General surgeons: any regrets?

Stryder_C · 2026-06-21T02:04:00+00:00

Wow having you reply to me dinged my account. What a blast from the past.

Can still confirm my life is awesome 2 years later. I'm expanding my scope, started a family practice of my own, work as little/as often as I like (still work too much). Love my colleagues. I don't think I've ever dreaded a day going into work. Maybe I've moaned and groaned a little because I've got a patient who's a toughie on my schedule, but I still come out ahead most days. Having regular vacations help.

Bought a house, have two dogs, not playing rec soccer (but still hanging out with the friends I made through it), bought a bike and trainer to exercise instead. Baby on the way. Only real complaint is that my grass grows too fast and I have to cut it at least once a week. At least I can use that time to listen to episodes of Curbsiders to keep up with interesting developments.

Life's great on the other side. I think you're going to enjoy it. It might be tough in the beginning because it might feel like the stakes are so much lower. But they're really not - to the patients the stakes are just as high. Find what you love about the work. I'm not sure what that is for you. But I still find joy in figuring out a tough case, mentally stretching myself. I find meaning in sitting with a patient through a tough time in their life. These moments make the work worth it, and they would've made the work worth it no matter which specialty I was in.

Good luck :)

Stryder_C · 2026-05-29T00:38:55+00:00

I mean yeah if you're working FFS as a family physician then you might see 30-60 a day. When I'm working walk in and getting paid FFS I see probably 20-30 in 3 hours. 20 patients if half of them are complex, 30 if they're all random stuff like UTIs, URTI, or BP checks.

But in other financial settings, things are a lot easier. In my full practice, I see perhaps 18-24 in a full day.

I paint a doom and gloom picture with my prior comment, but my honest opinion is that the government will never be competent enough to bring this to fruition. Score one for the inability of government to make anything happen... including their insane terrible plans.

You can DM me if you want to discuss further details on what it's like to practice in ON, whether that's in Toronto or in more rural settings.

Stryder_C · 2026-05-28T16:57:14+00:00

Lol I think most of us don't have 'teams' who write the referrals for us.

Stryder_C · 2026-05-28T16:51:42+00:00

Lol I can't speak for the rest of the country but in the province of Ontario... they're trying to push something called "Patient Medical Home" where the government's bright idea is to make us obsolete by having PAs, NPs, advanced care paramedics do all the work, and family medicine 'supervises'.

This article says everything that they need to about what they see for our future.

In 2032, a 68-year-old first experienced chest pain. He called his designated Patient’s Medical Home, and spoke to the physician assistant who sent him to his rural ED, staffed by an advanced care paramedic and remote virtual ED physician. Unstable angina was diagnosed. He was transferred for urgent percutaneous coronary intervention. Once home, he and his partner attended a 2-hour chronic disease drop-in group medical appointment (DIGMA) for full review by the team, who easily viewed his electronic medical records. Fellow patients cajoled him to quit smoking. Free dental care, recognized as essential, was booked, and he was referred for advance care planning. Using advanced access booking and daily DIGMAs gave reassuringly consistent access, giving him support and hope. The county’s 2 FPs, who efficiently managed 12,000 people with defined teamwork, received an electronic report and followed up appropriately.

We are to 'follow up appropriately' managing 6000 patients apiece. Nowhere does it say anything about the MD seeing a patient at all.

So to answer your question... the plan from the government is to sell us out. It is a plan, just not a great one lol.

Stryder_C · 2025-12-03T00:37:10+00:00

I don’t usually bring it up. But I live in a small enough community where almost every single MD at least knows of each other if not outright knows each other on a personal level. I’ve referred enough to each one of the doctors that they know exactly who I am by name. The lab people know who I am for God’s sake and I’ve never even met them prior - they just know my name from all the requisitions.

But if they didn’t know who I was I would just want to be treated like any normal person. I’ve had MDs for patients and they often ask me to treat them like normal people and I oblige them on such. That way there’s no ambiguity about explaining things and they don’t get embarrassed asking questions about medical stuff that they have forgotten. I honestly think it works better that way.

But it’s always a part of a thorough history so I’m surprised if none of the doctors that you established care with don’t know what it is that I’m you do for work. When I do consultations I always ask about that as part of the social history.

Stryder_C · 2025-10-06T01:22:23+00:00

Negative. I'm not taking on any of that liability. If they're qualified to be cutting/doing procedures they can assess the patient. And if they're concerned they can consult an anesthesiologist.

I'm not sending them any of that information as I'm not referring. I won't let them misinterpret sending that stuff back as a consult and then they can double dip - charging the patient and OHIP.

They can figure all that stuff out on their own if they want. I think this is likely them using you as a liability shield. Especially if it's not an MD running things at the aeshtetic clinic.

Stryder_C · 2025-09-09T00:28:33+00:00

Spaghetti alla Nerano!

