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Anaesthesia!


Guest TimmyMax

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Holy crap, guys, I am soo incredibly sorry, but my laptop died an untimely death last week and my internet access this past week has been extremely limited to public and hospital computers- definitely not the best for hosting something of this nature!

 

To make it up to you guys, let's try again later this week- I'll be at home and although that means I will have to resort to using my slow-as-heck desktop at home, I'm up for hosting this symposium any night this week that works well for anyone who is interested. Can we take a straw poll and decide a night (and time) that people can work with? Any night for me is good this week except for Monday.

 

Thanks a lot and sorry again about last week's failure to launch. RIP, Lappy! ;)

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Hey guys,

 

This symposium is cursed! Tonight at softball I had a FOOSH and I'm pretty sure I managed to break the head of my 2nd metacarpal (at least I'm pretty sure I did)! So this will have to be post-poned again- sorry, everyone! Unless, of course, you happen to be in the waiting room at the ER at UH here in London, in which I'd be happy to talk anesthesia! Sorry again, everyone! :(

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  • 4 weeks later...

Hey everyone,

 

Okay, so attempt #3 at the first ever International Anesthesia Symposium live chat will be next week. I have Monday and Wednesday nights available to do it, but we'll leave that to the popular opinion. The time will also be up for debate, as we can start at either 8 or 9 PM. You'll just have to excuse my slow-a$$ typing in advance, since my hand is still healing from my unfortunate softball mishap a few weeks ago. So opine away! Results will be tabulated on Sunday night, so check back for an update then!

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Hey everyone,

 

Okay, so attempt #3 at the first ever International Anesthesia Symposium live chat will be next week. I have Monday and Wednesday nights available to do it, but we'll leave that to the popular opinion. The time will also be up for debate, as we can start at either 8 or 9 PM. You'll just have to excuse my slow-a$$ typing in advance, since my hand is still healing from my unfortunate softball mishap a few weeks ago. So opine away! Results will be tabulated on Sunday night, so check back for an update then!

I vote for Monday night, 9pm! I'm on my anesthesia month right now, so this is good timing.

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Hey guys,

 

Okay, I guess there is a split opinion on this issue. Therefore, I will do two sessions- one tonight at 2100, as planned and another on Wednesday night at 2100 (or we can do a bit later, if the time difference is an issue- let me know!). See y'all a little later!

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  • 4 months later...
  • 1 month later...

Hey guys,

 

Just thought that I'd post a little update on the practical/financial side of things...

 

I've been in independent anesthesia practice now for almost 18 months. Since I wasn't amongst the lucky few who had a full-time position lined up (it's a long story, how I got screwed out of a position) to start when I finished on July 1st, I found myself with a crapload of debt, no income and no real job prospects. That said, the most important part was that I had an FRCPC and an independent practice license in hand (although that was a pain in the ar$e to get as well, for reasons that are stupid, but whatever).

 

Anyway, I ended up being contacted by the hospital that screwed me out of a full-time job, asking about my availability to locum later in the month of July. At this point, I was pretty much desperate to work, so I agreed, filled out their credentialing package and worked for a couple of days there. Before I left, they asked me to come back for two weeks in September and a few extra weeks in October. The other hospital in town heard about a new anesthesia locum in town and also got in touch with me, offering me a couple of weeks in October as well.

 

Since my job prospects in Ontario were looking pretty grim, I had asked one of the people that I had trained with in London before residency ended who had a staff position lined up if her hospital would be in need of a locum. She put me in contact with the chief of her department, and it turned out that they needed somebody for the entire month of August. Since this was in another province, I needed another license for that province, which was easy enough to fill out the paperwork and obtain (much easier than Ontario!). So now I had work for all of August (with a week off thrown in there to boot!).

 

Another guy who I had trained with in London had been screwed out of a job in another Ontario city emailed me while I was gone. He had been locuming a few places in Ontario and told me about one locum that he liked and that they were looking for people. So I contacted that place, and sure enough, they needed a locum for September. Another credentialing package followed, and now I had solid work until November!

