How much do Physicians make on average in Ontario?

[Alastriss]

Just a heads up to the guy who said doctors should be making 60k a few things:

 

- um...ridiculous debt to pay off?

- you don't want the guy or girl who is making life altering decisions to be affected by worrying about how they are going to pay the bills.

- Many doctors work so many hours a week that their spouses often take on lesser hours to make raising kids viable. They need that extra income to make such lifestyle choices viable

- Physicians can work a lot more hours than a '9-5' job.

[MillerTime]

Why do you seem so upset? It's not like MD is the only profession that requires training and responsibility.

 

PhDs study as long as MDs and the life can be as stressful.

 

And regarding the pay, if I had the choice between working minimum wage in a factory or pursuing school to become a physician also at the minimum wage, I would still go for it because working in a factory would drive me nuts.

 

And it's even more shameful that other professions that require no training or responsibility are associated with much higher salaries than medicine, cinema for example.

 

It is true that if the salaries were not as good and the recognition so high, not as many people would go in medicine.

 

Came out wrong then, didn't mean to sound upset.

 

But I was just kinda getting at the same thing as the person who was saying stefanci was quite idealistic, but still wanted to know if stefanci is a premed with experience workin with GPs/specialists, or a med student or what. Just wanted to see what was behind their argument.

[xylem29]

Why do you seem so upset? It's not like MD is the only profession that requires training and responsibility.

 

PhDs study as long as MDs and the life can be as stressful.

 

And regarding the pay, if I had the choice between working minimum wage in a factory or pursuing school to become a physician also at the minimum wage, I would still go for it because working in a factory would drive me nuts.

 

And it's even more shameful that other professions that require no training or responsibility are associated with much higher salaries than medicine, cinema for example.

 

It is true that if the salaries were not as good and the recognition so high, not as many people would go in medicine.

 

ROFL LMAO...I cannot believe someone actually is THAT misinformed, have you ever worked in a lab before? I mean, yea, it can be stressful doing a PhD but it's not comparable to doing an MD and once you do become a PhD, it's not even close in comparison to other high status professions - all my professors seem pretty relaxed to me when I worked with them. They all got to see their families.

 

Anyway, just pay attention the next time you or a loved one have to stay in the hospital. The real world is not all rose and peaches, medicine, healthcare - to the people who work in the field, is just a JOB. Just see how passionate and caring the doctors and nurses can be or cannot be and think about how difficult and stressful their jobs must be to turn them that way - if you expect doctor's, who just human beings, to be driven by compassion alone, then you'll eventually discover that you're wrong.

[Hatchepsout]

ROFL LMAO...I cannot believe someone actually is THAT misinformed, have you ever worked in a lab before? I mean, yea, it can be stressful doing a PhD but it's not comparable to doing an MD and once you do become a PhD, it's not even close in comparison to other high status professions - all my professors seem pretty relaxed to me when I worked with them. They all got to see their families.

 

Anyway, just pay attention the next time you or a loved one have to stay in the hospital. The real world is not all rose and peaches, medicine, healthcare - to the people who work in the field, is just a JOB. Just see how passionate and caring the doctors and nurses can be or cannot be and think about how difficult and stressful their jobs must be to turn them that way - if you expect doctor's, who just human beings, to be driven by compassion alone, then you'll eventually discover that you're wrong.

 

I am a PhD student so stop being so rude Yes some areas of research may be more stressful, depending what you are doing And by the way I'm talking about physicians, not patients. What you're saying is that patients must be paid for their stress? You're mixing everything up... I just said that I don't like when people complain that physicians should be paid more because they have more responsibilities and stress than in any other job.

 

I think though that you should make enough money to be able to pay back your loans from university, which can be incredibly high for medicine in some provinces. Although I think the problem is somewhere else. How come in Quebec med school tuition is 3500$ whereas it's 15000$ in Ontario? And the government loans and bursaries in Quebec are much better, which means that if you still live at home, which is the case for many med students in Quebec because they are only 18-19 years old when they start med school (and don't have to pay undergrad before either), you graduate with only about 10-12K in debt.

[mbene085]

An extra factor affecting people's views of physician pay is that we're next to the U.S. Yes, it means you have to work in their horrifying medical system, but if you're graduating with $180,000 of debt (the Ontario average, I believe), and especially if you want to be a FP or one of the lower-paid specialists, you could pay it off a heck of a lot faster by practicing down south.

