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Internal Medicine - no jobs even for General IM?


Gmaarom

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Hi,

 

I'm in my 3rd year of meds, and I've really been leaning towards IM. I've heard/read a lot of about the poor job prospects in most subspecialties (like GI, Cardio etc); however, my impression was that GIM has (and will continue to have) great job prospects. At least this is what I've gathered by talking to some residents and reading the boards. There are even some job postings when you search health force ontario: https://www.hfojobs.ca/UI/Professional/Physician/index.aspx?langID=1.

 

However, according the CMA: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Membership/profiles/Internal-Medicine_en.pdf (scroll down to the "in training" section) and ontario population needs based report: https://www.healthforceontario.ca/UserFiles/file/PolicymakersResearchers/needs-based-model-report-oct-2010-en.pdf, there are enough GIMs now and in the future. In fact if you look at the report, it indicates that GIM is going to be one of the LEAST in-demand specialties in the future. So what gives? I'm really starting to have second thoughts about going into IM if there will be no opportunities for jobs when I'm done.

 

Interestingly, according to the report and the CMA specialty profiles, radiology apparently is one of the most needed specialties right now and this need will continue to increase. Yet there are no job postings for rads on Health force ontario. Even Gen surg, which most students and residents have been claiming to have very poor job prospects, is actually still in demand at the moment.

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Hi,

 

I'm in my 3rd year of meds, and I've really been leaning towards IM. I've heard/read a lot of about the poor job prospects in most subspecialties (like GI, Cardio etc); however, my impression was that GIM has (and will continue to have) great job prospects. At least this is what I've gathered by talking to some residents and reading the boards. There are even some job postings when you search health force ontario: https://www.hfojobs.ca/UI/Professional/Physician/index.aspx?langID=1.

 

However, according the CMA: http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Membership/profiles/Internal-Medicine_en.pdf (scroll down to the "in training" section) and ontario population needs based report: https://www.healthforceontario.ca/UserFiles/file/PolicymakersResearchers/needs-based-model-report-oct-2010-en.pdf, there are enough GIMs now and in the future. In fact if you look at the report, it indicates that GIM is going to be one of the LEAST in-demand specialties in the future. So what gives? I'm really starting to have second thoughts about going into IM if there will be no opportunities for jobs when I'm done.

 

Interestingly, according to the report and the CMA specialty profiles, radiology apparently is one of the most needed specialties right now and this need will continue to increase. Yet there are no job postings for rads on Health force ontario. Even Gen surg, which most students and residents have been claiming to have very poor job prospects, is actually still in demand at the moment.

 

I think the job market looks horrible for a lot of specialties. The job market changes and fluctuates and goes through cycles so do what you love. You also need to clarify between "no jobs" and "no jobs in desirable spaces". They said for a long time that critical care jobs don't exist but there are a few here and there, just not in Toronto, Vancouver, Montreal, etc.

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Searched through that link... surprised to find lots of jobs for family doctors in the durham region (where I live).

But seems like psychiatry/pediatrics has a good market in toronto at the moment... derm as well. ENT/neurology as well in toronto. And cards in barrie.

 

Not overly bad for many though surgery looks terrible.

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I think the job market looks horrible for a lot of specialties. The job market changes and fluctuates and goes through cycles so do what you love. You also need to clarify between "no jobs" and "no jobs in desirable spaces". They said for a long time that critical care jobs don't exist but there are a few here and there, just not in Toronto, Vancouver, Montreal, etc.

 

I think that one should really consider job prospects when picking a career path. I mean if I love career x (which has poor job prospects and likely will continue to do so) and I merely like career y (which has great job prospects and is projected to continue as such), then I would probably pick career y. My problem is finding that career y. I've always taken comfort in the thought that "the more general you stay the better your job opportunities will be" and that there are always jobs for GIM. But it seems that this isn't even be true based on the Ontario needs-based report and the CMA which outright stated that there is no need for GIMs in Ontario in the future. I just don't want to end up like some of those orthopods or neurosurgeons who were told that people will eventually retire or that the job market goes in waves but unfortunately were forced to do fellowship after fellowship hoping for jobs to open up somewhere.... but they don't.