 

Basically, from then on in, I began to contact places which either I knew had recently built new hospitals or thought might be cool to visit. My friend put me in touch with the Northern Specialist Locum Program, which is a great program designed to bring specialists to the north for locums with the hope of ultimately recruiting them. It gives out great financial incentives and reimburses your costs, so all you really end up paying for while away on locum is your food and entertainment. The rest is covered for you.

 

So I contacted the major Northern Ontario cities, set up locums up there, and before I knew it, I had work for the rest of the year. By now, the locum offers were coming in so fast that I started to have to decline them. I was essentially living for free on the road, and making a great living while doing it!

 

And best of all were the job offers. Everywhere I locumed wanted me to join their staff permanently! After tipping off the hospital where I wanted to end up about the offers that I was getting and considering from other places, they eventually ponied up with an offer that was acceptable to me. They had been humming and hawing about a permanent position for me (ironically the same hospital that originally screwed me out of a job), mostly based on budget constraints, was the official party line, but I knew that it was really because they have a bunch of older staff that need to retire.

 

And the best part about being a locum??? You never have to ask anybody for vacation time- you just don't book yourself anywhere during the time you want off. I took 3 weeks off over the Christmas holidays, the first time that I had had both Christmas AND New Year's off since I was a 2nd year medical student!

 

So needless to say, since my wife and I were essentially still living like residents (we still have our apartment in London, which serves as our home base), albeit jet-setting ones with had minimal overhead, the money kept rolling in, and since we hadn't bought anything major (since I didn't know exactly where I was going to end up), the debt started to come down. Fast.

 

On the day I finished residency, my wife and I had $250K in debt and things were looking bleak. 13 months later, my LOC was in the black for the very first time. We are now in the market for a new car, new laptops, a house and one seriously long Caribbean vacation! ;)

 

So I guess the moral of the story is to not let things that are crappy, out of your control or both get you down. If you keep your nose to the grindstone and your eyes and ears open, doors will open for you, especially in this field!

 

If you have any questions about anything, feel free to PM me. I'll get back to you eventually!

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Thanks for the post Timmy. In a way, would you rather there be too few jobs available than too many? I feel like if we start getting a shortage of anesthesiologiosts, that's going to give the government incentive to start allowing CRNAs to practice in Canada. While I support their work in a monitored environment, they are fighting to claim equality to MDs and starting to win the right to fully independent care in the US. Their most recent victory has been getting the right to run pain clinics, just like fellowship trained anesthesiologists. I dont want to turn this into another CRNA debate but thought it would be interesting to hear your thoughts since you had to go through that stressful situation.

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Anesthesia. You have to be aware of what it really does. Main purpose: Analgesia. You feel no pain when you're undergoing a major surgery. That's another thing that you aren't left on the operation counter by yourself and that the anesthesiologist monitors each and every response your body makes.

It's amazing. :)

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In a way, would you rather there be too few jobs available than too many? I feel like if we start getting a shortage of anesthesiologiosts, that's going to give the government incentive to start allowing CRNAs to practice in Canada. While I support their work in a monitored environment, they are fighting to claim equality to MDs and starting to win the right to fully independent care in the US. Their most recent victory has been getting the right to run pain clinics, just like fellowship trained anesthesiologists.

 

It's never a good thing to have a shortage in any field, including general practice, because trust me, there are armies of underemployed "mid-level providers" (or whatever you want to call the group that includes CRNAs, PAs, RPNs, RNPs, AAs, midwives, pharmacists) circling like vultures, ready to snap up any little morsel that may come their way, either from MD indifference, government decree or some combination of the two. I am NEVER in favour of someone who didn't go to medical school being awarded equality to MDs, no matter what the circumstances. They are NOT the same!

