The Beginning of the End

Hey everybody. This is the post that I (and, I think, many of you) have been waiting for. Last week as I was walking down a loading ramp at Halifax Airport I received a call from the CPSO. I heard the familiar voice of the coordinator of the Registration Committee and she told me that they had reached a decision and approved my license to practice medicine in Ontario!

Needless to say, this news was well-timed and my family was pretty happy to hear it. As for myself, I suppose I have mixed feelings about it. It's a bit complicated and there are many reasons -- not the least of which is the fact that I do enjoy working here. When I made the decision to come to Newfoundland it was with the expectation that I could spend the rest of my career working here and that it may take a minimum of 5 years before I could return to Ontario (if at all). In retrospect, it's surprising how quickly I was able to come home.

As I mentioned in my previous post, this first step may very well end up being the easiest. The hard part is to find a job and the Anesthesia job market is very poor at the moment. I was contemplating taking a chance and jumping feet first into the Ontario locum market without the security of a permanent job offer. But, I've decided against it for the following reasons:

• The locum market seems to be just as bad as the permanent job market in Ontario. It is doubtful that I'll be able to successfully string together enough locums to last a full year.
• The Gov't of Nfld. just caved in to the NLMA's demands and doctors here will, on average, earn the same as other doctors in Atlantic Canada. (Translation: big pay raise).
  
• My position here in St. Anthony is not as secure as I thought it was. I don't have the space here to explain but thanks to a wishy-washy anesthetist elsewhere in the region, a 4th Anesthesia spot was created here in St. Anthony when, technically, there are only 3 on the books. If I resign and then say "oops", the 4th spot will likely vanish and no longer be available. (There goes Plan B).
  
• The Anesthesia job market in Nfld., which was fairly open as little as a year ago, has tightened up considerably. Chronic shortages are being filled and, I've heard, there may be an influx of Irish doctors fleeing the economic problems of Ireland and Nfld. may be attractive given the pre-existing contingent of Irish-trained doctors here. (There goes Plan C).
  
• I'm an anesthetist -- I don't take impulsive risks except under extreme duress. :)

So, I've decided on my job search strategy: I won't quit my position here in St. Anthony until I manage to secure a permanent job offer from Ontario. I'm going to start working on my CV and cover letter this weekend and I'll start making inquiries in earnest in the new year.

My travel plans are starting to shape up as well. I'll be going to Banff for a conference and to Winnipeg to visit a friend near the end of January. Then it'll be back to Toronto for Chinese New Year and then to Ottawa for another conference in early February. In early May I'll be travelling to Tibet and China with my parents.

Things are starting to fall into place!

Anesthesia School: Preschool

I can still clearly remember the moment when I discovered that I liked Anesthesia. We had received our North American average of 1-2 weeks of Anesthesia lectures and this was capped off by an afternoon visit to an OR with an Anesthetist. After introductions were made the staff Anesthetist pointed out the patient's vital signs -- his blood pressure was slightly low -- and then he showed me his bloodwork which also revealed that he was slightly hypocalcemic. He drew up a vial of calcium gluconate, told me watch, and then injected it into the patient's IV. Sure enough, 3 minutes later the patient's heart rate and blood pressure increased on the monitor. I was fascinated by not only the inotropic qualities of calcium but the instant gratification of seeing the results of one's actions. A teacher once told me that a general anesthetic is akin to performing a live physiologic experiment on a human being. Giving an anesthetic requires knowledge of physiology, pharmacology, disease processes, and surgical procedures and the sometimes complex interplay between the four.

Although I was interested in Internal Medicine and found it intellectually very challenging I wasn't particularly enthused by the fact that you don't seem to "cure" people too often and that a large part of the workload is often devoted to managing chronic diseases. Cynically, Internal Medicine is like a revolving door where patients come in, get a little bit better, get out, get worse, and come back. On the other hand, as another teacher pointed out to me, the chances of giving a patient a successful anesthetic are very, very high and you get to see the fruits of your labours very quickly. There are few specialties in medicine where you can see a patient, come up with a plan of treatment, execute that plan, see the results within a single work day, and then be able to do this the day after and day after that. An Internal Medicine resident once mockingly told me that "Anesthesia is Internal Medicine for people with short attention spans" which has an ounce of truth to it.

With my interest piqued I decided to do several rotations in Anesthesia. I soon found myself doing more reading and enjoying the rotations. Most importantly, after a hiatus of a few months, I later discovered that I missed doing Anesthesia. With this realization I knew for certain that I had found my calling and I started focusing my efforts on getting in to Anesthesia.

Only graduates from medicine can know the feeling of relief that comes from discovering the specialty you want to pursue. Unless you were in the minority who knew what they wanted from the get-go you had to muddle your way through medical school in the hopes of discovering what you want to do with the rest of your life. Throw in the pressure of competition for popular specialties and you've got a pressure cooker for the last year or two of medical school. I do remember seeing the crushing disappointment of classmates who went "unmatched" and failed to get into their desire specialties.

Yet, I thought I was one of the lucky ones. It's not uncommon for students to "discover" Anesthesia late in medical school; as a young specialty it has had to compete with the more established specialties like Internal Medicine or Surgery for classtime in medical schools. However, I was able to figure it out early enough in medical school that I could plan for and direct my clerkship towards applying for Anesthesia. Lastly, by looking at the statistics for previous years I found that Anesthesia wasn't supercompetitive like Dermatology or Ophthalmology. So, I went into the CaRMS match feeling almost confident that I would get into Anesthesia somewhere. When I did match to the University of Toronto for Anesthesia residency I was not only happy that I got in but I also felt lucky that things lined up and worked out well.

The irony is not lost on me.