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  1. Haha
    apple94 got a reaction from pt90 in The HOLY GRAIL of Casper Preparation - A Definitive Guide to Acing Casper   
    Ironically that comment shows that you lack something personality wise.
  2. Like
    apple94 reacted to LostLamb in Importance of Specialty Interest Groups for Matching   
    zero influence on matching.
    just another thing to list on your cv. 
  3. Like
    apple94 reacted to shikimate in When your preceptors say you are where you are supposed to be... does that mean they are not impressed?   
    It's vague and sometimes I think clinicians use it defensively when they don't feel like giving specific statements on someone's performance. Maybe they are busy, maybe they don't like teaching, or maybe they just want to get home that day. They should instead tell you explicitly if you are below, meet or exceed expectations. I feel a lot of clinicians aren't sure what to expect of a medical student (or a resident for that fact) unless they are very involved with teaching or curriculum development. Sometimes you have to remind them that you haven't done your core rotation, or you just began clerkship, or that you aren't an off service resident!
    There is no escaping of the anxiety trying to get "above expectations" for CaRMS because the residency system is screwed up. The only thing I can say is that you don't need to wow every attending to match, you just have to find 4-5 that you feel really good about that can go bat for you. If your goal is IM I would find someone that you've worked with for at least 1 week, and ask them if they feel "comfortable" giving you recommendation. It is a good sign when they say they are "comfortable" recommending you.
  4. Like
    apple94 reacted to rmorelan in When your preceptors say you are where you are supposed to be... does that mean they are not impressed?   
    Ha - this is one of the big problems with medicine - highly intelligent, hard working people really doing the job can be "average" in the pack. That isn't bad - it is just often relatively a new experience for many. The problem (and ha there is literature on this!) is that suddenly average people forget effectively how good they really are and can eventually stop advancing as well. That is a mistake which can be best combated if you know the effect exists. 
    The opposite would be for reference if you were put in another environment where by virtue of your skills, work ethic, and the intelligence you are gifted with you are a super performer - and everyone constantly tells you how amazing you are, and comes to with new things to do and so on. Big fish in a small pond sort of effect. 
    Being where you are suppose be is exactly that - you are doing just fine. One of the reasons I avoid that term is some people can read it wrong. 
  5. Like
    apple94 reacted to ACHQ in Last Minute Change in Specialties   
    Recent staff GIM grad here and staff at a community hospital.
    if you don't mind me asking what was the 5 year surgical specialty? Is this something you still want to pursue and did you love it as much as CTU (or more?). Do you like family medicine as much as either of those?
    What did you love about CTU most? was it the inpatient/ward work? was it the new consultations from the ER (or other areas)? was it the resuscitation's? was it clinics? was it all the above? if you exclusively only enjoyed inpatient ward work then family medicine with extra training in hospitalist medicine is not a bad idea, but doesn't offer the range of work possibilities GIM does (ER consults, urgent GIM clinics, inpatient consults to non-IM services).
    Given the COVID-19 pandemic (and the fact that we are definitely in the beginning of a 2nd wave) it may be tough to organize, but try to and see if you can get *any* Internal medicine related electives (GIM or sub-specialties). If your heart is truly set on it then at least give it a shot. Even if you can't get an elective you can at least apply and see what happens and delay making a decision right now (or at least have a decision made for you via carms interviews received or not received). I have seen people get interviews with minimal electives (they were using it as a backup), and given the pandemic you can definitely use that to help out your case.
    The one thing I would consider is if you are applying for  a 5 year specialty and get it it would be easier to transfer to Internal medicine (or family medicine) than the other way around (due to funding issues)
    Good luck!
  6. Like
    apple94 reacted to spiceham in Rheumatology and Endocrinology Competitiveness   
    As I'm finishing my last interview for carms 2.0 today.. Honestly the competitiveness of an IM subspecialty partially depends on your school and your year... 
    for example, Rheum may be super competitive at Mac in the 2021-2022 carms msm cycle because say there are 2 spots and 6 people from Mac that year want rheum, and often times people want to stay at home program making a specialty more competitive for that specific program that year. Sometimes a subspecialty is competitive across country - i.e. there are more total applicants across all canadian IM programs wanting a certain subspecialty than the total number of spots across country.