 

To answer your question, it is likely better to have too few jobs available (but not so few that people are leaving the province/country) than too many for precisely that reason, even if it can occasionally lead to short-term pain for some of us new graduates, including myself!

 

My reasoning is outlined above- if you start neglecting an area for whatever reason, the bureaucrats (pencil pushers who know nothing about the medical system other than how it looks on spreadsheets) will see/hear about it and start looking for a cheaper alternative. The general public will be in favour of farming this area out, because broadly speaking, the public wants to have their cake and eat it too (having 24/7 access to Service X, without having to pay anything/extra for it), and anything that can potentially result in a saving on taxes and/or government spending (or be spun that way) is political gold. It won't be until after it is all said and done (ie: too late) that someone will (hopefully!) look at the care actually being provided and see that it isn't the same or that the savings that were initially projected are not coming to fruition.

 

The problem is that once a given field gives up an area to "mid-level providers" (ie: prescription renewals, diabetes or well-baby checks in family practice, routine deliveries in OB, coughs/colds/bumps/bruises in the ER, simple suturing in the OR, chronic pain clinics (which is stupid, if you ask me) in anesthesia), there is a snowball's chance in hell of getting it back. Simply put, once it's gone, it's gone! And it's usually gone forever. The worst is that these groups will never stop pushing to have their responsibilities and autonomy expanded, especially once they get something. And worse still, I'm not 100% convinced that these "extra" services save time or money. They may increase access or keep access from decreasing, but unless there is an ongoing audit that can demonstrate that these services are in fact cost-efficient while providing a comparable level of patient care, I'm not in favour.

 

In closing, once you get through with your medical training and start practice, you may develop a generalized resentment for these people that went through all of 2 or 3 years at their local community college being able to do the same or similar things that you spent your 20s and the first part of your 30s busting your hump to be able to do. Heaven forbid you wind up in a position where you have to clean up after their mistakes (ie: midwife home birth disasters coming into your birthing unit if you're an OB), because trust me, if there's a bad outcome (and sooner or later there will be), the lawyers will be coming after the ones with the most money, and ninety-nine times out of a hundred, that's going to be you, Doctor!

 

So that's my two cents on the "mid-level providers" issue. I'm not opposed to them; I do think that they do have niches, but I do feel that these niches need to be well-defined and have limited levels of autonomy with ongoing cost-benefit analyses to make sure that these extra services are doing what they are supposed to be doing. Thanks for listening!

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  • 1 month later...

Congratulations! That is inspirational to pay off 250k of debt in 13 months!! The road ahead is gold plated.

 

Beef

 

Hey guys,

 

Just thought that I'd post a little update on the practical/financial side of things...

 

I've been in independent anesthesia practice now for almost 18 months. Since I wasn't amongst the lucky few who had a full-time position lined up (it's a long story, how I got screwed out of a position) to start when I finished on July 1st, I found myself with a crapload of debt, no income and no real job prospects. That said, the most important part was that I had an FRCPC and an independent practice license in hand (although that was a pain in the ar$e to get as well, for reasons that are stupid, but whatever).

 

Anyway, I ended up being contacted by the hospital that screwed me out of a full-time job, asking about my availability to locum later in the month of July. At this point, I was pretty much desperate to work, so I agreed, filled out their credentialing package and worked for a couple of days there. Before I left, they asked me to come back for two weeks in September and a few extra weeks in October. The other hospital in town heard about a new anesthesia locum in town and also got in touch with me, offering me a couple of weeks in October as well.

 

Since my job prospects in Ontario were looking pretty grim, I had asked one of the people that I had trained with in London before residency ended who had a staff position lined up if her hospital would be in need of a locum. She put me in contact with the chief of her department, and it turned out that they needed somebody for the entire month of August. Since this was in another province, I needed another license for that province, which was easy enough to fill out the paperwork and obtain (much easier than Ontario!). So now I had work for all of August (with a week off thrown in there to boot!).

