RESIDENTS

O.A.G.S. Resident Representative, Dr. Julie Ann Van Koughnett, PGY5, UWO

Julie Ann Van Koughnett As of May 15, 2010, Dr. Julie Ann Van Koughnett of London, Ontario succeeded Dr. Karen Devon as our new O.A.G.S. Resident Representative. We are confident that Julie Ann will endeavour to represent General Surgery residents throughout Ontario to the best of her ability. Feel free to contact her through our office pertaining to any and all resident matters: JulieAnn.VanKoughnett@londonhospitals.ca or info@oags.org.

I am the new O.A.G.S. Resident Representative and am very excited to be advocating for the interests of the General Surgery residents of Ontario for the next two years. I am a fifth year resident at the University of Western Ontario. I completed medical school at the University of Western Ontario and my undergraduate degree at the University of Guelph. I also recently completed a Master of Education degree in Health Professional Education at the University of Toronto. Having been born and raised in Ontario, I am keen to ensure the future quality of surgical services in the province. I grew up in Fort Erie, a large town in the Niagara Region. On a personal level, I have seen the effects of hospital restructuring and operating room closures on my family and home community. I hope my experiences in non-academic hospitals during medical school and residency, in addition to my current training in the city of London, will give me a well-rounded perspective on General Surgery and health care in Ontario to bring to O.A.G.S. I also bring knowledge from serving as resident representative on various committees during my residency to the OAGS, including positions on the Canadian Association of General Surgeons Residents Committee and the Department of Surgery Postgraduate Education Committee at the University of Western Ontario.

Advocacy as a resident is important to me, as my colleagues and I will soon share in General Surgery workforce issues. Preserving operating room time for surgeons in both community and academic hospitals, improving residents' understanding of the range of career options for a General Surgeon, and promoting the specialty to medical students are of personal interest. I look forward to sharing opinions and suggestions from the resident perspective with the Board of Directors as the O.A.G.S. Resident Representative. If there are any questions or resident issues you would like me to bring to the O.A.G.S. Board of Directors, please contact me at JulieAnn.VanKoughnett@londonhospitals.ca or info@oags.org.

Sincerely,
Julie Ann Van Koughnett
(Note: Scroll down to read Julie's first submission to the upcoming Resident Rostrum column in The Cutting Edge newsletter.)

17th OAGS Annual Meeting
Date: Saturday, October 29, 2011
Venue: Sheraton Toronto Airport Hotel & Conference Centre, 801 Dixon Rd., Toronto
Resident Fee: JUST $20!!! (admission to daytime academic meeting and meals 8am-6pm)...reception/banquet are separate.
Parking: FREE
Details: AGM
RSVP Deadline: October 21 - Register online here
Application Form: Click here. (membership dues includes free admission to the CME accredited annual meeting)
OAGS RESIDENT LIAISONS
NOTE: If you would like to be considered for one of these positions next year, let us know! To contact a liaison from your respective program to discuss any questions or concerns you may have that should be addressed by the OAGS or OMA Section on General Surgery, contact: info@oags.org or JulieAnn.VanKoughnett@londonhospitals.ca.
Past presentations given by Drs. Allan Okrainec and Grant Moffat addressed to residents in 2008 are still poignant and can be downloaded to help with your job search.

RESIDENT ROSTRUM (Summer, 2011; Issue #32)

Game, Set, and CaRMS Match   -   Dr. Julie Ann Van Koughnett, PGY5, UWO

Throughout academic and community hospitals in the province of Ontario, July marks the beginning of a new year of residency training in General Surgery. We welcome the new crop of excited first year surgery residents and offer congratulations to Ontario’s newly qualified general surgeons!

The CaRMS (Canadian Resident Matching Service) Match proved to be very successful for General Surgery in Ontario this year. During the winter and spring, fourth year medical students and residency programs eagerly awaited the match results after weeks of interviewing and ranking. The following is a summary of the General Surgery CaRMS Match from 2011. Why are these simple statistics so important? The residency match is the first step in shaping the future of General Surgery, in choosing those who will best serve our patients through clinical work, research, and advocacy for surgical issues.

