I Didn't Expect This... Full Time Family Medicine + Rural Emergency Medicine | Doctor VLOG

My first day back in rural emergency medicine was wild... As a new family medicine doctor working in Canada, I will opening my office in July and working full time. But in addition, I've also signed on to work rural emergency medicine as well. The plan is to commute 3 hours from my office to northern Ontario and work a 24 hour emerg shift 2-3 times per month. I've spent the last few months renewing my ACLS, PALS and other certifications and will be working with some of the best rural doctors in the province to sharpen my skills over the summer. This is how it's been going so far.
#RuralMedicine #doctor
Bio:
Hi everyone, it's nice to meet you 🤙 My name Is Gianluca and I'm a second year family medicine resident physician at McMaster University in Ontario, Canada. I'm just trying to document my experiences throughout my medical training and beyond to hopefully help inspire/guide some other students... and make things more fun for myself :) I post a new video once per week.
Feel free to contact me on KZbin or Instagram if you have any questions.
📬 Follow Me On Social Media
Instagram - @NXTgenMD
(That's all... medical residency and KZbin keep me busy enough 😅)
🎹 Music
All music comes from Epidemic sound.
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[@nxtgenmd]

Hey everyone, hope you enjoyed the video. If you have any other questions that I may be able to answer about emergency medicine, feel free to ask. Also, I just realized that I didn't really explain the term VSA for anyone who didn't already know. VSA stands for vital signs absent and refers to a patient who is being brought in by EMS in cardiac arrest. These are usually associated with poor outcomes especially if there has been a long period of "down time" before someone called the ambulance.

[@haroonahmed3873]

Great video! I’m about to start FM residency this summer and I’m wondering how ready you feel to practice rural EM independently? Are mentorships like this common? Also, if you know anyone who did the +1 in EM, how did they feel about entering independent practice wherever they ended up, compared to those who did the 5-year royal college program? I love FM for its variety but that makes it more difficult to decide on fellowships (hospitalist is really appealing too). Thanks!

[@nxtgenmd]

@@haroonahmed3873 Thanks dude 🤙 Rural EM is difficult - I don't think many people come out of residency and are 100% confident to handle everything that you're going to see up north. But I think that this is also a good thing because it reinforces the necessity to push yourself during the mentorship training and to keep studying up on your own time. From what I've seen, the FM grads that do well in rural ED are the ones that can adapt to change quickly and can learn to stay calm during emergencies that you haven't seen before. Having said that, while I know that I am not a replacement for a well seasoned rural doctor yet - I know that they need the extra help really badly and I'm confident that over the next 3 months, I will be fully ready. - Mentorships are common and vary depending on site location and how quickly the mentee advances. - The +1 EM docs in my experience do come out very well prepared - but this is also learner specific. Some people know that they need more time before they feel comfortable and will pursue the 5 year program for that reason. The 5 year docs are also amazing but I think it's incorrect to say that they are "better" than the +1 docs. - The best part about FM is the flexibility. Do what you want, work hard and you will be ok :) Good luck with residency!

[@axela4606]

Loved the video brother. You ever see yourself practicing outside of Canada or even Ontario?

[@nxtgenmd]

Thanks a lot my friend. Right now, I have no intention to leave Canada. But I do have all of my American exams done in case the reality of medicine in Canada changes significantly. Its never a bad thing to be overqualified in our field 🤙

[@tdwebste]

Rural Ontario needs doctors like you, willing to do some emergency. Farming is dangerous. Maybe each accident is not as serious as car accident, but far more frequent. Countless smashed fingers, hands and slashes, and a few head and other serious injuries. You are very appreciated. If you have time, please tells what would make your life as a family doctor doing emergency. More doctors? More nurses? More ER to help people before they arrive at hospital. Or is it burcratic, full time vs contractor.

