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ACHQ

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  1. Depends where you want to practice. I can only speak for the GTA. Most (almost all) Acute care hospitals in the GTA have a GIM hospitalist model now. A few still have some FM hospitalist. This change in the model of care is due to multiple factors, as over time more people end up wanting to do GIM and in turn have taken on more hospitalist roles, I have also heard from division heads that the FM's are moving away from it (due to their own reasons). As mentioned above, some places will have less acute type of patients that FM hospitalists care for. I can't really comment cause I haven't seen the FM hospitalist list before, but GIM lists definitely have several non-acute patients (I think this relates more to having such high volumes that you just do end up with some non-acute patients). If you are flexible in location, are ok with doing low acuity work (rehab hospitals, LTC homes, Complex continuing care, ALC transition hospitals/wards etc...), and like other things FM offers (FM clinics), then do FM + 1 in hospitalist. If you like other aspects of GIM work that is NON-hospitalist, i.e. ER admit service (which imo is the best part of GIM), GIM consult service, GIM clinics, than GIM is the way to go.
  2. I don't know where you heard that, but its not correct. All the community sites I've rotated through and staff I've talked to for job opportunities, routinely are as busy, if not busier than academic sites. The list is variable depending on the time of year and of course the hospital (as some are busier than others, and some have caps on number of patients per team, or ALC floors, or more than just 4-5 GIM MRPs on at a time), but generally between 18-30. I'm not going to dive into whether having a handful of residents do the actual work and staff just supervise is more efficient (its usually not), I guess if you had 2-3 seasoned senior residents (i.e. PGY3+), then it could be... but that's never the case. As a PGY4 at a community site, I can round on 8-12 patients by noon. Things are more efficient and I don't do any scut, there is no teaching or other time sucks which all helps. Also most academic staff aren't good billers and don't bill aggressively enough, as they belong to some communistic style practice plans (all billings and stipends and awards etc... go to a communal pot and it gets distributed to each physician). I would NEVER EVER EVER learn billing from an academic physician. I don't know about other universities, but at UofT department of medicine (as I mentioned above) ALL of the physicians billings go into a "pot". Its a bit complicated but at the end they "give back" a certain amount. Community GIM's are doing it routinely. Once you've been through enough you manage (you'll see once you finish)
  3. The old teaching/wisdom is that doing your residency in an area that you want to end up practicing. This is true to some degree, but the GTA is so large that as long as you choose a field that has lots of job opportunities (FM, Psych, IM etc...) you can still end up doing residency in one spot and end up working in another. You just have to be savvy in terms of networking, doing electives, and reaching out to the places you want to work. If you end up liking something with no jobs (or limited jobs), then thats a different story. I love Toronto. I lived here most of my life and have done medical school and residency here. My comments were geared towards the residency program (as you so rightly pointed out). I think right now you haven't even started your first day of medical school. I wouldn't worry about remaining in the GTA in the long term. If that is your ultimate goal over all else, then you can end up coming back eventually.
  4. Don't get me wrong. The program is strong from the perspective of training good internists, and it happens to be in one of the most posh/bougie cities in all of Canada (which some people like, others hate) But from an admin and political perspective, it's down right obscene. Its not anything that will effect your clinical training or experience (for the most part), but it can make your life less enjoyable. Some of my former UofT classmates would say the same re: medical school, but actually my UofT med school experience was excellent and I have nothing but nice things to say. I speak mostly of the residency experience
  5. As someone who did IM at UofT (and medical school), unless you absolutely cannot live anywhere else (which obviously you can cause according to your quote you're going to Western), stay away.