    Traditionally cardiology is one of those "country-wide competitive" specialties, though programs like rheum and endo can vary significantly depend on the year. 
  7. Like
    apple94 reacted to ACHQ in Rheumatology and Endocrinology Competitiveness   
    I should add my caveat that I speak for the GTA and Ontario... I hear Quebec is different and you have to do the 5 year program for some reason..... which is probably why people view the ones in the 4 year program "unfortunate", where as it is the complete opposite in the GTA. Most people want to just finish and practice in GIM, and yes some didn't match to their subspecialty but that was mainly due to location restriction etc... the MSM match can be stressful BUT if you apply country wide for whatever specialty you want, you will almost certainly get a spot somewhere... but it may not be your ideal location.
    I don't see the trend changing for the 4 year vs 5 year over the next 5-10 years in the GTA that is because most people in the community don't care and don't see the utility of the extra year in GIM. Again I speak only for GTA/Ontario and *NOT* Quebec (which is always a different beast).
    Every hospital arrangement is different. From the ones I was looking into before settling into my spot now most don't have that 2 weeks on 2 weeks off model you describe. The hospital is too busy and needs coverage so its hard to set a model up like that.
  8. Like
    apple94 reacted to ACHQ in Rheumatology and Endocrinology Competitiveness   
    outside of academic centers, no one cares if you do the 4 year or 5 year program. In the community you make substantially more vs academics so in fact there is a financial incentive to do the 4 year program so you can make money as soon as possible. At least in the GTA, there are *more* community hospitals than fully academic ones (No I don't count NYGH, TEGH or THP as academic...).
    As someone who did the 4 year GIM program, I'm done and live in Toronto and work in a large community hospital. Life is good
    Depends on how your contract is set up. Most acute care sites will make you sign up for a certain amount weeks/days. Mine is 9 weeks/yr of Hospitalist coverage (these are 7 day blocks), 3 weeks/yr of medical consults (also 7 day block), 4 weeks/yr of Urgent medicine clinic (only M-F), and 5 ER shifts a month (8 hour shifts: day- 8-4am, evening- 4pm-12am, night- 12am-8am)- with about 1-2 day shifts, 1-2 evening shifts, 1-2 night shifts. This IMO is pretty lifestyle friendly and gives me about 1-1.5 weeks off a months (the days aren't always stacked so nicely though).
    That being said I have just started and have been picking up extra stuff whenever I get a chance, and I still think I have a pretty decent lifestyle, with almost 2-2.5/3 weekends off a month and random days off here and there (like today and tomorrow).
  9. Like
    apple94 reacted to ACHQ in Rheumatology and Endocrinology Competitiveness   
    It doesn't work out so cleanly in terms of hours a week, heck its even hard to say how *many* weeks a year do you need to work to earn that much, because evening/nights pay way more, weekends pay more. Generally speaking if you pick up alot of that work you will make more. I wish I had a more solid answer but it isn't so black and white. It also depends on volumes (if you are at a very busy centre with lots of volume you will make more). *Generally* (not exact) but 1 week of work (~5ish days) is about 10k. So to *bill* 400k you need to work close to 40 weeks. That doesn't include the stipend/HOCC you get which in total for a year can range between 20-50k additional cash.
    GIM in hospital based practice pays 0 overhead. 0!
    Yes, or the 5 year GIM program, or you can technically do it as a subspecialist who can't find work/wants to make extra money/likes GIM doing GIM work.
    I agree with #4 and somewhat with #1. I just finished residency and the last few years consistently that I remember Heme was competitive as was ID (more than endo and rheum). As you mentioned certain years were worse than others
  10. Like
    apple94 reacted to ACHQ in Rheumatology and Endocrinology Competitiveness   
    GIM staff here at a large community hospital in the GTA
    It really actually depends on how much you want to make. You will make money between 300-500k, but that is a huge range and depends on how many days/weeks you want to work. Some people don't need to make 500k and are happy with 300k and therefore work less and love their life. Others need the money to buy a home or whatever and therefore work much more to try to make 500k (and in some cases beyond).