[@nxtgenmd]

Thank you very much 🤙 I agree entirely, farming is a very dangerous job and is compounded by the fact that because of the intensive workload, many people will not seek medical attention unless a situation is dire. In Ontario, we need all 3 of those things right now. There are hospitals that have closed down because of staffing shortages - this causes overcrowding at other centres. We also have many graduating family medicine doctors who do not want to work full time after residency for a variety of reasons... while I don't want people to be overworked, unfortunately not working enough makes things much worse too. The 1 change that would make my job in rural ER easier would be for every patient to have a good family doctor. Someone to manage their diabetes, do what they can for chronic pain and provide psychological treatment for depression, bipolar, etc. This would greatly cut down the strain on our ERs right now. Somehow doing something about the opioid crisis would also be a huge improvement

[@tdwebste]

@@nxtgenmd Thank you for sharing. I am sponsoring a couple people with the cost of their Paramedic training. So they can decide if they want to make the commitment to be a Doctor. The reason I do this, when I was in high school, a classmate and neighbour died in a farm accident near Blyth. I know the situation closing hospitals and emergency is very hard on volunteer firefighters and Paramedics.

[@amrmohammed3055]

Thanks for the update Doctor!

[@nxtgenmd]

💪

[@joannaigo5635]

Thanks for an awesome video as always. This part of emergency medicine can be quite overwhelming, but can also be rewarding when you have good outcomes. Keep up the great work. You really inspire me.

[@nxtgenmd]

Thank you very much for this :) all the best with everything on your end as well

[@sandranada]

Another awesome video. Thank you !! And thank you for talking about working emergency medicine as a family doctor. I'm torn between the two (residency-wise) and you just proved that you can absolutely do both. So you definitely answered my previous question (from your previous video). I'm looking forward to your next video!

[@nxtgenmd]

No problem! I'm glad that it helped :) I would reinforce the notion that if you are ever torn between family medicine and anything else, you should probably do family medicine. There is enough flexibility in the field where you will find something that you enjoy. Good luck!

[@SV-ey3sw]

goated video🔥🔥

[@nxtgenmd]

💪

[@jeanetteraichel8299]

I certainly hope that your community you'll be serving will appreciate a new, young doctor wanting to be a family medicine doctor. The older doctors have dealt with a lot of crap, and surely COVID only made it worse.

[@nxtgenmd]

You are 100% right. I have a lot of respect for the older doctors, but I also actively take steps to hopefully avoid becoming jaded with the profession

[@neshgaldino3574]

Hello Dr., I'm an IMG trying working my way to medical residency in Canada. I really appreciate your content! Could you please make a video about the different pathways FM doctors can follow after residency? Many thanks!

[@nxtgenmd]

Hi :) I'm glad the videos are helpful - check this one out if you haven't already. There should be some useful information for you. Good luck! kzbin.info/www/bejne/jqrOYouvqdONr6c

[@neshgaldino3574]

@@nxtgenmd Many thanks! It really helped a lot!

[@JustineMc92]

Not necessarily a rural emerg question, just a general emergency medicine/doctor question- I know that doctors are SUPPOSED to treat every patient with the same level of care etc, but how do you handle patients coming to emergency for minor things? Example: I have a central line and every time something happens with it (can't get blood return, won't flush etc) I have to go to Emerg to check to make sure it's still in place, community nurses can't administer CathFlo, get blood cultures drawn (all depends on the issue) and I always feel so bad for going to emergency for this even though my line is my lifeline and they can lead to bigger issues! I also quite often get doctors who make me feel bad for taking up their time for "silly issues" (yes, I've been told that) but it's what I have been told to do

[@nxtgenmd]

Hi Justine, I'm sorry to hear about your negative experiences on some occasions. I don't want to throw anyone under the bus, but we really should be as compassionate as possible with everyone - especially since I know that most people do not want to be waiting 9 hours in a busy ED and wouldn't be there at all if they could have avoided it. On the other hand, I also know that the ED can be a really taxing place on the healthcare staff working. Especially after 20 hours and 2 resuscitations (this is just an example). I try my best to walk into each encounter with an open mind and try to practice active listening - this is sometimes easier said than done. Access the ED when you need it and best of luck with everything.

[@mohammadsrour6685]

Thank you for your videos. I'm a family med Dr as well, I work outside Canada. I am applying for Nova Scotia license and hopefully will be getting it soon. I didnt discuss my contract in depth yet, but no one mentioned relocation/signing bonuses. From your experience, do drs get signing/relocation bonuses when signing new contract in Canada? In the US, signing bonus can be 20k.