 

No matter what we do, our physicians' salaries will always be compared with those in the U.S.

[A-Stark]

...so...you're...agreeing with me?

 

'Course.

[unknown user 7]

An extra factor affecting people's views of physician pay is that we're next to the U.S. Yes, it means you have to work in their horrifying medical system, but if you're graduating with $180,000 of debt (the Ontario average, I believe), and especially if you want to be a FP or one of the lower-paid specialists, you could pay it off a heck of a lot faster by practicing down south.

 

No matter what we do, our physicians' salaries will always be compared with those in the U.S.

 

I thought those down south got sued a lot more though.

[xylem29]

I am a PhD student so stop being so rude Yes some areas of research may be more stressful, depending what you are doing And by the way I'm talking about physicians, not patients. What you're saying is that patients must be paid for their stress? You're mixing everything up... I just said that I don't like when people complain that physicians should be paid more because they have more responsibilities and stress than in any other job.

 

I think though that you should make enough money to be able to pay back your loans from university, which can be incredibly high for medicine in some provinces. Although I think the problem is somewhere else. How come in Quebec med school tuition is 3500$ whereas it's 15000$ in Ontario? And the government loans and bursaries in Quebec are much better, which means that if you still live at home, which is the case for many med students in Quebec because they are only 18-19 years old when they start med school (and don't have to pay undergrad before either), you graduate with only about 10-12K in debt.

 

I think that physicians are paid just fine and that they deserve to be ranked amongst the top paid professions. So I don't really think that they should be paid more than say...lawyers, b/c they have "more X and more Y", b/c the reality is - all of the top paying professions are the same: long hours, long schooling, continuing education, re-licensing every X years, being audited, lots of stress and pressure. The thing is - almost all jobs are stressfull, there are very few stress free jobs, you'll always have someone breathing down your neck to make sure you're doing your job right and doing it FAST, "time is money" is too true when it comes to working, at least from my experience.

 

I know that doing a PhD is not a cake-walk and that an academic career is not stress free and relaxing - but overall, simply being a PhD lecturer is not comparable to a physician or any other high paying profession. For the most part, people get paid more as their responsibilties increase - there are PhDs in academic institutions who earn comparable salaries to physicians and their pressure and workload is probably comparable (though in terms of hours, probably not). So yea, the more responsibilities you have, the more you deserve to make - and this is how things work already.

 

Don't forget too that doctors have to pay overhead, malpractice insurance, are more likely to be sued, etc than professors. The loans don't just stop with tuition - you'll need a loan to open up a practice, loans for equipment, etc. You're essentially running a business and playing the part of the doctor - that's double the workload if you're an FP.

 

Bolded: I was saying that if you've ever been to a hospital for an extended stay, you will experience what healthcare is really like: a job. You have some great angels who show compassion and sensitivity to patients and families, but you also always encounter uncaring and mean workers, nurses and doctors alike. It's just a system and everyone does their best to make it work, but I understand when I go in for a visit to my FP with serious concerns (at least to me) and he goes "mmhmm, yes, mmhmm...should be fine, bye" before I'm even finished - it's fine, he's got a backlog of patients (customers if you want a comparison to a business) and he can only waste so much time with me. I feel like I just paid him my 15min for nothing but that's the system. So (and I'm not directing this at you, just in general) don't be so shocked when students and doctors are so concerned with money - it's a job, it's a means to an end. Most people work to live.

 

That's a good point about Quebec, however, Quebec physicians are the lowest paid in Canada. At the sametime, their cost of living is also lower. Seems like it's the market and economy that's playing a role here.

[coastalslacker]

Two quick points.

 

1. The person who said physicians should make 60k or 100k or whatever is retarded. Some nurses make 100k in the hospital I work at. My wife makes almost 60k as a relatively new teacher. She gets a total of 3 months off a year. She starts work at 8 and finishes at 4, plus some marking each day. If I'm going to spend 4 years in undergrad, 4 years in med school, 5 years in residency and 1 or 2 in fellowship, and then work long hours at a job that very few other people have the training to do, then I expect to be paid appropriately for it. Paid appropriately is relative to what other people make for doing other jobs.

