General Internists: how much do they earn? where do they work?

[kevinkwon84]

How much do, on average, General Internists earn annually? Do they normally work at the hospital or at their private clinics?

[Kirsteen]

How much do, on average, General Internists earn annually? Do they normally work at the hospital or at their private clinics?

Hi there,

 

General Internists can work both, in private clinics and in hospitals. As for earnings, it's difficult to say given that earnings reported in BC, for example, are for all types of Internal Medics.

 

Cheers,

Kirsteen

[kevinkwon84]

cool! one more question: if i do residency somewhere outside BC, would I still be able to practice in Vancouver? thnx

[clkt]

I have a question too. What kind of patients/cases do general internists see? Are they considered specialists in anything? I mean, do GPs refer you to a general internist?

[crackers]

I'm on ambulatory medicine right now... these are the sorts of things I've seen in the last two months (in a tertiary care centre, mind you)...

 

A patient admitted to hospital with a BP of 270/138, controlled on three drugs on discharge to 210/120... now presents for follow-up.

 

A patient with bony lesions in his spine, pelvis, thighs and ribs, stable for six months with minimal pain, and a pancreatic mass that disappeared.

 

A patient with diagnosed lung cancer whose breathing got bad but didn't want to come into hospital again --- so we needled her chest, got 1L off and she felt better and went home.

 

A patient with antiphospholipid antibody syndrome, on coumadin, with no family doctor to follow the INR.

 

We've seen outpatients with stable medical issues, done a couple of admissions out of the clinic. One poor guy had rapidly progressive ALS, to the point where in two weeks he went from walking up stairs with bags of groceries to not being able to put his pants on or pull them up. Another lady had 40 days and nights of diarrhea and was dry to the point of renal failure and fainting.

 

We've done consults for patients admitted to surgical services with big medical issues, like renal failure, prosthetic valves, rapid AFib, CHF, brittle diabetes, and rectal bleeding. Who am I kidding... it's 80% ortho patients.

 

We do pre-operative assessments on patients going for surgery --- which drugs to stop/hold/adjust (and when), how is their heart going to hold up (and do we need to postpone surgery to find out in more detail).

 

The internists I've worked with do chronic pain, exercise stress tests, ophthalmology pre-ops, clinical pharmacology, and see undifferentiated "medicine" patients. Some of them do CTU call (ie. you can GET A JOB DOING IT). Most of the patients are either referred from GPs who feel out of their depth (hypertension still! after 3 drugs, chronic abdominal pain not surgical, intermittent chest pain/shortness of breath), or from emerg when the patients are sick enough to get seen quickly but not sick enough to merit admission.

 

This is in a tertiary care centre. In the community, you could do all that plus diabetes, GI endoscopy, inflammatory bowel disease, arthritis, etc. Typical salaries are $200-$400K gross, depending on what you do and how hard you work.

 

Hope that helps.

 

PS. I'm a PGY-2 in internal medicine

[ffp]

Crackers pretty much said it all. (I'm PGY-4, finished IM in June).

 

Your career as an internest can be quite flexible. You can be community-based or work in an academic centre. You can work in a mid-sized city or a major centre. You can be involved with research, teaching, or administration as much or as little as you like. You can be involved with the inpatient medicine service or CTU, or the inpatient GIM consult service. You might choose to do treadmill tests, holter monitors, endoscopies, or read echocardiograms. You can divide your inpatient/outpatient time however you'd like, and most internists I know have a balance of both.

 

Your patients will be referred by GPs (unlike the US, a patient can't just decide to see an internist). Internists in Canada are consultants, not primary care providers.

 

In short, it's quite a flexible career, and you can always choose to subspecialize after 3 years of IM residency. Earnings will depend on how you structure your practice ie. how many patients you see, whether you do procedures, or whether you have a salaried academic position. The lowest-paid general internist I know made ~$75K last year (I accidently found out this information). She does ~90% research, and bills little (if anything) above her academic salary. Some of the community internists who do lots of procedures bill upwards of $400K. I think $2-300K would be ballpark for most general internists.

[clkt]

Very interesting. So if you don't specialize, residency for general internist is 3 years? Sounds like it is a very broad specialty. For the residents, do you find the variety overwhelming? Or is it more interesting than specializing?

[ffp]

Yes, clkt, you can enter general internal medicine through CaRMS. You do 3 years of IM, at which point you can subspecialize (cardio, allergy, resp, nephro, heme, GI, oncology, ID, rheum, endocrine, critical care - maybe a few others I'm forgetting - tired and on call). The subspecialties are 2 years, except cardio which is 3 years. Critical care used to be 2 years after IM, but now programs across the country are wanting you to have another specialty first - like resp - and then do ICU after that.

 

If you want to be a general internist, you do a fellowship in GIM after your core 3 IM years. Right now there are 1 and 2 year fellowships, but the 1-year fellowships are being phased out, and will probably be a thing of the past soon. People who matched to GIM this year were *strongly encouraged* to sign up for 2-year programs.

