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NeuroD

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Posts posted by NeuroD

  1. I haven't posted in years but I'm here to say MCCQE2 needs to go, and there are lots of us pushing for it. Personally I'm pushing it through RDoC.

    Unfortunately there is a parallel alternative being argued, which is to get it paid for through our provincial contracts. In my view making the cost invisible to residents will just ingrain it further as there will be less motivation to fight against something that'sbm "free".

  2. On 3/12/2020 at 11:55 PM, Intrepid86 said:

    The number of people who match to one of their top choices and who still aren't happy is disturbing. The only depressing thing here is the lack of resilience and gratitude on display. Sure, this will be an adjustment, but it is by no means the end of the world. If these supposedly suboptimal situations build even a little more character, then that alone would be worth it.

    The reason it's disturbing is not because of what it shows about resident's character. Instead it's disturbing because it reveals that the magic/honeymoon phase/idealization of medicine that we all had before getting in, doesn't last very long once you're here.

    Not even matching to your #1 choice, or landing your "ideal" job makes up for it.

  3. On 2/26/2020 at 8:43 PM, VivaColombia said:

    Recently met a PA in Winnipeg who works in Cardiology 5 days a week, minimal call shifts and makes 170k. Didn't believe it until I saw the hospital salary disclosure documents. It's a similar trend to the US where PAs are making really good money for the education/cost. And there is more regulation for NPs/PAs on the way in the near future so midline expansion is happening just like it did in the US.

     

    PA (and specialized RNs/NPs) are the best bang for buck careers right now. Low opportunity cost, no overheard, short training, minimal personal liability, much better hours, all for a six-figure salary that is actually higher than some MDs (170k for example is more than a good chunk of FP, neuro, peds docs).

    I enjoy medicine, but when kids ask me about going into the field, I ask them to make a serious cost-benefit analysis considering all of the above before they chose MD over PA/NP. The system/patients would benefit from more MDs, but it's probably in an individuals best interest to become a mid-level.

  4. 26 minutes ago, blueoval177 said:

    Psych where I'm at.

    Salary - full benefits, pension, holiday, sick time - cannot incorporate for this. 7.25 hrs mon-fri

    - 315k +  daily call stipend (1/7+) = 360k+ annual (no overhead)

    can still have private practice - most guys adding another 100-250+, all depends on lifestyle. So 450-550+ with benefits/pension/holidays. Have to ask an accountant what the benefits is worth but quite a bit with the pension matching. Have to work pretty hard FFS to keep up.

    :O!

     

    Prairies?

  5. Psych in Ontario got boosted a few years ago with the mental heth investments. Inga are much better now. And call shifts/locums can be really lucrative. 6-700k is what the ones I know, who work hard, make. That's awesome because a lot of the other traditionally lower billing specialties (neuro, ID, less) can't make that anywhere near that much even of they work hard.

  6. 37 minutes ago, rmorelan said:

    that's the trouble - when one group's bad behaviour poisons a school. Worse it doesn't sound like it is the first time, so again someone hasn't dealt with it at a higher level. 

    of course people are nervous with CARMS and don't want to rock the boat as it were - still don't forget to help address this in the proper fashion as per above. 

    Exactly. The rest of the hospital benefits if you guys DO report it and force them to change. Please do.

  7. Holy cow. Can't believe this is real. I'm pretty upset. How do they expect to provide good AN service to the hospital if they're scaring good eople away?

    ---- 

    Side note, I just wanted to address one of the earlier comments about Queen's. As bad as AN CaRMS interview might be, Queen's as a whole is the exact opposite! I've lived, rotated, and worked throughout most of southern Ontario, and Queen's/Kingston was my surprise favorite. People (outside of anesthesia I guess...geeez) are generally nicer than most other centers, there IS a really sense of community, and the city happens to fit my personality perfectly (don't come here if you're looking for Toronto's bar/club scene). NONE of that excuses how AN behaved during interviews though, and I hope you guys do report it.

  8. 48 minutes ago, rmorelan said:

    No it shouldn't - and if you objectively do the math it would take a couple of decades for most specialists to "catch up" - I really think that point is not stressed enough with the entire money side of medicine is talked about. Comparing apples to apples the say 3-5 years (or more) head start is really powerful. Factor in the fact that many of those specialists have no choice but to work more hours than a typical family doctors so to truly compare things you also have to equate that as well  (and of course extra hours often at worse times) .

    Some of the smartest BUSINESS minded doctors from my class objectively compared things and just went to family. It is actually hard to argue with their logic when you really look at things. 

    and even now ha - there is part of myself that thinks it would have been really nice if I just personally liked the field as a profession as there is so much going for it. I don't think I would, which is why I did something else but I am on that 5 extra year pathway, so I can really see the effects at this point (4 months to go ha!).  Five years of 80+ hour work weeks ha...and over 200 all nighters extra over FM, 12 months of every waking moment preparing for a crushing exam, and really not a ton of control over your schedule or major aspects of your life. 

