Categories > First Five

From Resident to Family Doctor: Time Management Tips to Help Keep You Sane

Are you a new family physician who struggles to stay on time in clinic? Are you a resident who worries about managing a full patient panel alone? Do you ever ask yourself: “How will I possibly pay off my student debt if I am limited to only seeing 10 patients a day!?”

It can be incredibly daunting to go from splitting a full patient list with your preceptor to your first day as a locum or new staff in a clinic with a full list of 20-30 patients whom you may know nothing about… This blog post is aimed at providing a quick (but by no means exhaustive) list of tips, tricks, and pearls to foster time management and efficiency in clinic! These pearls have been collected from multiple docs in their first five years of practice as well from some seasoned past preceptors – let’s learn from their experience of trial and error.

  • Pre-planning: A little planning goes a long way
    • On or prior to your first day speak with the front desk staff about expectations:
      • If a patient is late and you are already back-logged be firm about having them re-book or that you will see them at the end of the day. (understanding life happens and you will sometimes make exceptions, just don’t make it a habit and patients will respect your time)
      • Set boundaries early regarding double booking and walk-ins/add-ins
      • Be clear about how much time you would like patients to be booked for. Consider less time for prescription refills (5-10 mins) and more time (30 mins) for complete physicals, patient with long insurance forms, AISH forms, etc.
    • Early on find out how many patients you can comfortably manage in a day/per hour. This may increase as you get more comfortable or as you get to know your patient panel and you can change your appointment slots accordingly.
    • Plan breaks into your clinic day. Every 2-5 patients block off an appointment slot to catch up or act as a buffer for appointments that go over time.
    • Purposefully leave day-of appointment slots free if you’d like your patients to be able to see you on short notice or for small emergencies (and avoid being put behind schedule by “squeezing little Timmy in to look at his sprained ankle”)
    • Educate your patients at your first meeting – tell them to show up 10 minutes before their appointment in order to get vitals etc. so you can see them at their given appointment time. Train your staff to facilitate this process.
    • Identify the complex patients that might require more time and ask staff to book two time slots for them.
  • Delegate, delegate, delegate: get comfortable asking for help or asking others to do tasks that don’t need to be completed by you.
    • Have your MOA or nursing staff proofread and format your referral letters prior to sending them. Also have them collect information such as lists of medication or long past medical histories to attach to letters rather than you having to type it out.
    • Have your nurse or MOA collect information and start the paperwork for first prenatal appointments, or complex care plans prior to you seeing the patient.
    • Train your staff to get patients and equipment ready for you. E.g. if it’s a complete physical for a female who is due for a pap, make sure they are already undressed with a drape before you get into the room. If you’re doing a procedure, have the staff have all your equipment and gloves out and ready to go.
    • Have staff communicate lab/test/imaging results to patients if a phone call needs to be made
  • Paperwork/Charting
    • Build time into your schedule to do paperwork, review labwork and answer faxes (eg. A half day once per week or 30-60 mins every morning before clinic). If you don’t it quickly becomes overwhelming and WILL interrupt your work day.
    • Don’t reinvent the wheel – using a template, stamp, or quick text (based on your EMR functionality or ones you have personally created/saved) for encounters you see often (eg. Complete physicals, URTI, biopsies, sutures, IUDs…) saves you time not having to re-type everything by just having to modify it slightly per patient
    • Try to type while you are speaking with the patient;
      • Ergonomics of the room may not be ideal for this and certain clinical scenarios may require more of your full attention but typing as you are collecting information from the patient will cut down on time spent charting after the patient leaves.
    • Try to finish charting a patient encounter before moving onto the next patient (much more efficient to do it while your memory is fresh) rather than at the end of the day.
    • Hate typing or slow at it? Consider investing in software that allows you to dictate all patient encounters.
  • Billing
    • As a new grad billing is a steep learning curve – try to complete it on a daily basis while everything is fresh in your mind. Not only will you learn quicker but you will also be more efficient.
    • Once you know your billing codes a bit better do your billing as soon as you finish the patient encounter so none of the work is left for the end of the day.
    • Know which services are uninsured services and have a guide visible for patients and staff that lists the costs you/your office will charge for these services.
  • Getting the chatty or long-winded patients out of the room
    • When patients say they have a “list of things” hear them out but then ask them to identify which ones they want to focus on today as you want to ensure to give due attention to their most pressing concerns and book follow-up for others if you have to
    • Senior patients – ask them “what has changed since the last time I saw you” and you’ll often be able to avoid rehashing their chronic, unchanging hip pain or the lump they’ve had on their wrist since they were 4 years old.
    • Have the printer(s) located outside the visit rooms this allows for a very natural “come with me to get your prescription/x-ray req/lab req on your way out the door!”
  • Remember to be polite and courteous
    • Have front desk staff warn patients of time delays Eg. “Dr. X is 45 minutes behind schedule but you are next in line” – this will manage patient expectations as well as prevent a frustrated patient stewing in your waiting room for 45 minutes while waiting to be seen.
    • When you are behind schedule acknowledge your patients who have waited and apologize or thank them for their understanding.
    • Patient’s time is valuable too and simple acknowledgement goes a long way in securing a strong doctor/patient relationship.

