TheFlyGuy reacted to Cupboardsauce in Anesthesia Residency
Hi - Anesthesia senior resident.
Call burden is dependent on the program you are in. I can only speak to my program and what I know from some buddies across the country. Large academic hospitals typically want 24 hr resident coverage - so in my program we are typically doing the max allowable call a month (6-7 shifts). Depending on the program, shifts can be 12 hrs or 24 hrs in length. Typically a hospital that is busy overnight all night will have 12 hr call, while hospitals that tend to shut down at 11PM will have 24 hr call. Depending on the program you may also routinely get pre-call days for 12 hr shifts (ie don't come in to work until 6PM, work until 8AM, then get a post call day). Pre-call days are the best.
In anesthesia residency you also do a number of off-service rotations such as a decent amount of ICU, CCU, PICU, which all notably have more intense call requirements. However, there are also many rotations with more relaxed to no call burden - for us that is when we do sub-speciality rotations, in our senior years for studying purposes (the anesthesia exam is hard), and when we do rural rotations.
Overall, I would say that we have it better than our surgical and IM colleagues - we reliably get to go home at 8AM post call, are not expected to stay post call until 1PM or come in on weekends, and it has been easier for us to get requested vacation time. On the flip side, when you are on call overnight there is every chance you will be up all night working hard.
Lots of cool cases and high intensity cases in residency, mixed in with the bread and butter stuff. You will work hard, and cases can be stressful but rewarding. You can also have a life outside of residency. In the long run, if lifestyle is important to you there are lots of community and academic anesthesia jobs that will be great for balance. There are also a lot of jobs in anesthesia that are not great at balance. Luckily, you have many options and a great job market. Many people are accepting great jobs out of residency even at academic hospitals - an example might be accepting a full time position at 4 days a week with call once every two-three weeks, and 8-12 weeks of vacation time, no overhead, no clinic to cover. If spending less time / more relaxed residency is your highest priority consider if GP+1 might be right for you.
Lots of great options out there. I would encourage you to think about what you want your job and career to look like, rather then what you want your residency to look like. What is going to make you happy and fulfilled 15 years from now?
TheFlyGuy reacted to bearded frog in Canadian/American PREMED Student Consultanting Service
Wow didn't know that I was a "service" doing that for free here on pm101
TheFlyGuy reacted to medisforme in Is family medicine really that bad?
I am 1.5 years out of residency and don't understand all the doom and gloom around family medicine. As a disclaimer, I neither love nor hate family medicine. It provides a great income so I can provide for my family and enjoy the time I spend with them. The other disclaimer, is that I quickly gave up on trying to be an agent for change in our health care system, it is too inefficient and bureaucratic and not amenable to change. I am much happier just putting my head down and working within the parameters we have.
1) My personal opinion is that the NP/PA encroachment is almost irrelevant (at least in BC). There is such a dire lack of primary care that there will always be work for family doctors (outside of large cities at least). The city I work in, has at least 3 new NP's to help ease the fact that there is a 5 year wait to obtain a family doctor (i do have a problem with how much NP's earn per patient seen, which is a bit of a separate argument).
2) I also don't understand the paperwork argument
- don't refill Rx by fax
- charge patients for all private forms
- you bill for all simple communications with nursing homes, home health etc...
It's a non-issue if you follow the above 3 rules
3) Memorize your province's billing codes to help you maximize your income (I already outearn most of my colleagues who have no idea about all the billing codes available to them.) I earned >350K last year, with zero hospital work, zero evening work, and a minutiae of weekend work. I typically see about 30 patients on a full office day.
ie. psychosocial issues can easily be converted to counselling and mental health planning appointments, filter charts to see who qualifies for chronic disease management codes (ie. anyone who has ever had an Ha1c of 6.5 or above qualifies for CC diabetes codes regardless of their complexity) etc...
Negatives would be:
that certainly, there is a lot of frustration with certain patients who are demanding, neurotic etc... It doesn't provide a lot of job satisfaction.
A lot of the office based work involves listening and counselling on mental health issues (the medicine is just validating their feelings and providing simple advice, which is actually often quite helpful). That is not for everyone
Dealing with chronic pain (especially chronic back pain). Very difficult to convince patients there is little indication for medications, procedures etc... vs physio, tai chi, weight loss, stretches (as an aside see February 18 issue of the economist for a crazy story on how much is spent treating back pain in the US, it is nearly 80% of what is spend on all cancer treatments). This also doesn't lead to much job satisfaction.
