Ranking specialties in CaRMS

[MDinCanada]

5 minutes ago, heydere said:

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. 

Not difficult, I think a majority of those in private practice do at least a bit of cosmetics to help with the overhead, but it just kinda sucks going through 5 years of residency to do what family doctors/NPs can do. 

[1D7]

On 2/11/2021 at 1:09 AM, lovemedicinesomuch said:

Hi everyone,

I am in my last year of med school and I applied to one of the ROAD specialties and FM in CaRMS. Over medical school, I have worked so hard to have a solid CV to be competitive for that specialty. Now, at the end of med school,  I am currently feeling so drained.. and the thought of finishing a FM to be done in 2 years is quite appealing.  I would love to become a specialist and I really love subject matter of speciality that I am applying to, but sometimes I feel that I wont be successful in it or that even if i get in I am not sure if I can finish it successfully and I have worries that I may have to move to a different location with no family/friends... Sometimes I feel that I should just rank FM higher even though I may not enjoy it as much as the other specialty I am applying to.. I find FM to have a very reasonable schedule during residency and afterwards. I don't enjoy the subject matter that much, but I can function quite well in family medicine and find FM to be a good career option.

Did anyone have a similar experience going through CaRMS?

I felt the same way in a sense. I knew I'd enjoy doing residency somewhere reasonable but doubted that I'd be very happy working somewhere that was too far from my home province.

I ranked my specialty of choice within my province at the top, along with a few other programs further (but in locations I'd be happy living in). After that I ranked a few FM programs at my home program and in cities I'd be happy living in (which weren't many because I didn't have many FM interviews). At the bottom were the remaining specialty programs in provinces I'd be less happy to train. All in all this was probably close to ~18 programs? 13 programs of my preferred specialty and about 5 FM programs, with positions 1-8 being specialty programs, 9-13 being FM, and 14-18 being the specialty programs in undesirable locations.

As for residency, I enjoy most days of residency even though call is burdensome and the training is lengthy. If I did FM I'm sure I would have found some way to be content, but it wouldn't be as interesting and I doubt my desire to strive for excellence would be as strong.

[rmorelan]

On 2/11/2021 at 4:42 PM, 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?

Boring? ..... I feel mildly offended

 

[bellejolie]

14 hours ago, 1D7 said:

As for residency, I enjoy most days of residency even though call is burdensome and the training is lengthy. If I did FM I'm sure I would have found some way to be content, but it wouldn't be as interesting and I doubt my desire to strive for excellence would be as strong.

I find this kind of insulting tbh - i don't think family medicine residency creates a decreased desire for excellence? I find you have to work really hard to learn and become excellent since it's only a 2 year residency. Perhaps the patient population doesn't appeal to you, but in family medicine you can basically do anything you want from ER, to hospitalist, to geri to derm, to rural medicine (where you have crazy cases and less resources) and cosmetics. Your job options are endless, you're mobile not just within the country but in the world, and you're making money a lot sooner. You can also reinvent and change your career anytime you want whereas specialists are much more bound to their jobs and patient population. Finally, the people are pretty nice, you have program directors and preceptors that actually care about your well being which is a nice thing - doesn't actually mean the specialty is more "chill." So your "lack of desire to strive for excellence" would probably be a you thing, not a family medicine program thing. 

[1D7]

21 minutes ago, bellejolie said:

I find this kind of insulting tbh - i don't think family medicine residency creates a decreased desire for excellence? I find you have to work really hard to learn and become excellent since it's only a 2 year residency. Perhaps the patient population doesn't appeal to you, but in family medicine you can basically do anything you want from ER, to hospitalist, to geri to derm, to rural medicine (where you have crazy cases and less resources) and cosmetics. Your job options are endless, you're mobile not just within the country but in the world, and you're making money a lot sooner. You can also reinvent and change your career anytime you want whereas specialists are much more bound to their jobs and patient population. Finally, the people are pretty nice, you have program directors and preceptors that actually care about your well being which is a nice thing - doesn't actually mean the specialty is more "chill." So your "lack of desire to strive for excellence" would probably be a you thing, not a family medicine program thing. 