  6. Again it would depend on the hospital and their needs. At community hospitals the minimum I've seen is 12 weeks/yr (~1 week a month). Others require 16-20 weeks/yr. It also depends on whether you're part time or full time. For example full time 12 weeks is not bad, but for part time that might be a lot. Groups usually are flexible on people doing MORE work (meaning very few people will turn that down, they always need to cover vacations etc...), where as they will be much less flexible on you doing LESS work (cause they have to cover there services). For me personally 16-20 weeks of MRP/inpatient work is a lot. Ideally I want to work between 32-42 weeks a year total (probably more earlier on and then dial back), but definitely not more than 42. Of those 42 I want to minimize inpatient/hospitalist work as much as possible ahahahha. But to each their own. Very few Endo and Rheum will do GIM type work in the community. Mainly cause a) they don't want to/they don't have to so they choose a better lifestyle or b) their too busy with their subspecialty practice. I'm sure people find weeks here and there of GIM (whether its ER or wards) with whatever subspecialty, but for the clinic based ones, they would have to have their clinic closed for the time they are on service for GIM (it would be impossible in the community to do an outpatient busy endo/rheum/whatever clinic and do GIM wards or ER). Yes sorry those above (UHN (TGH, TWH), Mount Sinai, Sunnybrook, St. Mikes and Women's college) are academic sites in Toronto. Anything else is considered community in Toronto (or hybrid). Also be weary of using Academic sites as a model for practice. They are NOT how a community based clinician operates (in terms of number of weeks worked, inpatient vs outpatient mix etc...) or pay
  7. 4 years of GIM can easily find work anywhere NON-academic in the GTA. By non-academic I mean UHN (TGH, TWH), Mount Sinai, Sunnybrook, St. Mikes and Women's college. Outside of those select few hospitals, 4 year GIMs are the ones that get hired in the community (Including Markham, Richmond Hill, Barrie and Newmarket). Weeks on service and the mix of type of work differ between different sites so can't say 100% its always flexible (very few things in medicine are). Are you at UofT? That's the BS they try to sell to everyone on CTU. Most inpatient units across the country will have their share of complex patients, mixed in with the simple patients and the ever so boring ALC patients. As you go through your career your going to want to deal with simpler cases as oppose to the complex ones as they eat away at your soul. But getting back to your question, no a place will only transfer patients to a centre/hospital that is able to do things (of offer things) that the other hospital can't. Most of all the hospitals in the GTA (includoing the ones you listed) have the full spectrum of medicine AND surgical subspecialties. The only thing they don't have (usually) is neuro and cardiac surgery, transplant and trauma, which (if you haven't noticed) IM doesn't normally need on a day to day basis. Even most transplant and cancer patients can be managed at peripheral sites unless they are extremely complex or on experimental Rx. Plus lets be honest, most times on CTU at academic sites, if a patients gets slightly more complicated than a staff would like to admit, they will consult the F out the subspecialists.
  8. Nice! congrats on finding a set up that works for you. I'm looking to outpatient practice myself, but the overhead seems a killer, especially without those chronic disease premium codes. What % of overhead do you pay? How many patients do you see? How many are new consults?? I tried doing the math and it seems it would only be worth it for me if I saw at least 15 patients/day (all new) with 20% overhead, working 5 days a week (for like 42 weeks though).
  9. Its definitely possible anywhere including the GTA. TBH there's enough work that even a GIM (with a focus or not) will get referrals just because sometimes subspecialists referrals can take 2-6 months (whereas GIM you can probably see in like ~ 2 ish weeks at worse), and family doctors maybe too busy to completely be able to work someone up and initiate management. Sometimes they just want an opinion. The issue with most outpatient practice (regardless of specialty) is that you pay a large overhead (as discussed earlier). Sometimes its worth it if you have a better lifestyle. I've been looking into it myself however the overhead is a killer and without those chronic disease premiums it makes it harder to make as much as like an endo, rheum, resp, etc...
  10. I can only speak about Ontario, I have no idea about other provinces (although I have read it is approximately the same). Again a lot of this is anecdotal evidence, (but the CMA are also self reported), but I have never heard of anyone's overhead being as low as 20% even in a large group practice. I'm sure some of the family doctors here can comment. The numbers I hear are 25-30%. Most people I know plan to pay about 1/3 of their billings for overhead, I think if you get lucky and get a practice who offer 20% I would jump on it and never let go ahhaha Also right now that's what is being debated by the government vs OMA. Whether overhead is actually 20% vs 30%. Obviously the government thinks its 20% and the OMA says its 30%. It's probably somewhere between that.
