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insomnias

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  1. Like
    insomnias got a reaction from PlasticSurgery in How Does Transferring Residencies Work?   
    IM is brutal, especially in PGY1. Plus, independent practice with IM is 4yrs vs 2 (or 2.5 if transferring) for FM. If you want an outpatient practice where you see everything, IM might be overkill.
    The max amount of credit you can receive when transferring into FM from a Royal College specialty is 6 months, but you may not get that much, depending on the overlap between the rotations you've done and what the curriculum of the program is. The program also has an incentive to minimize your transfer credit so that they can get the service out of you.
  2. Like
    insomnias got a reaction from Pakoon in NP/PA   
    A few reasons NPs may not take off in Canada like they have in the US:
    1) No such thing as direct-entry programs (i.e. you cannot apply for a BScN+NP program), and US NPs are not granted equivalence
    2) Health authorities are given a lump sum budget at the beginning of the year. Staff (including NPs) come out of this budget. Physicians do not.
    2a) Consequently, there's no real incentive to shorten LoS
    3) NPs cost more than MDs after factoring in utilization
    4) Urban areas tend to be saturated with family doctors (at least in Alberta), whereas rural areas have a shortage. It's therefore hard for NPs to get a foothold in urban areas, which disincentivizes people from pursuing that path as opposed to going RN->MD
    Reasons CRNAs may not take off in Canada like they have in the US:
    1) Currently, no province allows them to work here, although I've heard BC may do so soon
    2) We already have anesthesiology assistants, but these are also utilized sparingly
    3) Family doctors can undergo a year of training in anesthesiology and work with ASA1/2 cases, primarily in rural hospitals. If CRNAs were to come, they'd have to compete against these family doctors, and it's very clear who would win that competition
  3. Like
    insomnias got a reaction from GeriGIM in NP/PA   
    A few reasons NPs may not take off in Canada like they have in the US:
    1) No such thing as direct-entry programs (i.e. you cannot apply for a BScN+NP program), and US NPs are not granted equivalence
    2) Health authorities are given a lump sum budget at the beginning of the year. Staff (including NPs) come out of this budget. Physicians do not.
    2a) Consequently, there's no real incentive to shorten LoS
    3) NPs cost more than MDs after factoring in utilization
    4) Urban areas tend to be saturated with family doctors (at least in Alberta), whereas rural areas have a shortage. It's therefore hard for NPs to get a foothold in urban areas, which disincentivizes people from pursuing that path as opposed to going RN->MD
    Reasons CRNAs may not take off in Canada like they have in the US:
    1) Currently, no province allows them to work here, although I've heard BC may do so soon
    2) We already have anesthesiology assistants, but these are also utilized sparingly
    3) Family doctors can undergo a year of training in anesthesiology and work with ASA1/2 cases, primarily in rural hospitals. If CRNAs were to come, they'd have to compete against these family doctors, and it's very clear who would win that competition
  4. Haha
    insomnias reacted to GeriGIM in NP/PA   
    How’s the mid-level (NP/PA/CRNA) workforce shaping up in Canada, particularly for FM, GIM and ED medicine? 
    Here, in America, mid-levels are increasingly a very desirable (ie cost-effective) alternative to physicians. In fact, nearly all hospitalists/GIM docs supervise at least one mid-level; it’s a requirement of the job. Several smaller hospitals now operate ORs without any physician anesthesiologists. 
    You’d think Canada would want to invest in mid-levels (to minimize health care costs). 
  5. Sad
    insomnias got a reaction from Keege T in Quality Of Calgary Fm Training?   
    I found this post written by a U of C FM grad which suggests their admin isn't the best, echoing above comments. https://www.**DELETED**.com/r/Residency/comments/kke63n/suing_your_residency/
  6. Like
    insomnias reacted to Cupboardsauce in Anesthesia Residency   
    I'm with the 5 year FRCPC program, so I am not the best person to chat about GPA lifestyle or job market. Couple things I thought about though:
     As far as I know in Western Canada, FRCPC trained anesthesiologists are close to the only trainees being hired on these days in major cities. There are lots of jobs for GPAs in great rural areas all over the country, and some medium sized locations. Doing a couple locums post residency to find the right fit has been a common pathway from some of my GPA pals, while others have already been an established GP in a certain town and have been asked to do the GPA training with a job on return. So all that to say, I would think you'd need to be comfortable living in a rural location as a GPA and should consider if that will work for your lifestyle/family/interests. This is a big consideration for lots of people. 
