ACHQ

GIM staff here, The answer will depend on location/province. I can speak for the GTA community hospitals. I don't know of any that have 24 hour call. Some places may still have 14 hour calls (6pm-8am), but the majority are 12 hours or 8 hour call shifts.

Doing no hospital based work/call? Pure outpatient Cards I wouldn't be surprised if they billed 800k-1 mill (this is assuming they do the whole gambit of diagnostics, like stress tests, echos, nuc scans, holters, that is where is their money is) GI (again I'm assuming they work at a scoping clinic of some sort), probably around the same. Remember the overhead for these places are sometimes killer when your doing scopes or cardiac diagnostics. Sometimes 30+% of your billings in something that lucrative. So although billing 1 million sounds amazing, they take 650-700k which is still amazing (but its not a 1 million ahhaha). Some people get lucky and can swing an overhead in the 15-20% range which makes something that really worth it (take home of 800-900k)

Agreed with above poster. I can't comment on the academic settings anymore but in large urban community hospitals I have colleagues who do ID and GIM (most of them do it due to a combination of compensation but also the fact that they also like GIM). It would make sense to do ID for that reason. Even if you were not sure it would make more sense to do ID and afterwards you can just do GIM if that is really all you want to do (whereas you can't do the opposite)

GIM staff here, wrote the exam in 2019. People fail the exam even with resources. Chances of failing without resources are exceedingly high. Wouldn't risk it.

Aside from Academic GIM (which unless your into teaching and/or research, is not that appealing) there isn't a reason to do the 5 year GIM program for the community. Our GIM lead and chief of medicine don't care if someone has gone through the 4 year or 5 year program. We just hired GIM's from both. Training may eventually become the norm (but it wont be like that anytime soon, as there is not indication of that), but likely it wont matter to anyone anyways the billing codes will not change (or additional ones be added) that I can guarantee (as the OMA GIM memebership group is not aiming to do that at all, we have bigger fish to fry like increasing our MRP codes, consults etc...)

every site is a bit different in how they structure the various medicine services at the hospital. My site we have a different hospitalist department (that consists of both FM-hospitalist and GIM hospitalist) and GIM division. The GIM division takes care of the ER consult call schedule, the inpatient medicine consult service (to surgery, OB, psych etc...), and our urgent GIM clinic. Most of the GIM's participate in hospitalist as well (but not to the same degree as those that just do hospitalist work). Typically at my centre GIMs do 6-12 weeks of Hospitalist a year, 3-5 ER consult shifts a month (8 hour shifts, mix of days, evenings and nights), 3 weeks of inpatient medical consults a year, and 2-4 weeks of urgent GIM clinic a year. Again this is ONE site. Each site is a bit different. In Ontario, an ER consult + admission is roughly 235 during the day, 275 in the evening, 290 on weekends or holidays, and 310 overnight.

It's really hard for me to give one number for GIM in ALL of Canada. Different provinces have different billing codes and $ attached to each of those codes. Even within a province, centres are set up slightly differently. Volumes can also vary. What I can tell you based off of the GTHA, in community sites (that are busy) is a range. That range can be higher or lower depending on really how much you work, how many nights and weekends/holidays vs how much time you have off. I think a rough estimate between 350-500k is accurate. Note that this is just FFS billings and does not include stipends which at some sites can be alot ranging between 50-100k for the year.

What you described sounds about right, similar to what I do. Billing for that can range between 40-45k if not more.

Easily. no its not as simple as 2 weeks on 2 weeks off model in CTU, because in real world medicine there is more than medicine wards. (ER consults, urgent GIM clinic, inpatient medical consults, etc...)

No difference in pay or billing codes. The difference in pay would really be at the academic vs community level (where many 5 year GIM's opt to do academics, although I still think the majority end up in community settings, where as 4 year GIM's almost always end up in community settings). When it comes to comparing those, by far and away community blows academics out of the water, and its not even close. We're talking about 200-300k difference in pay... (unless an academic GIM is making 450-500k, which I don't think any are, most are making 300-350k). I don't think 5-year specific billing codes will come anytime soon (or ever at all) in Ontario. The reason being is the vast majority of GIM's in Ontario are 4 year trained. To have things changed at the MOH level, there has to be enough support/push from the OMA level. The OMA has bigger fish to fry from a billing perspective, than introducing specific codes for 5 year GIM's for which an extremely small portion of the membership would benefit. Won't happen when we are struggling as a collective group (physicians in general, all specialities) to get pay raises/increase to billing codes for work we do that is truly undervalued.

most outpatient cardiologists don't want to do this, or can't get privileges due to saturation issues. Some will locum here and there though. TBH building an outpatient referral base is definitely better/easier to do if you work at a hospital, but if you are apart of a large practice, you can easily get enough referrals from the community from family doctors and internists/subspecialists for cardiac assessments. imo, if I was just an outpatient cardiologist (I'm far from it, just a lonely GIM in an acute care hospital). I would just do GIM ER shifts to make money, and at the same time build a referral base cause you can easily just have those cardiac patients referred to your outpatient practice once they leave hospital/discharged. A large chunk of our admissions on any given day are cardiac in nature (CHFe, CAD/ACS, Arrythmia's, Syncope etc...)

Not really requiring. *Most* large community CCU's don't have intubated patients (these patients go to our ICU) so they can easily be managed by the general cardiologist. Most general cardiologists are comfortable with sick cardiac patients (as long as the respiratory issue confounded by infection/airways disease/ARDS). Some of my colleagues do a Cardiac-Critical Care fellowship, which is a 1 year fellowship, not a true ICU fellowship. This isn't enough to work at a large ICU that requires formal FRCPC ICU training. I'm not sure how much of it is useful for a community CCU, but probably required for a job at a large academic centre (in the GTA- TGH, Sunnybrook, St Mikes), which have intubated patients in their CCU.

Yes, yes, no (for the most part now a days). (in the hospital anyways) the vast majority of my friends/colleagues that did cardio in the last 10 years have a fellowship in something (echo, HF, Interventional, EP), so that makes space and job market tight for those that don't have a certain fellowship to do certain things (i.e. caths). For example: we have 2 cardiologists that are not interventionalists, that do/did diagnostic caths. They do them extremely seldomly now. All of our cardiologists that do hospital call read echos regardless of whether they have a fellowship in echo. If you have your own clinic (or join a group) that has a diagnostic cards facility available (i.e. stress tests, holters, echos) you will likely read those diagnostic tests. Hospital resources are thin and hard to come by, so finding a job without something extra would be difficult, especially if *everyone* has it. If you can find a clinic group that has that capability and take you are then there is nothing stopping you as a general cardiologist to do those above diagnostics (with the exception of caths)

Honestly I found out from word of mouth and doing electives

wow has it been that long... I feel old ahhaha Tons of hospitals always looking for locums, especially nights and weekends which most full timers like to also give away. I would contact the GIM heads at the various hospitals, they can get you onto their locum email pool and get you hospital privileges. Most hospitals meet what you are talking about in terms of what you are looking for, but some will require CCRT coverage or at least admitting patients to ICU. some will have in house ICU but its best to ask each site.