 

This has nothing to do with a lack of altruism or lack of idealism. I'm a relatively altruistic guy, I plan to do medical missions when I'm all trained up. I friggin' love my job-NOTHING beats operating, nothing. But I would not have racked up well over 100k in debt, and devoted so many years to school/training to make 100k at the end of the day. My little brothers have business degrees and they finished school at 22, never to go back, and already have good jobs. Only an idiot (or a rich kid) would go into medicine if it only paid 100k at the end of the day.

 

2. Point two. The difference between a 2 year family medicine residency and a 5 year specialty is more than 3 years. As a family resident, for about 1/2 your training, you are an off-service resident for whom the expectations are relatively low. They don't expect you to know much while you're there and you're only there for a month. Since your residency is only two years long, you're never placed in positions of real responsibility. You do not need to go home and read about whatever you are on or upcoming cases. You just need to show up. Oh, and sometimes people mention the 3rd years, ie a year of ER, to show that the difference is only 2 years. Where I am, ER=4 shifts a week, or, 32 hours. In other words, one day on call and going home at noon the next day. Sounds like a vacation to me.

 

In a 5 year program the expectations are higher. I'm on my home service right now with a family medicine resident (who is awesome). When she goes home she chills out. When I go home I study for a few hours. She is going on to something else next month, and has no plans of studying extra for that either. I'm off to gen surg and will continue to spend nights reading about my specialty because when I get back on service the expectation will be that I will have been reading/learning the whole time I was away. Since the program is 5 years, the responsibility increases significantly each year. Add to that the other extras like research requirements, journal club, writing the principles of surgery exam (if you're in a surgical specialty).

 

Anyways, re-reading this it sounds like a bit of a diatribe. Whatever. [Most] specialists train longer and each year of their training is more challenging and time consuming than a year of family medicine. That is why they should get paid more. I love family medicine by the way and was planning on going into it for a long time (mostly because I was attracted to the chilled lifestyle which is possible).

[BlackJack]

I've been thinking about what you said coastalslacker, and it makes a lot of sense.

 

The training is more intense on surgery than on family. Surgeons are also required to work far more hours post-residency than a family doctor, who may have some flexibility. Personally, I don't think general surgeons get paid enough for the amount they work, and for their expertise, either. But that's another story...

 

I think the real problem is not just the paltry family medicine salary. It's the fact that family medicine is its own residency stream, and that once someone goes into it, they have no chance to upgrade later into a specialty.

 

In the past it used to be that a graduated medical student would do one year of a rotating internship, where he would be given full responsibility of patient care during that year, and then be able to practice general "family medicine" immediately after. If, after a few years, he wanted to pursue another specialty, he was able to do so.

 

 

 

Now, with the family medicine residency being an entirely separate entity, the rotations do not seem as "hardcore" as they were in a rotating internship. Services know that a family resident is "just going to be a family doctor" and don't expect much from them. Conversely, lots of family residents just don't take their rotations as seriously because they know they aren't expected to - the "real" residents take care of the important stuff. Additionally, family medicine does not offer any chance of "switching-up" in the future. Once you're an FP, you're an FP for life(maybe with some ER thrown in for good measure, but this isn't the norm).

 

I think its silly that FP is its own residency stream, and that this move has done more to harm the health care system than to augment it. Personally I'm not even sure why this change of FP to its own residency was necessary other than to give general practitioner docs the feeling that they've "specialized" in something. There's probably some other issues with faculty funding etc that I'm also not aware of. If anyone can divulge the reason for it, I would be very happy.

 

I would not have racked up well over 100k in debt, and devoted so many years to school/training to make 100k at the end of the day.

 

Wise words. I totally agree.

[xylem29]

Two quick points.

 

1. The person who said physicians should make 60k or 100k or whatever is retarded. Some nurses make 100k in the hospital I work at. My wife makes almost 60k as a relatively new teacher. She gets a total of 3 months off a year. She starts work at 8 and finishes at 4, plus some marking each day. If I'm going to spend 4 years in undergrad, 4 years in med school, 5 years in residency and 1 or 2 in fellowship, and then work long hours at a job that very few other people have the training to do, then I expect to be paid appropriately for it. Paid appropriately is relative to what other people make for doing other jobs.

