PGY-1 Frequently Asked Questions (FAQ).
Updated Sept. 9, 1999
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.
I
am still attempting to get more residents to participate in the writing
of this FAQ but have had little luck in recruitment at this time.
IF you found this piece of work helpful, please consider
contributing to it by emailing me your articles/opinions in the future.
The
information in this article (and more) can be found on my web site at:
http://mcmaster.cjb.net
You
can contact me at:
E.mail
-> [email protected]
Once again, welcome to the program and here are a couple of items:
Preamble
to the Program
Q) Internet access?
McMaster health sciences will be providing you with a new email address
if you require one. As for access, they have a university system that
costs roughly 50 cents/hour and supports up to 56k modem speeds. This is
a great plan if you only use the internet intermittently but if you're
like myself and use the internet > 20 hours/month, you might want to
consider going with an independent internet service provider (ISP) at
around $20/month for unlimited internet access.
If you live within a certain radius of McMaster, you can get cable modem
access for roughly $30 / month.
If you use wish to go with Cogeco Cable's @Home wave access, it costs
roughly $40 / month. Having said this, the cable modem route is just so
much faster that if you can afford it, give it a try.
Q) Gym facilites
I haven't used the Mac gym facilities but technically, as residents you
need to pay an additional fee to use the student facilities. My
understanding is that it is in the range of $40 / 3 months.
Most of the residents at our family practice that are using gyms have
enrolled in private gyms due to convenience issues.
If
you live in the downtown hospitals/ St. Joseph Hospital area, there are
a few residents I know of who have joined the YMCA in downtown (James
St.) It costs roughly
$30/month If you enroll as a student.
The
Program – Social Requirements
Q) Do I need a car?
A qualified YES. I know of about 3-4 residents that have managed just
fine without requiring a car during their PGY-1 year. Of course, this
all depends on where you live and where you do your rotations. Indeed,
there are a couple of dedicated (nutbars?) who have the displeasure of
commuting to Hamilton daily by GO bus.
In
general, most of your time will be spent at McMaster and when you ARE
doing full-time family practice, you can probably do without the car.
However, let’s get one this straight.
The Hamilton Transit system is unreliable and slow.
Unlike Toronto’s TTC or the Ottawa bus system, you can expect
to significantly increase your commute time with the transit system and
you are trapped in the city.
Q) Parking
Yes. This is perhaps the most important point. Perhaps they don't make
it clear (they certainly did not to me) but at Mac, the official line is
that you need a car for your residency. I know some residents that do
not, so it is possible, but it makes things much more difficult.
In fact, this is why they will even issue you tax receipts for
your car!
Parking is around $45-50 / month and will give you access to parking
facilities at all of the teaching hospitals. As a resident, you are (to
my understanding) assured of a parking spot and you can set this up the
day you register and pick up your incoming information from postgraduate
education.
This way, you save yourself the $6-8 parking charge on your registration
day.
The parking office is not always staffed by knowledgable attendants so
here's a tip -> get them to deduct the parking cost from your monthly
salary. Otherwise, you'd have to fork out $600 up front (which some
residents were asked to do). Instead,
have them deduct $50 /month which will hurt much less.
And
trust me, unless you have family resources (read -> $) you will be
hurting your first year if you want to tread water with your debt.
Q) Car Tax receipts and deductions
T2200 Forms. These are the official forms that indicate that you need a
car for your residency program. Although officially, you are only
allowed to claim a very limited amount of mileage (theoretically :) but
your lease payments, repairs, etc... should be deductible in one form or
another. At least I hope so since that's what I've submitted on my tax
form. I'll keep you updated when I get my tax refund back.
These forms will not be available until Feb/Mar. 2000 for the current
tax year.
"The program office forwards names of all residents in the program
verifying they require use of a vehicle as part of their duties as a
resident. A T2200 form can be issued to those wishing to use it for
income tax purposes by calling Lynn at Chedoke Payroll 521-2100 Ext.