    From an anesthesia perspective, the GPA vs FRCPC cases are quite different if you consider subspecialties of anesthesia (ie cardiac, thoracics, neuro/spine, transplant, major trauma, vascular) to the average rural anesthesia case,  but it's really not so different if you consider that a lot of your time as a non-subspecialist staff anesthesiologist will be doing bread and butter sedations and GAs no matter where you work. My advice would be to think hard about what will keep you fulfilled in your career in the long run. Like you mentioned, smaller centres will refer out their complex patients, so if you're someone who enjoys the more complex periop management of anesthesia then FRCPC affords more opportunities to explore that. For some of my colleagues, the challenge of approaching a complex case or acute resuscitation is what keeps them interested and fulfilled. However, some may find that as a FRCPC practitioner the novelty of looking after complex patients and doing complex cases will wear off with time and experience. The more cases you do the more routine it becomes, especially after you've been well trained for 5 years and given that you'll be working in larger hospitals with the support to manage complex periop surgical care. As either a FRCPC anesthesiologist or a GPA there will be cases that are challenging for you. Anesthesia in a rural setting is incredibly complex when faced with an acute presentation in a setting with limited hospital and staffing resources and considerations for transport/referral.
    In terms of working in ED/clinic as a GPA - I can't speak to this in detail. Some of my GP colleagues have gone on to just do GP anesthesia, and others have accepted jobs with time spent in ED or clinic or both. The variety and balance is certainly what many of my GPA colleagues have loved about their job. To me this seems like a wonderful option. Doing just anesthesiology means that you have less of other aspects of medical practice - things like patient continuity, history taking/diagnostics, and admitting/being MRP. Many of my colleagues don't find they miss these aspects of care as anesthesia alone affords a greater degree of flexibility with call/time-off/overhead, but for some people balancing out an anesthesia practice with time in clinic/other areas is a real value-add to their career. 
    I'm sure there are other factors that other people have considered important. My decision was based on not being interested in the FM training program, wanting the option of living in a major city and/or doing a subspecialty, and loving resuscitation/trauma medicine. However, as a medical student I didn't appreciate that things I thought were really exciting as a medical student are not as exciting after a couple years, and rather that it's the other aspects of my career - like patient-physician relationships and a sense of community in my workplace that keep me happy and excited to come to work.
     
  7. Confused
    insomnias got a reaction from LostLamb in Quality Of Calgary Fm Training?   
    I found this post written by a U of C FM grad which suggests their admin isn't the best, echoing above comments. https://www.**DELETED**.com/r/Residency/comments/kke63n/suing_your_residency/
  8. Like
    insomnias got a reaction from blah1234 in Trying to swap out of current residency, looking at Canadian/US options   
    Re working without a full residency in the US: It's possible, but most insurance companies won't let you bill (some, like Medicare/Medicaid and some of the advantage plans, might), and most hospitals won't give you privileges unless you're board certified or eligible. Malpractice insurance may also be more expensive. That means you'd be looking at working somewhere where they literally can not get any doctors (ie extremely rural or malignant) or in an outpatient, cash-only clinic. There are some non-clinical jobs, but those are a bit harder to get. SDN had a thread on this somewhere. It's even harder if you're not a US citizen because these jobs might not sponsor visas as readily.
  9. Like
    insomnias got a reaction from Nirvanesthesia in If you like FM, is there any point in exploring other specialties?   
    I guess this is a corollary of the whole "if you enjoy anything other than surgery do that." I like family medicine overall and am confident I could find a niche I'd enjoy spending the rest of my life doing. I also like various aspects of various other specialties, and I could enjoy doing those specialties for the rest of my life as well. Given the training time difference and flexibility in hours, location and scope of practice that's pretty much unparalleled by any other specialty, why pursue the RC specialties over family medicine? Financially, it doesn't seem to make sense. From a mental health perspective (call sucks) it doesn't seem to make sense. Am I missing something?
  10. Like
    insomnias got a reaction from LostLamb in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  11. Like
    insomnias got a reaction from Bookmark311 in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  12. Like
    insomnias got a reaction from polarbear89 in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  13. Like
    insomnias got a reaction from 1029384756md in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  14. Like
    insomnias got a reaction from klamar in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  15. Sad
    insomnias got a reaction from hijkl in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  16. Like
    insomnias got a reaction from Weltschmerz in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  17. Like
    insomnias got a reaction from ChemPetE in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  18. Like
    insomnias got a reaction from MD_Dream97 in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  19. Like
    insomnias got a reaction from dooogs in Are residents actually happy?   
