Hey everyone, thanks for watching 🤙 Feel free to like and comment as it really helps the video. Also, I included some resources in this video going over how to find work in rural medicine, pay breakdowns, etc. so if you’re here for that, also just feel free to skip through. Take care for now!
Hey Gianluca. I am currently completing my final year Family Medicine Registrarship/Residency in South Africa and recently came across your videos. Been loving catching up with your journey and can relate to so much of it too. From watching your videos I noted many similarities in our training programs. Of cause many conditions or experiences that may have shocked you are a norm over here, and in the same way there are many things you go through or have experienced that you share that I too have minimal experience with. I am planning to immigrate but am torn between rural Canada vs rural US. Im not really into big city life. It was real smart of you to start your USMLE journey during your Reg time. I wish i had done that. However I plan to start next year once ive completed my FM training and MMed Research. I still have a long way to go of course but your videos are inspiring. Keep up the good work man. Family Medicine doesnt get the respect it deserves and i am sure a big part of that is because it is also not well understood. You do a good job at showing what its all about.
Hey Brendon congrats on almost being done 🤙 We have 3 South African trained staff ER docs working with me right now and they've told me about how residency worked for them - very challenging but you will be well equipped for practice afterwards. Thanks so much for everything, I definitely agree with your point about family medicine being misunderstood. The USMLEs are quite difficult, but I'm confident that you will do well on them with some studying. Keep up the good work too and all the best with everything :) rural America is definitely a good place to work, but semi-rural or true rural Canada are both good choices as well - the weather tends to be colder for the most part in the winter though 😅
Would you mind going into detail on how you handle serious medical emergencies like heart attacks or strokes in a rural ER? I am assuming you stabilize and airlift to a larger hospital with the treatments for these serious conditions? When traveling northern Ontario, it has been on the back of mind as to what happens if you do have a serious emergency and you are only near these small hospitals, that in some cases are just really an ER with a few beds. We were in one town where the ER was call overnight, where they call the doctor if someone comes to the ER.
Hey Mike, great question 🤙So let's say a suspected STEMI comes in and you're the only doctor working in the ED and the wait is 9 hours to see you and then you get a call from the other side of the hospital that an inpatient fell from their bed and broke a long bone or hip.... hypothetically speaking. The name of the game is speed and prioritization. So unfortunately everyone that isn't dying right away needs to wait. Have nursing assess the inpatient - sats / monitors, ask for a review of the patient's history and get an order for pain management for them. (Keep in mind that you need to watch the O2 sats after opioid administration for severe pain management, so ask nursing to draw some naloxone as well). Get an ECG and draw HS-Troponin + cardiac labs on the ?STEMI. Call the closest cardiac centre in the area once you read the ECG and arrange for transport - they will ask you to send over the ECG and probably ask for serials to be done. Depending on length of time it's estimated that it'll take to get the patient there, you may need to treat them at your centre. PCI is favored as treatment for STEMI but usually if transport time is estimated to be > 2 hours from initial medical contact, then you'll be administering fibrinolysis. Cardiology will (hopefully) be available on the phone to answer questions and help adjust the plan depending on patient details. The unfortunate reality of medicine in many parts of Canada right now is that there are emergency departments that are supposed* to be providing care to thousands of residents that are flat out closed on weekends because they don't have staff... Many rural centres don't have CT scanners (MRI's are basically cryptids out here 😅), and some don't have X-ray or u/s after a certain time. We can ship you somewhere else, but the population spike affects all centres. Some centres actually don't have lab capabilities after a certain time so the lab techs are on-call as well. Everyone from nursing to doctors are trying their best with what we have, but the volume has really picked up.
Happy belated Birthday Gianluca! I'm starting as a first year med student at UAlberta this fall and your videos always make me feel excited to be on this journey!
Thank you dude :) Congrats on being accepted to U of A! I've heard great things about the program and hope that you enjoy your time there. All the best with everything and enjoy the rest of your well deserved summer break 💪
Sorry about your gun- violence experience.. honestly thought it's only found south of you Guys. Also thinking of doing FMed in case I get an opportunity to land that side... Always been an inspiration watching you
Thanks very much - its unfortunate but we definitely started to see increased gun violence in a variety of areas lately. Family med is a great place to be if you like the work :) I'm glad the videos have been helpful, best of luck with everything!
I meant by TTP when I found out my former GP couldn't take my insurance. He retired a couple years ago, unfortunately, a couple of months before I experienced a stroke. I met his son and daughter, and I understood his philosophy, and over the years while we poked and prodded, it was always fun
Happy birthday man, sounds like an adventure up there! I'm enjoying the small city feel of rochester mn right now, wouldnt mind living here. No traffic and everyone is friendly. Last day at mayo :( but got to do some awesome resuscitation cpr and intubation here, hopefully back again one day🤞
Has definitely been an adventure so far dude, and im sure there's more to come. Really glad you've been enjoying yourself too! Sounds like a great elective, make some good contacts and float the idea of you coming back in the future... you never know 😎
It’s been crazy seeing how far you’ve come since I discovered your channel almost 4 years ago. Thanks for the great vids as always keep up the great work! Also would love to know what your opinion is on what should be changed on how self defence laws work in Canada and how overall safety for doctors can be improved.
