Ranking specialties in CaRMS

[lovemedicinesomuch]

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[Bambi]

Well my experience was somewhat different. I applied to 2 specialties and FM, and felt that I would enjoy whichever field selected me. In my mind, I considered them equal but I did rank my choices. I was not prepared to compromise on location, so I only applied in one city, realizing I might not match. However, it worked out for me and the surgical specialty selected me. You can choose location where to apply and can rank your choices in order of your preference. After that, it is totally out of your hands. Good luck! 

[dooogs]

24 minutes ago, Bambi said:

Well my experience was somewhat different. I applied to 2 specialties and FM, and felt that I would enjoy whichever field selected me. In my mind, I considered them equal but I did rank my choices. I was not prepared to compromise on location, so I only applied in one city, realizing I might not match. However, it worked out for me and the surgical specialty selected me. You can choose location where to apply and can rank your choices in order of your preference. After that, it is totally out of your hands. Good luck! 

Did you tell the 2 specialties that they are your top choice? 

[Bambi]

I ranked FM last and the other specialty which did not select me first. This was only b/c I had to rank. I repeat, in my mind, I ranked them equally. My so-called 1st choice I had wanted ever since I was a child, OBGYN, and where I landed, I only thought of applying literally in the last days prior to CaRMS deadline.

Oh, in my Motivational Letters, each were told this was my dream and they were first choice - which, in a sense, was the truth.

[shikimate]

It's very very hard to fail in residency, so long as you pass your royal college exam, even if it's the bare minimum score, you'll be certified the same as someone who won a Nobel prize during residency. Also, not to mention you'll get paid the same per fee code lol. I wouldn't worry about not being "successful" in residency. You have to try really hard to do something stupid to fail. 

Job and fellowship wise, yes sometimes if you want an academic job you have to have some publications, MSc, few Nobel prize or whatever they want these days. But otherwise a lot of the "success" stuff residents do is more or less just a peacock's tail. Community job won't really care about most of these stuff, it's more good personality, good team work, and good connections that get you jobs.

Sometimes I don't understand people who force themselves to do all the extra "stuff" like MSc or fellowship just to end up doing the same job as someone who hasn't done it. Like instead of spending 2-3 years doing those you could've made like at least half a mil.

[shikimate]

And yes, 5 year residency can be quite draining, especially I'd say year 2-3 when it's a steep hill to climb and you gotta get into the deep end of learning that specialty. Gather resources, that's key, get all the notes, past tests, and whatever your specialty uses that's "high yield". Yeah it's nice if you can do some projects on the side but your first and foremost goal should be to 1) get certified, 2) get a job.

I would say finding like minded people/residents is the key. Not all your co-residents will have the same aspiration as you, and that's fine. If you can find 1-2 people that you really get along with, that could instantly boost your synergy. Don't just talk about residency stuff, talk about job searching, investing, relationship etc, look for synergy in every aspect of your life. Find a few staff who you also work well with. Do lots of electives and learn the world outside your academic center.

Don't waste your time trying to please everyone, maybe at beginning when you are weak and newbie it's ok, but once you are in PGY3 and ready to carve out your own path, start really contemplating and reflecting who's been your ally and who's been your enemy for the last 3 years. Don't get trapped in academia, I've seen that happen all too often, people get so happy like they won Lotto Max when their poster gets accepted to some Garbage Journal of Medical Oddities.

[shikimate]

Lastly in residency there will be staff who make you feel bad, useless, make you think you gotta beg them for a fellowship or something. That's their game to get you to become their academic slave. It's all mind games. You gotta remember what I said earlier, YOU PASS EXAM = YOU GET BOARD CERTIFIED = YOU GET PAID THE SAME (or even more than those losers, if you are smart with billing and accounting).

That's why it's so important to feel confident for your board exam. Never a bad idea to start studying early. Just like MCAT, find out early what's high yield, and start using all the resources you could find. Once you are confident about your ability to pass your boards, all the voices saying you suck are just flatus. Play safe in residency, if you are competent and work reasonably hard and study reasonably well, you'll get through it. Of course every PD wants to extract as much out of their employee (aka, YOU) as they can, but you don't owe them anything.

And start networking for jobs early, both academic and community. Go to as many events as possible, make cold calls, write those cold emails, don't fear rejection, sometimes it takes a few tries to open up a door. If you have an opportunity, do some site visits on your day off. Never dismiss somebody because their hospital is small or they aren't hiring right now, they could easily pass your name to someone who might be hiring (but not publicly posting their job), or give you a boost when your prospective employer calls them for reference. You'd be surprised how people know other people, and someone you met before, who you've probably half forgotten, had a good impression of you and get called by your recruiter. 

