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How are residency positions allocated among specialties?

Hi everyone, it’s been a long time since I updated the blog – something like 5 months. I’m in clerkship now, and it’s been very difficult to find time (and ideas) to write.

I did, however, want to put in a plug for a fantastic new Healthy Debate article called How Specialty Positions are Allocated for Medical School Graduates.

For students applying to medical school, it’s hard to imagine that there could be difficulty and challenges after you get in. The truth is that medicine, like any other profession, has its own unique problems that you cannot avoid.

For one, there is no guarantee that you will become the type of doctor you desire. The only guarantee is that you will be some kind of doctor. Want family medicine? Sure, you’ll get in somewhere, as it has hundreds of spots and is one of the least competitive programs in Canada. But want plastic surgery? Well, there are only ~25 spots in Canada. Good luck.

On top of that, even if you do become the type of doctor you desire, where are you going to work? Being a doctor doesn’t guarantee a job. Health care is like any other industry. Surgeons can’t just start operating – they need to have privileges at a hospital with an operating room. It is not uncommon for some physicians in Canada to graduate and be unable to find a job in certain specialties.

The article does a great job of explaining some of these issues, and I highly urge you to read the article and reflect on some of the challenges it brings up.

HD: Why Don’t More Doctors Do House Calls?

Just wanted to quickly promote an article from HealthyDebate called: Why Don’t More Doctors Do House Calls?

In the middle of the article, it mentioned a survey:

…Akhtar’s sentiment is backed by a recent survey she sent to the family medicine residents at the University of Toronto about the perceived barriers to doing house calls in their future practices. In her survey, lack of experience and mentorship were among the most frequent responses…

I actually worked with Dr. Akhtar on a research study this past year, and the survey mentioned was one of the pieces of our project (I’m hoping to write the paper up for this soon). It’s nice to see our work highlighted, but it’s even more important that the oft-forgotten topic of physician house calls (which I believe is a necessary component for our health care system for certain patients) is being more and more brought into the discussion.

It’s a good article and I encourage everyone to check it out =)

P.S. I’m also happy to answer any questions people have about physician house calls if anyone was interested.

What IS a Good Doctor?

This is a guest post by Jerome Liu, Joshua’s older brother.


This is an interesting debate. For those who don’t know me my name is Jerome, and I am Joshua’s brother. Currently I am studying first year medicine at UofT. I figured I would give my two cents on this topics because it is a very controversial one. Unfortunately I am more of an idealist than a realist. I think the problem here is that we all have a different vision of what the minimum requirements for a “Good Doctor” is. For some, being a good doctor entails being competent and providing the proper services to patients, but does not necessarily require genuine feelings of care for the patient. For others, a minimum requirement of being a good doctor are the altruistic motivations of trying to help patients as much as possible. I lean towards the latter.

Doctors who treat being a doctor as just a job, a means to an end (money or prestige or something else more materialistic as the end) may be able to provide care for some, many, or most patients in their care, but they will consistently miss many patients too, and these patients will be receiving less than adequate care. But you may be asking yourself, what do I mean that a competent doctor, who provides the proper services can provide less than adequate care just because he is not motivated by altruistic beliefs? Well I say this because of an important lesson that some of the doctors that have taught me been emphasizing: “It is not how smart you are that makes you a good doctor, but whether the patient takes the pill at the end of the day”.

So take for example, a doctor who is competent, and follows proper procedure and prescribes meds for his patient, but meds that have undesireable side effects (such as weight gain example). Patients who have a good repore with their doctor, who feel that they can trust their doctor, are more likely to take the pill than patients who don’t. For some patients, the good advice is all they need and so they may take the pills even from an non-altruistic doctor, but for others, like the above mentioned patients, they would not take the pill because they don’t trust their doctor to be making decisions in their best interests.

This phenomenon comes into play all the time. One of the most important things that we are learning right now is how to take a proper oral history of a patient. Taking an oral history is one of the first things a doctor usually does when seeing a patient for the first time. During this history we do not just ask questions about when did your pain start, how long has it hurt, does it radiate anywhere etc. but one requirement of the oral history is to ask the psychosocial history. This includes questions like: how has this affected your life? How does it affect your work? Are you worried about it? How is your family coping? Etc. We are taught that it is not just the physiological side of medicine that is important, but the psychosocial side too. I believe that a doctor who is in the job just for the money and prestige or some other non-altruistic reason may sometimes do this in a less than adequate fashion.

To be fair, I would once again emphasize that there are many patients that will do quite well with a doctor who is competent in every respect, but just does not truly care about the patient’s well being. BUT there are some patients out there who value being able to trust their doctor and who need to believe that he/she is working in the patient’s best interests at all times. It is with these patients that physicians without altruistic intentions will fail.

Unfortunately the medical schools cannot screen for such qualities. All we can do is hope that at the end of the day a majority of people who enter medicine do it for reasons beyond the money and prestige, but want to improve the lives of their fellow human beings.