  11. exactly. Something else to add that most people don't know. Hospitals rarely if ever give specialists or subspecialist's clinic space + nursing staff + admin staff, without the physician paying substantially more overhead then at a privately owned clinic, or joining a group clinic (with family doctors, and other specialists), with the same amount of resources. There are a few exceptions to this, where the hospital asks you to staff a clinic where you pay minimal/no overhead. The only one I know/can think of is a GIM rapid referral clinic. I'm not too sure about other disciplines.
  12. The Endo job market will always be good, for the sole reason that you can set up a purely outpatient practice (and not be associated with a hospital, which is great because it gets you out of doing call). It would NOT be wise to do an internal medicine residency to solely match to endo later. Not to say that it is or isn't uber competitive, but what if you don't match to endo... and you don't like GIM then you are totally screwed (not that you won't be a doctor but you'll be stuck in a specialty you don't enjoy), because in the MSM match there are no re-entry's or transfers or do overs (its one shot, can't ever reapply). With all that being said, if you are willing to go ANYWHERE in the country to do endo, then sure you can do Internal medicine and still probably match somewhere (but then you have to be happy with any location). The pay generally for endo is at the lower end of the spectrum of IM specialties cause it is non-procedural. 300-400k+ is the ball park (large range because it depends on how much you work and how efficient you are) with at least 25-30% overhead. I would be shocked if endo didn't make more then family medicine because new patient/consult for endo is $157/pt, follow ups are usually $70/pt. New consults might take some more time, but endo follow ups take less than 10 min. Combine that with your Diabetes premium and your chronic disease billing premium (which all endo patients are), if you fill your day with patients 8/9-4/5 you can see how the above pay is possible.
  13. Jobs in academic GIM at UofT (aka Toronto) are also very tight, and they will only get much tighter in the next 5-10 years (when you will be finished and looking for a job). As stated above by LittleDaisy about the requirements. Even if you do those, you will be a Clinical associate for 1-5 years where you pay a tax of all your billings to the group and get NONE of their benefits, until one day they decide to take you on as a full time faculty.
  14. I'm not a surgeon (far from it), but my understanding is the use of robotics in medicine is still limited (even if the technological advancements in the field make it possible). Also if that is what you would want, you would definitely need to do research in that field (i.e. come on as faculty and be a clinical scientist or investigator) where you would only be asked to do at MOST 50% clinical work (most of which would be done by residents/fellows anyways) and of that how much would actually involve robotics? You will 100% be asked/told to do: fellowship(s)/sub-fellowship + more advance research training (Ph.D, even though you have a masters) + Clinical associate work (Which they will say you can combine with a Ph.D/sub-fellowship, to spin it to make it seem worthwhile). This is the new norm and it is bonkers. The faster people realize it the faster than can cut loose and get out. Unfortunately this will not change because the supply for crazy competitive doctors willing to make years and years of sacrifice to get those faculty positions is not going way. If most people/everyone just refused to do that then maybe you'll see it retract but that ain't happening.
  15. I learned that the hard way like most people. I still like what I do overall, but some of the things I have seen, heard and experienced are truly mind boggling and leave a sour taste in your mouth. You think that in a field where you're supposed to care for people would be devoid of these things, but that's just me being naïve. They get a cut of 20-30% of your total billings. Meaning you get anywhere between 70-80% back Unfortunately you CANNOT get a faculty position without doing some CA work. On rare occasions they have people come on as faculty that don't do CA work but that would constitute maybe 1% (or even less), meaning its the exception not the rule. This applies to ALL medicine specialties for sure (and it seems like surgery as well, and I wouldn't be surprised if it applied to ALL academic positions in the faculty of medicine). I've heard similar things happening at other sites across Canada (although not as brutal as UofT). These things are even being promoted by Senior admins (department and faculty heads) as necessary! TBH why go for an academic position then when "I don't get off/orgasm over research or teaching at all". Just finish residency and start working in the community where you can make $$ and have a semblance of a life.
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