 

This has nothing to do with a lack of altruism or lack of idealism. I'm a relatively altruistic guy, I plan to do medical missions when I'm all trained up. I friggin' love my job-NOTHING beats operating, nothing. But I would not have racked up well over 100k in debt, and devoted so many years to school/training to make 100k at the end of the day. My little brothers have business degrees and they finished school at 22, never to go back, and already have good jobs. Only an idiot (or a rich kid) would go into medicine if it only paid 100k at the end of the day.

 

2. Point two. The difference between a 2 year family medicine residency and a 5 year specialty is more than 3 years. As a family resident, for about 1/2 your training, you are an off-service resident for whom the expectations are relatively low. They don't expect you to know much while you're there and you're only there for a month. Since your residency is only two years long, you're never placed in positions of real responsibility. You do not need to go home and read about whatever you are on or upcoming cases. You just need to show up. Oh, and sometimes people mention the 3rd years, ie a year of ER, to show that the difference is only 2 years. Where I am, ER=4 shifts a week, or, 32 hours. In other words, one day on call and going home at noon the next day. Sounds like a vacation to me.

 

In a 5 year program the expectations are higher. I'm on my home service right now with a family medicine resident (who is awesome). When she goes home she chills out. When I go home I study for a few hours. She is going on to something else next month, and has no plans of studying extra for that either. I'm off to gen surg and will continue to spend nights reading about my specialty because when I get back on service the expectation will be that I will have been reading/learning the whole time I was away. Since the program is 5 years, the responsibility increases significantly each year. Add to that the other extras like research requirements, journal club, writing the principles of surgery exam (if you're in a surgical specialty).

 

Anyways, re-reading this it sounds like a bit of a diatribe. Whatever. [Most] specialists train longer and each year of their training is more challenging and time consuming than a year of family medicine. That is why they should get paid more. I love family medicine by the way and was planning on going into it for a long time (mostly because I was attracted to the chilled lifestyle which is possible).

 

Good post. Don't forget in addition to all the medical licnesing exams you'll also have to write and pass the board exams to become certified. Most people who do 5 yr programs go onto to do an additional 2 year fellowship. Let's not forget the 80 hour work weeks (mostly) and sometimes 100 hour (not unheard of) work week for surgical residents. Then you'll have to retest to remain board certified every X years and I think you'll have to retest for your medical license in general right? How often do surgeons really get sued?

 

When it comes to surgery, I'm only concerned with your skill - not your ideals. I don't really care what has driven you to work so hard to reach the very top of your field, and what continues to drive you to be as close to perfect as possible (I had a physician TELL ME that it's your EGO during my interview, the need to know it all, to perfect it all, to be able to carry out the procedures with perfect precision, not to make a mistake, that drove him, the satisfaction of knowing that you are a master at what you do - it wasn't a nice little fuzzy feeling of "oh, I have a duty to save humanity") I just want you to be good at what you do.

[xylem29]

I've been thinking about what you said coastalslacker, and it makes a lot of sense.

 

The training is more intense on surgery than on family. Surgeons are also required to work far more hours post-residency than a family doctor, who may have some flexibility. Personally, I don't think general surgeons get paid enough for the amount they work, and for their expertise, either. But that's another story...

 

I think the real problem is not just the paltry family medicine salary. It's the fact that family medicine is its own residency stream, and that once someone goes into it, they have no chance to upgrade later into a specialty.

 

In the past it used to be that a graduated medical student would do one year of a rotating internship, where he would be given full responsibility of patient care during that year, and then be able to practice general "family medicine" immediately after. If, after a few years, he wanted to pursue another specialty, he was able to do so.

 

 

 

Now, with the family medicine residency being an entirely separate entity, the rotations do not seem as "hardcore" as they were in a rotating internship. Services know that a family resident is "just going to be a family doctor" and don't expect much from them. Conversely, lots of family residents just don't take their rotations as seriously because they know they aren't expected to - the "real" residents take care of the important stuff. Additionally, family medicine does not offer any chance of "switching-up" in the future. Once you're an FP, you're an FP for life(maybe with some ER thrown in for good measure, but this isn't the norm).

 

I think its silly that FP is its own residency stream, and that this move has done more to harm the health care system than to augment it. Personally I'm not even sure why this change of FP to its own residency was necessary other than to give general practitioner docs the feeling that they've "specialized" in something. There's probably some other issues with faculty funding etc that I'm also not aware of. If anyone can divulge the reason for it, I would be very happy.

