with vague bilateral calf pain after hiking a few days prior, thought it was muscle strain, but ordered a d-dimer anyway because he had a prior history of clots. His Well's score was low. A few hours later he ended up in the ER with a PE. Seems like he did have a clot in one of his legs whereas the other leg was just a muscle strain. Sometimes you just can't know what is truly high acuity, but residency programs in family medicine do train you to recognise obvious high emergency situations.
    I still look things up a lot. I can't possibly know what to treat with for a guy who drank a bunch of dirty water in Nicaragua and ended up with a Blastocystis hominis infection. I mean, I know now, but for the most part my patients have appreciated after I told them I need to research more about their condition, or more about how to properly manage their kid's catch-up schedule for vaccines, than trying to fake knowledge you don't have, which is both dangerous and unethical.
  10. Like
    Lactic Folly reacted to katakari in Challenges of Family Medicine   
    I don't find any of these to be challenging aspects of family medicine. Most of my management is based on history, if you have a concerning undifferentiated finding, you can always get an echo, get a chest x-ray, or do a biopsy.
    In a community family medicine site, often you don't have the opportunity to refer due to limited resources. This gives you the opportunity and impetus to manage a lot on your own. In all the patient's I see in a week, I would say I refer less than 5% of the time, and even then would be a likely overestimate.
    Often the longitudinal relationship can benefit you in high stakes situations. I remember one patient walked in on 9L of O2 and looked terrible. I sent him home because he had a restrictive lung disease and no further management could be offered him. I was able to say this comfortably because of the longitudinal relationship we had with him. His family disagreed with me and sent him to the hospital. Well of course, someone who doesn't know this guy, is going to admit him to the ICU, begin workup of this idiopathic disease and he found himself with 3 organs severely damaged due to iatrogenic investigations/management, transported inbetween several hospitals for different management of the varying iatrogenic comorbidities, and I saw him in rehab a few weeks later with no difference to his management or diagnosis.
    Patients seem to not mind that I look things up, especially when I am open about it.
    Now, for the challenges I face in family medicine:
    1) Being the coordinator of care. You are responsible for everything and often have to tie together poor communication from various health fields, records, notes etc. You also can't turf your patient back to family medicine when you're at a loss for what to do or when it doesn't fit your specialty's area of expertise
    2) Diversity of knowledge required. The specialists I work with often have reductionist views of disease because they see things that are already worked up. You have to begin from the ground and consider so many various possiblities, choose the right tests without choosing too many, etc. You're often admonished for not having specialist expertise in every specialty. It takes a lot of work to find a balance
    3) Chronic disease. Chronic disease can often be frustrating when patient's don't get better and you have to manage their investigations, tell them why they can't have another MRI or more opioids, and this can upset people
    4) Benign disease. On the same spectrum, having to tell people why they don't need antibiotics for a small cough. It's also really easy to miss something severe at the same time. Anyone can manage a STEMI - there's a basic protocol for it. But that low risk chest pain that comes into your office with a few almost-red flags, deciding what to do there is where medicine gets very nuanced.
    That being said, you need to shadow some family doctors. It's a great field, but it's not for everyone.
  11. Like
    Lactic Folly got a reaction from LittleDaisy in Where to look for Family Medicine jobs?   
    Not an FM, but if you have the opportunity to rotate through where you would like to work, that may be helpful. I've often seen people stay in communities where they trained.
  12. Like
    Lactic Folly reacted to bearded frog in Specialties   
    Healthy Patients        Min Acuity        Min Procedures     Comment
    Family medicine                X                          X                           X                 Big range. Only place you will see completely healthy pts.
    Physiatry                           O                          X                 *rehab type stuff    Relatively physically active specialty, sees patients needing rehab.
    Psychiatry                         O                         X                           X              If you're seeing a psych, you're probably sick, but possibly not physically
    [Gen] Pediatrics                O                      varies                       X                 Big range, usually not healthy pts. Can be high acuity in hosptialists.
