六九色堂

Persistence and hard work pay off for Canadians who study medicine abroad at 六九色堂, complete residency in the USA and return to Canada to practice. 六九色堂 graduate Dr. Rebecca Bremner, a hospitalist/family medicine physician from a small town in Ontario, has lots to say about her particular journey. Dr. Bremner completed her rural family medicine residency at in Bogalusa, Louisiana. After completing her undergrad at the University of Ontario Institute of Technology, graduating from 六九色堂 and finishing her residency, Dr. Bremner returned to her native Canada to practice family medicine.

The 六九色堂 Endeavour鈥攁s part of a new Alumni Achievers series focusing on the success stories of 六九色堂 graduates鈥攔ecently interviewed Dr. Bremner about her medical education and how 六九色堂 helped her eventually return to Canada to practice medicine.

How 六九色堂 paved the road to residency

What about her medical education at 六九色堂 helped her get where she is today?

鈥淚 would say the number of experiences that have come with studying abroad has really helped shape who I am as a person right now,鈥� Dr. Bremner said. 鈥淧rior to going to St. Kitts for med school, I had never flown before. The only reason I had ever really left Canada was to go on the odd shopping trip to upstate New York. Moving so far away for school really helped me grow as a person and to come out of my shell. It definitely put me in certain instances where I maybe didn't feel comfortable, but I think that ultimately that helped me grow as a person. Just the number of different places I've lived and the number of cultures that I've experienced has really helped me grow as a physician because we deal with people from all walks of life. I'm able to just wrap all of that into when I'm interacting with patients and use that in handling different situations.鈥�

What are some of the best things about being a 六九色堂 graduate back practicing in Canada?

鈥淭he one thing, thinking back to basic sciences鈥攁nd I would attribute to my success鈥� is the quality of the professors that we had. The way that our professors teach, I think, is different from if I had stayed here in Canada and gone to medical school. Some things are self-taught here. I don't think that would have been a successful strategy for me. The fact that the professors just lay out all of the information in a super easy-to-understand way is helpful for each student鈥檚 success, and if you don't understand, that's okay because they have tons of time where you're able to access them in their office hours. Our basic sciences professors helped me develop the basic knowledge I needed to succeed. I also feel the number of different clinical experiences that I had throughout school also was helpful in my success. In medicine, if you're staying in one hospital setting and dealing with the same attendings time and time over, you may not be able to grow as much as a person. The way I've chosen how to practice medicine: I've picked and chosen from all the different doctors I've worked with, things that I liked that they did, or maybe things that I didn't like that I made sure I would never do again. With all of the moving that I did, even though it, at times, was a little challenging to find housing and things like that, I'm really thankful for all the different physicians that I worked with in terms of my clinical rotations to help me just figure out how I want to practice medicine.鈥�

What else is appealing for Canadian students studying medicine abroad, besides the obvious things like the great weather in St. Kitts?

鈥淚 wasn't a beach person, which probably helped with my success. I made sure I was always in class. Anyone applying to medical school in Canada knows it's extremely challenging to get in. Even if you have perfect grades/you have good reference letters, it's not always enough. I'm very thankful that 六九色堂 gives you that chance to not have to give up on your goals and they are so accepting of Canadian students. The difficult thing, of course, is always getting a residency to make sure that you're are able to become board certified. In choosing a Caribbean school, you need to make sure that you're going somewhere reputable that has good rapport with different residency programs so that you have that opportunity to match and ultimately end up board certified. I only applied to one Caribbean school, and it was 六九色堂. Thankfully, I got in. It led to where I'm at today. But I think the fact that 六九色堂 is so reputable that the Ross family has a really good background in terms of making sure that their students succeed is how I ultimately chose this school.鈥�

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Love of biology sparked interest in medicine

Dr. Bremner did not plan on becoming a doctor while growing up in the small town of Thomasburg, Ontario, Canada.