[@nxtgenmd]

Glad the videos are helpful :) Yes there are signing bonuses - these vary by province and by city / region. In Ontario, only the more rural places offer signing bonuses (usually between 25,000 - 100,000 dollars for a 5 year commitment). I believe that of all the provinces, newfound currently has the largest signing bonuses - exceeding $200,000 at the highest tier from what I've been told. Here is the link: workinhealthnl.ca/incentives/#forPhysicians Good luck with everything!

[@LindaMartin-hn9py]

Hey Gianluca! Thank you for the amazing video :) I just had 2 questions... 1) Is it possible to work emergency medicine as an attending only from Monday to Friday during daytime hours (7am-7pm), no nights, and no weekends at any hospitals in the GTA? Or would this be too far fetched? 2) Is it very hard to get into the FM/EM +1 program as an IMG who has completed a Canadian FM residency? Thanks a bunch! :)

[@nxtgenmd]

Glad it helped :) 1) The GTA is a very different situation than what I'm describing - positions are more competitive when applying from what I've heard and many times, you have access to much more support. However, I have never heard of someone never working overnight as an ED doctor and no weekends / holidays ever would be unheard of in acute care in my experience. 2) It depends on the application year and your application. I know that in my year in particular, matching to the +1 was not challenging at my program - we had funding for 2 spaces and nobody at our home campus wanted one of hose spaces. Do your electives, try to publish, get to know the chief of staff and things will often work out well Good luck!

[@user-wm5ix5de5j]

Has anyone ever told you that you resemble somewhat Patrice Bergeron, previously of the Boston Bruins?

[@nxtgenmd]

You're the first, but I do see it a little bit aha :)

[@paramandeepsandhu154]

do you drink coffee everyday?

[@nxtgenmd]

Yes unfortunately. Especially when working overnight in the ED, my caffeine intake is higher than it should be. I do not recommend this.

[@mushtaqtaleb6479]

I am just curious , How you guys get paid when it comes to rural 24 shift ,is it by hours or by shift? Great video as always .

[@nxtgenmd]

Thank you 🤙 Pay varies by shift length, number of patients seen and equity. There are usually bonuses for overnight and weekends / holidays. It also varies by province and city. Some ER docs will use a fee for service schedule and others will have blended model funded in part by the hospital. Hope this helps

[@DennisBolanos]

Doc, is it true that rural patients are more grateful for the chance to see a doctor and less entitled than urban patients? 🛡🔰⚕

[@nxtgenmd]

It depends on the patient - generalizing is hard, but the stereotype of the thankful rural patient on average does hold true in my experience :) On the other hand though, there is a very bad opiate use problem in many rural communities. Patients often come to the ED seeking refills of large volumes of narcotics. These people are unfortunately not usually happy to have seen you if you needed to decline their request

[@DennisBolanos]

@@nxtgenmd Ah, I see. Thank you!

[@gourabsarker9552]

Sir what is your full time salary now as a full time family medicine doctor in Canada? Plz reply. Thanks a lot.

[@nxtgenmd]

this is the video that you want to see I believe - kzbin.info/www/bejne/jqrOYouvqdONr6c

[@bismillahatef7179]

Hi doctor, i am a new comer to canada it has been 6 months that i am here, i get to canada through special immigration process from Afghanistan and i was a recently graduated from medical university which is in the accepted list international universities, please guide me a little bit that how can i become a licensed doctor in here, i live in Calgary and i don’t know what to follow for references and what to study and what steps i will face please guide me a little bit, i will be thankful to u, i have followed some of ur videos about this but still i have questions like what is the residency exam and what does it mean is it necessary or not, i also don’t what are the reference books for medical university in canada because beside short notes like Toronto notes i need some explaining books too cuz i studied all my lectures in my own language, so i need those explaining boos too pls

[@joshbritton]

Now working in rural emergency medicine, how true do you think the rural medicine videos from Dr Glaucomflecken are? 😂

[@nxtgenmd]

VERY true dude 😂 Dr. G Is right on the money 90+ % of the time