     

    That's assuming the specialists catch up at all. Bunch of us (including mine) never do/makee than FM, and have less flexibility for changing our practice focus or revenue source.

    If you enjoy clinic/family, take it VERY seriously.

  9. On 2/8/2020 at 12:19 PM, 1D7 said:

     

    I don't think pay should be a big factor in your decision since family medicine does out earn some 4-5 year specialty residencies (e.g . neuro, paeds, etc.) and has options to literally be some of the highest earners. Additionally the fact that you start earning some real money 3-5 years earlier than many other specialties puts you ahead in terms of life and investments, which is worth quite a bit with our decade-long bull market.

    This should not be underestimated.

  10. 1 hour ago, Let'sGo1990 said:

    My understanding is that other people are able to sell their small businesses at retirement and receive 700-800k of that money tax free. Physicians cannot take advantage of this. I have questions based on this:

    Because doctors usually cannot sell their practices, what do they do with the money stuck inside their corporation? If the corporation continues to exist during retirement so they can pay themselves annually from it, do you still have to pay costs associated with incorporating?

    Does the CRA raise eyebrows if your corporation with zero revenue is paying out dividends and salaries?

    Thanks. Feel free to correct any flaws in my understand. I was doing some rereading surrounding the changes to the small business tax rules. 

    I'm a resident, so take what I say with a grain of salt, but I've seen plenty of FPs sell their practice/rosters.

    Yes you have to pay incorporation fees to keep it open, and no it's not a problem for it to keep paying you out when it doesn't not have revenue. Using your corporation like this is what was intended for our retirement.

  11. 4 hours ago, rmorelan said:

    At Ottawa and in where I have worked in the US the stroke team and the on call radiologist are all at the scanner when a ...

    I would agree that that sort of "emergency radiology" is ideal (and I hope your field grows). My point still stands though, what of the many cases where management decisions are made based on a subspecialtist's interpretation? It's still quite common, and not just in neuro/stroke. Should that work continue to go unpaid? Especially when there are major discrepancies in relativity?

    And it's not just with rads. For example, many acute decisions are made based on ECGs, but billings go to a cardiologist who interprets them much later. It's a recurrent theme. Perhaps it wouldn't matter so much if relativity wasn't skewed so heavily.

  12. 1 hour ago, rmorelan said:

    although a stroke study should never be read "hours later" ha - let alone days. That is flat our improper care. 

    I am part of the "new generation" of radiology, and things are changing. Fields get stuck in their history in a sense and radiology definitely did - there are a ton of staff that are currently working that predate the technology that allows anyone to read a study fast (20 years ago is not that long ago in medical terms ha). No PACS, no electronic reports, reports were mailed out or at best faxed - took days to get results. Nothing could happen fast ha. People went into the field with expectations as a result - no different than many other fields that also had to painfully adjust (I remember the major complaints when family medicine had to as their practise teams work evenings and weekends for the first time - many people went into that field because they didn't have to work evenings and weekends ha)

    We don't live in that world now and radiology is changing - faster in the US than here but change regardless. It's a good thing too because old ways don't work, and hurt our patients. Radiology is becoming a 24/7 service - I for instance read the stroke studies at the scanner so as fast as they can possibly be read. That is a good thing because we are the best trained to read them (it is literally our jobs ha and we have the training to look at all possible pathology that may be present) and we have to step up to do that.  We just have to. If your centre cannot provide that level of service then nighthawk services are becoming more common to cover the difference (makes sense as small radiology teams cannot go 24/7 - you end up with teams of 4-5 radiologies doing worse call than junior residents forever - it destroys people - particularly as they get older, and already are getting reduced sleep with young families). 

     

     

    I imagine that's at your fellowship center in the US? Was it the same when you did residency in Ottawa? At most of the places that I've done stroke rotations, neuro stands at the scanner and reads it live and decides on TPA before rads is in the room.

    Of course Rads are the best trained in the field, but for the neuro example, unless its a subspecialized neuro rad they trust, neuro will usually just interpret it themselves. You see this with even more specialized fields (like the stroke example I gave, or the MS specialists who see one thing all day every day. Sure they'll miss a thyroid mass, but the MS management decisions often come down to the specialists read of the image).

  13. 10 hours ago, Raptors905 said:

    I am not sure the competitiveness is a factor in salary. 
     

    They are paid well. No one is diminishing their work. They provide an important service. So do lots of other specialities that are paid less and have to do call without benefit of real time radiology. Getting 1 million with 12 weeks off a year and no call beyond 9pm is a great deal 

    Yeah and I'd also say that that logic should be applied to the services that make management decisions (some times split second ones like in stroke) based on their own reading of scans, independent from the rads read that may show up hours to days later.

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