    I have been working fairly hard right now because I just started, but my actual commitment is about roughly 30-34 weeks a year (depending on how i stack my ER consult shifts). With that there is no doubt you can bill close to 300-350k/yr (not including the HOCC stipend you get) and so the total could be close to 350-400k. I've been picking up extra work so I can't be super accurate on those projections but they are estimates, and it also depends on how much volume you see too.
  11. Like
    apple94 reacted to Edict in Job opportunities in ENT and urology   
    Actually the job market is opening up in some of these small specialties at this very moment. NLengr is right though, as a general rule, the job market is shit and it isn't ever going to get better.
    It is sheer luck that sometimes the job market opens up, but even then these places are picky. They want someone who the exact fellowship they are looking for, the right "fit" and many places are happy holding down the fort for a few years until they find the "right" person. In fact, many places (primarily academic centers) recruit internationally, and there is never a shortage of surgeons internationally who are better than you who would be happy to take a Canadian salary. So all in all, you will have job openings that don't fill while there are grads out there jobless. The important thing to remember about surgical specialties is that you are buying into a lifestyle not a job. You will work twice as hard for half the reward of any of your other friends, all so you can operate. If that sounds like a sweet deal for you, then do it. Otherwise, save yourself. 
    The job market in the US is generally speaking very good for surgeons however. If you are open to the idea of moving to the states, surgery is not an absolutely miserable choice.
    I would almost go ahead and argue that if you are not willing to relocate, do not do surgery ever. The number of surgeons who get away with never having to live in a place they would rather not live in for at least a few years of their career is probably in the single digits. 
    Also, anyone who thinks surgeons make a lot of money is lost. Surgeons absolutely do not make more money they almost always make less. Most physicians are able to make the same or more as surgeons if they work the same hours. Factor in the extra training and less flexibility in hours etc., surgeons definitely come out worse. 
  12. Haha
    apple94 got a reaction from neurologist19 in The HOLY GRAIL of Casper Preparation - A Definitive Guide to Acing Casper   
    Ironically that comment shows that you lack something personality wise.
  13. Thanks
    apple94 got a reaction from zerochance in The HOLY GRAIL of Casper Preparation - A Definitive Guide to Acing Casper   
    Ironically that comment shows that you lack something personality wise.
  14. Like
    apple94 reacted to ACHQ in internal medicine - income/lifestyle as a hospitalist or subspecialists   
    I'm not a staff (yet), but I have talked to staff community doctors that work in those hospitals (and others in the GTA).
    One said PARTIME (e.g. 20-21 weeks, so more than 1 week off a month) of work GIM work (mixture of wards, ER consults and clinics) pays $300k gross (but with minimal to no overhead), this was for Trillium.

    A General Internist at North York General said working 36 weeks (considered "full time") they grossed close to 400k (again minimal to no overhead).
  15. Like
    apple94 reacted to Arztin in Why do individuals say that becoming a doctor for the money is not worth it?   
    It's pretty obvious that most MDs make a very good living, and there aren't so many professions that would allow you to make as much as a physician or surgeon. Financially, I'm pretty much sure it is worth if for majority of people who pursue medicine.
    However, money shouldn't be the main reason IMO for the following reasons (just a few reasons I can think of right now, but there are many more):
    - your youth devoted to studying. UG +/- something else, then med school, then residency (2-6 years) +/- fellowship +/- advanced degree depending where you can/want to work. I've heard of cardiologists doing 2 fellowships + advanced degree for a job. (4 years of UG, 4 for MD, 3 for IM, 3 for cardio, 4 years of fellowship, 1-3 for advanced degree). You do the math. Time is not something you get back with money.
    - It's pretty hard to do something you hate your entire life with such a long training. There are people who stop after med school and move on to other things in life. Then, there are people who carry on with residency for whatever reason (feeling stuck? feeling like they can't go back? too much debt?) but I sometimes wonder why they are in medicine. Fortunately, they tend to be rare. A friend of mine told me she worked with an anesthesiologist who hated his job, so did everything super fast because he just hated his job, but still does it for the money. I mean, 400k of continuous cashflow vs restarting in something else with a much lower wage. I can understand his decision.