Most jobs aren't posted, especially the good ones. The good ones that get posted have a lot of fakes (aka they already hired someone but have to post an ad for regulatory purposes). Just remember that. 

 

[indefatigable]

...

[MDinCanada]

I built a pretty strong candidature for dermatology from the first day of medical school and then decided not to apply.

I became pretty jaded around the middle of clerkship, I looked at everyone around me (including the derms) and didn't see anyone living a life that I aspired to live, it all just seemed a bit underwhelming... 

I ended up applying to family medicine only. I chose family medicine because the flexibility of the career is extremely important, I want to be able to shape my practice around my interests at whatever stage of life I'm in (didn't see myself doing ONLY derm for the rest of my career... I really enjoyed other specialties i rotated in as well like psych, if not more, because I actually felt like the relationships that were developed were fulfilling and helped me appreciate my own life better). I'm very much of an opportunist, and being a GP makes it easier to get involved in new, exciting things because the scope is just so much larger, and I'm probably more interested in careers in medicine that are bit non-traditional anyways. I guess my reasoning can be seen as selfish, but at the end of the day, I need to prioritize my own happiness because I would serve better as a happy doctor than as an unhappy doctor. 

CaRMS is such an interesting process because it pushes you to reflect on what you prioritize most in your life in ways that very few careers do. Most people probably end up questioning their lives and the choices much later in life, when it's already too late... I think what matters is that you allow yourself to freely reflect on your priorities and sources of happiness, without too much outside influence, and know that a lot of people around you feel the same way!

 

[CaRMS2021]

Does ROAD even apply in Canada? I feel like that's an American concept. Radiology is a hidden gem - not super competitive, very well paying, boring and obscure enough most won't discover their interested in it. Ophtho and Derm I'll give it to you. Anesthesia isn't very competitive. Where is the plastics, ENT, Emerg, etc?

[offmychestplease]

1 hour ago, CaRMS2021 said:

Does ROAD even apply in Canada? I feel like that's an American concept. Radiology is a hidden gem - not super competitive, very well paying, boring and obscure enough most won't discover their interested in it. Ophtho and Derm I'll give it to you. Anesthesia isn't very competitive. Where is the plastics, ENT, Emerg, etc?

ROAD is for fields that are well paying and have good lifestyle + bonus of good job prospects. It does not necessarily correlate to competitiveness (anesthesia is much closer to the ROAD definition than plastics and is much less competitive). It also does not correlate to how "interesting" a field commonly is or so-called 'prestige' (which is BS anyway and for insecure immature people).

The only true field that fits the bill is Derm as it is both very high paying and great lifestyle and amazing job prospects (no need for fellowship).

Radiology is very high paying but the residency is very hard, you need a fellowship for a job, and staff life is very busy too...so it does not fit the bill.

Optho is very high paying but you need to get through a 5 year difficult surgical residency + fellowship after that. The market where the real money lies (LASIK) is hard to break into with very few jobs as well. 

Anesthesia is paid well (but def not exceptionally well) and does have good prospects (no need for fellowship), and the lifestyle in both residency and staff is certainly better than surgery but not as good as FM/ER/Derm due to call. So I guess Anesthesia fits the bill for ROAD but not as much as derm. 

Plastics and ENT have horrendous residences + fellowships + staff life + few jobs + the big money is only in cosmetics which is very hard to break into so def not close to ROAD.

ER does have good lifestyle if shift work is your thing, but the pay is not too exorbitant (again ROAD generally is for high pay and good lifestyle).

So if you're using the ROAD definition...at the present time in Canada...for the fields you listed... it goes like this:

Derm > Anesthesia > Radiology (for $, no lifestyle)/EM (for lifestyle, not so much $) > Plastics/Optho/ENT

[MDinCanada]

23 minutes ago, offmychestplease said:

ROAD is for fields that are well paying and have good lifestyle + bonus of good job prospects. It does not necessarily correlate to competitiveness (anesthesia is much closer to the ROAD definition than plastics and is much less competitive). It also does not correlate to how "interesting" a field commonly is.

The only true field that fits the bill is Derm as it is both very high paying and great lifestyle and amazing job prospects (no need for fellowship).

Radiology is very high paying but the residency is very hard, you need a fellowship for a job, and staff life is very busy too...so it does not fit the bill.

Optho is very high paying but you need to get through a 5 year difficult surgical residency + fellowship after that. The market where the real money lies (LASIK) is hard to break into with very few jobs as well. 

Anesthesia is paid well and does have good prospects (no need for fellowship), and the lifestyle in both residency and staff is certainly better than surgery but not as good as FM/ER/Derm due to call. So I guess Anesthesia fits the bill for ROAD but not as much as derm. 