Thanks so much bud. As always thanks for your support as well ✌Its a complicated answer (and question) but I think that I can start by saying that many rural ED's don't have security guards. If someone came into a hospital with a gun... we have no means of defending ourselves or the public other than calling the police - which may be 5-10 minutes away in a best case scenario or 10 minutes + in others. In Canada, there's a very classic legal case whereby a to-be burglar fell through a roof that he was stealing from and actually successfully sued the owner of the property for damages in 1982 - you can read about it here: www.overlawyered.com/2006/09/the-burglar-and-the-skylight-another-debunking-that-isnt/ All this to say that many of us are quite scared of legal persecution even in situations of clear self defence because of the very high burden on the defendant to prove that their actions were not excessive. Having said that, I'm not a lawyer so I'd defer to one for a better answer as to what exactly is justified self defence from gun violence. Having experienced albeit relatively controlled gun violence while working, I personally would feel better if either security or police was hired to protect patients and staff at all times. The majority of Canadians are not trained (or comfortable enough with the concept) of handling fire arms. But on a personal note, I am in favor of personal gun ownership for self defence or in the very least, less than lethal munitions i.e tasers.
Thanks for sharing the rural medicine experience and happy birthday! You mentioned what your typical shifts look like in terms of hours. What does a typical work week look like in terms of days working vs days off?
Family medicine residency is too short and varied for proper understanding of management of many conditions...But I guess even at the end of fam med residency you continually learn as a staff.
I'm curious as to why you say that? :) There's been a longstanding debate about this in the community and I'd like to know why 6 years of post graduate training (after undergrad) is perceived as too short? And what would the ideal length of time be?
@@nxtgenmd Medical school is intense but really only sets the foundation for clinical medicine, which is truly learned in residency. Residency for Royal College specialists is generally 5 years, and these specialists only have to know one organ system. In family medicine you have to know it all (to be a good fam doc, IMO), and 2 years of residency is just way too short to learn it all. Many conditions get mismanaged because of lack of experience and clinical exposure in a safe setting, which is what residency is for. It boggles my mind that residency is only 2 years for one of the most complex specialties. Its somewhat dangerous IMO.
@@jasonb4254 Thanks Jason, that's certainly one way to look at it. Another though would be to acknowledge that "specialists" as they are correctly named are the end of the line in our medical system. The additional training afforded to them is done because cases referred to them don't have another level of care that will follow. A cardiologist doesn't refer a patient to a cardiologist ++, because a cardiologist has been designated the expert in that field through their training. In family medicine, we do not need to become specialists in everything - to do so would require multiple 5 year specialty residencies and would likely see the physician retire before they can go into independent practice. Instead, it is our goal to address the 95% of cases that do not warrant specialty referral. In other words, we have access to the support of various specialists from many different fields. The average family doctor does in fact continue to learn as they practice - some studies I've heard about do say that the average family doc will hit their peak intellectual capacity in the field 3-5 years post residency. Unfortunately many conditions get mismanaged period. This is true even for specialists with longer residencies. The best we can do is to study hard and make the most of our time in training and afterwards. There are some family doctors (and specialists) that are better than others - I think that people who say otherwise aren't being realistic. But IMO training for the field of family medicine builds off of the clinical work started in medical school (clerkship) and sets us up well for our careers 🤙 Thank you for the input :)
You will be an amazing doctor once freed from residency! Here is what I expect in a doctor: Not jaded Caring Compassionate No gaslighting LISTEN Validate what the patient is feeling I am lucky, I took a chance and called to see if a new, freshly freed from residency in November, family doctor Taking patients. Yes, it's a hour nus r8de ONE way, bit 30 minutes when bumbling city officials can get the thrice delayed Valley Line LRT opened. He is an amazing young doctor and managed to do more in ONE appointment than my doc I fired has in four years. I am sure you will be as good as my doc, and your both totally handsome as hell!
Some of us end up writing the USMLE exams during medical school and residency in case we ever need them in the future - I.e we move to the US for work or additional training. It is easier to take the exam now instead of giving up months of work in the future to study. Also taking the USMLE exams helps with general medical knowledge as the exam is largely thought to be more difficult than the Canadian exams for Canadian trained doctors
@@Buttercup312 no one is going anywhere. Writing the American exams now helps plan ahead in case you need to move to the states in the future. Ex. your partner has to move there for work and you don't want to leave them or your parents get sick and you want to move closer to them to take care of them. We should want our family doctors to take the American exams. They are generally regarded as more challenging than the Canadian exams and help us to learn more medicine. Now we do lose family doctors and specialists each year to the US. You can't blame the doctors - if conditions are more favorable for them in the US, then the onus is on our system to keep them here.
Sorry about your gun- violence experience.. honestly thought it's only found south of you Guys. Also thinking of doing FMed in case I get an opportunity to land that side... Always been an inspiration watching you
