Guest warpath5 Posted May 21, 2003 Report Share Posted May 21, 2003 I actually have a few questions: 1) Is it possible to go into plastics after a general surgery residency or after a few years of general surgery (like in the States), or do you always have to enter in PGY1? 2) How competitive is ortho in Canada? 3)Is there a website where I can find which specialties are eligible/not eligible to practice in Canada after residency in the States? Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted May 21, 2003 Report Share Posted May 21, 2003 Welcome to the forums... 1) There is no dedicated stream or formal process for general surgery residents/graduates to apply into Plastic surgery residencies. As you've suspected, Plastics is its own dedicated stream from the beginning of residency (like the Integrated Plastics spots in the US). You could attempt to transfer out of your general surgery residency into a plastic surgery residency, and while this happens, it's rare, and is predicated on your general surgery funding (which is what pays your salary for your 5-6 years of residency) transferring into the plastics program. No funding, no transfer. 2) Residency stats are found here: www.carms.ca/stats/stats_index.htm Here's the stats for Ortho over the past few years. The first number is the percentage of people who got into their first choice ortho program, the second is the percentage of people who matching into ortho somewhere, but perhaps not at their first choice. As you can see, it's tough, but if you are open to going anywhere for training, chances are reasonable that you'll get your residency: 2003: 54% first choice, 81% overall match rate 2002: 67% first choice, 82% overall match rate 2001: 58% first choice, 85% overall match rate 2000: 48% first choice, 83% overall match rate 3) There is no such website. What you want to do if you are interested in returning to Canada after a US residency is to visit the Royal College of Physicians and Surgeons of Canada, and ask them. Here's the website: rcpsc.medical.org/english/ They will be the ones to look at the program where you are doing residency, and can make the call as to whether you are free to write the Canadian board exam for that specialty, or whether you might need some extra residency time first. There are certain residencies that are longer in Canada than in the US (Ophthalmology, Anesthesiology, General Pediatrics, General Internal Medicine are all one year onger up here), and perhaps these specialties don't transfer as easily. All Canadian surgical residents write an exam called the Principles of Surgery exam (POS), which is written during your R2 year, so you might need to come back to Canada while you are doing your US residency to write that. Ian Link to comment Share on other sites More sharing options...
Guest warpath5 Posted May 21, 2003 Report Share Posted May 21, 2003 Another question: With all this talk down here in the States about the new 80-hr rule during residency, I was just wondering how many hours the average surgrey resident works in a week. Do they have restrictions on how many hours residents in Canada can work? Which specialty usually has the longest hours during residency and how much? Sorry for all the questions, but I'm planning to go back to Canada after med school, and I'll like to know how similar or different things are. Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted May 22, 2003 Report Share Posted May 22, 2003 In Canada, each province has a provincial association which represents it when negotiating to the university/teaching hospital. In BC, this is PAR-BC. In Ontario, it's PAIRO. You can find each province's link here: www.par-bc.org/links.htm The negotiations conclude with a contract which dictates things like annual salary, maximum frequency of on-call time, and benefits. Here's the current set of contracts, although I believe there are some new ones coming down the pipe. If I remember correctly, contracts are re-negotiated every 2-3 years. www.carms.ca/procedure/salaries.htm Hours are long for every surgical residency. Longer for General surgery, Neurosurgery, and Orthopedics, but still long for Urology, ENT, and Plastics. There are no exact numbers I can give you because it will vary with the number of patients you have on service, how efficiently your team runs, and how much scut is delegated to your team vs. being taken care of by ancillary staff. I'm pretty sure I went over 80 hours/week in several of my clerkship rotations in third year, and if that's what it takes to get patients seen and treated, then that's what needs to be done. Ian Link to comment Share on other sites More sharing options...
Guest faqir9 Posted May 22, 2003 Report Share Posted May 22, 2003 Thats an interesting response. The reason the US went to a 80 hour limit has nothing to with folks who lack the work ethic to do "what needs to be done" to "get patients seen and treated," nor a kindler/gentler approach to training residents. It happened because overworked residents were killing patients. If you were the patient would you want to see a doctor working the 105th (or whatever) hour of the week? Link to comment Share on other sites More sharing options...
Guest cracked30 Posted July 24, 2003 Report Share Posted July 24, 2003 Someones gotta do the work though, right? Continuity of care should be first when dealing with surgical patients. Link to comment Share on other sites More sharing options...