Plastics and ENT have horrendous residences + fellowships + staff life + few jobs + the big money is only in cosmetics which is very hard to break into so def not close to ROAD.

ER does have good lifestyle if shift work is your thing, but the pay is not too exorbitant (again ROAD generally is for high pay and good lifestyle).

So if you're using the ROAD definition...at the present time in Canada...for the fields you listed... it goes like this:

Derm > Anesthesia > Radiology (for $, no lifestyle)/EM (for lifestyle, not so much $) > Plastics/Optho/ENT

I agree with this, except that Derm isnt super high-paying everywhere in Canada. You'll have to break into cosmetics for the big bucks as well.

[bearded frog]

ROAD is a bit archaic, some sources use E-ROAD with emerg, it was a thing in the early 2000s specifically seen as lifestyle specialties, specific to the US, and there are quite a few differences in Canada and a lot has changed in 20 years.

That being said, it goes back way longer than that. This article from 1968 lists those (and ENT) as particularly good specialties for women so they can have time to also be a good wife a mother...

https://books.google.ca/books?id=K1Hkk1ENB0oC&pg=PA44&dq=radiology+ophthalmology+anesthesiology+dermatology&hl=en&sa=X&ved=2ahUKEwigpZqm1eXuAhVOXM0KHaQdCOsQ6AEwAnoECAUQAg#v=onepage&q=radiology ophthalmology anesthesiology dermatology&f=false

[hero147]

On 2/11/2021 at 5:28 PM, offmychestplease said:

 

Optho is very high paying but you need to get through a 5 year difficult surgical residency + fellowship after that. The market where the real money lies (LASIK) is hard to break into with very few jobs as well. 

 

What makes ophthal a difficult surgical residency? Their OR days are often not that long and they don't round on majority of their patients. Some residencies even have dedicated residents to do urgent care clinic/consults from the emerg. Do agree on the job market though. 

[bread]

On 2/11/2021 at 9:33 AM, Bambi said:

I ranked FM last and the other specialty which did not select me first. This was only b/c I had to rank. I repeat, in my mind, I ranked them equally. My so-called 1st choice I had wanted ever since I was a child, OBGYN, and where I landed, I only thought of applying literally in the last days prior to CaRMS deadline.

Oh, in my Motivational Letters, each were told this was my dream and they were first choice - which, in a sense, was the truth.

I applied to more than one specialty also  maybe a silly question, but how did you let your references know after you matched? Mine all asked me to let them know how things work out (and of course I’d like to send another thank you after the match), but I feel badly about telling the ones that wrote me a letter for the specialty I don’t end up matching to, that I matched to a different specialty. 

[offmychestplease]

36 minutes ago, hero147 said:

What makes ophthal a difficult surgical residency? Their OR days are often not that long and they don't round on majority of their patients. Some residencies even have dedicated residents to do urgent care clinic/consults from the emerg. Do agree on the job market though. 

well it's still a surgical residency after all, and besides there are several off-service rotations in other disciplines and other surgical fields throughout and then there is the FRCPC year/exam

[CaRMS2021]

6 minutes ago, bread said:

I applied to more than one specialty also  maybe a silly question, but how did you let your references know after you matched? Mine all asked me to let them know how things work out (and of course I’d like to send another thank you after the match), but I feel badly about telling the ones that wrote me a letter for the specialty I don’t end up matching to, that I matched to a different specialty. 

I'm in the same position. I feel that those in the 'back-up' specialty would understand and want the best for you regardless of the outcome. You very well may have needed to match into their specialty if you didn't get your preferred specialty!

[bread]

15 minutes ago, CaRMS2021 said:

I'm in the same position. I feel that those in the 'back-up' specialty would understand and want the best for you regardless of the outcome. You very well may have needed to match into their specialty if you didn't get your preferred specialty!

That’s very true!  I’m not sure about you, but I didn’t tell mine that I was applying to more than one specialty (to be honest, I feel like I’d be equally happy in all options and none are really backups, if that makes sense). But you’re right, I’m sure they will understand!

[CaRMS2021]

56 minutes ago, bread said:

That’s very true!  I’m not sure about you, but I didn’t tell mine that I was applying to more than one specialty (to be honest, I feel like I’d be equally happy in all options and none are really backups, if that makes sense). But you’re right, I’m sure they will understand!

Same, they'll be surprised to say the least

[dooogs]

Im wondering how do you explain the elective choices if you apply to multiple specialties? My understanding is that you list what electives you took? Sorry if this is common knowledge!