And finally BE HONEST with yourself if you are feeling overwhelmed in clinic and/or constantly running behind schedule and modify accordingly. Be supportive and appreciative of your staff while being clear about expectations; they are there to help. The smoother your clinic days run the happier you, your staff and your patients will be.

If you are interested in reading more on the topic the PDF below entitled “Doctor on Time” by J.W. Crosby has come to me highly recommended as a must read for new in practice family doctors!

Author: Jennifer Ortynski Bsc, MD, CCFP

Navigating the World of Insurance

Insurance—it’s a complicated subject that most medical students and residents leave on the back burner during training. However, there are many different types of insurance to consider as you make the transition to becoming a staff physician.

Depending on your specific situation, here is a list of the most common types of insurance purchased by physicians:

    1. Disability Insurance
      If you were a resident physician in Alberta, the Professional Association of Resident Physicians of Alberta (PARA) automatically provided Group Disability Insurance that was based on your salary as a resident. However, this benefit expires once you have completed your training, unless you submit an application to convert your existing PARA coverage to a disability insurance plan with the Alberta Medical Association (AMA). Note that conversion packages are normally emailed out to residents near the end of training since the conversion application must be submitted before the end of your residency contract in order to ensure continuous coverage. However, you have up to 60 days following the end of your contract to apply. More information can be found here.

      There are numerous add-ons to consider such as the Cost of Living Adjustment (COLA) that adjusts your disability benefit based on inflation, and the Guaranteed Insurability Benefit (GIB) that gives you the option of increasing your coverage annually without proof of good health. Add-ons do result in extra cost, but depending on your situation, may be helpful so it is a good idea to discuss this with your insurance provider. Of note: If you are planning on moving and practicing outside of Alberta, it is still possible to convert your PARA insurance to a plan with the AMA, as long as you maintain your membership with the AMA (for a yearly fee).

      As your income increases, you may want to re-evaluate the amount of disability insurance coverage you have purchased.