Canadian Picture: Overall, 4,531 applicants participated in CaRMS for all residency positions in Canada. The majority of applicants (2,576) were from Canadian medical schools. Approximately 1,920 international medical students and 35 American medical school students also participated. Out of the 3,012 positions available in Canada, 2,909 positions were filled, with 90% of those spots filled in the first iteration of the match. About half of residency positions are for Family Medicine and the remainder is divided among the specialties.

Focus on Ontario: There were 1,126 residency positions available in Ontario at our six medical schools – University of Ottawa, Queen’s University, University of Toronto, McMaster University, Northern Ontario School of Medicine, and University of Western Ontario. There were 860 applicants from Ontario medical schools registered for CaRMS. There are more Ontario applicants than from any other province, with Quebec being a close second (816 applicants).

The General Surgery Story: In General Surgery, there were 104 positions reserved for Canadian medical school applicants and 10 positions for international medical school applicants across the country. Every position in General Surgery was filled in the first iteration of the match. That is, there were no unmatched positions in General Surgery left for the second round or overall. Interest in General Surgery was very high! Of the Canadian medical school applicants who matched to General Surgery, 94% had ranked General Surgery as their first choice of discipline. That is an exceptional number, signaling the high demand and genuine true interest in General Surgery. There were also 59 international medical school students who applied to a separate pool of General Surgery residency positions as their first choice of discipline. There were 9 positions across the country for international medical graduates in General Surgery, leaving 49 unmatched international applicants and one who matched to another discipline.
Interestingly, even though 94% of successful candidates had ranked General Surgery as their first choice of discipline, most applicants to General Surgery also applied to another discipline. Of the 213 applicants to General Surgery, 64 applied to ONLY General Surgery. The rate of applying to more than one specialty was comparable to every other surgical specialty in the country. Perhaps the most important information can be gleaned from the demand for General Surgery positions. Of all residency positions in the country for Canadian graduates, 3.8% of positions are reserved for General Surgery. However, 4.8% of all applicants’ first choices were for General Surgery… there is more demand than availability.

Potential New OAGS Members: In Ontario, there were 36 CaRMS positions in General Surgery between the six Ontario medical schools, plus additional positions reserved for international medical students committed to staying in Canada after residency. There are variations between medical schools in the interest in General Surgery of their graduating medical classes. The table below represents the percentage of medical students from Ontario schools who applied to General Surgery as their first choice in CaRMS. Why is there variation between schools? Does the selection process for medical school applicants vary? Is the student population inherently different? Is the clerkship experience different?
While these rates vary year to year, residents and surgeons must strive to present a realistic and fair representation of what a career in General Surgery will entail, encourage best suited medical students, and allow students to make the best informed choice of specialty. The challenge then becomes providing the best training to the optimal number of trainees based on residency workload and job prospects, but that is a larger discussion not to be addressed here! It is very encouraging that so many medical students are excited by their experiences in General Surgery, enough to strongly consider our specialty in their daunting task of choosing a career path.
School of Medicine    Percentage of Class Applying
to General Surgery as 1st Choice
Ottawa 2.7
Queen's 3.1
U of T 4.5
McMaster U 6.1
NOSM 0
UWO 10.1

As always, if there are any resident related issues you would like to be brought to the OAGS, please contact me at info@oags.org or JulieAnn.VanKoughnett@londonhospitals.ca , or contact your neighbourhood OAGS Resident Liaison.
Current OAGS Resident Liaisons:   
McMaster University - Dr. Joey McDonald
University of Ottawa - Dr. Amber Menezes
University of Western Ontario - Dr. Luc Dubois, Dr. Sami Chadi, and Dr. Julie Ann Van Koughnett
University of Toronto - Dr. Chloe McAlister
Queen’s University - Dr. Alison Archibald
Northern Ontario School of Medicine - Dr. Alisha Mills

Julie Ann Van Koughnett
OAGS Resident Representative
PGY 5, General Surgery
University of Western Ontario

RESIDENT ROSTRUM (Fall, 2010; Issue #31)