    Molecular Genetics           O                          X                          X             You're not healthy if you're seeing a geneticist. But no genetic emergencies
    Rheum/allergy              yes for allergy            X                          X               Some healhy pts for allergists, but they do minor procedures
    Geriatrics                          O                          X                           X                  Never going to see a healthy person ever
    Hematology                       O                         X                            O              Heme pts can be very sick. Some do bone marrow biopsies etc
    endocrine                       mix                         mix                          X               T1DM checkups can be realtively healthy, but also manage DKA etc.
    maternal fetal med            O                        O                            O             A surgeon expected to do crash c-sections. Not what you're looking for
  13. Like
    Lactic Folly got a reaction from mew in 2 weeks until panel interview: how should I use my remaining time effectively?   
    Well, it's natural to feel nervous given the fairly high stakes, but it sounds like you've done a lot of prep. Recording yourself might be helpful for reassurance, I agree.
    The question is - is it necessary to feel ready? Or simply to go there with your degree of preparation and perform well regardless of how you are feeling on the inside?
  14. Like
    Lactic Folly got a reaction from niceshrp in Unfilled carms spots   
    Also this. Don't see it often said here, but should be highlighted as well.
  15. Like
    Lactic Folly reacted to silvantes in Unmatched....Is it still possible to specialize?   
    It is most certainly a possible option to still get your choice next year. You will hear many things. Some physicians will tell you that going unmatched in this new era means nothing, they don't care about it due to the current issues. Some older physicians will tell you however that you are damaged goods. It hurts. You will also realize however when talking to alot of these physicians that they have really no idea how the new match system works or how you should rank programs. I had many people tell me not to waste my time with my top choice this year, Radiology, as it was too competitive. If you truly know how the match works you know that ranking long shots above realistic expectations WILL NOT HURT YOU. 
    I'm glad I did not listen and tried to not get discouraged as I matched to Radiology this year. Your biggest support will be a mentor in the field, if you don't already have one find one quick, preferably at your home school.
    I also heard alot that I should just "settle" and do Family medicine, the funny thing is that I received zero interviews as I applied across the country for Family. Family is a great choice but I knew I wouldn't be happy doing it and no one wanted me for it. Despite references and electives in family the climate for the match has changed, it's a different world and it's alot about luck and who you know. It's an unfortunate situation. 
    Please keep your head up high, it will be the worst year but you'll get through it. Now that I've matched my wife and I plan to do some advocacy work. No one wants to rock the boat while waiting to match the next year, don't. Hopefully those of us that matched after not and our colleagues can push for the change that's needed.
    For reference, my school offered minimal support so I could not do electives. I continued working with a mentor in research, attempted to do a Masters which funding flopped on and needed to support my wife and kids. You will have the worst time getting a job as an MD. I eventually found employment but they threatened to fire me if I went to residency interviews... I quit. I'm very happy now but still looking for ways to make some money until July. Sold my car, left our rental to live with family. LOC maxed. It's been a heck of a year.
    Lean on family and friends for support.
    Good luck and God Bless.
  16. Like
    Lactic Folly got a reaction from Arztin in Unfilled carms spots   
    Agree this is a powerful factor, though likely dwarfed by the converse (someone on the committee who vetoes your application). This is because there are multiple people on the selection committee, so there may be several candidates being strongly supported by someone. The rank order for a program with limited spots would then still end up being a group consensus of sorts. Although dependent on group dynamics, if there is opposition to a candidate (even if it is a minority vote), it is the path of lesser resistance for a group to go along with their colleague.
    So, I think candidates should not interpret this as a reason to stop striving for excellence, as I still see people matching on the overall strength of their applications sans elective, suggesting no "connection" other than what may be formed during the interview. But do try to avoid annoying anyone. Yes, like any other job selection process, there can be a fair amount of subjectivity and 'fit'.