    2. Term Life Insurance
      As an Alberta resident physician, PARA provided limited life insurance automatically to all residents. Similar to disability insurance, you can convert the PARA policy for life insurance to an AMA policy upon graduation. The application form is the same. Adjustments can be made to the amount of coverage, which will depend on your specific situation.
    3. Accidental Death and Dismemberment Insurance
      Again, PARA provided this insurance automatically to all Alberta resident physicians. However, there is no option to convert to an AMA plan after graduation. If you choose to incorporate this type of insurance into your portfolio, you will need to purchase this separately.
    4. Critical Illness Insurance
      This coverage is optional, but provides a one-time lump sum payment in the event you are diagnosed with a critical illness as defined by the particular policy you are considering. There is usually a specific survival period that must be exceeded before the payment is given out and this will vary based on the insurance company you are dealing with.
    5. Professional Overhead Expense Insurance (POE)
      This type of insurance is relevant to physicians who are joining a practice permanently or purchasing a clinic where you may be incurring regular business-related costs. In the event you are unable to work, POE insurance comes into effect to help cover the cost of rent/mortgage, electricity and water bills, employee salaries, etc. If you are a locum physician, POE insurance is generally unnecessary.
    6. Travel Medical Insurance
      Health and wellness is important for physician longevity but, before you step outside of Canada, be sure to consider your options for travel medical insurance. This may have been included under your medical benefits as a resident (in Alberta, this was covered by Alberta Blue Cross), but it is no longer available after completing training. There are many credit cards that now provide travel medical insurance, but another option would be to purchase travel medical insurance separately through another provider. At the very least, your coverage should encompass the duration of travel and you may consider adding extra days in case of delays.

Some additional items to consider as you navigate the insurance world are:

    1. Update your beneficiary
      This may change depending on your life situation (e.g. marriage, divorce).
    2. Readdress your coverage after major life events
      For example, you may want to consider increasing your life insurance if you purchase a new home or have a child.

Insurance may seem like another item to add to the stress of transitioning to practice but, once it is set up, it can provide you with added reassurance that you are helping to protect what is most valuable to you.

About the Author

Dr. Michelle Chow is a family physician and NAMS certified menopause practitioner in Calgary, Alberta. She has an urban general practice with a special interest in women’s health, and also practices low risk obstetrics.

Financial Freedom for the (Young) Family Physician

Answering Your Tax Questions

One of the focuses of the ACFP’s First Five Years in Practice (FFYP) Committee this year is to empower our membership with skills to achieve financial independence.

As a member of the FFYP Committee, I have been asked to review the Federal Tax changes for the benefit of the ACFP membership. Please note that I am not an accountant or tax expert, and all decisions made using this information should be done in consultation with a professional.

The Committee is in the process of organizing several education events for our membership in this regard. If you are a physician in your first five years of practice, residency, or even a medical student, feel free to join our FFYP Facebook group or visit our website.

Federal Tax Changes
For years, physicians have been encouraged to incorporate as a means to offset reduced compensation at the provincial level by saving on taxes. The two primary ways in which tax bills were reduced by incorporating was by income splitting and tax deferral of retained earnings. Firstly, a corporation could give dividends to a shareholder (usually a spouse or a child over the age of 18), lowering the overall family tax bill by taxing personal income in the lower income shareholder rather than taxing personal income in the hands of one person. Secondly, a physician could retain their earnings within a corporation, avoiding personal income tax on those earnings, investing those earnings to earn passive income, and withdrawing money from the corporation in years where earnings are lower (i.e. parental leave, years of illness/disability, or in retirement). However, the Federal Government has committed to two tax changes that limit these advantages.

Firstly, to avoid being taxed at the highest marginal tax rate, dividends paid to family members who are also shareholders must pass a reasonability test. That is, the amount of dividends matches the amount of contribution the family member shareholder has given to the corporation. A different reasonability test has been in place for salaries for some time, but now the concept of “reasonability” is applied to dividends as well. There are several ways to assure dividends to a family member shareholder will not be subject to the reasonability test which include if the shareholder is:

  • A spouse that is aged 65 or over,
  • Adult aged 18 or over who have made a substantial labour contribution (generally an average of at least 20 hours per week) to the business during the year, or during any five previous years,
  • Adult aged 25 or over who own 10 per cent or more of a corporation that earns less than 90 per cent of its income from the provision of services and is not a professional corporation.

This is especially unfortunate, as the income splitting benefit of corporations was an excellent way for young physicians to save on taxes to pay off debt and begin saving for retirement. Some corporations can respond to the increased taxes by raising the price on its goods and services, which unfortunately, a medical corporation can not.