鈥淚t's kind of one of those places where you drive through, if you blink, you miss it. But where I grew up, the closest town (Tweed) was about 1,100 people give or take, and where I'm living right now is the closest city to where I grew up, which is Belleville. I did not always want to be a doctor, which is always an interesting question that I get, because some people are just set on it from the get-go. I thought I always wanted to be a high school science teacher, because I loved science. I loved helping people, and in making a difference in others' lives. My grade 11 biology teacher, when she asked me what I wanted to do in terms of where I was going after high school, I told her I wanted to just get a bachelor of science, complete a concurrent education degree, and be a teacher. She was like, 鈥楧on't do that.鈥� So that made me sit up and take note. She told me, 'You can achieve a lot more than this. I want you to think about being a physician.'" This career path had never been in my forefront of thought. She kind of went behind my back and signed me up for a 鈥楥areers in Medicine Day鈥� at our local hospital (the corporation for which I now work) and made me go. I gave it a thought and said 鈥淥kay, I'll consider this. And then the more I thought about medicine, I was always really interested in forensic science as well. I thought, okay鈥擨'll go to medical school and do pathology and become a medical examiner.鈥�

Things did not go exactly as planned.

鈥淎fter my first year of undergrad, I actually got really, really sick and ended up hospitalized for a number of days with pyelonephritis [a severe kidney infection]. I was very septic from it; it was obviously life-threatening at that point. Unfortunately, I had kind of a bad encounter with one of the residents while I was in the hospital. And that taught me that I could be so much better for my patients and that every patient just deserves care and compassion. It taught me that I felt like I could be the physician that people needed. And then when I went out into my clinical rotations, I realized that I'm good at talking to people and turns that I wanted to deal with live patients.鈥�

She told us about working as a family medicine doctor and where she is currently practicing.

A typical work day as a doctor in Canada

What is a typical day like for Dr. Bremner these days at in Ontario?

鈥淚 am practicing in Trenton, Ontario, which is the next city over from where  we live (Belleville). It's about a 25-minute drive from home. Trenton houses the largest air base in all of Canada. I am on a model of both hospitalist medicine and clinic medicine. For our hospitalist model right now, I'm working about every six weeks give or take. For one week, from Tuesday to Tuesday, I'm on call 24/7 for seven days. Our hospital is a little lower acuity than what I was used to in residency. We don't have ventilated patients or anything like that. And we typically run about a 25-patient census. So that's what I manage independently. And then we have some long-term-care type patients as well that are mostly managed by a nurse practitioner. It's been a long haul to get my license here in Ontario and to get approved for independent practice. I have now received final approval to join a family health organization, which is a group of physicians. We also have a couple of nurse practitioners in our clinic, a nutritionist, a pharmacist, a social worker for counseling, and that kind of stuff so it is a team-oriented model to help care for patients. You have to achieve full approval with the Ministry of Health to join a FHO [family health organization] which also is a lengthy process. But right now, I'm locuming in the clinic. On days that the doctors want to take time off or they don't feel like coming in for after-hours clinic, I take their clinic days and see patients for them in the interim and then as of April 1st, everything will be good to go for me to have a roster of patients of my own. I aim to be in the clinic about two and a half days per week. And then the weeks that I'm on hospitalist medicine, the other physicians cover for me.鈥�

The hospital in which she presently works is small.

鈥淲e have a pretty much a maximum of 25 acute patients and about 10 CCC patients, which are managed by the nurse practitioner. The CCC patients are in slow stream rehab; that doesn't say that we can't have patients boarding in the emergency department, but the hospital that I've joined is part of a healthcare corporation. So, we have specialists available to us, and if we need them, such as a patient鈥檚 level of care exceeds what we are capable of giving them, we're able transport them over to the main hospital here in Belleville to get them scoped, if they have a GI bleed [for example] and then we repatriate them back to our hospital, or if they require intubation or something such as ICU, then we transfer within our corporation typically to get them to the higher level of care that they need.鈥�

Dr. Bremner is working as both a hospitalist as well as a family medicine physician. She explained the differences between the two specialties.

