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Edict

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Posts posted by Edict

  1. On 4/20/2021 at 6:51 PM, shikimate said:

    I didn't know FM are doing less surgery now, I'd think it would be important to have at least surgical exposure.

    Anecdotally I remember I had a skin neoplasm removed by a FM, it was benign but prone to recurrence. When she reviewed the path report she didn't even think to read about the margin which was very close haha. Obviously I was less than impressed.

    Yes, but to be perfectly honest most family med residents who do gen surg rotations probably end up doing mostly scut and very little operating. 

  2. On 4/5/2021 at 3:21 PM, zoxy said:

    That's 100 percent true. I can think of over ten Canadian cardiac surgeons without American Board boards who are practising in the US. Folks at Ohio State, Cleveland University Hospitals, Vanderbilt, UCSD, UC Davis, The Brigham, Mt. Sinai, UPenn, University of Kansas at Kansas City, Stanford affiliated community hospitals, UTexas Southwestern, and Boston Children's. Those are very good places. Also another two surgeons who were at Northwestern and Baylor but then came back to Canada when positions opened up here.

    However, all of those folks are at big academic institutions that negotiate bulk liability insurance rates . It's not possible to get community jobs without American Boards, the liability cost would be too much for a community hospital. I've also anecdotally heard that insurance companies are increasingly stricter in enforcing board certification to lower their own liability. American surgeons know that Canadian training is just as good, but you can't trust a jury whipped up by ambulance chasing lawyers to know that. I wouldn't be surprised if this led to a greater reluctance on the part of American academic centres to employ Canadians in the furture.

    I've been toying with the thought of doing GenSurg in Canada first, and then a two year ACGME cardio-thoracic fellowship in the US. It's actually only one year longer than a six year training program in Canada. I know a surgeon who did GenSurg in Toronto and then did an ACGME fellowship in the US and stayed there. Even if I can't get someone to sponsor me for an H1B for the ACGME fellowship and go there on a J1, I wouldn't mind doing two years of extra fellowship here in Canada after that. I feel like two years of minimally invasive or transplant fellowship and double board certification would make someone very employable. Not too unreasonable at nine years as well.

    If you complete a canadian cardiac surgery residency you can complete a 2 year CT fellowship in the states and be BC/BE in the US. Only reason to do it imo is if you changed your mind and wanted to do general thoracic. The same path in Canada would require a 3 year fellowship with 1 yr of general surgery included. 

  3. On 4/5/2021 at 3:21 PM, zoxy said:

    That's 100 percent true. I can think of over ten Canadian cardiac surgeons without American Board boards who are practising in the US. Folks at Ohio State, Cleveland University Hospitals, Vanderbilt, UCSD, UC Davis, The Brigham, Mt. Sinai, UPenn, University of Kansas at Kansas City, Stanford affiliated community hospitals, UTexas Southwestern, and Boston Children's. Those are very good places. Also another two surgeons who were at Northwestern and Baylor but then came back to Canada when positions opened up here.

    However, all of those folks are at big academic institutions that negotiate bulk liability insurance rates . It's not possible to get community jobs without American Boards, the liability cost would be too much for a community hospital. I've also anecdotally heard that insurance companies are increasingly stricter in enforcing board certification to lower their own liability. American surgeons know that Canadian training is just as good, but you can't trust a jury whipped up by ambulance chasing lawyers to know that. I wouldn't be surprised if this led to a greater reluctance on the part of American academic centres to employ Canadians in the furture.

    I've been toying with the thought of doing GenSurg in Canada first, and then a two year ACGME cardio-thoracic fellowship in the US. It's actually only one year longer than a six year training program in Canada. I know a surgeon who did GenSurg in Toronto and then did an ACGME fellowship in the US and stayed there. Even if I can't get someone to sponsor me for an H1B for the ACGME fellowship and go there on a J1, I wouldn't mind doing two years of extra fellowship here in Canada after that. I feel like two years of minimally invasive or transplant fellowship and double board certification would make someone very employable. Not too unreasonable at nine years as well.

    I do know of many canadian cardiac surgeons practicing in the community though, they aren't as high profile but they aren't board eligible. 