Secondly, the Federal government was concerned that corporations were receiving a tax benefit on business income earned at the small business corporate tax rate and then reinvested in passive investments. The Small Business combined Federal and Provincial corporate tax rate in Alberta for 2018 is 12% on the first $500,000 of Active Business Income (the tax rate on Business Income in excess of this limit is 27%). This means a corporation could earn $500,000 of Active Business Income, pay tax at 12% = $60,000, leaving $440,000 of cash left to invest in passive investments. If the $500,000 was earned as an individual, the tax rate would be much higher–leaving less for the individual to invest. This gives a distinct tax advantage to the corporation if the money is used for passive investments.

Commencing with corporate tax years beginning AFTER December 31, 2018 (so the first full corporate tax year end subject to these new rules is December 31, 2019, giving taxpayers some time to adjust to the changes), two new rules are put in place:

  1. Corporations will have reduced access to the Small Business tax rate when their “passive income” exceeds $50,000 in a tax year. This reduced access begins at $50,001 and is graduated in until the corporation reaches $150,000 of passive income. Once $150,000 of passive income is reached, the corporation no longer has any Small Business tax rate. “Passive Income” for purposes of this test is defined to include interest, rent, royalties, and dividends from portfolio investments and capital gains. However, there is an exception for certain capital gains such as disposition of property used in an active business (including goodwill) and capital gains on disposition of shares or interest of another active business corporation or active business partnership. Additionally, the prior year passive investment income of all associated corporations is used to calculate the reduced Small Business tax rate, so you can’t use multiple corporations to eliminate this issue. Additionally, there is NO Grandfathering of existing investment pools. The only relevant calculation going forward is the “AAII” – Adjusted Aggregate Investment Income which does not take into account any grandfathering of currently held investments and is basically the current years investment income,
  2. There will be a new regime of two Refundable Tax pools. Currently there is one pool where a corporation pays an additional temporary tax on investment income which accumulates in a pool. Once the corporation pays a taxable dividend, the pool is refunded to the corporation. Now there will be two pools for different types of tax on investment income.

Tax Planning
In Alberta, the corporate tax rate on active and passive combined business income will be either 12% (Small Business rate) or 27% (General Rate). Alberta Personal Tax rates are in nine different tax brackets, but generally personal incomes over $100,000 will incur personal tax of at least 36% and will increase to 48% once personal income is over $300,000. This means that active and passive combined business income earned in a corporation will still enjoy a Tax Deferral even at the General Business Rate of between 9% (36% – 27%) and 21% (48% – 27%). This Tax Deferral, if enjoyed over a long period of time, may still be preferential even if the Small Business tax rate is eliminated.

However, this Tax Deferral can be a Tax Penalty if the cash extracted out of the corporation by way of dividends in the same year as the corporate active and passive combined business income is incurred at the General Rate. For example, if a corporation is taxed at the General Rate, then pays out the leftover cash as dividends, the Tax Penalty (considering the combined corporate and personal taxes) is over 2%.

As a result, physicians are encouraged to meet with their accountants to discuss how to limit passive income earned on corporate investments, including using investments that don’t distribute interest or dividends or investments that favour capital gains. They may also decide that paying salaries from the corporation and then investing in RRSPs and TFSAs may be a stronger option for retirement planning with limits on growth on corporate retained earnings.

This article was written in consultation with an accountant. If you have questions pertaining to the information found in this article, please contact your personal or business accountant.

About the Author

Dinesh Witharana is a family physician in Spruce Grove who primarily focuses on community primary care of palliative patients. He often brings residents with him to his hospice rounds and home visits. He also enjoys participating on The Provincial Palliative Tumor Group as an Executive Member, the AMA Section of Palliative Care Fee Committee, The ACFP’s First Five Years In Practice Committee, and soon the Core Committee for the Cancer Strategic Clinical Network. He lives in Spruce Grove with two amazing children, Nala (3 years old) and Kaius (4 months old) and a extraordinary wife, Wing.




First Five Blog: Should You R3?