 

In internal medicine, there is A LOT to know. It can seem overwhelming, but nobody actually knows everything. There are common things we see every day, and then things that are not-so-common. Even the attendings are always looking things up. I found that the breadth of IM was one of the most interesting things. When you subspecialize, you are expected to know EVERYTHING about one particular organ system - so it still works out to be a lot of knowledge. For example, in cardio, I need to know the genetics behind the different hypertrophic cardiomyopathies, the electrophysiologic mechanisms behind weird and wonderful arrhythmias, all of the clinical trials in heart failure, etc... so even though you are specializing in only one system, you have to be the EXPERT and have very detailed knowledge.

 

Right now, as I prepare for my IM Royal College Exams, the breadth of IM is definitely stressing me out!

[physiology]

Hello,

 

In smaller communities, GIMs can do scopes, broncs, stress tests, echos...but in larger academic settings, forget about it. The cardiologists won't let you touch their echos or stress tests with a 10 foot pole.

 

GI - same thing, touch their scopes and die. They don't even like the general surgeons doing em'.

 

Physio

[everyoneloveschem]

This post is old, but I am finding it particularly relevant now as I try to decide between family medicine and internal medicine. I was hoping that any residents/staff out there might be able to comment on brain power required for GIM.

 

Sure, I am smart enough to do med school and get decent grades. I like the thought of doing GIM, but I'm a bit nervous that I won't be able to hack it, brain-wise and I really don't want to be a bad internist. How does one know? Do I just try and if I can't do it, transfer to family? Thoughts? As was pointed out, the amount of knowledge is infinite, so how do you know when you know enough?

 

Also, how brutal is the residency for lifestyle? I'm okay sacrificing personal time a bit, but I know my limits and I can't go go go for hours indefinitely.

 

Thanks for any pearls of wisdom.

[national]

hate to break it to you, but the "amount of knowledge" for family medicine is also infinite

 

hours of work for internal medicine are pretty intense - regular call, ICU/CCU rotations, etc etc. workload is probably university/hospital dependent. in terms of knowledge/intelligence, i'm firmly of the belief that if you can graduate from medical school, you're capable of doing pretty much any residency. as you mentioned, lifestyle and workload are probably the most important factors.

[Coach]

So, if you really want to do these procedures, either consider doing a full subspecialty fellowship or working in a smaller community.

 

It appears from what I read that "smaller communities" allow greater freedom for doctors such as general practitioners (i.e. FP +1 yr) to do EM or anaesthetics, and GIMs (without subspeciality) to scope and do cardio work.

 

What I'm still unsure on is where the line is drawn between a smaller community and a larger city. Yes it's easy to use a far north town as an example of a small community and a city like Toronto as example of big. But in Ontario, could someone please give me a few examples of decent size communities that would still be considered "small."

 

Hopefully I'm being clear and not tripping over myself in the question: basically looking for examples of what is technically considered small (in Ontario) while still being within a reasonable drive of a decent size city and not too far north (i.e. the snow belt). Maybe I'm looking for utopia (or at least able to have the cake and eat it).

 

Thx

[Jochi1543]

It appears from what I read that "smaller communities" allow greater freedom for doctors such as general practitioners (i.e. FP +1 yr) to do EM or anaesthetics, and GIMs (without subspeciality) to scope and do cardio work.

 

What I'm still unsure on is where the line is drawn between a smaller community and a larger city. Yes it's easy to use a far north town as an example of a small community and a city like Toronto as example of big. But in Ontario, could someone please give me a few examples of decent size communities that would still be considered "small."

 

Hopefully I'm being clear and not tripping over myself in the question: basically looking for examples of what is technically considered small (in Ontario) while still being within a reasonable drive of a decent size city and not too far north (i.e. the snow belt). Maybe I'm looking for utopia (or at least able to have the cake and eat it).

 

Thx

 

 

It depends on what fellowship you're in as an FP. There are lots of people in big cities working in emerg with FP+EM - the 5-yr residency just can't churn out enough ER docs to keep up with the demand, so this shortage probably won't go anywhere anytime soon. Anesthesia is another story, though. I asked an FM+AS guy whether there are any urban opportunities and he said there's an oversaturation of full-fledged anesthesiologists in big cities, so it's a lost cause. I asked him if a city like Red Deer (about 100,000) would hire an FM+AS to do anesthesia and he said it'd be very unlikely. So that gives you an idea.

[moo]

As a family doc, I rarely refer to GIM, except in the hospital, and that's usually only because the internist is there, while I'm in my office and I can't deal with emergencies. (Don't want to leave the office and get behind.) There is a general internist who works in the same building as us and she pretty much works as a general practitioner. No hospital work. Does a few treadmill EKGs here and there and reads EKGs. Otherwise, she manages DM, CHF, etc. that other GPs refer to her. In fact, there is a joke in our office not to refer to her because "you'll never see your patient again." She pretty much does stuff that a FP does but also does some stress EKGs, that's about it.