Summer Days, Drifting Away   -   Dr. Julie Ann Van Koughnett, PGY4, UWO

Allow me to introduce myself. I am the new OAGS Resident Representative and very excited to be advocating for the interests of the General Surgery residents of Ontario for the next two years. I am a fourth year resident at the University of Western Ontario. I completed medical school at the University of Western Ontario and my undergraduate degree at the University of Guelph. I also recently completed a Master of Education degree in Health Professional Education at the University of Toronto. Having been born and raised in Fort Erie, a large town in the Niagara Region, Ontario health care has always been important to me. Like my fellow residents, I find myself thinking more and more about the future state of health care and surgical services in Ontario as the years go by. Location of practice, remuneration options, scope of practice, and advocacy for patients have become ever present topics of thought as I near the end of my surgical residency.

Now, let's get to the meat of the matter. As I write this column, the hospitals in London, like all hospitals in Ontario, are in the middle of "summer slowdown". I had just returned to clinical work after completing a year of research and was eager to get back into the swing of things on the first of July. I know I am not alone in feeling irritated by the reduction in functional operating rooms during the summer. While there are always floor issues to be addressed and clinics to attend (in other words, there is always work to keep us busy), we cannot ignore the fundamental importance of elective surgery to our training experience! This year, the impact of summer slowdown seems particularly restrictive to me. Perhaps this is because I am now a senior resident and itching for as much operative experience as possible. I hear the frustrated complaints of surgeons who have lost operating days and of patients who have to wait longer for elective procedures. Clearly, those who suffer most are the patients whose care is compromised by budgetary and vacation constraints. As residents, we must throw our voice into the discourse on this important issue, as it greatly affects us as well.

While not all residencies are affected by summer slowdowns, surgical programs must advocate for improved access to surgical services during the summer. Summer slowdowns may give residents a chance to focus on a balanced clinical experience and allow for a less stressful week, but we must consider what we are losing in the process for two months of the year. For a rotation that lasts only one, two, or three months, a lack of operative time undoubtedly has a substantial impact on the educational value of that rotation. Then add in work hour restrictions, post-call home after handover rules, and educational half days. Scheduling around scant operating days may be very difficult, if not unrealistic.

I hope you will join me in comparing your procedure log from this past summer to other times of the year. Is there a noticeable difference? If yes, please speak to your local PAIRO representatives about the important impact summer slowdowns have on surgical residents' education. Then think ahead to a few short years from now when our livelihoods and our abilities to properly care for our patients will be impaired by summer slowdowns. Take part in the discussion and lobby for the best possible surgical residencies in Ontario. The future of our profession depends on the medical students and residents of today. Get involved in surgical education and advocacy.

Finally, I would like to encourage all the residents of Ontario to become members of OAGS and attend the Annual General Meeting on October 30, 2010. Make the trip to Toronto and learn about essential standards in the practice of General Surgery, network with other residents and general surgeons, and improve your awareness of issues facing the future of General Surgery in Ontario. I hope to see you there!

If there are any questions or resident issues you would like me to bring to the OAGS Board of Directors, please feel free to email me at JulieAnn.VanKoughnett@londonhospitals.ca or info@oags.org.

Julie Ann Van Koughnett
PGY 4, General Surgery
University of Western Ontario

RESIDENT ROSTRUM (Fall/Winter, 2010; Issue #30)

The Good, the Bad, and the Ugly of Surgical Residency   -   Dr. Karen Devon

I recently attended a lecture on a surgical education topic. The speaker began with a head-to-head time comparison of various aspects of his residency training in 1990, compared with what we residents experience now. The bottom line was that trainees now spend more days officially on the job, yet with less “prime time” surgical training. As I reach graduation, perhaps less of a generalist than my predecessors, residents are facing new pressures on their education. This Resident Rostrum column will address changes both positive and negative.