鈥淚t鈥檚 kind of a newer model particularly here in Canada for hospitalists. The way it used to work is the family physician themselves would be the admitting doc, but having the hospitalist as the admitting doc takes the onus off of the family physician and helps with their quality of life. With family physicians, of course their primary responsibility is with their private practice in the community. So, when a patient presents to the emergency department, if the emergency department physician deems them sick enough or needing a level of care that needs them to be admitted to the hospital, then hospitalist comes down and evaluates the patient and decides, does this patient need to be admitted to hospital? Can we provide the care that they require here at our facility? Because sometimes you look at a patient, and say, this is way beyond my scope of practice and what I'm capable of providing the patient. If I deem them appropriate for admission, then I place admit orders. I, of course, am responsible for their history and physical. Then I round on that patient every single day while they're admitted to the hospital, I try to fix whatever brought them to the hospital, and then either myself of the next hospitalist taking over from me determines when is the patient stable enough for disposition. So, whether that's going back home, whether it's going to rehab, whether it's going to like a long-term care facility, we help to coordinate that. We鈥檙e responsible for all of their care during their admission and making sure that we're coordinating proper community supports for them so that when we do discharge them home, the patient can succeed and we look to minimize the likelihood that they're going to end up readmitted to our facility. This, of course, varies from just your outpatient medicine.

鈥淪eeing patients in the clinic, of course鈥攜ou run into those situations sometimes where the patient presents and they're so sick, they need to be admitted to the hospital, but it's mostly just your typical run of the mill cough, cold, congestion, UTIs, back pain, diabetes management, those kinds of things that you manage in the clinic, which is more the preventative side of things, preventing your patient from ending up admitted to the hospital. But sometimes these things happen, people get sick. So, it's kind of the more acute illnesses that you deal with as a hospitalist.鈥�

Residency in rural Louisiana

Dr. Bremner completed her family medicine residency at Louisiana State University in Bogalusa, Louisiana. She said she learned a lot about working in a medically underserved rural area.

鈥淯nderserved is a perfect use of the word when it comes to the Bogalusa area,鈥� she said. 鈥淪o [in Bogalusa] we are the only rural family medicine program of all of the residencies out of the New Orleans area, LSU. I specifically wanted a rural program. We were an unopposed residency. So, what that means is there were no other residents in our hospital other than family medicine. We basically had full run of the hospital and all of the different services. I wanted to be able to leave residency feeling competent and being able to practice medicine independently and not coming out worried that I didn't have adequate training or unfamiliarity in a lot of areas. I'm extremely thankful for the training I received in Bogalusa. I would never trade it for anything in the world, even though at times, things were absolutely crazy.鈥�

Working at a rural Louisiana hospital during the COVID-19 pandemic was rough. PPE like N95 masks were scarce, and there were few ventilators.

鈥淚t was a very challenging time. New Orleans was one of the epicenters in all of the US when that first wave came through. And at times, we were maxed out on our ventilators and ICU beds and there were no beds to transfer patients, but that made me grow so much in terms of not only dealing with very acutely ill patients, but also just how to best manage my time. It gave me a lot of perspective on what is really important in life. We really didn't have a lot of specialists in our hospital. We really only had nephrology, infectious disease, and only for a portion of my residency did we have cardiology on call. And in a population where I would say about 85% of my patients were on Medicaid, getting them to specialists was challenging, because not all specialists take Medicaid. Therefore, I had to provide a lot of extra care to my patients and fill the shoes of these specialists I did not have access to.鈥�

Since the hospital was small, COVID-19 patients often had to be transferred to larger hospitals in the nearby cities.

鈥淭here were long wait times to get our patients into New Orleans or Baton Rouge or things like that. We also lost our dialysis contract in the midst of the second wave, which presented even bigger challenges for our patients in renal failure. So, we had to become very resourceful and kind of step outside of our realm of what you would normally do as a family medicine physician, to be able manage these patients until we could get them to the specialists. This also meant extra opportunities to learn in the outpatient setting as well. We did all kinds of things like excisional biopsies in our clinic, joint injections, EMBs, all kinds of stuff. And those were precepted actually by our family medicine attendings. It鈥檚 not like you had to go out on an orthopedics rotation just to learn how to do a joint injection. So, those things became kind of second nature to us, whereas it wouldn't always be the case with your family medicine residents who maybe train in more urban areas.鈥�

The greater New Orleans metro area was one of the first and worst places in the USA to experience the COVID-19 pandemic in early 2020. Dr. Bremner was on the front lines and admits it was a scary time.