7869. "
If
you want more tax tips -> go to my web site and read the summary of
the tax tips to residents that one of the local accountants gave us a
talk on.
Q) How do I get email/internet access?
I cannot emphasize how important it is for you to get a functional email
account of some sort. You can even get free internet accounts at: "www.hotmail.com"
or "mail.yahoo.com". With a functional email address, you will
be able to keep in touch with the rounds happening at the hospital and
official announcements. In addition, it will be the main method of
contact for the chief residents to disseminate information to you.
Your
official email address will be issued to you after you have arrived.
The problem is, it will be deactivated after you graduate (the
cheapskates). Thus, if you
come from Toronto where they keep your email address active forever, you
might just want to stick with that one instead of changing it again in 2
years.
Q) How do I get a password to access the computer for lab
work/scheduling.
You need to show up at MUMC 1C7 with your ID badge to activate your
account to access the hospital's lab and radiology report system. It
will allow you to look up patient demographics as well as get current
and past reports.
MAKE
sure that they activate your access to radiology reports as well since
residents (including myself) sometimes do not have this activated when
they arrive.
The Perks
What
Perks?
Q) Where is the food? freebies?
This is a true tragedy. The official McMaster line is that drug company
sponsored food will rot your mind and cause widespread decay and
corruption. Seriously. There is a strong negatory line on the whole free
lunch thing and it is frowned upon to have this done.
Now,
some practices/supervisors are nice enough to turn a blind eye to this
whole thing and we indeed do have some residents that are happily full
at the end of the day. But
this is a rare event and you shouldn’t expect it.
If you’re from ANYWHERE else, expect to starve and spend at
least $300 more for your own food over the year.
AT LEAST.
Can
you tell that I don’t necessarily support this policy J
Q)
How about local events?
Let’s
face it… Hamilton is a hole. The
downtown core has been rotting due to economic decay and the collapse of
the steel market and resource center over the last 2 decades.
I WOULD NOT ever raise a family in the downtown core.
WARNING, WARNING MASTER ROBINSON….
However,
Oakville and Burlington are really great places to live.
If you MUST stay in the Hamilton region, consider living in
Dundas or Ancaster… suburbs of Hamilton.
OR you could live up on the Mountain.
Don’t
understand all of the geographic land marks?
Look it up on the map posted on my web site.
There
are really some incredible foliage and outdoor activities that you could
do in Hamilton… But if it
were me, I’d prefer living in Burlington proper instead.
Q)
How about taxes? Line or credit?
I
refer you to the very informative talk that one of the local tax
accountants gave on this subject.
http://mcmaster.cjb.net
If
you have the typical resident debt ($40-80 k) then do not expect to do
much more than tread water. However,
if you want to live a reasonable, semi-glamorous life (drive a 1987
Tempo, eat at Taco Bell, go to $2.50 movies) then expect to go into
deeper debt.
What
about the raise as a PGY-2. Forget
it. It’s all gone after
you register for your 2 licensing exams.
No more. Gone, gone.
Living as a Resident
Specific
MUMC FPU (Mcmaster University Medical Center Family Practice Unit)
Questions?
Q)
What is the call frequency?
In
general, you can expect call to run between 1/5 – 1/7 depending on the
number of compatriots that you have.
If you take a week holiday, expect your call to be compressed.
The reason for this is that vacation time only accounts for 5
working days and officially, you can be put back on call on the adjacent
weekend. HOWEVER, almost no
one will do this to you (unless you request to work that weekend
specifically) so that in order to free up the weekend as well, your call
days will be compressed into the time when you are here?
Q)
What if I’m sick?
Tough
Luck. But seriously, if you cannot make it to the workday; the MOST
important thing that you can do is call the secretary as close to 8 am
as possible. That way, they
can cancel/reschedule patients if they have to.
IF you are going to be away for a period of time, you should make
sure that your supervisor knows about it.
Q)
I NEED a Holiday NOW!
Ok,
keep you pants on (unless you’re going to the Bahamas).
The official line is that you should submit your holiday requests
about 1 month prior to the rotation.