 

Can any current residents shed some light on the job issues they might be facing in the future in IM?

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  • 2 weeks later...

Surveys and job boards are usually not the greatest resources. There are always underserved areas looking for docs and IM is quite flexible since (in low competition centres) any subspecialty can provide GIM service.

 

Your training will take longer than the cycle of job availability will take to turn over so it's very difficult to say what will be open when you're done. Local factors (e.g Is the faculty old and is there an impending mass exodus due to retirement, or are all the staff in the centre you want to work at under 40?) play a bigger role than nationwide trends.

 

On one hand it's kind of intimidating trying to figure out if you can find a position, on the other, I've yet to be asked for spare change by any internists while walking downtown.

 

The number of positions may also drastically increase if a chunk of our cohort decides that 70-80h/wk is ridiculous (and we make way more money than most people really need) and start dividing up the workload in a more lifestyle-friendly manner. Personally I'd love to work 8 months a year and take 1/3 less money.

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You'd have to be *extremely* efficient or do a lot of call to bill that high for GIM, rural or urban, even with HOCC stipends, acute stroke stipends, ICU coverage, etc. Procedures would increase that significantly, but it's not common to find a place where you can do them in significant volume. 300 to 450K is much more likely for a new grad.

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You'd have to be *extremely* efficient or do a lot of call to bill that high for GIM, rural or urban, even with HOCC stipends, acute stroke stipends, ICU coverage, etc. Procedures would increase that significantly, but it's not common to find a place where you can do them in significant volume. 300 to 450K is much more likely for a new grad.

 

+1 - you won't be billing 800k-1mil as a GIM. Even interventional cardiology has a hard time getting up to that billing bracket, and that is the most lucrative subspeciality from internal medicine.

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Ya, I guess its a unique situation. For example, one does stress tests, bronchoscopy, colonoscopy, OGD, dialysis, cancer clinic, ICU coverage and maybe about 1 in 5 call.

 

I think the name "Typical Premed" speaks to the depth/accuracy/delusion of information being provided.

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So it seems like there are different ways to do "GIM":

 

-you can do 3 years of core IM and then write your exams and go off and try to get a job (correct me if I'm wrong pleasE)

 

-You can do your 3 years of core IM, and then one additional year typically at your home school in GIM

 

-You can do 3 years of core IM + 2 additional subspecialty years in GIM.

 

 

Could someone please explain how these pathways ultimately differ when it comes to likelihood of getting jobs, type of jobs/scope of practice, location, pay etc.

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Also, I've heard that if you choose to subspecialize, you can still do GIM even if your subspecialty was in something else (ie nephro, endo etc).

 

Is this true? So that means that if someone couldn't get a job as a cardiologist, they could just do some GIM?

 

Along similar lines, how practical would it be for someone to have their own private practice specialty clinic (ie endocrinology) in the community and then do some GIM on the side at a community (or academic) hospital a few days a week?

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You can't get a job after just 3 years of core IM (in Canada; US training is 3 years). You need to do at least a 4th year in IM, or a 4th + 5th year in GIM, or a subspecialty (the first subspecialty year counts as year 4 of IM). Then you write your exams during the 4th year, and get licensed as an internist.

 

You can do IM as a subspecialist. No problem. Most subspecialists are more interested in their own field than GIM, but some do part time GIM in addition to their subspecialty.

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You can't get a job after just 3 years of core IM (in Canada; US training is 3 years). You need to do at least a 4th year in IM, or a 4th + 5th year in GIM, or a subspecialty (the first subspecialty year counts as year 4 of IM). Then you write your exams during the 4th year, and get licensed as an internist.

 

You can do IM as a subspecialist. No problem. Most subspecialists are more interested in their own field than GIM, but some do part time GIM in addition to their subspecialty.

 

What's the point of the GIM "subspecialty" vs. the old 4 year path?

 

Seems like either:

1. Adding pointless extra training time (aka servitude time) for nothing more than credentialism and cheap labour

2. 4 year GIM isn't sufficient for training and should be done away with.