[Bambi]

dooogs - it never came up for me to explain. Anyhow, the purpose of electives  is to discover your ultimate interest while gaining experience, so it is easy to spin the story you were exploring your options.

bread - CaRMS2021 gave an excellent answer.  The parties who gave references will be happy that you matched and they understand the game, i.e., that we often apply to more than one field, rank our choices and it is out of our hands where we finally land. They will be so happy for you!

[designed]

On 2/11/2021 at 8:06 AM, shikimate said:

Lastly in residency there will be staff who make you feel bad, useless, make you think you gotta beg them for a fellowship or something. That's their game to get you to become their academic slave. It's all mind games. You gotta remember what I said earlier, YOU PASS EXAM = YOU GET BOARD CERTIFIED = YOU GET PAID THE SAME (or even more than those losers, if you are smart with billing and accounting).

That's why it's so important to feel confident for your board exam. Never a bad idea to start studying early. Just like MCAT, find out early what's high yield, and start using all the resources you could find. Once you are confident about your ability to pass your boards, all the voices saying you suck are just flatus. Play safe in residency, if you are competent and work reasonably hard and study reasonably well, you'll get through it. Of course every PD wants to extract as much out of their employee (aka, YOU) as they can, but you don't owe them anything.

And start networking for jobs early, both academic and community. Go to as many events as possible, make cold calls, write those cold emails, don't fear rejection, sometimes it takes a few tries to open up a door. If you have an opportunity, do some site visits on your day off. Never dismiss somebody because their hospital is small or they aren't hiring right now, they could easily pass your name to someone who might be hiring (but not publicly posting their job), or give you a boost when your prospective employer calls them for reference. You'd be surprised how people know other people, and someone you met before, who you've probably half forgotten, had a good impression of you and get called by your recruiter. 

Most jobs aren't posted, especially the good ones. The good ones that get posted have a lot of fakes (aka they already hired someone but have to post an ad for regulatory purposes). Just remember that. 

 

I just wanted to reply to say that your post really resonated with me. I'm in the third year of my residency now, I feel like I still get caught up in the day to day life of residency (thinking about my performance in residency, stress about call, etc.). You've articulated and distilled residency into the most important parts-- that if you pass your exam, pass your rotations, meet your residency program requirements, then you achieve pretty much the same result in the end.

To answer the OP, when I applied to CaRMS, I applied broadly to both family medicine and a 5-year specialty. Like you, I didn't know which specialty to choose, as I could have imagined myself quite happy with both. I ended up ranking the 5-year specialty, and I ended up matching to a less desirable location for this 5-year specialty. When I decided, I thought, "what is another 3 more years to do what I want?" "It's minimal in the grand scheme of my entire career." "I'm choosing to do what I want."

Well, let me tell you. I am tired. Not to scare you, but now that I'm in my third year, I still have around 2.5 years until I graduate, and sometimes it's hard to see the end. Right now, '3 more years' feels like a long, long time, especially a time when you're still doing call. I'm tired of feeling the need to please my preceptors, I'm tired of call, I'm tired of the unique feeling of powerlessness that you feel as a resident in your program. I'm tired of the pandemic and the risk I take when I see patients. In 20 years, would I have been happier doing this 5-year specialty than if I did family medicine? Who knows? I can just say if I could go back in time, I would probably do family medicine and be 'free' sooner. 

[MDinCanada]

25 minutes ago, designed said:

Well, let me tell you. I am tired. Not to scare you, but now that I'm in my third year, I still have around 2.5 years until I graduate, and sometimes it's hard to see the end. Right now, '3 more years' feels like a long, long time, especially a time when you're still doing call. I'm tired of feeling the need to please my preceptors, I'm tired of call, I'm tired of the unique feeling of powerlessness that you feel as a resident in your program. I'm tired of the pandemic and the risk I take when I see patients. In 20 years, would I have been happier doing this 5-year specialty than if I did family medicine? Who knows? I can just say if I could go back in time, I would probably do family medicine and be 'free' sooner. 

Does it really ever end though?

From what I observed, it's super stressful landing your ideal job, and then if you work in a hospital, you still have to climb the ladder as a new attending (the older attendings get priority over picking call schedule hours, etc.), there's a lot more politics in medicine that I ever could have imagined. It seems to me that the only way to break free is to do community medicine...

 

 

[designed]

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[heydere]

On 2/11/2021 at 5:52 PM, MDinCanada said:

I agree with this, except that Derm isnt super high-paying everywhere in Canada. You'll have to break into cosmetics for the big bucks as well.

How hard is it to get into the cosmetics as a dermatologist? I understand that Family physicians, NPs and even beauticians do all sorts of cosmetics now, especially lasers.