  17. Like
    Lactic Folly got a reaction from daffodils in Unfilled carms spots   
    Agree this is a powerful factor, though likely dwarfed by the converse (someone on the committee who vetoes your application). This is because there are multiple people on the selection committee, so there may be several candidates being strongly supported by someone. The rank order for a program with limited spots would then still end up being a group consensus of sorts. Although dependent on group dynamics, if there is opposition to a candidate (even if it is a minority vote), it is the path of lesser resistance for a group to go along with their colleague.
    So, I think candidates should not interpret this as a reason to stop striving for excellence, as I still see people matching on the overall strength of their applications sans elective, suggesting no "connection" other than what may be formed during the interview. But do try to avoid annoying anyone. Yes, like any other job selection process, there can be a fair amount of subjectivity and 'fit'.
  18. Like
    Lactic Folly got a reaction from MisterSlippery in Unfilled carms spots   
    Agree this is a powerful factor, though likely dwarfed by the converse (someone on the committee who vetoes your application). This is because there are multiple people on the selection committee, so there may be several candidates being strongly supported by someone. The rank order for a program with limited spots would then still end up being a group consensus of sorts. Although dependent on group dynamics, if there is opposition to a candidate (even if it is a minority vote), it is the path of lesser resistance for a group to go along with their colleague.
    So, I think candidates should not interpret this as a reason to stop striving for excellence, as I still see people matching on the overall strength of their applications sans elective, suggesting no "connection" other than what may be formed during the interview. But do try to avoid annoying anyone. Yes, like any other job selection process, there can be a fair amount of subjectivity and 'fit'.
  19. Like
    Lactic Folly got a reaction from indefatigable in Unfilled carms spots   
    Agree this is a powerful factor, though likely dwarfed by the converse (someone on the committee who vetoes your application). This is because there are multiple people on the selection committee, so there may be several candidates being strongly supported by someone. The rank order for a program with limited spots would then still end up being a group consensus of sorts. Although dependent on group dynamics, if there is opposition to a candidate (even if it is a minority vote), it is the path of lesser resistance for a group to go along with their colleague.
    So, I think candidates should not interpret this as a reason to stop striving for excellence, as I still see people matching on the overall strength of their applications sans elective, suggesting no "connection" other than what may be formed during the interview. But do try to avoid annoying anyone. Yes, like any other job selection process, there can be a fair amount of subjectivity and 'fit'.
  20. Like
    Lactic Folly got a reaction from indefatigable in Out Of Province Disadvantage?   
    Assuming those don't go awry. CaRMS is a strange beast, as has often been said.
  21. Like
    Lactic Folly got a reaction from TheLeo in Should I put my fast food job on my application?   
    Some people like to see such jobs on applications - the thought is less sense of entitlement.
  22. Like
    Lactic Folly got a reaction from OwnerOfTheTARDIS in Am I going to be at a disadvantage because of my age?   
    Neither - you'd be expected to possess the level of maturity appropriate for someone entering a professional program, who would be seeing patients soon after, and potentially treating them independently in a matter of several years. This applies to all candidates regardless of age.
  23. Like
    Lactic Folly got a reaction from frenchpress in Am I going to be at a disadvantage because of my age?   
    Neither - you'd be expected to possess the level of maturity appropriate for someone entering a professional program, who would be seeing patients soon after, and potentially treating them independently in a matter of several years. This applies to all candidates regardless of age.
  24. Like
    Lactic Folly got a reaction from USMDCanadian in Am I going to be at a disadvantage because of my age?   
    Neither - you'd be expected to possess the level of maturity appropriate for someone entering a professional program, who would be seeing patients soon after, and potentially treating them independently in a matter of several years. This applies to all candidates regardless of age.
  25. Like
    Lactic Folly got a reaction from SunAndMoon in Am I going to be at a disadvantage because of my age?   
    Neither - you'd be expected to possess the level of maturity appropriate for someone entering a professional program, who would be seeing patients soon after, and potentially treating them independently in a matter of several years. This applies to all candidates regardless of age.
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