  4. On 4/3/2021 at 1:26 AM, zoxy said:

    The 6 year residency is broken down into 5 years of actual clinical training (2 years foundations+3 years at the senior level) plus an enrichment year that can be clinical or research. Most people add an extra year of research for two years of research in total and get a masters degrees for seven years of total training time. You then probably need a year or two of fellowship(Aortic, Minimally Invasive, Congenital, Transplant and Mechanical Circulatory Support) if you want an academic job anywhere in Canada. And before you ask, even in Saskatoon and Winnipeg the recent hires all have graduate degrees and fellowships.

    In all the doom and gloom you do have exit options. With a CVSx residency you can do a two year fellowship in General Thoracic or Vascular and get Royal College certified in them. I know of two surgeons who've taken the thoracic route while another who's taken the vascular one. Vascular in particular has a relatively good job market relative to other surgical specialties but a horrible patient population and bad hours, even for surgery. Another option after a CVSx is to do a two year critical care fellowship which makes you board certifiable for Critical Care.

    I've spent a lot of time thinking about CVSx myself and still haven't reached a conclusion. On one hand, it seems insane that anyone would knowingly put themselves through this. Median age of entry in English language med schools is around 24. The prospect of being unemployed and over a hundred thousand dollars in debt after the Residency+PhD/Masters+Fellowship route at 38 is not appealing. On the other hand, I feel that trying to predict the job market 10-15 years from now is a fool's errand. So many variables could impact this. The long term results from the TAVR vs SAVR trials in low risk patients for aortic valves, the long term Mitraclip trials for Mitral replacement, the future of LVAD use, future retirement trends of practising surgeons, provincial government health priorities, and general fiscal situation will all impact the job market. At this point, I feel like if CVSx is the only thing you can see yourself being happy with then go for it. Just remember that you only have one life to live and to make the decision with open eyes. How many other things in life would you be willing to give up to be a CVSx surgeon?

    I don't think job market will ever be good in cardiac, the residency program in surgery is somewhat Halstedian, attrition is built in. It should be something you do only if its the only thing that will make you happy.

     

  5. On 4/2/2021 at 8:48 PM, zoxy said:

    I know this is late but I wanted to chime in. Canadian CVSx residency does NOT make you board eligible in the US, as cardiac surgery and thoracic surgery are considered to be one specialty there(officially called thoracic sugery). However, you DO have the option of doing a 2-3 year cardiothoracic fellowship after a Canadian cardiac surgery residency, that would make you eligible for the American Board of Thoracic Surgery. It should be noted that if you do the fellowship on a J1 visa, you would have to leave the US for 2 years. Getting the program to sponsor the more desirable H1B visa that does not come with J1's restrictions is non trivial.

    Also keep in mind that the US cardiac job market, while miles better than Canada, is poor compared to other surgical specialties like Vascular or Ortho. In fact, from early 2000's to mid 2010's, many of the ACGME cardiothoracic fellowships went unfilled. This was actually the main impetus for the establishment of the integrated cardiothoracic (I6) programs in 2008. Since then, they've reduced the number of cardiothoracic fellowship spots and improvement in the job market has made the fellowship somewhat competitive.

    Just a piece of advice, you don't want to end up doing a CVSx residency+PhD+Family Medicine residency. And before you ask, yes, I know someone who ended up there.

     

    Very well informed, one point to add is you don't need to do a cardiothoracic fellowship to get a job in the US. You don't actually need to be board certified or eligible to work in the US, the FRCSC is enough.

  6. 8 hours ago, Butterfly_ said:

    It takes lots of government $$$ and resources to train a medical doctor. I don’t think the government is going to spend more money expanding spots for med schools.

    The reason why med school seats are restricted is because we lack government funding in the first place.

    Also, most docs aren’t salaried. It’s mainly fee for service.

    Apparently Ryerson was given permission for a new medical school though in Brampton :blink:

  7. On 3/7/2021 at 2:02 PM, MaudeB said:

    Hello everyone! So I have been looking around for info and asking questions about the clerkship and residency schedule policies. I am wondering, how do you all handle the tiredness and weariness of those demanding years? I am in Qc so my understanding is that during residency, the max hours is 16h/days with 8 hours of rest between shifts and you work every other week end. So during the 8 hours of rest, you have to go home from the clinical site, possibly eat and study/read and sleep... Which does not leave a lot of time to rest and sleep! I work about 65h week at the moment and I am pretty exhausted. When I finish working at midnight, I feel exhausted all day the next day, and it gets worst with every long day, until I get a full day of rest... I'm a older too so obviously that does not help, I'm a mom and sleeping only 4-5 hours a night is getting harder every year! I wish I was in my 20s!...