By Dr. Shan Lu

If you are in your second year of residency, you may be considering whether or not to do an R3. I had the same question in my second year and, to some extent, still do. This blog shares my personal story and links to the CFPC website for additional information about their Certificate of Added Competence (CAC) program.

First, the story. I became interested in the Care of the Elderly (COE) when I was in my second year of Family Medicine Residency. At the time, I was already five months pregnant with my first child. I had decided that I was interested enough in the field of COE that I would like to specialize in it, so I went ahead and applied for an R3. I was accepted and the University of Alberta even agreed to a deferred start date so I could have my maternity leave as planned.

As my deferred start date drew closer, I became increasingly aware of the difficulties I might face in balancing residency and a child under one year old. I wanted to get working (part-time at that). I had previously established enough connections in the COE field that helped me to land a related part-time position, and I’ve been working at a job I love, and learning in the field, since. Occasionally, I’ve consider returning to do a 6-month accelerated R3 in COE—mostly so that I could have the CAC behind my name.

Now the details. The CFPC currently only allows those who have completed an R3 program in the areas of COE, Sports and Exercise Medicine (SEM), Family Practice Anesthesia (FPA), Palliative Care (PC), and Emergency Medicine (EM). Newly approved domains are Addiction Medicine and Enhanced Surgical Skills.

The CFPC website states they are evaluating how people who have on the job learning could apply and be qualified for a CAC within their chosen field. For example, Emergency Medicine (EM) is a bit different, as you could gain enough experience on the job to then challenge the exam or to go through an R3 EM program. More details are available on their website:

Everyone’s experience will be different but, here are some factors you may want to consider when deciding whether or not to do an R3:

  1. Your stage of life,
  2. If you can do the same job without the extra year or if the extra year is crucial to get into the field you like,
  3. How easily you would be able to obtain the CAC if you don’t do the R3 right after your R2 year.

Hope this has been helpful.

Dealing With a College Complaint – Putting It Into Perspective

By Dr. Shan Lu and Dr. Kaili Hoffart

Patient A was admitted due to weakness, falls, failure to thrive. He was still driving prior to admission. However, his cognitive screen revealed red flags about his ability to drive safely. After discussion with the patient, the attending physician filed a form to Alberta Driver Fitness Monitoring. Patient A complained to the CPSA, outlining that the cognitive screen was not warranted and felt that the conclusions made regarding driving safety were erroneous. The complaint was initially rejected by the CPSA complaint director. The patient then appealed to the Complaint Review Committee (CRC). The CRC decided to review the complaint and had asked the physician to submit a written explanation. The physician contacted the CMPA and was assigned a case physician who helped to review and explain the CRC process. The attending physician then wrote a letter of explanation in reply to the patient’s complaints. The letter, all communications with the CPSA pertaining to this case, and all letters from patient A to the CPSA were reviewed by the CMPA physician. All this was then forwarded to a CMPA lawyer for review. The attending physician met with the lawyer to provide more information. The CMPA lawyer then modified the letter from a legal perspective. When the final draft had been approved by the physician, it was hand delivered to the CPSA prior to deadline set by the CRC. Throughout the process, the CMPA was responsive and reassuring.

It is almost inevitable that at some point a disgruntled patient will express their views to the college. Approximately 60% of all practicing physicians will have a patient complaint registered against them at some point in their careers.

A recent article entitled “Complaints Should be Something to Smile About” in The Medical Post written by Donalee Moulton highlights just this:


Patient complaints strike fear into most physicians. The deputy registrar of the College of Physicians and Surgeons of Saskatchewan (CPSS) would rather they bring a smile to doctors’ faces. “My goal is that when a physician receives a complaint to jump up and say, ‘Yes! This is a chance to improve my practice,’” Dr. Micheal Howard-Tripp told the Medical Post in an interview.
There is no room for complacency when it comes to complaints, he added. Approximately 60% of all practicing physicians will have a patient complaint registered about them at some point in their career.