I would just say speak to a variety of family docs about their experiences before making a decision as you will find a wide variety of opinions.
TheFlyGuy reacted to Pterygoid in I need an honest assessment
Here's a gestalt view: you're (slightly) below average in GPA, and 5 points below average in overall MCAT score. Slightly above average NAQ (although NAQ will fluctuate every year, based on the pool - be cognizant of this).
I'd recommend an MCAT rewrite for a 514+ if possible for you and/or reflect on your interview style for improvements. Either of these might push you over the edge for an acceptance. Otherwise, there's not much else to do other than apply again. Every year is a different pool of applicants, with different reviewers and interviewers. Your score may drastically go up or down the following year. Nature of the system, the only fair aspect is that everyone has to go through it.
Hopefully you receive more useful responses than mine.
TheFlyGuy got a reaction from Byolo in Urgent question CV
Not sure if McGill has some specific rule for this, but if it helps the way I've seen it done elsewhere for publications is to put a blank in place of your name; file reviewers will understand that's where your name should go to assess your level of contribution.
TheFlyGuy reacted to honeymoon in Students who bought luxury cars during clerkship, how do you feel about them now?
dude just buy the porsche i can live vicariously thru your PM101 posts
TheFlyGuy reacted to ellorie in Advice? addiction
This is my suggested approach to having any kind of mental health condition in this field: keep your head down, your mouth shut, and play your cards close to your chest.
Trust the people who are bound to you by confidentiality (i.e. your own care team). Find people you can trust as a priority, especially if you need to move at any point - if you no longer need specialist care, find a good family doctor and develop a relationship so that you have a point of contact, and so that you have somewhere to go if things hit the fan (as they always can, and more than ever with the stress of medical training). You don't want to be stuck needing a letter for the College and having to try to get it from someone who barely knows you.
Figure out which institutions/organizations function to protect/help you and which ones do not. The ones whose priority is something other than you, do NOT lie to them or conceal things from them that you are required to disclose - but do not give them more than the minimum they ask for, when they ask for it. This includes your medical school, your residency program, your hospital, and your supervisors as a whole, and ESPECIALLY your provincial College. Understand what they are entitled to know, when they are entitled to know it, and do not give them more. Be professional and honest in your interactions with them at all times but do not give them anything they do not require.
Some organizations will exist for the primary purpose of helping you - this can include the residents' union (though they often have little power), student support/disability services/resident wellness (these are a slight grey zone so you have to feel it out a bit), or the provincial physician health program. Trust them cautiously and reach out for help/support/accommodations early if you need them, because getting support early and staying on track is way better than having a relapse or an episode and having it affect patient care. But do not tell them your whole life story. Tell them what they need to know to help you. Always start by sharing the minimum, and then if it goes well, you can always say more later. But you cannot unsay things. You want them to see you as: proactive, cooperative, seeking care appropriately, keeping patient care/safety in mind, and being professional. Show/tell them how you are being these things despite whatever blooper you are asking for help with and they will be far more likely to help you and protect your ability to work/keep you working. These are things that these organizations have told me that they want to see, after I have engaged with them, and seeing those things from me caused them to be helpful and protective of my career. I have had some bloopers that I have had to ask for help with and I have never been taken off work because I have always prioritized patient safety and showed everyone that I was handling my stuff responsibly and with attention to my professional responsibilities.
When it comes to supervisors, you will need mentors who you can trust. Your mentors will not necessarily (or even probably) be mentors who are assigned to you or your primary supervisors. Develop these relationships slowly. I have been burned here. Feel people out and get to know them before you disclose anything. Listen to how they talk about patients, how they talk about colleagues, and watch how they relate to you. Show them you are a smart and capable doctor so that they already know that about you before you tell them anything. I have two amazing mentors who know the deep details of my business, that I could call at any time, in any state, and be totally honest, and they have been invaluable in advocating for me, supporting me, and helping me navigate residency, but this emerged over a period of several years - I did not really develop this level of trust with them until PGY4-5. These are largely people who supervised me at some point. There is a broader circle of people who know the broad shape of various aspects of my business but not the details or the full picture, maybe another 3-4, and those relationships are great and helpful too - but the number of people I trust implicitly is very small.