The first culprit in our diminishing prime time, of course, is decreasing work hours. When I began residency in 2004, we were to leave at noon after an in-house call shift.  The senior residents at that time had not been through the system in that manner and resented our “time off”. However, leaving at noon was not an option or even a rule; I was told by my program director that this is a legal contract by which we had to abide. Of course, the contract has been breached time and time again over the past 5 years by the self-motivated adult learners that constitute residents. Now yet again there is a new PAIRO contract diminishing work hours. As of July, all residents on 24 hour call had two hours to sign over and then they must be sent home. So, in general surgery, starting at 6:30 means leaving by 8:30. At my institution, all 31 surgical divisions applied for an exemption to the new contract as lobbied for by the surgical residents; however, this exemption is unlikely to be sustained forever. Again, while in the ideal world, working in an exhausted state of mind may not be true learning, certainly, leaving the excess service behind for one’s colleagues diminished the other person’s ability to focus on educational experiences. As Chief Resident, I finally sympathize with my senior residents back then who were, unbeknownst to me, picking up my slack. Would it be ideal from an educational standpoint to be fresh learners all the time?  I believe so; however, the way in which the current system has adapted is by stretching everyone thin rather than finding ways to make it work.

Is there a solution to on-call woes? Perhaps. Many hospitals in Ontario have now begun to institute Acute Care Services(ACS)-dedicated on-call teams.  In the US, a new generation of surgeons is being trained this way. In speaking with my recent and graduation colleagues, many like the idea of call only - no overhead or permanent practice.  In fact, many are currently discussing forming ACS practice groups which would be dispatched to places seeking call coverage via a centralized system. As far as education goes, the ACS service, I believe, is a gem. Please read a first hand account of Nicole Callan’s experience in Ottawa, also found on this page.

While most ranted about (by resident and attending staff alike), closer to decent work hours is by no means the primary cause of diminishing prime time. This year in Ontario, both ER wait times strategies and OR cancellations have affected our training to a much greater degree. I can think of innumerable times this year where I woke at my usual 5:30 time to make rounds for 6:30 and the OR for 8 am only to arrive at my day of awake and alert educational operating and be told that “the OR is cancelled because there are no beds”. This was often followed by squabbles about the unfortunate patient (who should admittedly be first priority), lost income, disrupted schedules, but never by discussions about the educational loss to the residents, yet again. Then, if one does get the chance to scrub, there’s the ‘3 o’clock rush’. The OR budget does not allow for late rooms, and thus we hear a final plea: “Please don’t let the resident do this one. We have to be done on time.”

Now, what about the ER? While no one would argue that a sick patient needs urgent care, on the other hand a routine referral for biliary colic could once work its way through the surgical and educational hierarchy. Medical student sees the patient, who reviews with the junior resident, who calls the senior resident and so on. Well, again things are changing and in some cases, in fact, completely reversing. When your division-head receives an email alert every 15 minutes past 2 hours that a patient has been in the emergency room, he sometimes even goes directly to see the patient himself (believe it or not!). This translates into lost opportunities for learning and teaching. “Why did that patient with a wound infection wait 3 hours?”, I was asked recently. “There were 4 traumas,” I replied. “You could have left the junior to take care of the traumas and seen the patient quickly,” was what I got in return.  Is that really what I should have done? Even more disillusioning is while it may change the recorded wait time, the patient once admitted still ‘waits’ for his/her acute care bed, as there are none available. However, I just lost my opportunity to see two traumas through. No med student taking a history. No junior resident writing orders.  No senior resident teaching.

I often hear people speaking about our economic times, and they tell me physicians are recession proof.  However, I’m not so sure when it comes to surgical education. Luckily, recessions do not last forever, and as always, we will adapt to the changing times.

- Dr. Karen Devon, PGY5 UofT Chief Resident, is the OAGS Resident Representative. Comments and suggestions relating to resident matters can be emailed to: .

RESIDENT ROSTRUM (Spring/Summer, 2009; Issue #29)

Blood Borne Pathogen Testing & Future Implications   -   Dr. Karen Devon
The issue of blood-borne pathogen infection risk and therefore testing has always been a sensitive one in the health care profession, particularly to surgeons. Given the ever-increasing emphasis on patient safety and confidentiality, the issue is coming to the forefront of discussions internationally and will continue to do so.