 

 

 

Wise words. I totally agree.

 

I know that you can do a 1 year anaesthetist residency and provide anaesthesia for small scale surgeries, not sure if one can do that exclusively though.

[coastalslacker]

.

 

I think its silly that FP is its own residency stream, and that this move has done more to harm the health care system than to augment it. Personally I'm not even sure why this change of FP to its own residency was necessary other than to give general practitioner docs the feeling that they've "specialized" in something. There's probably some other issues with faculty funding etc that I'm also not aware of. If anyone can divulge the reason for it, I would be very happy.

 

 

This change was advocated for by family doctors for exactly the reason you've described-"the feeling that they've specialized in something". The thought process was that family medicine is a specialty too (agreed) and thus should be it's own residency stream (not agreed, especially given the fact that this seems to be a significant factor in less people pursuing family medicine).

[AMmd]

Two quick points.

 

1. The person who said physicians should make 60k or 100k or whatever is retarded. Some nurses make 100k in the hospital I work at. My wife makes almost 60k as a relatively new teacher. She gets a total of 3 months off a year. She starts work at 8 and finishes at 4, plus some marking each day. If I'm going to spend 4 years in undergrad, 4 years in med school, 5 years in residency and 1 or 2 in fellowship, and then work long hours at a job that very few other people have the training to do, then I expect to be paid appropriately for it. Paid appropriately is relative to what other people make for doing other jobs.

 

so most of europe is retarded eh? hehehe

the nurses making 100K must be working overtime all the time, or they are some sort of directors or something.

[coastalslacker]

so most of europe is retarded eh? .

 

Yes. Since we're talking about physicians in Canada, I must obviously be refering to the European medical system (which I'm sure is homogenous salary-wise from the U.K. to the Czech republic.....). Gosh you're clever.

[JewelLeigh]

I just want to respond to some of the comments regarding family medicine (apologies in advance for the sidetrack of the thread)...

 

Yes, 5-year residents spend more time "on-service." However, I did not appreciate the insinuation that family med residents can and do just chill out while off service, and that we family med residents expect the "real" residents do the "important" work. Add to that the inflammatory comment about family medicine residents not being placed in positions of "real responsibility" - Ouch! Despite your attempt at a few comments being nice towards family med, this came off as quite insulting.

 

While this may have been your experience with family residents, it is certainly not the norm for me nor my close counterparts in my family medicine program. Yes, we may only be on your specialty service for a month...but this too can be incredibly stressful! Do not forget that specialty residents have FIVE years to learn your ONE area of medicine but that family residents have TWO years to learn MANY areas of medicine!! Yes, of course I understand that the level of detail and skill in the specialty area that the specialty resident must learn is hugely more than the family resident needs to know...but please don't discount the broad education that family medicine resident must obtain in a very short period of time. I do not have the luxury of time that I imagine specialty residents have. If I don't learn the skills now during my single month on your service, I probably won't get another chance during residency!

 

Add to this the struggle of being the "off-service" resident, especially being the FAMILY MEDICINE off-service resident - it's very difficult at times to obtain learning opportunities! In my experience, 'the "real" residents' aren't expected to "take care of the important stuff" because the family med and other "off-service" residents don't bother - it's because the off-service residents are placed last in line to get to do the important stuff!! I WANT to do the important stuff, because my month on your service is my only chance...but in tertiary centres, as the family med resident, I am 2nd last in line behind the fellow, the sr. specialty resident, the jr. specialty resident, the other off-service resident who isn't family med and the clerk who is interested in this specialty! The only person I get dibs over is the clerk who wants to do family med!

 

While it was written as if being "off-service" is fabulous because you can bugger off to "chill-out," and that being "on-service" means getting stuck with all the work...the other side of the coin is that for any resident, being "on-service" means you get more attention from staff who have a more vested interest in your learning, you get the more interesting patients and procedures, sometimes you get more respect, etc., etc., etc. I'd rather be treated and get to function as an on-service resident any day on any rotation!