    So I'm wondering, how do you all get through those very demanding years? Any tips and tricks? Anything that should be prioritized, like exercice and rest?

    Thank you all so much for your help and advice!

     

    3 things:

    1. Your body gets more used to it with time, to a limit of course

    2. You make sacrifices or improve time management - fewer hobbies, less time for self care etc.

    3. Remember that there are people who work harder than you and have made it just fine, it is doable.

    It is truly very challenging. I work long hours with very little "off" time. What I have found is, prioritizing sleep is most important, for me if i'm getting enough sleep 6 hrs a day, coffee will get me through any call shift, if i'm sleep deprived however, I start to notice that coffee becomes less effective, that's when I know I need to get more sleep.

     

  8. It really is a combination of factors, but one of the biggest issues is that being a staff cardiac/neuro surgeon is very challenging and likely more challenging than people think. It is almost impossible with current selection criteria to predict who will be a successful cardiac/neuro surgeon from medical school. The selection process for medical school focuses of good academics and social skills which are important in a physician, but only part of what is looked at for surgery. We rarely look at technical skills, leadership, high stress/teamwork in the residency application process, but these are often more important to train a successful surgeon.

    We do train more residents in cardiac/neuro and a number of other surgical specialties than we need and part of the reason is call (more so in some than others) but another reason is they want to be able to weed out those not suited. I like to say entering a surgical residency is just the first step, it is an opportunity to try and become a surgeon, not a golden ticket. Unfortunately, surgical reimbursement has declined relative to other specialties in recent years while the work life balance has remained the same (hours have dropped slightly but length of training is longer) and the risk/reward ratio simply is not optimal anymore and it truly is hard to recommend to anyone without an undying passion or love for the field.

  9. On 2/4/2021 at 1:23 AM, Jack Marcos said:

    Not sure if you know the answer to this, but you seem to have pretty good insight. So I’ll ask anyways lol
    1) do you know how US residencies view Canadian medical students? What would be the most important things to focus on to get into a US residency? is it really possible to get US residency coming from Canada?
     

    2) I know some recent Canadian neurosurgeons who moved to the US but like you said they cannot become board certified if they did a Canadian residency, so what are the major limitations without being board certified? Is it harder to do academic or private practice without board certification.

    2) The answer to your question is that you don't need board certification to practice in the US. You do need to have your FRCSC aka your Royal College certification however.

  10. On 3/5/2021 at 10:36 AM, Tullius said:

    For example, if a patient presents to the ED in a rural location with ruptured AAA, and this center has no vascular surgeon, would they wait for transport and hope the patient survives, or would a general surgeon do the emergent AAA repair?

    This would probably vary depending on if the surgeon was comfortable doing an emergent AAA repair or wanted to do it. If the surgeon wasn't comfortable or did not want to do it, they would send the patient to the nearest vascular surgeon. So to answer your question, this would really depend on local practice patterns which would be heavily dependent on the surgeon involved.

  11. Just now, offmychestplease said:

    Many +1EM's get directly hired on to the biggest ER departments in downtown Toronto upon graduation. 

    I know this very well, but my question is more of not whether they are hired, it is, do they truly feel competent in the beginning. I find doing a rotation or two in any specialty often teaches you some stuff but also shows you a whole area that you actually don't know.  

  12. On 2/7/2020 at 10:53 PM, magneto said:

    After finishing EM residency, my plan is to initially work mostly in ED in a mid-size city.

    From my limited personal experience, most recent CCFP-EM (2+1) grads are choosing to practice in only ED in urban/suburban settings. Very few would go to rural settings.

    However, there are many CCFP-EM grads who practice both FM and EM and you can find them in any setting (urban/suburban/rural).

    Where would you like to practice? Do you want to do both FM and EM?

    In my opinion, I think family medicine residency alone with rotations/electives in EM/ICU/Trauma and hard work is enough to be a competent doctor in a rural setting. I don't think 2+1 is needed (just my opinion).

    Again, in my opinion, most CCFP-EM residency programs are very strong and prepare their residents to work in any center in Canada (Tertiary care, Trauma centers, Urban vs Suburban vs Rural etc.). Therefore, most graduates end up working in mid-size (if not large hospitals). However, jobs are not super easy for 2+1 grads at very big academic hospitals but the probability is not zero.