Recently, as the OAGS Representative, it was brought to my attention by a medical student that in order to do an elective at one of our Ontario schools, she was required to provide evidence of HIV testing. After my bringing it to the OAGS board, there was some investigation and we obtained a legal opinion on this matter. The concern was that students were potentially being discriminated against, as this policy was based on a CPSO policy which obligates physicians to know their status, yet not necessarily to disclose this. However, as you know, there has been a change to the annual license renewal form by the CPSO asking whether one has tested positive for Hepatitis B, C , HIV or AIDS. It remains to be seen whether a physician will challenge this new requirement.

I believe that the policy of which we were informed, the first of its kind for any professional health care students in the country, may have wide reaching implications. The conclusion of the legal opinion was that the policy was defensible (however, had not yet put to legal test in court) and that there could be a distinction between testing students and fully licensed physicians. Undergraduate Deans have more recently implemented a policy based on current evidence which is intended to apply to all medical students in Ontario but does not deal specifically with HIV testing or reporting; therefore, this school reserved the right to make changes.

No jurisdiction in Canada has implemented mandatory testing of physicians, and some haven’t recognized that testing is medically unnecessary. Furthermore, physicians do not have to the right to request patients be tested prior to treatment. So, how can the reverse be justified, particularly when the risk to patients is lower than that to physicians? In fact, I often wonder how the risk to the patient compares to the risks of being cared for by trainees on the 36th hour of their shift. The consequences of disclosure may be career altering, while in theory confidentiality is promised. There is a recent anecdote from a physician I know who had a solid needle stick injury and positive lab tests. The physician’s hepatologist involved the lab director at this institution as he suspected (correctly) a false positive result. The lab director, without consent from the physician in question, alerted the hospital of the test result. The physician received an email while away on vacation informing him of a committee which was to be set up in order to discuss his practice privileges. How are we as current and future surgeons expected to react to such a situation when it is entirely unclear how infected physicians will be treated by licensing bodies, institutions, insurance companies and patients?

What are the responsibilities of the profession and public to surgeons who are denied the opportunity to work due to an injury they received serving others? And why are the ground-rules not being defined, based on the best evidence available, before these policies are being written? It is as of yet unclear what would happen to the infected student at the institution in question. Another Canadian school, while not having a mandatory testing policy, does state an obligation to inform the Dean of the school and even includes a statement that the student may not be able to complete their clinical requirements and may be required to withdraw. The University of Queensland (Australia) policy for students clearly states that all students must be tested for HIV prior to enrolment and that their infection could have significant implications on their future career options (with respect to exposure-prone procedures).

The American Medical Student Association has a strong stance on HIV including opposing mandatory testing. They recognize that such action violates personal rights to privacy without medical justification. They also believe that a student or resident should be allowed to complete their medical education as long as they are physically able and have no contagious opportunistic infection. This last position is consistent with the policy adopted by the Ontario Human Rights Tribunal as well as the Canadian Human Rights Act. The Act notes in a 2007 release that no instances in Canada of HIV infection in patients resulted from exposure to infected health care workers and therefore health care workers should be afforded the opportunity to continue to work at their usual occupation, provided they meet performance standards.

As students and residents, we stand to be further disadvantaged as we cannot get coverage for our future earning potential. General Surgery is already becoming less attractive to young trainees. I suspect these occupational risks and financial burdens may create even further avoidance of our specialty. Therefore, we have not yet seen the end of this issue and I think the opinions of surgeons, whatever they may be, should be an integral part of the process of defining the future of blood borne pathogen testing in Ontario.

In closing, if anyone has any opinion pieces that they would like included in future newsletters or any issues or questions at all, please feel free to contact me! - Karen

- Dr. Karen Devon, PGY4 UofT, is the OAGS Resident Representative. Comments and suggestions relating to resident matters can be emailed to: .

RESIDENT ROSTRUM (Fall'08/Winter'09; Issue #28)

General Surgery Resident Survey Says...   -   Dr. Karen Devon
Thanks to those of you who filled out our survey over the past couple of months. We had about a 30% response rate which was spread relatively equally amongst schools and PG years with the exception of final year residents (who I imagine were knee deep in books). So, my clinical epidemiology training would tell me the results may not be generalizable but they are both interesting and informative nonetheless. I would like to present the results to you here.

