Kevin's McMaster Medicine Page
Kevin's McMaster Medicine Page |
Carms Frequently Asked Questions (FAQ)This is incomplete and a work in progress. Please email me any further questions and things you would like added to the FAQ. Thanks Updated Feb. 18, 2000 By: Kevin Leung I would be pleased to answer additional questions and update this FAQ. Please email additional questions to:
Standard
Disclaimer:
The opinions and comments provided in this document are that of a single
(as of current) resident and as such do not represent the opinions of the Dept.
of Family Medicine, Postgraduate @ Mcmaster or the MUMC FPU.
Having said that, if you have any problems with that, you can choose to
bugger off at this point and there will be no hard feelings – honest. Background: Originally
from Scarborough, I did both my undergrad and medical school training at the
University of Toronto. I applied to
the CARMS process in 1998 through the couples match with my fiancée (Alice) who
did her medical school through the University of Ottawa. We both ended up in Hamilton, she is currently in the
Radiology program and I am in the Family Medicine program. This was the 5th (coupled) rank list and
represents Alice’s 2nd personal choice and my 5th
personal choice. I
am currently completing my family medicine residency (9 more months to go – 7
minimum). Rightly or wrongly, I a
currently the chief resident at the McMaster University Medical Center (MUMC)
Family practice unit (FPU). Questions to cover: These are a combination of answers to some of the applicants who have contacted me and some questions I would not have thought to ask. Either way, they represent very personal opinions so make sure you ask around before you commit. Q. Where should I apply?
If you are not serious about family medicine (read – backup) then apply even more widely as your resume probably reflects your lack of interest / breadth (ie. Looks like you have an aweful lot of neurosurgery electives and those 3 publications in neurosurgery illustrated… hmm?!) In fact, if you are using this as a backup, consider submitting different CV’s (if possible) that tone down on the amount of specialty work that you did. Q. What if I changed my mind… originally wanted <SPECIALTY> and now decide to do family medicine? A. Look, I have 2 friends that went through similar scenarios. 1) Toronto Grad that was really an outstanding applicant, did a lot of urology electives/research then decided because of a change in life circumstances (read – getting a life and marriage) chose family. Although a good candidate, he was overlooked by his 1st FM choice. 2) Ottawa grad who did lots of surgery electives and was really surgically keen until match time. His final decision was any family medicine program over surgery due to lifestyle (and sanity) reasons. Final match. Welcome to Hamilton Surgery my friend… The gist of this is that perhaps a more rounded CV (with less emphasis on certain aspects) might have netted these guys higher rank choices. Am I sure à NoT AT ALL. This is only wild speculation but makes so much intrinsic sense. Q. How does the Hamilton FM program compare with XYZ program? A. What do you want to hear?
Q. But I’ve
done all my training at XYZ institutions. Should
I go elsewhere to broaden my horizons? A. If you are thinking of leaving for Quality reasons (ie. One program providing better training), the truth is that there is little baseline variation in the programs unless you wish to choose urban vs. rural. All of them are fairly homogenous and will give you the training required to pass the licensing exams and graduate. There is something to be said for exploring. However, what usually anchors someone to a site is family & friends and you have to wonder how much joy you’ll get by being separated from them. There are very few programs that you would regret NOT going to (again, unless you choose rural) and so, this probably shouldn’t be a big factor in your decision making process. Q. How does McMaster compare with Toronto? In Hamilton, the 3 urban sites are fairly uniform and even despite their variations, would be slightly better than your Toronto average. However, in my opinion, they are not good enough to warrant displacing yourself from somewhere you REALLY want to be and coming here. However, if you’re moving, it’s as good as any of the other sites. Now, a couple of other vicious rumours. Ottawa’s program seems to be fairly well regarded and I would guess them to have an even higher MEAN training/happiness level. Queen’s program combines quite a bit of rural training and relocation (i.e. peds). For some reason, Western’s program (despite the Library of FM being there) does not seem to get any kudos from anyone. Having said that, they did do some pioneering working “patient-centered medicine” About the Program Q. What are some good points about the residency program at Hamilton? A. OK, I feel some obligation to sell my program… Here goes.
Q. What are
some areas requiring improvement? As with any program, there are always things requiring change. Here are my ideas of some of them in no particular order.
A. The McMaster program is one of the more flexible programs for family medicine. Firstly, we have 3 months of electives/selectives in 2nd year. Secondly, you will do either a 2 or 4 month rotation in the community (this includes a smaller town/ ROMP program, etc...) in the second year. As for the core rotations, you will get a very urban flavor of training UNLESS you actively plan your program and rotations yourself to spend more time out of the city. Thus, you can make it pretty much as rural as you want and if you choose to plan in advance (ie: do community based residency training) then it is a pretty good program in a prime southern ontario region.