    - while your non medical friends will have moved on, you will be leading a much more busy and irregular life. E.G. some of my friends are accountants. They work pretty hard, like 50-60 hours. But when they go home, they are done. I'm in my late 20s, and I'm a junior resident. I have to work close to that amount if terms of hours + calls + study time. You get tired after a while. In surgery, the hours are worse. Once residency is done, staff physicians obviously still do calls. The surgeon on call will have to do the 3 AM emergent case even if they haven't slept much the night before. The ICU staff will have to go in at 3 AM to take over the unstable patient. Most jobs won't require you to do this.
    - it's a long process from which you'll a lot from, but everyone in the medical field loses a bit of their humanity with time - for some, only a bit, for some, they lose it entirely. You'll see a lot of things that happen, but shouldn't have happened that way, ethically speaking, or sometimes clinically speaking. With time, you start to get more more numb because you can't do anything, and it wouldn't really change anything. I've seen physicians so burnt out and/or completely cynical. They were probably once upon a time wide-eyed empathetic and curious premeds/med students - kinda hard to imagine...
    - the intense stress and disappointment/futility sometimes. The first time a patient and coded right in front of my eyes while I was rounding... Having to call the code, and lead the code until someone more senior arrives.... That took 3-4 minutes during which I felt extremely awful, but you can imagine these 3-4 minutes felt like hours for me. The patient died later that day. It was my second patient who died that day, and there was another patient I suggested palliative care the same day. That day felt pretty shitty. My friends doing other things don't have to deal with this kind of stuff.
    - the babysitting: as someone who held other jobs before, I feel like it is a common theme in many Canadian schools to think that med students (and sometimes residents) cannot think on their own and are kind of thought of as babies. My older peers really hated that also - going from a full grown adult in the 30s doing their jobs independently and now being treated like a kiddo. Now as a resident, it's not as bad, but still, especially as a junior, I'm still working in a setting of lesser power differential, where I have to do some of the work, smile, not stir shit up, make sure I'm appreciated.
    Anyways, your question is absolutely legit. So here is my answer.
    The money for sure is decent when everything is done, but if you hate medicine and you mainly do medicine for the money, you can probably still finish med school and residency and work as a MD, but pretty sure that would be a horrible decision leaving to a life of regrets.
  16. Like
    apple94 reacted to LeBronto2019 in How To Be Competitive To Match To Ophthalmology   
    You seem very passionate about a certain specialty and don't care about money at all...
  17. Haha
    apple94 got a reaction from Dr. A in The HOLY GRAIL of Casper Preparation - A Definitive Guide to Acing Casper   
    Ironically that comment shows that you lack something personality wise.
  18. Haha
    apple94 got a reaction from Premedstudent0307 in The HOLY GRAIL of Casper Preparation - A Definitive Guide to Acing Casper   
    Ironically that comment shows that you lack something personality wise.
  19. Haha
    apple94 got a reaction from simplycomplicated in The HOLY GRAIL of Casper Preparation - A Definitive Guide to Acing Casper   
    Ironically that comment shows that you lack something personality wise.
  20. Like
    apple94 got a reaction from oneday1 in McMaster Health Science vs. Queen's new Health Science + scholarship   
    there has to come a point when Mac stops getting away with shit like this.
  21. Like
    apple94 reacted to garlic in Post-match depression   
    Thank you everyone for taking the time to write encouraging words and for sharing their personal stories. I have read and re-read your responses countless times. They've been a source of strength especially when I felt alone and self-conscious.
    Importantly, I also showed this thread to my loved ones who were also struggling with my match result. They were amazed to hear how common disappointment and struggles are in this carms process, often through no fault of the applicants (who generally have put in unthinkable amounts of effort and emotional investment over 4+ years). Although unfortunate, it was also comforting for them to know that regret, sadness and fear can happen even when people get their preferred choices. Because of your responses, we all learned the spectrum of intense emotions that goes from getting what (one thinks) one wants to going unmatched.