鈥淥ur program is quite heavy in terms of inpatient medicine, if you compared it to other family medicine programs. We do six months of inpatient medicine in our first year and then three months in our second year and two months in our third year. So, you basically spend a third of your residency just managing admitted patients, which of course is what gave me my love of hospitalist medicine now. But I was on service in March of 2020, when we had one of the state's first positive patients. The patient of course ended up on the ventilator and all kinds of things happened to her, eventually leading to her demise. The greatest challenge with COVID-19 was not knowing how to treat it. Typically, someone comes to the hospital with a disease, and you know how to treat it, the methodology is tried and true. It's been tested and studied; you can look it up on UpToDate. This can help you to manage things that you might not be totally familiar with. But with Covid, you had no clue what you were doing every day, the guidelines changed. You never knew what was going on. So, between that and trying to manage all the things you were responsible for when you were on call, like our labor and delivery patients, our newborns, our patients on the med surg floor, it was a very busy time.鈥�

Advice for Canadians studying medicine abroad

Being a Canadian who studied medicine abroad at a Caribbean medical school like 六九色堂, completing residency in the USA and then returning to Canada to practice may sound overwhelming to a lot of Canadian students. Dr. Bremner has advice for Canadians who attended 六九色堂 or other Caribbean medical schools and want to return to Canada to practice.

鈥淚t is a very long, arduous process, but the one thing I would say is, if that's your goal, then don't give up. Just keep pushing. For me, there were a lot of personal reasons why I wanted to return home. I had lived all over the US and ultimately had decided in the end, I wanted to be closer to family. Being away from family in particular during COVID-19 and not being able to leave the United States to come home to visit, I think really impacted my decision as well. And my father had gotten sick. So, there were just so many reasons for me to come back, but it was always on my forefront of thought even at the time of applying to 六九色堂, because I had actually known someone that had gone to 六九色堂 and had returned back to Canada. I knew it was a challenging situation. I didn't know everything that was going to happen with my licensing over the past six months. But I think, if coming back home is what's going to make you happiest, then don't settle. I think even for the fact that it took me 230 days to get my license in Ontario, I consider it short-term pain for long-term gain. Everyone of course does something for a living, and it just seems to be that family medicine is what I do, because it's what I love. But at the end of the day, you should be happy where you're working. And if coming back home to Canada is what makes you happiest, then I think it's absolutely worth it to put up with the six months of fighting with the regulatory bodies, because there is a way. You will find a way鈥攜ou just have to stick with it.鈥�

Having worked as a doctor in both the US and Canada, there are indeed differences and also similarities between the two healthcare systems in both countries.

鈥淧eople are always asking me, 鈥榊ou know, what's it like to be from Canada and practice medicine in the US and then go back?鈥� I think that both systems of course have challenges. They're just very different challenges. For me, where I did my residency, it's a little bit of a unique situation, but in most areas where you have most of your patients on a private payer source, of course, they have access to specialists and things like that. Now where I was, there were limited specialists that I could send my patients to. Of course, there were extended wait times. This doesn't vary much from where I am right now, of course, to get people into specialists at times there is longer wait times, but the biggest difference I can say in terms of Canada versus the US is here in Canada, kind of everyone's on a level playing field. We have what everyone considers 鈥榮ocialized medicine,鈥� but basically it doesn't matter if you're homeless. It doesn't matter if you're the Prime Minister of Canada; we all have the same level playing field, the same payer source. Everyone is kind of on the same access to care. Whereas that was one of the challenges I saw in the US for a lot of my patients. If they didn't have as good of a payer source, then they had to wait long periods of time and reduced access to care. And that was a challenge to me at times.鈥�

What else should Canadians studying medicine abroad know?

鈥淭he one thing I would say, particularly to Canadians, how at many of my classmates who were Canadian, many have stayed in the US and I think just reinforcing whatever makes you happy at the end of the day is what matters. Really consider where you are going to practice medicine. Is this somewhere that you want to stay long term, particularly if you're going to open a practice? For me, returning back home to stay permanently was my final goal, because I want to be somewhere that I'm not going to leave. Leaving my patients in Louisiana was one of the hardest things I ever did. Having to admit to that decision and own it, and in doing something that was best for me, at the time, was very hard. So, if coming back home is your goal, there is a way to do it. I have proven that it's challenging. It's stressful, but don't give up on your dreams if that's what you ultimately want to do.鈥�

YouTube video interview with Dr. Rebecca Bremner