In actuality, if you know about a specific time period that you
need off, let the rotation/chief resident know as soon as possible.
For family medicine, you can easily find out who the chief
resident will be when you are on.
For
off-service rotations -> either hunt down the program director or do
what most of us do which is submit the holiday sheets to Postgraduate
medicine who will forward it to the appropriate scape-goat. Remember that all you holiday requests MUST be in around
February or you lose them. This
does not apply to your conference days however.
OK,
now what if you need a holiday during family medicine.
The most important thing to do is make sure that you are
booked/blocked out on the computer system so that they don’t schedule
patients for you on those days.
To
book out, the easiest way is to get onto the computer and do it
yourself. The other way is
just to fill out another form and submit this to the receptionists.
BTW, your staff will also need to be notified/agree with your
holiday in advance of this booking.
Generally, the limiting factor on family medicine is that you
must submit your holiday request before they start booking patients for
you on those days.
FOR
PGY-1’s this means 4-6 weeks in advance.
For PGY-2’s, you are not booked as far in advance.
On Call
I
find that most of the questions new residents have center around call.
Q)
When should I call staff?
Well,
this depends on 1) the staff and 2) your comfort level.
The MUMC FPU staff physicians are ALL extremely available and
supportive of residents. Having said that, you should probably call them always
before you tell them to come in, if you are going to refer them to a
consulation service, or on touchy things that could get medicolegally
difficult -> just to cover yourself.
As
a PGY-1, I encourage you to review your cases with your staff.
It is up to you whether you would like to bunch the calls up
together.
All
the staff physician’s like to get a courtesy call around 10-10:30 pm
just to let them know of any issues that came up through the night.
Q)
When and What do I have to see?
The on-call service at MUMC is a courtesy, non-profit (ie: we don’t
get paid) service to our patients.
As such, it is my firm belief that patients should not be abusing
us by calling about deferrable items.
However, you’ll find that you will be getting more than your
fair share of nuisance calls throughout your family rotation.
Now
here comes the important SAFETY PART!
-
when
returning calls from home, always use the *67 preceding your call to
turn off the patient’s call display feature.
Otherwise, you might get crank/follow up calls by your patients
directly to your home. It’s
happened
-
If
you have safety concerns, see them in ER or have your staff come in so
that you can see the patients together.
This applies to known rapists, villians, pirates and acutely
psychotic patients. I’m
serious, it’s happened
-
NEVER
offer to go to somebody’s home. Unless
your staff suggests it, this is a NO, NO.
If they are sick enough to be seen tonight (and impinge on your
time), they deserve an ambulance. Also,
you won’t have the support you need to treat a sicko in the community.
Don’t do it
-
If
someone is suicidal/homicidal, send them to the Emergency Psychiatric
Team (EPT) at St. Joseph’s Hospital
Call
coverage really runs from 5pm – 9 am the next morning.
We are responsible for seeing patients from 5 pm – 11 pm IF
they are urgent/emergent. After 11 pm, you can ask them to either call for an
appointment in the morning or you can send them directly to their
closest emergency.
There
are 3 exceptions:
1)
Pronouncement of death – this should be done
fairly rapidly as it can be quite distressing for the family to have the
corpse of a loved one at home until the next shift at 9 am
2)
We are the Most Responsible Physician (MRP) for a
few (2-6 patients) on the 4C chronic care ward.
So, if they need to be seen overnight, we come in.
Fortunately, this is a fairly rare event as they are usually
palliative patients.
3)
Obstetrics coverage – more about this in the
next section
Now
here comes part of the REAL truth.
The
FPU is a rostered system. (It
has time and time again showed me NOT to be a rostered physician).
As such, if your patient sees another family doctor, you will be
deducted the cost of your patient.
You get (let’s say - $80) / month for the patient.
If your patient sneaks off to a walk in clinic, you are DIRECTLY
billed $18 for that visit. If
your patient goes to a walk-in 10 times in that month, you will have
lost all $80 AND you have to cough up an additional $100 to this clinic.