I got burned very badly by one supervisor as a result of disclosing something that in retrospect I should not have trusted that supervisor with, and had another concurrent supervisor tell me (after finding out about it through the hospital gossip mill, as almost the entire department did, which was a whole other horrifying chapter): "this is my advice to you: you think your supervisors are there to help you but they are not. They are there to judge you. Show them what they want to see."
I say this not because I agree with it (I think it's a despicable thing to say to a resident who just got burned as badly as I did) but because some staff will operate this way and you want to find out who those are and avoid them like the plague in terms of being open or vulnerable or asking for help.
This incident was the thing that primarily solidified my strategy above, and happened mid-residency. I wish I had applied this strategy much sooner in residency because it would have saved me a lot of heartache and also hassle.
You might make a mistake. Hopefully you have been judicious and disclosed only a little. If so, you correct course and move on. I had some blips (small and also big) and course corrected and it was fine. The key to course correcting is being proactive, doing damage control, and extracting yourself as quickly and cleanly as possible. There is no need to catastrophize and think that your medical career will be some kind of lonely hell where you never get to be yourself and everyone is awful to you and one misstep will end your career. You just need to be smart and cautious and adjust as needed.
As I said in my earlier posts, none of this is insurmountable. As long as you keep in control of your disclosures at key decision points (medical school admission, residency match, license application, finding a job) you can wobble a little bit in other areas.
Most people in medicine are not frankly malignant and most do want to help and support you. They just also may have their own unconscious biases and competing priorities that may not be in your interests, and a few will be frankly malignant and it can be hard to know who those are going in (though you will figure it out fairly quickly if you pay attention).
There are wonderful people in medicine and overall the culture is changing. People with these kinds of challenges going into the field is extremely valuable in changing the landscape because the more people there are out there, the more mentorship there is for others behind us, and the more we can change things to make it better for every generation of medical trainees and doctors. But in my mind there is no reason to expose yourself to unnecessary risk when there are other ways to accomplish the same thing. Trust the people that have shown themselves to be trustworthy and let them help you, but don't throw your information out into the winds with no control over where it sticks. I have done this. Sometimes it was fine. Sometimes it ended with a lot of tears and a big mess that I had to run around cleaning up.
This is my two cents as a somewhat, but not overly, salty person at the end of training and the beginning of real life.
TheFlyGuy reacted to rmorelan in Medicine...
sure rub it in ha
although I will say watch what happens in Quebec if you try to increase it or otherwise take advantage of the situation. There is actually a "response". They are not afraid to get shall I say vocal about the situation.
In the rest of Canada in comparison - it goes up and is there is well basically nothing.
TheFlyGuy reacted to regretful spoon in Vanier scholarship nominee on application?
Thanks for the info, valid points I didn’t realize the process varied so much at different universities. Also to clarify I did make it to the national nomination ie I am in the final 10 quotes not just nominated by my department to apply (idk if that makes a difference), I was considering adding it and discussing how I am the first person in my lab to make it to the national level and the first from my department to make it to the national level for a CIHR nomination if I have space but as you mentioned it may be tough to judge so I will see if I have anything stronger to put. Thanks for your advice it is greatly appreciated!
TheFlyGuy got a reaction from Nirvanesthesia in Frustrated with the admissions system
The slights against certain groups aside, I also resonate with the message (and anger) in OP's post. The admissions process really does contain an absurd degree of luck, subjectivity, and bias, and it will always be frustrating to see the inequities that exist play out in such an important part of all of our lives (especially when others who have been successful are oblivious to the imperfections of the system); it would be nice to see something done about it and I don't think we should stop striving for ways to improve the system just because its difficult or inconvenient. Some of the brightest and most caring people I know have been rejected from med who I think would be outstanding physicians, and it's tough to see. That said, some of the elements of the system will be here to stay and we do have to be able to accept that and either keep trying, or move on.
If anything what I always hope people take away from the fact that the admissions process here is so subjective is that it shouldn't change anyone's perception or their worth or abilities. Personally, it's actually encouraged me to feel less competitive and develop a better sense of comradery with those going through the pipeline. Imo, people who get in/are in should spend their time propping up the community (including those who are striving to get into medicine), and those who don't should work towards accepting that, in a way, they're casualties of a broken (or at least imperfect) system and that, after a point, it's not them. No one gets in without at least some luck. We all have to play with the hands we're dealt in life and comparison to others is a sure fire way to be unhappy. It is frustrating, but can't always change how other people think, so the best we can do is foster the kind of positive relationships with premeds and med students alike we'd like to have, and perpetuate it forward to affect a positive change that way. Until we're in a senor enough position to try to affect changes in the broader process anyways (which is a tall order as it is, in addition to the fact that most people I know who've gotten to that point are happy to just put the whose thing behind them and get on with life).
