How competitive is residency?

[MedPen]

So very very wrong.

 

Read the globe and mail article for more info:

 

http://www.theglobeandmail.com/life/health/canadian-surgeons-face-flat-lining-job-market/article1920006/

 

Thanks for the link. It was a very interesting read.

I hope by the time I graduate that things will be different. If not, oh well, I'll find something else. While ortho is the dream, there is always the possibility of finding another dream.

[NLengr]

Premed? You know, its funny but I had the same idealistic expectations of medicine. Going through the ringer makes you cognizant to the reality.

 

What derm/ophtho offer in terms of satisfaction isn't purely monetary, its also independence. Medical specialties that are tied to hospitals, and family medicine with all of its inefficiencies(to get paid well you need to practice McMedicine), have had their autonomy confiscated.

 

Also, spending all day dealing with complex patients who have multiple interacting medical and social problems isn't as exciting or non repetitive as it's cracked up to be. It can be a real pain in the butt.

 

Plus, even generalists get lots of repetition. Every general internist has loads of 75 yr old diabetic, HTN, Hyperlipidemic, vasculopath. You see them all day long. Ditto family with the sore throats and back pains.

[NLengr]

LASIK is private medicine and they can charge what the market will bear. You can't compare it to Medicare.

 

If Neurosurgery was private, than I can garuntee you NSx's would make similar or greater amounts.

[Mandibular]

Ah they are not schmuck, ophtalmology is extremely complex and delicate. Did you take an elective in ophtalmology or neuro surgery?

 

So is everything else in the human body. That doesn't justify a 7 digit salary to these people. why not get paid abit less and give a bit more to primary care (FM/EM/PSY/ hell,even GIM)

[BigM]

So is everything else in the human body. That doesn't justify a 7 digit salary to these people. why not get paid abit less and give a bit more to primary care (FM/EM/PSY/ hell,even GIM)

 

From spending a few days shadowing opthamologists I have seen that cataract removal is a large portion of what they bill OHIP for. I have been told that the current billing codes for cataracts haven't changed since it was a procedure which took a few hours. It now takes about 15-20 minutes and I have seen an optamologist crank through them like a production line. This is something that probably needs to be scaled back.

 

That said, opthamology is a highly competitive speciality to get into. The surgeons are well trained and probably deserve to be making well over the average physician salary.

[aaronjw]

From spending a few days shadowing opthamologists I have seen that cataract removal is a large portion of what they bill OHIP for. I have been told that the current billing codes for cataracts haven't changed since it was a procedure which took a few hours. It now takes about 15-20 minutes and I have seen an optamologist crank through them like a production line. This is something that probably needs to be scaled back.

 

That said, opthamology is a highly competitive speciality to get into. The surgeons are well trained and probably deserve to be making well over the average physician salary.

 

Can someone explain this to me? How are they anymore well trained than a GIM or subspecialities thereof or Ortho's?

 

Just curious...

[BigM]

Can someone explain this to me? How are they anymore well trained than a GIM or subspecialities thereof or Ortho's?

 

Just curious...

 

I didn't mean to compare optho to other surgical specialities. I was trying to point on that there's often differences in resident lifestyle between surgical and non-surgical disciplines. I'm personally interested in psych and most psychiatrists have told me that their residency was not much more demanding than a 9-5 job. This isn't the case in surgical residencies.

 

Yes, internal medicine and many other non-surgical residencies have demanding peroids. But as far as what's been described to me, it seems that ON AVERAGE, surgical residences are probably more grueling that non-surgical. I don't mean to say that other specialties are less trained than opthos either, but there's probably some differences in the amount of time the average opthamologist has sacrificed compared to the average non-surgical physician throughout the entire course of their training.

[thebouque]

but there's probably some differences in the amount of time the average opthamologist has sacrificed compared to the average non-surgical physician throughout the entire course of their training.

 

I wouldn't say that. Ophtalmology residency isn't easy, but internal medicine residency is at least as demanding (maybe even more).

[apache]

yeah, you're right, i was talking about the lasikmd doc's that do laser eye surgeries every 20 minutes, they're outliers within the outliers in ophthalmology.