Dr. Howard-Tripp recommends doctors first read the letter discussing the complaint. Then, he said, they should put it down. “Let your emotions settle.”

Although it may sound counterintuitive, it is also helpful to talk with colleagues. “When a physician gets a complaint, they tend to hold it very close to their chest. My recommendation would be to share it with others. Complaints often reflect systemic problems,” noted Dr. Howard-Tripp.

He also suggests doctors take the initiative and offer up a solution to the problem highlighted in the complaint. For example, if a doctor reviews their patient notes and concludes they were inadequate or incomplete, it can be helpful to acknowledge this and undertake a continuing medical education program directed at this practice area.

The solution may be acceptable to the patient and help resolve the complaint, especially if the issue is not seen as serious. Even if the solution is not accepted, the physician’s effort to resolve the issue will be well received by the regulator. That would stand in their favor, said Dr. Howard-Tripp.

In an article Dr. Howard-Tripp wrote on the issue in the most recent issue of the CPSS magazine, DocTalk, he stressed that honesty – with yourself – is also the best policy. “Honestly reflect upon the communication style you used. At times we physicians don’t realize that our communication style is not effective for certain patients. If there are improvements you could make in your communication, acknowledge these and the opportunity to improve.”

Physicians must also recognize that each complaint stands on its own and defaulting to the status quo in response to a complaint is not acceptable. Dr. Howard-Tripp points out that many doctors, for example, respond to complaints by stating “it is my usual practice.” “That doesn’t help us,” he noted. “We want to know what happened in this situation. Your response needs to satisfy the patient.”

Receiving a complaint can mirror the process of grief. Physicians will frequently go through stages of shock, anger, rejection and acceptance. It may be helpful to have professional advice along the way. Dr. Howard-Tripp encourages physicians to speak with the Canadian Medical Protective Association. “It’s better to correct any mistakes at the beginning.”

Do not hesitate to reach out to the CMPA early on in this process to request assistance and guidance. Their guidance and support not only helps to ease anxiety but ensures all necessary steps are followed. For further information or questions regarding CMPA assistance and legal issues, the Association can be reached at 1(800) 267-6522. If you call, you will be placed in direct contact with a physician advisor who can provide confidential medical-legal advice.

The First 5 Years

Medicine is many things. It is constantly challenging, humbling when you least expect it, stressful within an instant and rewarding in circumstances you would never anticipate. The ways in which medicine can surprise, and even fool you, is particularly evident in a physician’s first five years of practice.

The early stages of medical practice are met with beaming optimism as a long educational journey finally comes to a close. Despite this enthusiasm forging a new path can be outright terrifying at times (okay maybe even all the time). One often longs for the patiently observing staff to come forth from the shadows and peer over their shoulder once more.

One of the best ways to get ready for this exciting new frontier in one’s career is to quite simply—prepare. It may sound obvious but preparation can truly make a difference when starting practice and this most important step should start well before you even enter practice. While physicians are well educated for clinical roles and responsibilities, it’s all the other stuff that many of us tend to ignore which requires attention as we commence practice.

So Where To Begin…
Getting one’s privileges and licenses in order is one of the most time consuming and paper-work heavy aspects of the process. Considering that this has fun written all over it…many seem to stall on this opportunity at form completion nirvana. Yes, it will take forever to complete all the forms, and having them reviewed and signed off will take even longer than eternity, so it’s best to start as soon as you can!

The Alberta College of Family Physicians First Five Years Committee has a link to all the general privileges and licensing steps required for Alberta (applicable to FRCPC colleagues as well). This may be a good place to start to get one’s bearings on the process. Try to cover off all the forms and registrations at once as most require similar documentation and you won’t have to worry about it later should the need suddenly arise. (Link:

Other important aspects to set in place include establishing your professional team. It is imperative to find a lawyer for your practice basics (for example, document notarization, establishing your professional corporation, etc.). In addition, finding a good accountant will be essential as you move through your early years of practice when there are a lot of financial changes occurring. A financial planner will also be crucial in this regard.