About 75 percent of residents intend to pursue further fellowship training. This, as far as I know, has increased compared to the past. The following is the breakdown of potential specialties:
• Colorectal 11.9%
• Hepatobiliary 7.1%
• Laparoscopic 28.6%
• Pediatric 9.5%
• Intensive Care 57.1%
• Vascular 14.3%
• Thoracic 9.5%
• Other (breast, surgical oncology, trauma, don’t know) 20%

Clearly, the nature of our basic training is changing due to work hour restrictions, lifestyle choices and new paradigms. In attending the American College of Surgeons Annual Congress in the past year, this topic was front and centre with discussions surrounding the idea of hospitalist general surgeons who take emergency call (perhaps the topic of a future Resident Rostrum column). Furthermore, the debate over whether laparoscopic training will cease to exist and simply be entirely integrated into the core training program is ongoing. It certainly was a popular response in our population of residents. Five percent of our respondents noted that they would not be ready or confident enough for independent practice; however, the majority claimed wanting to become a subspecialist as the reason for fellowship training. Twenty-five percent of residents believe they will not be able to find employment without additional training. And finally, others cite financial incentives, peer pressure, or simply enjoying the area of choice as adding variety to practice (ie. ICU).

Now, where do we think we will we be working? Fifty-seven percent would like to stay in Ontario, while 17% would move to other provinces; 22% are uncertain, 2% are planning to move south of the border and another 2% are hoping to go overseas (i.e. Asia, Africa). In terms of community size, the distribution was relatively normal with most (36.5%) wanting to work in communities of 250,000-1,000,000 and the least (12.7%) in communities of 20,000-100,000. Sixty-two percent of residents intend to be community surgeons as opposed to academic ones and 90% intend to include “basic” general surgical elements in their practice (despite the high number of budding specialists!)

The next part of the survey addressed expectations of what work life will be like. Here they are: (refer to the article for the complete table)

And finally, in order of most frequent response to least, here are factors that will influence us residents on where to practice once we’ve completed training:
• Job satisfaction
• Personalities of physician colleagues
• Earning potential lifestyle
• Proximity to extended family
• On-call frequency
• Hospital resources
• Availability of job for spouse
• Community size
• Access to schools and other resources for children
• Access to recreational, cultural, religious facilities
• Familiarity with practice setting
• Specialty coverage
• Others: research opportunities, salaried positions, availability of mentorship with Sr. colleagues Finally, residents expressed that they felt there was not enough information on opportunities for Canadian residents, what to expect and how to plan for the future both professionally and financially. We hope that our Resident Session at the recent 14th OAGS Annual Meeting (Nov.1/08) addressed most of these questions. We’d like to thank both Dr. Allan Okrainec and Dr. Grant Moffat, as their presentations were outstanding and a great compliment to the overall meeting for the residents! Be sure to check out their presentations on the OAGS Residents page: www.oags.org. The turnout for the overall meeting was quite good, 12 of whom were residents, 2 fellows and 2 med students. It was a great way to get to know future colleagues and to have your questions addressed one on one. Resident membership dues were only $10 courtesy of Covidien and included the meeting in its entirety. Keep us in mind for 2009!

In closing, if anyone has any opinion pieces that they would like included in future newsletters or any issues or questions at all, please feel free to contact me! - Karen

- Dr. Karen Devon, PGY4 UofT, is the OAGS Resident Representative. Comments and suggestions relating to resident matters can be emailed to: .

RESIDENT ROSTRUM (Spring/Summer, 2008; Issue #27)

Dr. Karen Devon
To those of you who don’t yet know me, I am the new Resident Representative to the OAGS. My role is to represent residents to the board and express our opinions to our soon-to-be colleagues as well as disseminate important information from Ontario’s general surgery community to the residents. I hope that the dialogue will be in both directions. Thus far, attending board meetings has been an interesting and educational experience, and it is clear to me that this is an excellent forum for discussion and debate and has highlighted the important work that the organization does to protect the interests of patients and surgeons in Ontario.