 

Another guy who I had trained with in London had been screwed out of a job in another Ontario city emailed me while I was gone. He had been locuming a few places in Ontario and told me about one locum that he liked and that they were looking for people. So I contacted that place, and sure enough, they needed a locum for September. Another credentialing package followed, and now I had solid work until November!

 

Basically, from then on in, I began to contact places which either I knew had recently built new hospitals or thought might be cool to visit. My friend put me in touch with the Northern Specialist Locum Program, which is a great program designed to bring specialists to the north for locums with the hope of ultimately recruiting them. It gives out great financial incentives and reimburses your costs, so all you really end up paying for while away on locum is your food and entertainment. The rest is covered for you.

 

So I contacted the major Northern Ontario cities, set up locums up there, and before I knew it, I had work for the rest of the year. By now, the locum offers were coming in so fast that I started to have to decline them. I was essentially living for free on the road, and making a great living while doing it!

 

And best of all were the job offers. Everywhere I locumed wanted me to join their staff permanently! After tipping off the hospital where I wanted to end up about the offers that I was getting and considering from other places, they eventually ponied up with an offer that was acceptable to me. They had been humming and hawing about a permanent position for me (ironically the same hospital that originally screwed me out of a job), mostly based on budget constraints, was the official party line, but I knew that it was really because they have a bunch of older staff that need to retire.

 

And the best part about being a locum??? You never have to ask anybody for vacation time- you just don't book yourself anywhere during the time you want off. I took 3 weeks off over the Christmas holidays, the first time that I had had both Christmas AND New Year's off since I was a 2nd year medical student!

 

So needless to say, since my wife and I were essentially still living like residents (we still have our apartment in London, which serves as our home base), albeit jet-setting ones with had minimal overhead, the money kept rolling in, and since we hadn't bought anything major (since I didn't know exactly where I was going to end up), the debt started to come down. Fast.

 

On the day I finished residency, my wife and I had $250K in debt and things were looking bleak. 13 months later, my LOC was in the black for the very first time. We are now in the market for a new car, new laptops, a house and one seriously long Caribbean vacation! ;)

 

So I guess the moral of the story is to not let things that are crappy, out of your control or both get you down. If you keep your nose to the grindstone and your eyes and ears open, doors will open for you, especially in this field!

 

If you have any questions about anything, feel free to PM me. I'll get back to you eventually!

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  • 3 months later...

I know this is probably answered somewhere, but can anyone please summarize for me how competitive anesthesiology is? If I were to do 3 two week electives in 4th year, and have a pre-clerkship elective, and a paper in anesthesiology (minor contribution), how good are my chances? Where does it rank compared to derm, plastics, ENT, etc.?

 

Lastly, if you had four electives to plan, are there certain places you'd want to do your electives to maximize your chances of matching? I'll do one elective at my home school, then spread the other three out. Not picky about location, just want to match.

 

Not dead set on anesthesia, but its on my short list as I started to think about fourth year electives...

 

Thanks!

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Competitiveness is a hard thing to measure as it seems to fluctuate from year to year. If you look at the CaRMS stats from 2012, 130 people listed anesthesia as their first choice and of those, 94 matched. The 7 remaining spots were filled were filled by people who had listed anaesthesia as their second or third choice.

 

You should be able to get interviews with 6 weeks of anesthesia elective time. With regards to location, there are a few things to consider. There are places like Manitoba that don't seem to offer interviews to those who haven't done a rotation there. Considering they have a very strong program that would probably be a good choice for one of your electives. Dalhousie is also a great place because they assign you to the same preceptor for the entire two weeks. This allows you to get a strong letter of reference (assuming the two weeks goes well). I'm sure others can chime in regarding their experience at other locations (there's also a thread that discusses anesthesia electives that you can check out). In general though, all of the anesthesia programs in Canada are strong, pick a place you could see yourself living for five years and go check out their program.

 

Best of luck!

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