    Every time somebody says that, I like to point to the example of Switzerland which has residencies of comparable length to ours in most specialties while abiding by EU work hour restrictions (48h/week max with no more than 13h of continuous work), and the RCPSC recognizes their training as equivalent for the purposes of exam eligibility. The reason we have long hours during residency isn't because it's a trade-off between hours worked vs competency but because resident labour is significantly cheaper to the government/hospital than that of attending physicians.
  20. Like
    insomnias got a reaction from Sleepywood in Government (Student) Loans - Several Questions Related to Strategizing Funds   
    A lot of these depend on your province.
    1) Canada student loans and some provincial student loans begin to require repayment within 6mo of graduating. The rest require repayment after finishing residency. LOCs generally require repayment starting 2yrs post-residency/fellowship
    2) Depends on the province.
    2.5) Some provinces won't count it if it's in a TFSA
    3) No
    4) If you can afford to pay it off, it might be worth it, but that depends on you comparing the cost of paying it off (med LOC interest) vs not paying it off (undergrad LOC interest)
  21. Like
    insomnias got a reaction from Mel96b in Love in the Time of C[OVID-19]holera   
    My suggestion: you and your ex-gf had been dating for at least 4 (possibly more) years, and you only broke it off last month. Take at least a month to process this and sort of wallow in the loneliness. This is an admittedly terrible time to be lonely, but unless you're 100% over that relationship, it's not really super healthy to pursue anything right now. Especially not with a classmate with whom you may be stuck for the next 3+ years. You need to regain that sense of self you might've lost during the relationship
  22. Thanks
    insomnias got a reaction from Ss123toy in Things you wish you knew before you started med   
    There are some people who can't deal with having to see patients all day / having to constrain appointments to 10-15 mins / having to treat the entire spectrum of illness. Those people can't tolerate FM. There are some who love that. Then, there are some who are ok with it. The premise is that if you're ok with all of that stuff, just do FM (because shorter training time, greater job mobility, whatever)
  23. Like
    insomnias got a reaction from dh. in Love in the Time of C[OVID-19]holera   
    My suggestion: you and your ex-gf had been dating for at least 4 (possibly more) years, and you only broke it off last month. Take at least a month to process this and sort of wallow in the loneliness. This is an admittedly terrible time to be lonely, but unless you're 100% over that relationship, it's not really super healthy to pursue anything right now. Especially not with a classmate with whom you may be stuck for the next 3+ years. You need to regain that sense of self you might've lost during the relationship
  24. Like
    insomnias got a reaction from tuttifruti in Love in the Time of C[OVID-19]holera   
    My suggestion: you and your ex-gf had been dating for at least 4 (possibly more) years, and you only broke it off last month. Take at least a month to process this and sort of wallow in the loneliness. This is an admittedly terrible time to be lonely, but unless you're 100% over that relationship, it's not really super healthy to pursue anything right now. Especially not with a classmate with whom you may be stuck for the next 3+ years. You need to regain that sense of self you might've lost during the relationship
  25. Like
    insomnias got a reaction from DNA Doc in Is family medicine really that bad?   
    Example 1: my family doctor went into it because it was a 2 year program. He's been in practice for >20 yrs. He takes his time with patients, all his patients love him, etc. He hates being a family doctor. He continues to urge me not to do it.
    Example 2: a family doctor I shadowed works ~3 days/week, still makes 6 figures, and is maybe 4 years out of residency. Loves it.
    Imo, FM is like every other specialty in that you can find a way to love it or you can find a way to hate it. Uniquely, there's so many potential niches that if you literally have no clue what you want to do, you have the ability to find that thing that you'd enjoy doing, and do it.
    As for midlevel incursion into FM in Canada: I don't see it as being as big of a concern. The entire purpose of FM being gatekeepers to specialists is to keep system costs down. NP/PAs send more referrals than FM does for the same patient complexity level. As a result, an expansion of their scope of practice would result in increased healthcare costs in the long run, which would be great for anyone working in the MoH who then runs the stats on why that happened. The more imminent possibility is that IMGs get the ability to practice at the same scope an NP/PA has today, or at a more expanded scope compared to midlevels. Unlike in the US, IMGs (especially CSAs) are viewed pretty favourably by the public here.
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