One of the hot topics in resident life these days is that of the limited licensure pilot project which has been a goal of the resident’s association for many years. Such restricted practice is approved and widely used in eight of the nine other provinces with residents. There appears to be many advantages of such a program intended to assist communities and patients in need due to physician shortages. For the residents, the numerous benefits include: exposure to community practice and variety of cases, generalist training, aiding in the transition to independent practice, improving financial well-being, and fulfilling CANMEDS competencies.

Currently in Ontario in order to be eligible, residents must have completed the MCCQE 1 and 2 exams in good standing, pay a yearly fee of $515 and submit a separate application to each of the potential work units (even if both are in the same hospital). This has been described as a lengthy process of up to 16 weeks per application as it goes through numerous committees for approval.

Furthermore, there will be several restrictions as follows. Work hours are limited to those already stipulated in the PAIRO collective agreement. This is a controversial issue, as the PAIRO agreement exists to restrict the hours residents are required to work for their employers, and none of the other provinces where limited licensure exists imposes this. In addition, one will not be able to take any shift within 12 hours prior to a residency shift. Deans and program directors will also have the right to veto the project for individual or all residents at any time. In terms of remuneration, currently it appears that residents will be paid through the hospitals and amounts have not yet been stipulated and therefore will be negotiated on an individual basis. In most surgical programs, residents will be allowed to work in the ICU, emergency department and by taking surgery call including assisting in the OR. Some program directors have placed additional restrictions where the resident is only permitted to work in locations where they’ve previously done service.

The feedback from residents have been mixed. One colleague has said, “Nobody in the General Surgery program during a clinical rotation will be able to take calls. It’s ridiculous that the programs have the right to regulate what a resident will do with his or her free time. The way it should work is that you can take as many calls as you think is adequate and if the program thinks your performance is being affected, then they take the appropriate measures. This is not going to fulfil the goals of improving resident’s income and ameliorate the shortage of the province.” Another has commented on the significant amount of paperwork that appears to be involved and adds, “In principle, it’s nice to know that we can freelance, but I can’t see myself wanting to add anything extra to the time I already spend as a resident.  The only aspect that might change my mind is a substantial increase in salary.” PAIRO recognizes some of the difficulties and states, “Ontario residents definitely share concerns that this process is cumbersome at present and needs to be streamlined in the future. We are hoping that the educational centres and CPSO can soon follow the examples of other provinces in creating a more efficient process, especially in the current time of physician shortages”. However, there are some positive outlooks as well and the project is particularly attractive to residents on research rotations. One resident has applied purely in order to support the project as it has been suggested that once deemed successful, money to pay the residents will actually come from the government. Furthermore at some sites, the moonlighting that is already occurring under the table will be legitimized. I would love to hear more of your thoughts as this project gets underway.

In closing, I’d like to encourage residents to become involved as members and attend future annual meetings. It is evident to me that OAGS is an important voice representing all of us at the Ontario Medical Association and lobbying for important issues such as OR access and on call coverage. The organization also helps to implement guidelines and continuing education programs and keeps us all up to date on current events and controversial issues affecting general surgeons such as wait times, regionalization, most responsible physician position statement, anaesthesia for endoscopy, and province-wide colorectal screening initiatives.

In 2007, we had a good turnout at the 13th OAGS Annual Meeting with ten percent of the attendees being residents. The talks were both educational and riveting and included progressive issues such as bariatric surgery in Ontario by Dr. Laz Klein and an incredible talk on a surgeon’s experience in Iraq by the keynote speaker Dr. Carlos Brown. This year, the meeting is on November 1, 2008 and we are organizing a resident break-out session which may include topics such as finding a job and starting a practice as well as what to expect once you’re out in the real world. It’s a great opportunity to meet your future colleagues and employers, so I hope you will join us!

Resident annual dues are $20. In the past few years, however, this has been discounted to $10 due to resident sponsor Tyco Healthcare/Covidien. Hopefully, they will sponsor us again when the new fiscal begins this fall. Check our website for up-to-date details: www.oags.org

In the next column of the Resident Rostrum, the exciting results of your resident survey will be published. Thank you to those who have participated thus far. Those who haven’t yet are encouraged to do so, as it will only take five minutes: www.oags.org/resident.htm .





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