 

Second, I hope that the comment regarding family residents never being placed in positions of "real responsibility" was not meant in the way it came across. Family medicine residents have their own patients for whom they are responsible during their family med rotations...and in 2 years, while the specialty residents have 3 more years of supervised training, family medicine residents will be licensed, independently practicing physicians. This is plenty of responsibility imo. If the comment referred only to the responsibility given to family medicine residents during off-service rotations, then my response, in keeping with what I already said, is that this is a big problem. Again - in less than 2 years a family resident will be out and could easily be the sole doctor in an emerg department, the sole doctor at a delivery, etc.... There is a system problem with specialty training for family residents when the training does not convey the level of knowledge, decision-making skills and responsibility that the resident will need only a few short months down the road. This is certainly something that I know Mac is looking into for the future...

 

In general, I have a HUGE amount of respect for specialty residents, especially those with notoriously long hours such as surgery and internal medicine. In return, I hope and expect that most of my colleagues in specialty residencies have a similar respect for the different and unique challenges and stress (also including very long hours, at least in my program and for the family doctors I work with) faced by those training and working in family medicine.

 

Finally, in response to the comment "you're an FP for life(maybe with some ER thrown in for good measure, but this isn't the norm)" - I just want to make sure this isn't misconstrued, as this "norm" only represents the bigger centres.

 

Of course I know that there is no longer a rotating internship, and once finished a family med residency, you have gone down that path without much opportunity for specialist training. However, I want to add, just for the record, that family doctors in MUCH of Canada continue to do a lot of work that is considered specialist territory in the tertiary centres. In bigger cities, the specialists are responsible for the majority of hospital work and admissions. But, in many smaller cities and certainly most or all small towns, family doctors RUN the hospitals, with specialists having the role of consultant. Family docs do in-patient and ICU care, provide the anesthesia, run the emerg department and in some places (unfortunately the number of these places is falling), continue to do the much of the low-risk OB. This is why I chose to do rural family med training and why I will work in a rural environment in the future - much more fun imo!

 

Okie doke...I haven't posted in a long time, and have certainly made up for it with this post! Definitely enough from me tonight Take care all!

[Hatchepsout]

Thank you very much JewelLeigh for your supportive and inspirational post to people who want to become family med physicians

[JewelLeigh]

Thank you very much JewelLeigh for your supportive and inspirational post to people who want to become family med physicians

My pleasure! I love my chosen career path and would encourage anyone to try an elective in family medicine outside a tertiary centre

[Guest Wildboyz]

Nice post Jewel

 

Soo.. to do Family Med requires only 2 years after Medical School (4 Yrs)?

 

That is.....ahhwesome!

[JewelLeigh]

Nice post Jewel

 

Soo.. to do Family Med requires only 2 years after Medical School (4 Yrs)?

 

That is.....ahhwesome!

You are correct, family medicine residency is 2 years in length following the normal 3-4 years of medical school. All other specialties are 4, 5 or 6+ years of residency training after medical school.

[coastalslacker]

Second, I hope that the comment regarding family residents never being placed in positions of "real responsibility" was not meant in the way it came across. Family medicine residents have their own patients for whom they are responsible during their family med rotations...and in 2 years, while the specialty residents have 3 more years of supervised training, family medicine residents will be licensed, independently practicing physicians. This is plenty of responsibility imo. If the comment referred only to the responsibility given to family medicine residents during off-service rotations, then my response, in keeping with what I already said, is that this is a big problem. Again - in less than 2 years a family resident will be out and could easily be the sole doctor in an emerg department, the sole doctor at a delivery, etc.... There is a system problem with specialty training for family residents when the training does not convey the level of knowledge, decision-making skills and responsibility that the resident will need only a few short months down the road. This is certainly something that I know Mac is looking into for the future...

 

It was meant how it was written, not sure how you chose to read it. As a family medicine resident while off-service you are not placed in posistions of responsibility. Everyone as an R1/R2 is "responsible" for patients. This is not the same as the responsibility that accrues as one becomes a more senior resident in a particular specialty. The fact that in your 3rd year after med school you will have your own patients and may be the only doc in an ER somewhere or at a delivery isn't particularly relevant. At that point in time you will be getting compensated appropriately for that high level of responsibility. My post was a reply to statements made regarding the differences in compensation between family physicians and specialists. The fact that my FM med school classmates will be out working and making good money 3 years after med school while I will still be pulling in a resident's sarlary for very long hours only strengthens the argument that specialists should be paid more.