    The points brought up here helped my loved ones and I talk through difficult topics that actually extended beyond the superficial problem of "moving away." For example, my parents spoke about their fear of being abandoned in their old age. I also learned I was a protective factor when a friend was at a low point and thinking of ending his life. As many of you mentioned above, life is complex and perhaps these post-match feelings are influenced by/stem from things much more elaborate than disappointment over a result. It made me wonder how much each of us keep inside of ourselves, for whatever reasons...fear of being judged, no opportunity to be vulnerable, etc. Match day is such a huge deal for us M4's that it's easy to forget the way others may be feeling or affected.
    To the people who commented about lack of resilence or that perhaps I should've spent more time on my ROL: I still appreciate your comments and contributions to this topic. However, I also encourage you to consider the impact of your words on those who are going through stressful, tumultuous, and quickly-changing times. There are many factors beyond inertia or lack of gratefulness that contribute to post-match emotions. I am truly happy for you if you have never felt so dejected/lost/frustrated. Because it sucks. But I ask you this, is compassion to a hurting stranger a bad thing? As we have all experienced, this field can be isolating, exhausting, thankless even on good days. Criticizing people for having worries/interests/responsibilities/goals outside of medicine is a huge contributor to burnout and perpetuates unhealthy bullying behaviour. I am cognizant that my situation could definitely be worse. But this is not a stress/sacrifice Olympics.
    This past week has felt so long and I admit I've had some incredibly dark thoughts. But thank you all for showing me that I am not alone. That things will get better. That this is a distressing and confusing time for many of us, regardless of result.
    Hoping everyone stays safe and healthy during this difficult time. Keep well
  22. Like
    apple94 reacted to rmorelan in Post-match depression   
    Bit controversial topic but I think we need to talk about this a bit so there is a better understanding of what this process is like. 
    It isn't unusual at all to have very mixed emotions with CARMS no matter what you get. For one thing people make a ton of friends in medical school and go through a shared bonding experience that is pretty unusual. Even if you stay at the same institution the majority of your friends are likely to move away (in my case I went from a class of 171 in my year, but I was very involved over many years to going to a school where 11 of us matched - and ended up just far enough away that realistically visiting friends/family was going to be an issue). Change on this scale - new job, new home, loss of contacts/friends and new milestone to concern ourselves with in the years to come hit very quickly. It is a fragile time for many. 
    Plus you are so focused on achieving this one thing that of course it is hyped up to the maximum. The journey is quite often more rewarding than actually arriving ha. There is an almost inevitable  let down after as you can finally refocus on the bigger picture. 
    You can be happy you got what you want and still be sad of what you are about to lose. You can be resilient enough to endure what is to come and still be challenged by it as well. Ignoring all that just sets up for the exact mental health issues our profession has. 
  23. Like
    apple94 reacted to NeuroD in Post-match depression   
    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.
  24. Like
    apple94 reacted to mastersgrad in Post-match depression   
    I'm also feeling this depression.
    I decided to rank location over speciality and it burned me. I matched to my top location but not my top speciality, when ranking I truly thought I would be happy in either speciality. But since the match I've just been sad everyday thinking of the would've, could've, should've.  I thought that I would be happy to stay with my partner, family and friends but now that the match is done I just feel major regret. 
  25. Like
    apple94 reacted to hero147 in Post-match depression   
    Residency goes by quickly. Faster than undergrad, faster than medical school. You'll be so busy most of the time you won't have time to mope. If you are really invested in your relationship with your girlfriend, there are ways to make it work. You have 4 weeks of vacation to spend with each other as well as taking a couple of personal days to see each other on weekends sounds nice even if short lived. Plus there's things like skype/facebook messenger/whatsapp for the times you need her through the week. You will slowly adapt to a new life in your new city and make new lifelong friends. I would know because I was in your situation at the beginning of residency as well. I was homesick every day and it only hit when I started living here but slowly but surely I got used to it, made new friends and started a new life. I still am not happy being far from home, but it's a lot better than when I arrived.
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