    Let me know if I answered your question.

     

    Not to offend in anyway, but i'm curious as to your thoughts that a 2+1 is enough to work in tertiary/trauma center. From my residency experience, having done several rotations in ICU/Trauma/EM haven't made me feel confident in working in those settings alone. I certainly can see enhanced learning if this was your area of focus, but my feeling is that it would definitely take a lot of extra self-study/on the job time before I felt like I could do it independently. 

  13. On 6/22/2019 at 7:56 AM, user123456 said:

    I don’t mind going through all the academics (fellowship/msc/phd) and working very hard. Just as long as there is possibility at a GTA/Hamilton/Calg/Vancouver hospital

    If you are among the best in your surgical cohort (i.e. you work harder than your other co-residents) and you get along well with people, this is possible. Otherwise its not. Just being willing to go through all the academics is not enough. Doing a PhD is not enough, you need to be very productive during it. 

    I think the answer is that it is doable, but you should not expect that if you go through the motions you will get a job there.

    Not sure if this is what you are thinking but... if you are hoping to be in a big city because you like city life, I would think again. The people who are in the big city, work so hard they don't enjoy the big city. So either way, you aren't enjoying city life.  

  14. On 12/10/2020 at 11:22 AM, UKdocCadborn said:

    I have been reading through these forums for the better part of the month and decided to bite the bullet and ask the questions that I have. Thanks in advance for your assistance. 

    I am a Canadian born, UK-trained doctor hoping to settle back home in the GTA. I have completed internal medicine training (4 years) in the UK and initially was going down a very academic haem-onc path. However, I have recently realised that the passion I thought I had for research and haem-onc as a whole does not exist and what I really love about being a doctor is seeing and treating sick patients, while keeping it quite general.

    In terms of exams and licensing I have done the following: 1) Completed MCCEQ1 (hoping to do the Q2 early 2021 if I can get a spot), 2) Had my internal medicine training verified by the Royal College and have been deemed eligible to sit the royal college internal medicine exams which I plan to do in 2022. (for what it's worth I have done the UK MRCP, but don't think that means much in Canada). 

    Due to family and person reasons I cannot come back to Canada until 2025. I am planning on doing a family medicine residency ((MRCGP) in the UK which will take 2.5 years and is directly recognised by the CFCC without any further exams needed. After that I plan to either work as an internal medicine middle grade doctor for 1.5 years/do some locum GP work in the UK. I then plan on doing one of the University of Toronto internal medicine hospitalist fellowships either at TGH or Sunnybrook. Ultimately, I like internal medicine but not so much GP. My main reason for doing family medicine training is to guarantee I can find a job of some description in the GTA, and I have got about four years of time to kill in the UK. My questions were:

    1) How difficult do you think it would be for me to get a job as an internist based out of a hospital in the GTA with my credentials (my main concerns is not having done general internal medicine sub-specialty training although I will have done a 1-year Toronto fellowship)?

    2) My dream job (if such a thing exists) would be to work as an internist with possibly a special interest in cardiology, mixing my time between hospital medicine and outpatient clinic. Financially, would that be more lucrative than being a family doctor who does some locum internal medicine shifts on the side? 

    3) How confident in critical care would a GTA-based internist need to be? I can recognise and treat sick patients and escalate to ITU as needed, but have very minimal experience in intubation/inotropic support/haemofiltration. That is a skill-set I hope to expand on during my year of fellowship at UofT.

    Thanks. 

    1) Don't think it would be that hard, there are plenty of jobs, certainly you could get a hospitalist job, because that requires family medicine training alone. Do you have a UK IM license? Does 4 years of training get you fully certified in IM that would be recognized as equivalent to the Canadian FRCPC IM?

    Getting a job as an internist may be not possible without a license in internal medicine (either UK full IM license or Canadian FRCPC IM). Your pay would likely be a hospitalist's pay and you would bill as a family physician in that case.  

    2) All this depends on if you are a licensed Internist or a licensed GP. 

    3) You would need to be quite confident, in the GTA, there are limited critical care jobs and even fully trained ICU doctors have trouble finding ICU time. The fellowship you are asking about doesn't sound like it would provide you with any ICU experience. It doesn't have call either, so it really would be mostly for you a chance to network and get your foot in the door and see how the Canadian system works. I doubt you would learn much. 