 

I think part of the solution to family medicine residents getting more out of off-service rotations is to have them in peripheral centres. Being someplace where you aren't lined up behind a bunch of on-service residents to do procedures etc. would provide much greater hands-on opportunities. Queens FM has many rotations in peripheral areas and the reviews tend to be quite strong. You probably work harder, but you work more directly with attending physicians and have much more autonomy.

[BlackJack]

 

I think part of the solution to family medicine residents getting more out of off-service rotations is to have them in peripheral centres. Being someplace where you aren't lined up behind a bunch of on-service residents to do procedures etc. would provide much greater hands-on opportunities. Queens FM has many rotations in peripheral areas and the reviews tend to be quite strong. You probably work harder, but you work more directly with attending physicians and have much more autonomy.

 

I've heard some complaints from FM residents about doing residency at peripheral areas, such as:

 

1. the peripheral center is not academically based, and thus teaching and innovation is not stressed.

 

2. family doctors who run offices are not salaried by a hospital and are thus trying to churn out patients to meet the bottom line. A resident only slows that process.

 

3. specialists make money on consults, and having to deal with and teach a resident in FM during these consults slows down the throughput. Thus, lots of specialists don't want anything to do with FM residents in peripheral centers.

 

4. specialists who perform procedures, like obs/gyns etc., are more concerned about keeping sharp themselves than teaching an FM resident. Thus, they take all of the cases, giving the FM resident little to do.

[siobhansiobhan]

It was meant how it was written, not sure how you chose to read it.

 

no one point of view can claim meaning. meaning comes from the interaction between writer and reader(s) - and with a cursory read-through of this thread, sounds like there's some hotness at that interface. if you want a reader, you must allow for a co-created meaning, and co-created fall-out, and co-created repair. that's what relationship, conversation and meaning are all about.

[coastalslacker]

I've heard some complaints from FM residents about doing residency at peripheral areas, such as:

 

1. the peripheral center is not academically based, and thus teaching and innovation is not stressed.

 

2. family doctors who run offices are not salaried by a hospital and are thus trying to churn out patients to meet the bottom line. A resident only slows that process.

 

3. specialists make money on consults, and having to deal with and teach a resident in FM during these consults slows down the throughput. Thus, lots of specialists don't want anything to do with FM residents in peripheral centers.

 

4. specialists who perform procedures, like obs/gyns etc., are more concerned about keeping sharp themselves than teaching an FM resident. Thus, they take all of the cases, giving the FM resident little to do.

 

1. The teaching that happens in academic centres, however, is generally at a level that is beyond what a family physician needs to know. When we have our fracture rounds and senior residents start talking about how they would fix something and the approach they would use I'm pretty sure off-service residents would rather be anywhere else. Very low yield. Also, not sure innovation matters. The point of spending a month on ortho or cardiology or whatever is to get a general exposure to the specialty and take away some knowledge you can apply to your practice. Learning about the latest procedures isn't nearly as important as learning when one needs to refer a patient for common conditions.

 

2. Lack of payment/poor compensation for teaching in the periphery is a widely-identified problem. That said, as a med student early in clerkship I was able to help the rural family doc I worked with churn through a significantly increased number of patients. I expect that once most people get to residency they would lighten the work load of whomever they are working with.

 

3. This is probably true. Also, many specialists are in the periphery because they don't want to be at a teaching hospital.

 

4. I think it all depends on the enthusiasm of the resident. If by cases you mean surgical cases, C-sections, births requiring forceps I would say-what is the problem? That is not within the scope of what family physicians will be doing unless they go on to take a third year in OB/GYN. If you mean routine L&D then that would be a problem. I did my OB/GYN in the periphery as a med student and got to do all the uncomplicated births. Also did births with the fam MD I was with. Personally, I don't think FM residents should complain about not doing surgical cases, simply because even surgical R1's are at the back of the bus in terms of opportunities to do stuff in the OR. We often are left with just closing up but we still have to have read about the procedure, anatomy, approach prior to the case. While operating more would make their rotations more interesting (mine too!) it just is not in the scope of what they will be doing for a job.

 

 

This thread has wandered off-course a bit....sorry.

[coastalslacker]

Wow. Flashbacks to my BA in English.... .

 

I can, however, appreciate what you are saying. While my response was blunt, I do not think my original statement was unclear. I find that often people on forums give only a "cursory read through" to things prior to responding to them.