 

#1 is currently the favorite theme of the greater medical community right now, in my opinion anyway.

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Agreed. Hospitals/the government want experienced labor at cut rates. A fifth year of GIM training = getting a doc who would have cost at least 250k under the old system for 80k. Huge savings.

 

This credentialism is stupid. First it was the CCFP with their family medicine joke residencies, and then the overabundance of fellowships in rads, surgery etc. Now it seems the GIM people want to jump in on it.

 

I got the awesome advice a few days ago that a residency, fellowship (x1-2) AND Masters wasn't enough to secure a job in a big center anymore. Now places have started also demanding PhD's. This is to be a clinical surgeon, not even a surgeon scientist. Things are just getting out of control.

 

Some glad I don't wanna go to a major center when I am done.

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I got the awesome advice a few days ago that a residency, fellowship (x1-2) AND Masters wasn't enough to secure a job in a big center anymore. Now places have started also demanding PhD's. This is to be a clinical surgeon, not even a surgeon scientist. Things are just getting out of control.

 

Some glad I don't wanna go to a major center when I am done.[/QUOtE]

 

I keep seeing this posted time and time again and have to clarify it. It's not that centers are demanding PhDs;it's the fact that the job field is oversaturated such that nearly most jobs are going to people with graduate degrees. All else being equal, why wouldn't you grab someone with more education?

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I keep seeing this posted time and time again and have to clarify it. It's not that centers are demanding PhDs;it's the fact that the job field is oversaturated such that nearly most jobs are going to people with graduate degrees. All else being equal, why wouldn't you grab someone with more education?

 

Yeah I agree that it's an effect of a flooded job market. But it's not only a situation where there are a bunch of people with grad degrees or multiple fellowships already in the market. Many places are telling residents or current fellows "We have a job for you, but we'd really like/recommend you do ________ thing before we hire you". Sometimes what is recommended will be at best minimally applicable for the person in the future.

 

You are correct that part of this is due to a flooded job market, but that doesn't make it any less ridiculous.

 

From a society point of view, all this extra education, that is at best borderline appicable to the job for say, a clinical surgeon, just increases the cost of medical care. The government pays a ton of money to finance extra fellowships and graduate degrees. It's may be a good investment if the doc puts the extra education to good use, but the reality is the clinical surgeon may make very little use of much of the extra education. You don't need 1-2 fellowships to, for example, work as a community Ortho in a city of 100,000 thats within 4 hours of TWO major academic centers (example of someone I know). Another guy I know is doing one of the most respected fellowships in the country in his specialty (as the hospital's current staff's request) to work in a city of 100,000 at a community hospital within an hour of a major academic center. There is no way those guys will do the work they will have been trained to do. It'll mostly get referred to the adjacent academic centers leaving them to do the bread and butter work that they learned in residency.

 

From the point of view of med students, residents and fellows, it's also a huge deal. It represents the loss of hundreds of thousands of dollars of lifetime income, PLUS a reduced ability to save for retirement by missing out on compounding interest AND a reduced ability to retire at an earlier age.

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  • 1 month later...
What's the point of the GIM "subspecialty" vs. the old 4 year path?

 

Seems like either:

1. Adding pointless extra training time (aka servitude time) for nothing more than credentialism and cheap labour

2. 4 year GIM isn't sufficient for training and should be done away with.

 

#1 is currently the favorite theme of the greater medical community right now, in my opinion anyway.

 

 

it opens up opportunities for GIM to "specialize", my prediction is that in the near future General Internal Medicine will be like another area within internal medicine (With a possible focus on areas not covered traditional subspecialties -- or put less emphasis on -- like bone health, palliative care, multiple chronic comorbidities (HTN,DM,High CHL with Hx of TIA)) etc etc

 

but rlly i think its more for people who want to do some more research --and for these people an extra year is good since you get funding to do some research for you wouldnt be able to get if you were to do a master's separately (~$20k stipend vs ~$60-70k salary?)

 

 

if you wanted to be a community hospitalist, a 4 yr GIM would be enough though

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