Guest faqir9 Posted July 25, 2003 Report Share Posted July 25, 2003 Well, given my experience in the past here, I am very leery of taking up this point. Particularly in light of the thermonuclear wars that have erupted on studentdoctor.net on this topic. But I will say this: I could NOT disagree more. I would not let a surgical resident working past hour 100 so much as look in the direction of my room. I would not let her anywhere NEAR one of my loved ones. There is all sorts of evidence in the US as to what happens, and ultimately that's why they went to 80 hours. Not because they felt bad for residents. The whole somebody's gotta do the work/ continuity of care in surgery, etc...its strikes me as a little too machismo. Or at least not what I would personally want from my own surgeon. I'd much rather one with the attitude "y'know what, I'm really good until about hour 79...but you wouldn't want a pilot who was falling asleep at the wheel and right now you don't want me." But as I said, this has all been discussed, and rehashed again and again on SDN. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted July 26, 2003 Report Share Posted July 26, 2003 Hmm. . . I've been thinking. My buddy is a journalist, and when he's got a hot story (ie he was on the Action Democratique bus during the Quebec elections) he works 80+ hour weeks, incl weekends and some 8 to 5 shits. . . that's 8 am to 5 AM. Talking to him, I was reminded of my future. . . Like an MD, this guy has no benefits (ie pension, dental plan.) Worse, he has no job security - he's on contract, and could easily not be picked up when the contract expires. And there's nowhere near the earning potential of an MD. The only advantages are that he was out before 25, didn't have as much debt after schooling (though he did have a lot!) But he loves his job and to him it's worth it in the end - he's had chances to chill with Joe Sakic, Patrick Roy, Jose Theodore, Bernard Landry, Jean Charest. . . and he was with Patrick Roy's dad when Roy retired. Just something to think about next time you think you have it rough busting your balls 80-100 hrs a week in clerkship/residency/beyond. Link to comment Share on other sites More sharing options...
Guest cheech10 Posted July 26, 2003 Report Share Posted July 26, 2003 UWOMED2005, It's not about wanting cushy jobs (which is what you seem to be implying; sorry if I'm wrong here); it's about patient care and how it suffers due to errors caused by overworked staff. That's why the 80-hour limit was imposed in the states. Your journalist friend won't kill anyone if he makes a mistake because he's too tired, and the rates of medical errors are high enough that I think we should be doing anything possible to minimize them. cracked30, Continuity of care is always going to be an issue. Whether the handoffs are at slightly longer or shorter intervals, they will still happen, and happen multiple times over the course of one typical (surgical) patient's stay. So a more effective goal would be to work on the quality of sign-outs, and decrease the number of errors per sign-off. With the endless amount of technology being invested into medicine, a patient tracking system that is effective should be attainable. Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted July 26, 2003 Report Share Posted July 26, 2003 So a more effective goal would be to work on the quality of sign-outs, and decrease the number of errors per sign-off.No arguments here. This is a crucial part of the patient care paradigm. I think you'll see firsthand during clerkships that there's huge variability between how handouts are done, and that some ways work much worse than others. Still, the bigger issue at hand is not that over-worked people make mistakes. That's a non-starter. The point is that there's a fixed (or ever increasing) total amount of work to be done, and without more providers to take the load off, people are going to be working bigger hours. If you want to solve this problem, you've got to get more med students, more residents, more staff, more nurses/PT's/OT's/dieticians around to spread the work out more evenly. Passing a law limiting the number of hours you can work is a cop-out because it just displaces that additional workload onto the next guy coming on shift. The core issue is that we need more health care providers. And we all know how well the manpower shortage is being handled... Ian Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted July 27, 2003 Report Share Posted July 27, 2003 Cheech - yeah, I agree with you entirely on that point, and I do think hours worked by physicians should be capped for safety reasons. It's just I sometimes find we complain about our hours so much we forget we're not the only field that does it. Ian - once again, couldn't agree with you more. The system needs more doctors. Of course, the flipside of that would be more competition among doctors for work (though we're a LONG way from that in most specialties) and a resultant decline in job stability for us. And, if a doctor is working 80-100 hours, then he's probably billing all that time too. . . to decrease to 40-50 hours would be theoretically cutting his billings in half. Plus it would be costing the system more. Makes me think I'm sounding like Jerry MacGuire when I say that we need to have less patients and give more time to them individually. . . Link to comment Share on other sites More sharing options...
Guest cheech10 Posted July 27, 2003 Report Share Posted July 27, 2003 Ian, I agree, we do need more staff, and it's unfortunate that governments currently look like they want fewer staff to keep doing more. Eventually I suppose things will reverse. Link to comment Share on other sites More sharing options...
Guest cracked30 Posted August 3, 2003 Report Share Posted August 3, 2003 When you look at the impetus for the change in work hours, the Libby Zion case, the outcome doesn't make sense. The resident prescribed Demerol, she did say she was on Nardil, but failed to mention, actually hid, that she was taking cocaine. The media picked it up and ran with it. The truth is, I don't think anyone could have predicted the outcome, tired or not. Link to comment Share on other sites More sharing options...
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