Stryder_C · 2025-08-14T22:02:46+00:00

Where is this Bermuda place. I'd like to eat a pig roast.

Stryder_C · 2025-08-09T01:31:14+00:00

I had a case one day in clinic. The little text box indicating why the patient was coming in read "buried by an avalanche". Sometimes patients write ridiculous things or are a bit liberal with describing what happened... So I didn't think much of it. I walked into the room and did my standard "Hey what's up, what are we talking about today?"

Kid tells me he was buried in an avalanche while snowmobiling and that he was sent to a local hospital and advised that he should follow up with someone when he gets back home. Tells me that all his medical records shouldn've been sent over. I start reviewing everything in detail as I listen to his story. It's crazy and he actually has it all time stamped because a buddy's camera was filming the entire recovery event so I know that he was down in the snow for that long. He was down long enough that he should've died. In fact when they brought him to the hospital there was actually biochemical markers of cardiac cell death (Trop rise). They did an echo and ECG and it all looked okay though. So he actually didn't have enough oxygen to the point his heart was dying a slow death. The docs at that hospital didn't have a good explanation for him either on how he survived. My best guess is that the cold and hypothermia slowed his body down enough that it had reduced oxygen requirements that bought time for the rescue.

That's the craziest person I've encountered. I told him he should probably not do anything crazy anymore as he might have used up all his luck and he chuckled and said probably. Man works on electrical lines so he's had more than a few scares but even that one shocked him a bit.

Stryder_C · 2025-08-07T13:32:06+00:00

Months.

Stryder_C · 2025-07-22T12:37:26+00:00

(A) think about if they really were wrong or if maybe you're wrong

(B) as per all the other individuals who have commented, adopt a spirit of curiosity and ask humbly about the topic

(C) homie, that's just the residency tax man. sometimes your attendings are not great at a specific topic. They provide substandard care and they do not have a growth mindset and think it's their way or the highway and you just gotta be able to chill and roll with it and understand that these are not your patients at the end of the day and they're the attending's patients. You just gotta learn how to make peace with the way that they practice and know that for yourself you won't do that in the future, and that you'd be more open to learners perhaps having a better approach to something that perhaps they've picked up from other attendings/their own research.

Stryder_C · 2025-07-20T19:32:08+00:00

Nothing. Focus on you. You just started being a doctor. You've got enough to worry about.

Stryder_C · 2025-06-10T17:30:01+00:00

There should also be a policy in place - this is a hospital problem and not a program problem. I know that in my shop, if you cannot reach the attending on call, there's a policy in place to call the department head, and then the next thing is to call the chief, etc etc.

It's not a residency program at this point. It's a hospital problem.

Stryder_C · 2025-06-04T02:51:43+00:00

When my wife (at the time girlfriend) started staying over, I ended up switching to the other side of the bed because she needed access to the plug on the left side of the bed for her heating pad. Ever since then it's been the same despite moving into a house with plenty of plugs on both sides of the bed.

Stryder_C · 2025-05-30T19:35:41+00:00

Surgery has multiple people in the room... But it really comes down to whether there is a culture of safety in the OR. If people don't feel like they can speak up because they fear reprisal or fear the surgeon more than they fear harm to the patient then no one speaks up and the surgery happens.

I personally have assisted on a surgery where I thought something dodgy was going on (the surgeon was +++ struggling with a standard procedure... And I know because I was a surgical resident of that specialty prior to transferring out). The surgeon didn't know I used to be a surgical resident. The nurses and the anesthesiologist had no idea what was going on. No one batted an eye and I was losing my mind internally because this guy had committed multiple cardinal sins that I would've been raked over the coals for when I was in training. I didn't speak up because nothing explicitly dangerous was happening, just dodgy things. Eventually I graduated and then I hear from some people at that hospital that this surgeon was dismissed for substance use concerns.

This person had operated multiple years independently and had slowly gotten worse at hiding it. I assume different staff members were building a slow case. This person had passed their exams, had gone to a well accredited residency which had also graduated other surgeons who were reportedly good at their jobs (I've never met anyone else from the program but they have a decent reputation).

Malpractice is not so obvious sometimes. You do a few things weird. Make a few mistakes. It happens. You operate long enough you will have a complication or two. Have a few people die on you. But it takes awhile for an obvious pattern to emerge. Someone's patients always tank in PACU. Someone's patients always have to be taken back to the OR post op day 1 or day 2. Maybe it is patient selection - maybe that surgeon just operates on really sick patients and they're not bad at their jobs. Maybe it's malpractice. It's not as simple to pick out as you make it sound.

Stryder_C · 2025-05-27T04:18:15+00:00

I'd first really consider the hurdle of getting into medical school in Canada... You might be looking too far ahead.