TheFlyGuy reacted to Bambi in For On-going activites should I put hours into the future?
Future is uncertain and therefore, irrelevant. Once future has become the past, it is then okay to record as an actual activity.
TheFlyGuy got a reaction from arthurb in Job vs Master’s Degree, in terms of benefits for med school applications
Grad pool makes it easier, but it’s now just stated that “applicants will receive credit during the file review process” depending on which type of grads degree you’re doing (course-based MSc vs thesis-based MSc vs PhD), and whether it’s conferred or in progress, so it should be purely helpful (unless it’s an in progress course-based MSc, which UofT gives no bonus for). While other schools don’t have separate pools per say, they do give explicit credit for grad degrees as well (ie. Mac), which are not an enormous advantage and often requires them to be conferred already (like Mac), but are again purely helpful and don’t stand to harm you in any way.
If you land a unique/impactful job that experience could be quite helpful in the application, as could your spare time to keep up with ECs, so I won’t comment on comparing the grad degree vs work experience, I think that’s situation dependent, but the grad degree only stands to help you for med.
TheFlyGuy got a reaction from anonymouspanda in McMaster Accepted/Waitlisted/Rejected 2019-2020
Honestly, there’s a metric ton of luck with the process as it is anyways, both before and after the interview, the lottery has just brought it to the forefront of everyone’s minds. I went from no interviews three cycles in a row to four acceptances this time, wth (largely) the same app compared to last year. Aside from maybe just finally getting a chance to interview somewhere, I didn’t really improve, just got lucky with who read the app and essays, maybe who interviewed me, etc.
Getting in is almost more of a logistical hurdle once you’re competitive (which you obviously are), and def not something you should take personally. Where you'll make your mark is in med school and beyond with the the people you meet, the patients you treat, and the choices you make. I understand not being thrilled about Mac, they’re not my flavour either (no offence to the ppl who disagree, power to you!), but now you have the opportunity to make that difference in your own life and in the lives of others, so don’t feel like it isn’t earned (at least with any more luck than anyone else); grasp it with two hands and be the best Doctor you can be.
Tbh you’re one of the ppl I’ve been rooting for since joining the forums @inkbat haha, so I’m real happy things worked out for you; best of luck in the fall!
TheFlyGuy got a reaction from MD9511 in Grad student references
I would choose the one you have a better relationship with and who can speak more positively and in more detail about you (i.e. who knows you better). Unless the supervisor specifically asks for your input, I personally wouldn't bring up the idea of collaborating on the CAF
TheFlyGuy reacted to DrOtter in Chances getting into McMaster?
McMaster is an extremely long shot even with a 130+ CARS given your cGPA. They only look at numbers, so your experience unfortunately isn't considered here.
If your 2-year GPA at least above 3.7, you maybe have a shot at Queen's but you need at least a 126 CARS (according to the posted stats on the forum in the last few years). They look at your ECs a bit more.
Otherwise, I'd recommend getting a second BSc degree in something you can excel at if med is truly your lifelong dream.
TheFlyGuy got a reaction from DrOtter in Chances getting into McMaster?
Even with a stellar CARS score (I’m talking 130+), I think you would still be held back by your GPA. Seeing as how Mac looks at your cGPA (i.e. doesn’t drop any courses), and doesn’t care about any of the experiences you’ve had (ECs, work, and volunteering are irrelevant to them, unless it’s a graduate degree), unfortunately I don’t see you having a realistic shot there regardless of how well you do on CARS or Casper.
Gpa is crazy important for Canadian med schools, so if you had an upward trend in your degree, some of the schools that let you drop certain courses to produce a wGPA, or use only your two best years, could be on the table (particularly if your experiences are strong), but that’s hard to judge without knowing your GPA breakdown year-by-year, if they were full course-load, etc. Realistically though, unless your upward trend is REALLY strong, you’re going to have a tough time getting your foot in the door anywhere for an interview, especially in Ontario; I think the GPA is too low to meet the cutoffs to even be considered. Likely, the remedy here would have to be further undergraduate studies to bring it up.
I’m sure not the answer you wanted to hear, but I hope it helps!