Fun eh!
Now,
we all know that family physicians work in the ER. Thus, if our patients see a family doc/ER, we still get
deducted for the FULL COST of that emerg visit. You can imagine the implications on billing can’t you.
Now,
the patients have signed a contract saying that they will not see
another doc. However, there
is NO implication to them if they screw us over and break the contract.
No financial penalty. No
slap on the wrist. In fact,
the government is secretly chuckling at our loss in the background.
After all, you fat-cat family physicians deserve to get stiffed,
don’t you? [wow, I
surprise myself with my bitterness sometimes and I haven’t even
graduated yet!]
Once again, I iterate that this has taught me that a) rostering is bad,
b) patients can break the contract with no repurcussions and c) family
docs only exist to be abused.
I
would be delighted to hear any responses that you may have.
Convince me otherwise.
Q)
I am following a maternity patient – what happens?
Before 37 weeks, they go straight to OB, do not pass go, do not collect
$200.
At
38 weeks, you hand out your pager number to your patient (assuming we
get pagers after 2 years of broken promises by post-grad).
If the patient goes into labour, they call you and you start the
whole ball rolling. Don’t
worry, the staff physician will be right there to provide supervision.
You
carry the pager from 38 – 41 weeks.
At 41 weeks, we induce them if they still haven’t popped yet.
Q)
What about weekends and OB coverage?
Well, there’s the crux of the problem.
No one wants to be stuck for 3 weeks/ob patient.
The official line is that you need to hand it off to another
resident. Having said that,
only 1 of our residents (in 2 years) is committed to doing OB when she
graduates and even then, there is no reason why they want to do your
work for you.
Thus,
we have arranged that you will sign out your patient to the on-call
resident on the weekend. You
still carry your pager (if you are local) and the on-call resident will
do your INITIAL assessment for you.
This gives you time to wrap up your affairs and get your butt
back to the city to do the delivery.
This
is type of coverage is not a given.
If any of your fellow residents says NO (and they have a perfect
right to), then you have to beg/plead arrange something on your own.
Thus, this policy is reviewed at the beginning of each rotation.
Q)
Why don’t we just have the ON-CALL resident do the delivery?
I wish it were that simple. Official
line – all residents will participate in 6 deliveries during their
family rotation. Now the
gripe. The damn program
does not enforce this. Indeed,
there are residents that still graduate without having to suffer through
these 6 deliveries. I am
particularly bitter about this since both program directors do not and
have no interest in getting their own units in order with respect to
enforcing these 6 deliveries.
Q)
When should I take holidays?
Well,
the simple answer is whenever you feel like it. Now, for personal recommendations.
I
find that those that have saved up their holidays until the end tend to
burn out by that time (read – me).
Even though family medicine is your home rotation, it is NOT that
light. Call is reasonable
but the days are heavy and filled with patients.
Unlike your specialty rotations, there really is no down time
(other than lunch) as each patient you see is on a timer.
Thus,
I think it would be wise to spread out your holidays.
You do get lots of them. You
receive 4 weeks of vacation time and 7 days of conference leave.
The vacation time must be taken in chunks of 1 week blocks
although some residents seem to have gotten away with submitting it as
vacation time.
Some
people group their vacation time into 1 big block to go away for a nice
long vacation. That’s
fine but just keep in mind that it may contribute to burn out.
Not so much in the PGY-2 year as it is lighter but PGY-1 can get
fairly heavy without a break.
Q)
What the hell do you do?
I
see my job as getting this web site up and running and sustainable
before I finish my residency program.
Q)
Where can I submit more questions?
I
will happily answer all questions and tack on the answers onto this FAQ.
Remember, your
questions are mimicked by many of the other people so feel free to ask.
I don’t bite (usually).
Submit
questions by email:
[email protected]
Future
questions to be answered.
1) What selectives/electives/longitudinal elective times are there?
2) How do I know which ones to select? Which day will it be on?
8) Can you give me some rotation reviews? Where can I submit one?