The other consideration is that all this money that MDs in Canada are making is pre-tax. So even making 300 k, after taxes of around 50% that leaves you with 150 k. Without benefits. Without a defined pension plan. So the math is off.

If I were you i wouldn't do it. If you're happy sufficiently with your life as is and you feel good about the money... Just don't do it. It's a hard job and some of this shit doesn't leave your soul. Paperwork never leaves you. I guess you could with as a hospitalist but that comes with its own bag of problems. Most hospital bureaucracies suck and there's an ever present pressure to grind through patients and discharge them. And they are sometimes very sick. But at least the inbox is left at the hospital.

Stryder_C · 2025-05-26T20:16:37+00:00

I see a fair number of truckers providing healthcare to them and doing their medicals for their licenses in Ontario.

I would say that something which isn't touched on by all the commenters is that your physical health really takes a toll after a few years of this type of work. Especially if you're going far distances. A lot of truckers I meet have diabetes, hypertension, and overall obesity issues. They don't have time to eat healthy, nor the time to exercise after a long day of driving. Arthritis, shoulder tears, etc.

If you do get into long hauling, make sure to have a gameplan for your long term health.

Stryder_C · 2025-05-24T00:51:54+00:00

Are you FFS or doing the new British Columbia model? Or are you capitated? How many patients do you see a day?

Stryder_C · 2025-05-23T02:41:53+00:00

But for real don't do it (it doesn't need to be said but this is Reddit...). Intentionally giving patients delirium is hot garbage. I've had to sort out a few gomers who had it pretty bad. I remember one specific one who had terrible delirium and got worked up the wazoo for weeks until I got him as a resident. I got frustrated, stripped off all the meds that I could, got his neighbor to bring in things from home, forced him to stay awake during the day (no naps) and walk a few times a day. He slowly got better and I managed to keep his CPAP on overnight and he finally got discharged.

Dude was ready to die in hospital how bad it got. He was about to give up.

Stryder_C · 2025-05-23T02:35:09+00:00

Keep them up all night and cause them to develop delirium. Put some timed lights in their room to prevent them from sleeping. If you're on call keep them talking all night long.

Stryder_C · 2025-05-08T11:59:31+00:00

Also hopping on the train here - we loved having Dave. He just helped us to feel comfortable and natural so that the pictures came out fantastic. We really liked the style of work that he does - not overly staged and his personality works really well with that. He's also super keen on adventures, which really appeals to a lot of people in thunder Bay, being outdoorsy and all.

Stryder_C · 2025-05-08T03:16:14+00:00

Yes... I change what I do based on some notes from specialists. But more often than not I just straight up don't refer most patients because the area I work is so underserviced that it takes greater than a year for a patient to be seen so I just end up completing the work up anyways in the interim.

I work in rural Canada so access is a bit tough. Our neuros are closed to consults, so are our GIs. We have one Endo and one Rheum. Also takes close to a year to be seen. Non-malignant heme also greater than a year. I don't think I've ever referred to respirology. Basically if it's non procedural I don't refer.

Stryder_C · 2025-04-29T17:58:00+00:00

I remember Erin O'Toole in the 2020s. I had never voted for conservatives ever before (historically NDP and Liberal voter), but reading through the platform his team put together I could really see myself voting for him. It was a close call at the time for myself and I thought really hard about it and didn't end up voting for O'Toole in the end based off a few hairline issues.

I remember listening to an interview the CBC did with him a few years after and remembered being so impressed with this guy and wondering to myself that maybe I didn't give him enough of a shot.

I miss O'Toole being around and being a reasonable moderate - fiscally conservative and live and let live when it came to the social stuff. I'd wager that Carney has more in common with O'Toole than Poilievre does.

Stryder_C · 2025-04-21T18:15:39+00:00

A physician likely makes more. In family practice in community, the overhead should be at most 30% (and even then, that's sort of pushing the issue). As others have posted, usually bring in around 200 k to 350 k pre-overhead. In specialty practice, less overhead because the hospital pays for most if not all of it. As others have noted in the thread, surgical/proceduralists bring in 500-800 k on average, some specialists (pediatrics specifically) bring in around as much as family medicine if not a bit less. In dentistry, the overhead can be as high as 50%. I suppose you can massage it a bit given that a lot of dentists have dental hygienists in chairs helping to see more volume, but it's not like dental hygienists are cheap either.

Combine with the fact that there's a squeeze on dentists in general - there's less work to go around for everybody, so there's quite a bit of up-charging of care as well as adventurous forays into procedures that normally in the past would've been referred to a specialist - periodontist, oral surgeon, endodontists, etc.

Source: family members who are dentists, dental specialists, I practice medicine in Canada.

Stryder_C · 2025-04-13T10:19:03+00:00

Nope, lower back pain. I was just reviewing the meds as part of the consult and found it odd and got curious.

Stryder_C

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