Q. How is Hamilton? 2 VERY big advantages (I'll say it again) - close to Toronto/central ontario - close to the USA (cross border shopping/trips). If you're into gambling, Niagara Falls casino is 30 min. away. Of course, you'll have to sell drugs or something in order to make enough $ to gamble with since your pay probably won't cut it. Having said that, the suburbs are just as nice as Toronto and Oakville/Burlington is both RICH [Check out the lakeside Burlington Golf & Country club with it’s $800k admission rate) and beautiful.
A. It depends. I'm used to having specialist support and if you stay in Central Ontario, my answer would be yes. If I'm 1/2 hour - 45 min. outside of a major medical site, I would personally be comfortable there. However, if you asked me whether I would be comfortable in
Atikokan (town pop - 7000) then the answer would be - not really. I
haven't "tuned" my family medicine experience enough to go fully rural
right off the bat comfortably. For example, you can do up to 6 months (in your second year) of family medicine in a rural community rather than at an urban site. That is as good as you'll get with most other rural programs. But it doesn't come handed to you on a plate (although they are seriously talking about implementing a pre packaged, semi-rural program for residents coming in.) Q. Why did you choose family medicine (FM)? A. I’m afraid that I’m going to talk about the pragmatic side of things.
Q. What do family docs really get paid? A. If you look at the OMA stats, the answer is around $120 k. Their number represents a before expenses (GROSS) value. This is pretty dismal as your take home (give 40% expenses) would give you about $70 k. There are a couple of snippets in truth.
Q. That’s pretty dismal.
A. Yes and no. Compared to the other specialties, it does seem slightly off-kilter as specialties (read: lazy-ass radiologists) can gross > $ 300 k without working any more hours than you would to get your $ 180 k. However, relative to the population (ave. family income = $ 60 k) it’s not shabby. You decide whether your decade of training is worth more / less.
Q. Will I have to work in isolated, northern town Ontario? A. NOT unless you like the outdoors. The doctor population in Ontario is so tight right now that Southern Ontario is officially underserviced. Cambridge, Guelph, Burlington - prime sites are all in need of family docs. In fact, Niagara Falls is asking for 150 doctors (good luck - that's almost the entire UofT med school population of 1 year). It has never been better in terms of job prospects. Unlike the 1980's/90's patients are no longer a premium in a practice. There is no such item as Goodwill because if you start up anywhere in Southern Ontario (outside of a few major cities) you will fill your practice in less than 4 months. If you go to Milton/Burlington - you can work at 100% capacity in the first month if you wished. (Perhaps a bit optimistic - but close!) Q.
What about other programs? A.
Well, I would have to defer real answers to the specialty residents but
because I have no shame in sharing rumours and slamming programs; let me tell
you of a couple of programs that seem to be having an inordinate share of
problems. 1) Internal Medicine – when I first got here, I thought that the general internal medicine program at McMaster was pretty solid. After all, Gordon Guyatt – guru of evidence-based medicine resides here. However, I now have MUCH to qualify to that. The sub-specialty training here at Mac is pretty good. Indeed, you’re more likely to get your sub-specialty of choice here as they greatly favour their own graduates/residents in internal medicine. However, their General internal medicine is pretty shabby.
Part of the problem (from personal opinion and discussion with the
seniors) is that there are very few (read- NONE) pure general internists here.
They all have their little subspecialty. (eg: general-hematology, general-pharmacology, general-epidemiology,
general-respirology, general-cardiology). When
your generalists are off doing bronchoscopies and running exercise-stress tests;
their general medicine knowledge (and the stuff they can teach), suffers… [It
reminds me of the old dual-class characters in dungeons and dragons; masters of
none but very flexible – but I date myself!] I always find that a good indicator of resident happiness and program flexibility is the number of transfer outs. This year, 4 SENIORS left the program (for personal reasons and others). It is so bad, that they are talking about closing a clinical teaching unit. UPDATE - they will close down the Henderson teaching site in July
2000. This means SMR's go back to 1/4-1/5 call and CTUs will be
consolidated at 3 centers. Also,
their seniors do general medicine call. They
ALWAYS do 1 in 5 no matter what rotation their on.