 

1.5 million is very hyperbolic. This is an outlier IMO (like the mythical GP who makes 450k).

[A-Stark]

I think this is ridiculous. I'm sure ophtho residents work hard after the PGY-1 year but it doesn't compare to, say, the average medicine senior acting as code time leader while covering emerg at the same time. Same goes for subspecialty residents in cardio, GI, ICU, nephro, and any other area with sick patients. Even the psych emerg is busy all night.

 

I didn't mean to compare optho to other surgical specialities. I was trying to point on that there's often differences in resident lifestyle between surgical and non-surgical disciplines. I'm personally interested in psych and most psychiatrists have told me that their residency was not much more demanding than a 9-5 job. This isn't the case in surgical residencies.

 

Yes, internal medicine and many other non-surgical residencies have demanding peroids. But as far as what's been described to me, it seems that ON AVERAGE, surgical residences are probably more grueling that non-surgical. I don't mean to say that other specialties are less trained than opthos either, but there's probably some differences in the amount of time the average opthamologist has sacrificed compared to the average non-surgical physician throughout the entire course of their training.

[BigM]

I think this is ridiculous. I'm sure ophtho residents work hard after the PGY-1 year but it doesn't compare to, say, the average medicine senior acting as code time leader while covering emerg at the same time. Same goes for subspecialty residents in cardio, GI, ICU, nephro, and any other area with sick patients. Even the psych emerg is busy all night.

 

I don't disagree, as I said, every residency has it's very demanding peroids. For surgeons, doing trauma call would be certainly be no walk in the park.

[A-Stark]

I don't disagree, as I said, every residency has it's very demanding peroids. For surgeons, doing trauma call would be certainly be no walk in the park.

 

I have never seen an ophtho resident let alone an ophtho staff at a trauma code. Certainly traumas are busy and perhaps stressful, but so are code blues and crashing ICU patients. Surgery residents definitely get up early and do a lot of busy call (at least on gen surg, ortho, neurosurg, sometimes plastics, not so much urology or ENT) but medicine call can be extremely busy.

[BigM]

I have never seen an ophtho resident let alone an ophtho staff at a trauma code. Certainly traumas are busy and perhaps stressful, but so are code blues and crashing ICU patients. Surgery residents definitely get up early and do a lot of busy call (at least on gen surg, ortho, neurosurg, sometimes plastics, not so much urology or ENT) but medicine call can be extremely busy.

 

So you've reduced my talk about surgical residency (at first I talking about optho but then I started discussing surgical residencies as a whole) to meaning strictly optho residency. Then you reduced my discussion about non-surgical residencies to "the average medicine senior acting as code time leader while covering emerg at the same time". Do you see the problem here?

 

Although its arguably not fair to lump things into surgical vs non-surgical specialities, we do it all the time. I believe that if you throw things into these two very broad categories that the average number of hours sacrificed (from the start of medical school) would be more intensive on the surgical side than the non-surgical side. You are welcome to dispute this, its just my personal belief.

[A-Stark]

So you've reduced my talk about surgical residency (at first I talking about optho but then I started discussing surgical residencies as a whole) to meaning strictly optho residency. Then you reduced my discussion about non-surgical residencies to "the average medicine senior acting as code time leader while covering emerg at the same time". Do you see the problem here?

 

Although its arguably not fair to lump things into surgical vs non-surgical specialities, we do it all the time. I believe that if you throw things into these two very broad categories that the average number of hours sacrificed (from the start of medical school) would be more intensive on the surgical side than the non-surgical side. You are welcome to dispute this, its just my personal belief.

 

As ever, it depends. Any inpatient service with lots of sick patients and direct admissions from emerg is going to be very busy. Any surgical service that primarily offers elective admissions and - especially - same day surgeries will be as busy as their clinics and ORs and no more. For example, my core gen surg rotation was on the acute/emergency service which started at 6 or 6:30 and went right to 6 everyday. Rounds could actually last two hours or more and the day was filled with consults and - as a CC3 - waiting to review patients. It was pretty tiring but I really enjoyed it.

 

(Of course, I'm probably not applying even to one IM program as backup, so I don't know why I'm belabouring the point.)