When searching for such professionals its best to ask around, as your colleagues will know competent professionals with experience in medical practice. Since physicians have unique accounting and legal needs, look for someone who has worked with several physicians, and has an interest in this area. Having trusted professionals in place from the start will help you ease into early practice.

Another essential element of early practice is having mentors. There are assigned mentors throughout training, often a primary preceptor or a program director; but what happens when you finish? Who will that be now? Unless you’re proactive, you might find yourself without a mentor. Having a more experienced mentor to talk to and advise you through the more complicated parts of medicine is of immense value. Inevitably challenges will arise, often not directly clinical, and having access to a trusted mentor you can call or text to ask questions can really make all the difference. Soak in the knowledge and experience of others.

Furthermore, whether with a mentor or a peer, when you confront a difficult or stressful situation try to debrief. It’s important to have a group of trusted peers or practice colleagues you can talk to when you’ve simply had a bad day. Knowing that others have gone through similar challenges or hearing their words of comfort can make a stressful situation manageable, or help to process a difficult experience.

Another important principle in early practice is “err on the side of asking.” If you’re not sure about how to manage a dilemma or scenario just ask. I often find that physicians are reluctant to call expert colleagues, designated lines or even CMPA. These services are there to help you, and even if you think your question is inconsequential or small, do not hesitate to call them. At minimum it’s a learning opportunity and at best, it’s rescuing clinical or legal advice on how to manage a challenging situation.

When establishing your practice, try to weave variety into your day to day work. Doing five days of clinic a week can be very draining and may burn you out. Having even a half day for an area of interest, procedures, or an administrative role can help keep your work schedule varied and fresh. Those with more diversity in their practice, and utilizing their full set of skills, are often more satisfied professionally. Furthermore, once you commence practice you can lose your skills very quickly if you don’t use them, so capitalize on opportunities to participate in many areas of interest early on.

It is essential for early career physicians to be engaged and involved. There is already so much on the go during this phase, and just keeping afloat with clinical medicine can be exhausting but in today’s environment new doctors also need to have a strong voice and participate in whatever ways interest them. If you’re interested in education, take on teaching roles, or if you have an interest in policy or advocacy look for leadership and administrative opportunities. Expand your scope beyond just routine clinical duties from the start, and it will enrich your career.

Do stuff that is not medicine. I don’t think I could close this article without also mentioning that you should have a life outside of medicine. The first five years are often clinically heavy, but be cautious not to burn yourself out as soon as you start. There is no need to pick up every last locum or every open call shift. Learn to say “no.” Spend time with your family and friends, travel, stay active, participate in activities you enjoy, or even take on new hobbies—because before you know it you’ll be the one looking back on your first five.

Dr. Jalil grew up on the Saskatchewan Prairies. She obtained her undergraduate and medical degree in Saskatchewan before moving to Calgary for residency. After completing her residency in Family Medicine, Dr. Jalil did an R3 year in Women’s Health.

Dr. Rabiya Jalil, BSc, MD, CCFP
Primary care for complex and vulnerable populations, surgical assisting, and women’s/ sexual health. Dr. Jalil serves on a number of committees and also takes an active role in medical education, teaching at the University of Calgary and as the Medical Director of the Alberta International Medical Graduate Program.

Friedberg, Mark W. et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. RAND Corporation, 2013,

Article originally published in Vital Signs magazine.

Dying With Assistance

“Death comes for all of us…Most lives are lived with passivity toward death-it’s something that happens to you and those around you…but [we] trained for years to actively engage death, to grapple with it…and, in so doing, to confront the meaning of a life…The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” (Kalanithi, 2016)

In his book, When Breath Becomes Air, Paul Kalanithi, a senior neurosurgical resident faces his own mortality after years of staving off the death of his patients. His book raises the question: What is our role in patient death as a physician? With modern advances of pharmacology, oncologic treatments, surgical technology, and medical devices, it would appear that we are trying to prevent death at all costs. But what about those costs?