Always general medicine. So
with the loss of 4 seniors, their SMR’s are really hurting with call (read
long-term 1 in 3-4). UPDATE - I know some of you have been asking whether to come here for Internal Medicine with all their problems? Training has improved a lot (3-4 years ago 50% of their residents failed their college exams) and this past year, I heard that all their residents passed. Thus, you will probably end up doing fine despite their problems. I asked the question of one of the CMR's here (Feb. 2000) and his answer was that the program will probably recover and is solid. He's been telling people to go somewhere else for a year as we just don't know what the changes to the CTU's will mean to the residents. Also, the postgraduate program has had a lot of problems implementing changes in a timely fashion so that although the promise is that things will change July 2000. That might not be true. I would really appreciate it if you could share some of the answers you have been getting from the residents at the interviews with me so I can share the information. IF YOU REALLY, REALLY WANT INTERNAL MEDICINE, the problems at McMaster should probably not keep you from ranking it. 2)
General Surgery – I learned that they have lost 3 seniors over the last year.
2 left in the last month. This
is pretty nasty for a small program (5 residents/year) and really puts pressure
on them. Also, I really sympathize
with them (their current chief is a good guy – really) since they do not get
family medicine residents rotating through to help them out with service.
However, the program is talking about putting G.P. extenders (clinical
associates) which are docs who will help them out with service and call.
The
problem there is that, as always, there are a few key bad apples (read-
assholes) which are teaching staff. Q.
Is it possible to transfers
between programs (at Hamilton) We both got non-committal support from the postgraduate department on these transfers. In fact, for my discipline switch, they basically said that there was no funding and I would have to ask the IM program director whether they would cough up funding for me. Of course, they said they would notify me if that changed (and they didn't despite several transfers that DID happen over the year).
2) My
colleague, also requested a transfer from Hamilton FM to Toronto FM at the same
time. He was very aggressive in pursuing his transfer and talked to the family medicine directors in Toronto and Hamilton who were both agreeable to the notion. Postgrad refused to release funding. So... here he is finishing PGY-2 in Hamilton with me. Actually,
not quite true, he attempted to transfer into Community Medicine (and even met
with the program director) but once again, they pulled that "no
funding" BS on him. That was after 4 internal medicine residents had
left! Hard to swallow? 3) A Community Medicine resident met with the ObGyn director to discuss a transfer. Funding was already there but the ObGyn director refused cause the program could not "accomodate more trainees." Nice guy (no really, he is) but he is the same director that let 4 (?5) spots go completely unmatched in the first round 2 years ago in ObGyn. 4) Now, after all this miserable, self-pitying whining (despicable :) Here are just some of the transfers that DID happen while I was in Hamilton. Gen. Surg -> Anesthesia Internal Medicine -> Anesthesia, Family Medicine x2, Community Medicine => Yes, they lost 4 (rumored 5) over the last year, ouch :) Ortho Surg -> Family Medicine Emerg -> Pathology, Ortho Surg FM (Ottawa) -> FM (Hamilton) => it is possible and OTTAWA was nice enough to release funding Community Medicine -> Family Medicine Toronto Peds -> Hamilton Radiology Ottawa Radiology -> Hamilton Radiology
Q. Should I match to a 2nd choice program and try to transfer? A. There are very few programs where transfers happen easily. The only (widely known) exception to this rule is University of Toronto where the Dean has an unofficial policy that no resident should continue in a program that they are not interested. Thus, there are special circumstances in Toronto where a LOT of trading can happen. As I have mentioned before, transfers happen in Hamilton but they are not favoured. If you are patient (and willing to wait) for a transfer, SOMETHING might be able to be accomodated with you over a 12 month period. But highly desired specialties may not EVER become available. Therefore, I would NOT advise choosing a 2nd choice program in Hamilton as a backup. IF YOU DO. Then choose a program with 5 years of funding. That way, at least you have some chips on your plate that you can negotiate with. Without the 5 years of funding, expect heavy resistance (or be prepared to plead and beg your case to a sympathetic ear - if you can find one). Q.
Should I go unmatched? A. This is a strategy that has become much more viable but is still not encouraged. CARMS has changed their policy (check with them on this one) over the last 1-2 years so that if you go unmatched, you are still eligible for next years FIRST round of computer matching. Back in my days <SIGH>, those that went unmatched were placed in the SECOND round of computer matching. Thus, if you went unmatched and did electives/research for a year, you should be in a pretty good position. CAVEAT: Some programs (not necessarily family medicine) frown on those that take an extra year to start their residency training. There is a general conception (in some programs) that if you didn't match the first time - either you weren't serious or something was wrong with you to make you ineligible. So you are still taking your chances and this should not be a primary strategy for most people.
Q. What if I do take an extra year off? A. Whatever you do, have a good explanation for what you did with your time and why you took it off. Family medicine is pretty good about "lifestyle" choices and reasons but don't expect Neurosurgery to smile upon someone that need to take a "1 year life break". Whatever you do, don't call it an ENRICHMENT year a McMaster. That's the name they give to "extra" training that clerks get here when they fail a year!
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