is there any way a doctor can "upgrade"?

[Guest PerfectMoment]

by upgrade i mean, can a family doctor one day decide that he wants to get into opthalmalogy? is this even possible? if it is, does one need to take some carms exams or something? thx

[Guest aneliz]

You can switch disciplines...but this is can be difficult. Basically it depends on what you want to do and where you want to do it. Some specialties have 're-entry' positions available for doctors that want to do something else...and some under serviced areas will sponsor a re-entry position to try and lure somebody to their area to practice in a needed specialty...(like obstetrics) Your chances of going this route is all dependent on where you want to practice and what you want to do. Not so sure that optho would be the type of specialty that would fall in this category...I am not an expert in this area...maybe some of the other moderators have some more to add to this!

[Guest Ian Wong]

You would need to re-enter and do the five-year Ophthalmology residency. You might get the first year of residency waived (because that is a general year with little to no Ophthalmology) due to your previous experience, but you'd have to do the remainder of the residency. Here's a previous posting on this topic in the CaRMS forum:

 

pub125.ezboard.com/fpremed101frm25.showMessage?topicID=93.topic

 

Ian

UBC, Med 4

[Guest moo]

I know a doc who was a ER doc for twenty years, then did a psych residency and is a psychiatrist now. It's definitely possible, as for how hard it is, I don't know.

[Guest UWOMED2005]

We have a couple of prof's who did that as well - one was a family doc up north before going into respirology. But I think that was under the old system where everyone did an internship then applied for residencies. I think it was fairly common place then to do your internship, work for a couple of years (or moonlight) as a GP, THEN decide on doing a specialty. Now that the whole thing is integrated I think switching is much more difficult.

 

BTW, Ophthalmology is really tough to get into. . . I can't see them diverting spots to already trained specialists who decide later to switch specialties. So I think if you do want to switch, you're limited to lesser competitive specialties.

 

On another note, I think many specialties are rather flexible in terms of the scope of what you can do. For example, we have a Neurologist who teaches us who, after seeing numerous hypertension related strokes, decided to get into hypertension management. So I think if you didn't like what you did within a specialty (ie strokes to alzheimer's within neurology) you could always change. And also, I think family medicine is one of the MOST flexible specialties, especially with the new one year training programs in things such as anaesthesia and Emerg.

[Guest peachy]

Why would diverting spots to already trained specialists be less preferable? (Assuming that the person who wanted to switch specialties happened to be a very competitive applicant, just like those coming out of med school)

[Guest moo]

...because the new specialist trained has a fewer work life than a fresh grad out of med school, assuming, of course, that most who graduate med school are in their mid to late twenties and the doc who wants to switch is considerably older than that.

[Guest UWOMED2005]

There could also conceivably be questions as to why that applicant didn't go into ophthalmology in the first place.

[Guest peachy]

Hmn. That's age discrimination - and if it's not okay to discriminate against those who start medical school later, then I'm not sure why it would be okay to discriminate against those who want to start a particular residency later.

[Guest Ian Wong]

There are not a lot of spots allocated to "re-entry" applicants, so even if you WANTED to re-train, you may not necessarily have the opportunity to do so. A "re-entry" applicant, in terms of absolute man-power, is also just like losing a physician in that one GP must first be absorbed to produce one specialist. Of course, if that GP were so disgruntled that he/she would have otherwise left the field of medicine, then I guess you could describe it as a "save" of sorts...

 

Ian

UBC, Med 4

[Guest moo]

well you can think of it as age discrimination. It's different though from med schools age discriminating, because older folks who go to med school tend to go into primary care specialties (not always, but very often) where docs are always needed. It also shows lack of dedication, but I always think of it as one of the many advantages of the MD degree in that it is very flexible. You may one day decide you don't want to do, say surgery, and decide to go into internal or something, just for a change. It does happen, but it's rare.

[Guest marbledust]

Why does it show "a lack of dedication" as you put it? The interests, needs, and goals of everybody changes as they progress through any career. Deciding to change specialities does not make one any less dedicated to medicine or patients.

[Guest macdaddyeh]

Consistent with the discussion on changing specialties, can anyone tell me how the combined GP/Emerg. specialty works? Do you do your residency as a GP, then do Emerg for an extra year? Is it interchangeable? Considered an extra credential? Do many people make this "switch?"

[Guest UWOMED2005]

Yeah - my understanding is that's pretty much it. First you do a Family medicine residency to get your CCFP accreditation, then you do a one year program in emerg. You're not as attractive as the 5-year emerg docs to the big academic centres, but there's a shortage of emerg docs now so most other hospitals are more than willing to hire 3-year docs. In fact, many small centres now use Family Docs WITHOUT the extra year of emerg to cover their ER.

 

The UWO Emerg department has an excellent website - check it for some more accurate info.

[Guest jmh2005]

Really, you are not considered a "switcher" if you go this route. First you train as a Family Physician (a 2 year residency) then apply (you can apply anywhere that has the extra year, you don't necessarily have to go to the same school you did your Family training with...) to do an extra year in Emergency Medicine. Similar programs exist for Anesthesia, Palliative Care and a few others as well.

 

So, the bonus to this route is that you are a Family Physician (CCFP) with an additional certification in EM, so you would have an MD,CCFP(EM). Many docs have a family practice and also do P/T emerg (especially is small-medium size communities), but some just do emerg F/T.

 

The EM exam is very difficult from what I hear, there are those who do the extra year just for the training, and wait to take the exam after practicing a few years, but some do write it right away...its up to you...most ERs are so in need of physicians, many doc's do not have the EM, and many hospitals do not require it. Have a licence to practice medicine??...good enough!! The other route is the Royal College route (FRCPC) where you do a 5 year residency in EM...however there are only 10-12 spots across Canada each year, all in large centres predominantly, quite competitive. Most people that choose this route are those who do wish to work in large centres, do trauma, research and often wish to get into the admin. sides of things as well.

 

So, there are many options after family medicine if you so choose!! Hope that helps!