  15. With specialties as difficult as derm, they are swimming in applicants who have near perfect CVs. There are many derm gunners who don't get in each year. I don't think you have any realistic chance with dermatology given the competitiveness. I would honestly focus on trying to match to something that is more feasible. I would strongly consider IM or FM for you if you are interested in dermatology, they are similarities and you can do some derm with FM + derm certificate. 

  16. With a 2.7 GPA, your chances realistically are only in the Caribbean without a superb MCAT. I would advise you to avoid healthcare professions in general as they are heavily GPA focused and without doing another undergrad you don't really have a chance at any health professional school in Canada with a 2.7 GPA. 

     

     

     

  17. On 11/9/2020 at 12:55 PM, MedHopefull144 said:

    Hey guys,

    I'm a first-year med student, and my school isn't allowing any in person shadowing/observerships at the moment. I'm interested in surgery, and given how competitive it is, I want to start setting myself up for success as early as possible. 

    I've heard mixed things in terms of research expectations, involvement in surgery-related clubs/initiatives, and practicing suturing early. Importantly, what can I do to start building connections early one? Also, in terms of research, how useful is it to publish on a non-surgical topic?

    I'd really like to know what activities are worth engaging in, and which activities only provide a marginal benefit. Where should I be focusing my energy? 

    Any input would be much appreciated

    Get involved in clubs/initiatives, definitely network. It's all networking, meeting residents, meeting staff, doing research. It all helps. Doing research in a related field is totally fine although its more efficient to do it in the field you apply to. Definitely explore specialties first, find a few you think you'll like and start with those and narrow down as you go. By the beginning of clerkship you should have 1-3 specialties you are thinking of applying for. 

  18. On 8/11/2020 at 8:22 PM, anonnow said:

     

    This may be a temporary feeling borne out of burnout or the realities of med school (though I have never had more than a passing interest in any topic we've studied so far). I am also feeling extreme shame for taking away the spot from another student who could've excelled in my place. Part of me thinks I need to put my head down and just persevere because I'm older now and can't keep switching careers. I also know there are niches in family medicine that could potentially solve the problem of interest. I don't mind things like sports medicine or addictions. I assume there wouldn't be as much of a need for breadth of knowledge if I just become, for example, a GP sports. But I don't know if I can do 4 more years of this when there is a decent job I could have within a 1-2 years that pays ~100k that I would enjoy more than this.

    If this job is 1-2 years away and is a guarantee or near guarantee, I would strongly consider that option. Burnout is one thing and its true that studying 60-70 hrs a week won't last forever, but what I'm more concerned about is that you seem to be worried about the responsibilities that a family doctor has to have. A lot of it is true, it gets harder and harder and clerkship will be harder than pre-clerkship and residency will be harder than clerkship. Even staff life is not easy as having that responsibility is a huge task. On the one hand, the studying will get easier because you just simply realize that you don't need to know every thing. 99% of the time its the same things that show up and in the 1% you don't know, you can ask others for help. But what doesn't get easier is the sense of responsibility and the work. It isn't easy money for sure. I urge you to think things through some more, when do you need to make a decision? Try to spend less time studying and see how you feel. If it is simply just a work hour issue, that should be manageable, but what you should really consider is this part: 

    I don't think this anxiety will slow down because clerkship hasn't even started, and the thought that I will be responsible for people's lives is terrifying me. I thought I had the strength to uphold that responsibility, but honestly, I'd rather not deal with it. Sacrificing my happiness isn't worth the job, especially when I read that patients are extremely demanding of their family doctors. I don't think I could handle the short appointments and constant need to be perfect. Given that I have no passion, I don't even think it would be fair to patients. My gut is telling me that I'll be miserable as a family doctor.

    I am also overwhelmed by the amount of information you have to know as a family doctor. For instance, I am having a lot of trouble remembering the names of medications, their indications, contraindications, etc. I review concepts every day but remembering the details never works. And like I said above, this issue is exacerbated because I have no interest in the material. So I'm constantly dragging myself to learn more. 

    Don't worry about taking a spot from someone, focus on yourself and what makes you happy. You earned your spot in medical school and you fully deserve to be here. I know the imposter syndrome and the feelings of guilt, but the question is whether you want to be there or not, not whether you deserve it or what others will think. 

     

     

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