As a family physician with a special interest in palliative care, I witness the frustration that can occur when we are faced with a patient with an incurable illness. As a result, we try to manage and reverse it. Take for example the case of Jane, a 50 year old woman with advanced early-onset dementia who is diagnosed with a biliary duct obstruction from a pancreatic cancer. Is there a fixable problem? Yes. But should we fix the problem? No one asks the latter question and Jane is rolled into the OR. There’s also Doug, a 67 year old man with lung cancer who is admitted for a pneumonia that is not responding to oral antibiotics. He is admitted to the ICU for vasopressors to keep his blood pressure up and IV antibiotics to try to fix the pneumonia. Doug passes away 3 weeks later, in ICU hooked up to 2 monitors, 3 IVs, 1 central line, and a BiPap machine. These interventions may have prolonged the lives of Jane and Doug, but would they have personally chosen them if they were made aware of the price to pay for the time gained?

What if death is not the enemy? What if anything that affected both the quality and quantity of life were made the enemy. This could include both diseases and our cures. Tom is an 85 year old man with a severe ischemic stroke resulting in sustained hemiparesis and difficulty swallowing. He is at high risk of contracting aspiration pneumonia if he is allowed to eat, and so he is denied any food for his safety. Tom asks if he can eat a hamburger. A family conference is held, and his family is made aware of the risks of his request. Tom enjoys multiple homemade meals before he passes away a few days later. His family wonder if they did the right thing and question the doctor’s decision to allow him to eat, but Tom already said what he wanted. He wanted to live until he died. And to him, living meant having a hamburger with his family.

Just this past week, a patient with liver cancer was admitted for a viral pneumonia. His distressed family requested something more for his dyspnea as they watched him struggle. As he reaches out gasping for air and restless from hypoxia, the family is told there is nothing more than can be done without risking his life.

A physician must really ask themself, are we truly battling against death? It may happen regardless of what is done, but it is our patient’s lives that we can truly impact. Near the end of the journey with a life-limiting illness, the interactions with health care matter most. As death nears, health care decisions can have a dramatic effect on how our patients and their families remember the last days. The issue of medical assistance in dying is far too complex for the scope of this article. But there is no question: When our patients are dying, they need our help more than ever.

Reflections on My First Five Years in Family Practice

Welcome to the Inaugural ACFP First Five Year Blog Post!

Our first post will be look back at my first year of practice after graduating residency. The first posting is Part 1 of three where I will focus on things I learned about myself and adapting to a new life of being the staff physician.

PART 1: Reflections on Being a Fresh Grad

There is a learning curve

I remember my first day in clinic after graduating like it was yesterday—I had a full schedule of patients and this was it—I’m a big boy now. Thinking about it now, there were many things I didn’t know that I had to quickly learn on the fly. I was always told there was a learning curve coming out of residency but I didn’t understand it until I experienced it for myself.

There is more than one way to practice medicine
As a learner, there was always only one way to practice that I knew of – the way of my preceptor. Now that I’m on my own, I see how people approach problems differently and this is ok. Medicine is an art and a science.

Textbook cases are not the norm.
As a resident, one of my preceptors had a favourite saying – after discussing cases she’d often sit back in her chair and say “Ah, the uncertainty of family medicine”. I don’t think I genuinely appreciated what that meant until after graduating. Now, I truly appreciate that most cases are a shade of gray.

Don’t be afraid to teach.
Teaching a student, or heaven forbid, a resident can be a bit daunting when you yourself are fresh out of residency. Don’t worry – despite your own fears you do have something to offer as you have more experience and time in the game. It’ll also keep your knowledge sharp and provide you with some outside perspective on your medical practice.

Medicine is always changing and the practitioner is always evolving; I suppose this is why it’s called the practice of medicine! What four things did you learn about yourself in your first year of practice? Please feel free to leave comments below!

Don’t forget to check back here next month for Part 2: Reflections on Practice Management.