 

My electives since have been oncology services. One included very reasonable clinics and ORs... some days I was done before 3 and I can't say there were many that even approached 5. My current one has been light - rounding as late as 7:30 and so little going on that there was only a single clinic, a morning of scopes, and two ORs the whole week last week. Needless to stay my days weren't very long.

 

On the other hand medicine rotations - in such things as inpatient general medicine and cardiology - have meant hours of rounding, hours of paperwork and phone calls and dictations and working from 7:45 til at least 5 and frequently 6 or later. It's very busy and not very forgiving for down time. Sure I didn't have to go in quite as early, but I'm not sure that routinely staying later is really worth it.

 

Anyway, the point is that in residency (more so than clerkship, albeit with the nice bonus of some level of income), you will work hard on any acute medical or surgical service - and sometimes longer on certain types of gen surg rotations, to take one example. But that doesn't apply all the time and - simply put - a medicine residency is no cake-walk.

[Lactic Folly]

Thread on ophtho call (one of those fields that many don't get exposed to during medical school):

http://forums.studentdoctor.net/showthread.php?t=433508

[Mourning Cloak]

As a clerk, my favourite thing about derms is that if you ever get the chance to consult them, they're always so jazzed about what you've found.

 

Had a middle aged female with RF and honest-to-God erythema marginatum. The rash wasn't going to kill her (or diagnose her, for that matter) but that derm attending danced into the ED to get a look at it. I guess doing relatively little call makes you a lot more amenable about it.

 

The surgeons aren't impressed by anything.

 

Me: "This 21 year old has testicular seminoma metastatic to his stomach and small bowel. Consult for SBO ? intusseception. Also of note, the tumor has learned to sing and dance."

 

Gen surg: "You got me out of bed for this?"

[thebouque]

 

The surgeon is never impressed because nothing in real life can be as impressive as a dream.

 

You mean performing surgery is like a dream??

[NLengr]

You mean performing surgery is like a dream??

 

It's better.

[Jochi1543]

I doubt your derm is actually doing this. Any GP knows how to treat warts and does not need to refer to a dermatologist for that. .

 

You'd be surprised, I just finished a derm elective and half of the referrals were for warts and seborrheic keratoses. I came out of it firmly convinced that a derm rotation should be MANDATORY in family medicine residencies. Even in 1 week, you'd see so many common conditions that you'll save yourself 90% of derm referrals in the future. The docs had either the nurses or myself do all the blasting with liquid nitrogen, but it still wastes some of their time to have to pop in there and look at it and do the required paperwork. They could be using that time to check their Mohs surgery slides or treat a kid's pustular psoriasis instead.

 

One of my preceptors said that he kept a log of his diagnoses for a year when he was a resident and in an ENTIRE year he only made 77 diagnoses - in the meantime, there's something like 2400+ diagnoses in dermatology. So you keep seeing the same stuff over and over and over.

[leviathan]

Crazy. Thanks for the info, I'm definitely planning on doing a derm elective before I graduate.

[D-Rock]

I came out of it firmly convinced that a derm rotation should be MANDATORY in family medicine residencies. Even in 1 week, you'd see so many common conditions that you'll save yourself 90% of derm referrals in the future.

 

Good medical schools have you do this in your clerkship.

[thebouque]

Good medical schools have you do this in your clerkship.

 

Troll 10 char

[1234]

Good medical schools have you do this in your clerkship.

 

Derm rotations are generally terrible. Either they are super boring (BCC, psoriasis, SCC spectrum), or, they are too high level for clerks/FM residents (Pemphigus variants).

[bored]

Don't you guys the americans have a better system with their USMLE? they let the standardized test decide who gets what residency, instead of having good contacts and stuff like that..

[Jochi1543]

Don't you guys the americans have a better system with their USMLE? they let the standardized test decide who gets what residency, instead of having good contacts and stuff like that..

 

It sure is interesting. I have a friend in the US who was all about family med and how gunning is the worst thing ever and everyone just needs to relax.....then he got an INSANE score on his Step 2 and decided he wanted to do derm all of a sudden.