Relax. Where did I say it has to do with FM itself? I already said I'm not as interested in FM as I am in my own specialty.

[AB.Med.]

On 2/11/2021 at 12:04 PM, MDinCanada said:

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.

Are you working in family medicine now, and do you feel the hours are flexible? Do you mind sharing if you feel like the hours can be overwhelming in residency and/or early years of practice? Is the net pay similar to what you had expected? (the info I see online is so mixed!) Hopefully you are happy about your decision to switch from derm. If you are willing to share any of this, I'd appreciate it. And hopefully it doesn't detract too much from the original thread, perhaps relevant for CaRMS. Family Med is my only goal and I'm trying to learn as much as possible about it - I'm worried I'll regret the decision to switch careers so I'm just trying to get as much insight as possible! Thanks.

[shikimate]

On 2/13/2021 at 6:43 PM, designed said:

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. 

 

If you can, do some community elective, preferably not too onerous, maybe smaller hospital. 

Academic center is all about extracting as much out of their residents as they can, that's why you feel like a hamster on a spinning wheel. 

Do a community elective, at a small hospital, maybe during the summer. 99% of time it's more chill, people are more friendly, and work is so much easier than academic centers.

Like people in community hospitals actually have a life after work, they'll probably invite you to BBQ, maybe go fishing with you, or just sit and enjoy the weather.

Get out of academic center for a while, really helps you recharge. 

I know some programs won't like it when their residents don't do elective at Harvard or something to get fellowship, well you have to advocate for yourself if that's the case. Try to talk to different staff and squeeze out at least 2 weeks somewhere chill. 

If you burn out at end of PGY3 it's game over! You need at least 1.5 years of full blast energy to do your RC exam. How can you study in PGY4 when you're already kaput in PGY3?

Also I get asked how do I find preceptors in community for elective? Well you do what it takes to find them. with COVID no conferences, so try cold calling hospital, maybe leave a message for them. Ask other people in your department see if they can pass to you email of people in community hospital. Or better let them pass on a message that you want to do a community elective. It's kinda like entrepreneurship, you gotta do what you gotta do to get what you want. 

Don't be afraid of rejection. I've cold emailed over 2 dozen places for jobs, I'd say >80% of time you never hear back, or you get some generic nonsense from HR like "we'll keep your file and contact you when an opportunity arise". All you need is 1 acceptance, just like med school.

Also once you are in community, keep making connections, everybody, family docs, locum docs, admins in clinics and hospitals. You never know when you'll meet someone who has a connection that will help you in the future. Someone who "just happens" to have "inside knowledge" that so and so hospital is budgeting for a new position, or so and so doc is retiring and will need a replacement in 2 years, etc.

[shikimate]

PGY4 will be difficult period, your expectation will be very high, and your workload will increase. At the same time you will definitely want to start studying for RC exam, and probably American board as well. Also a lot of fellowships start accepting applications in PGY4 so that's added burden for you.

So it's critical at end of PGY3 or beginning of PGY4 you get a "recharge". Whether that's an easy block without call or a chill elective somewhere nice. 4 weeks around June/July would be ideal, nice weather, you get a pay raise as PGY4, need a positive start in PGY4 to build momentum for RC studying.

Winter is always hard, especially with COVID as we are lacking social gatherings. Once weather is warmer take advantage of outdoors when you have time. Take a run or walk along the lake/river. Sit down in a park and bath in the sun. Go to a grass field with nobody around and SHOUT OUT ALL YOUR FRUSTRATIONS.

PGY4 is a critical period and you must find a day to sit down, with clear and uncluttered mind and full stomach (aka not post call day) and draw out a plan that includes 1) your RC studying strategy and timeline, 2) your fellowship or job hunting strategy, 3) your plan B if fellowship/job plan A falls apart 4) who are the strategic people you will study with for RC (assuming there are >2 residents in your program), and 5) who are the strategic staff you will now ally with to get reference letters for fellowship/job.