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5 year vs 4 year GIM program


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Hey all,

 

I had a question regarding what you guys have been hearing about the 5 year vs 4 year GIM business and how it will affect those of us in residency now.

 

Say after your 3 core IM years you apply to a fellowship like GI, ICU, Cardio, Resp etc, and in your 4th year you write your Royal college IM board, and in your 5th year your subspecialty board.

 

As a subspecialist, and with the 4 year GIM equivalent, what are some things that will limit you from what a 5 year GIM other than say working at an academic center?

 

1) What's to stop you from opening up a GIM office practice anywhere other than GPs referring to you?

2) typically what geographic locations would actually hire you on as a GIM? I know that towns around the size of 50k would have no problems hiring you on as a GIM if you are a sub-specialist but wondering whether how big of a hospital you can go before you're likely to get beat out by a 5 year GIM

3) any difference in terms of billing?

4) Reading around it looks like you can challenge the exam after 5 years of practice will this functionally elevate you to the status of a 5 year GIM subspecialist with regards to job prospects even at academic centers?

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Hey all,

 

I had a question regarding what you guys have been hearing about the 5 year vs 4 year GIM business and how it will affect those of us in residency now.

 

Say after your 3 core IM years you apply to a fellowship like GI, ICU, Cardio, Resp etc, and in your 4th year you write your Royal college IM board, and in your 5th year your subspecialty board.

 

As a subspecialist, and with the 4 year GIM equivalent, what are some things that will limit you from what a 5 year GIM other than say working at an academic center?

 

1) What's to stop you from opening up a GIM office practice anywhere other than GPs referring to you?

2) typically what geographic locations would actually hire you on as a GIM? I know that towns around the size of 50k would have no problems hiring you on as a GIM if you are a sub-specialist but wondering whether how big of a hospital you can go before you're likely to get beat out by a 5 year GIM

3) any difference in terms of billing?

4) Reading around it looks like you can challenge the exam after 5 years of practice will this functionally elevate you to the status of a 5 year GIM subspecialist with regards to job prospects even at academic centers?

 

AFAIK.

 

1. Nothing

2. All except major academic centers.

3. No.

4. Probably but not sure.

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I would just go for the extra year of training. You have no idea how badly the college might want to screw you over in years to come. It's an extra year that you can use to hone in your productivity. And it's paid well anyway.

 

They are certainly looking at changing the billing codes to push out the subspecialists doing the GIM type work. And this may spillover to the 4 year trainees as well.

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I would just go for the extra year of training. You have no idea how badly the college might want to screw you over in years to come. It's an extra year that you can use to hone in your productivity. And it's paid well anyway.

 

They are certainly looking at changing the billing codes to push out the subspecialists doing the GIM type work. And this may spillover to the 4 year trainees as well.

 

Ya but some of us want to do GIM just not primarily, I have another subspecialty in mind that would permit you to keep up your general skills but would still like to do GIM on the side as well.

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  • 9 months later...

I recently finished a 5 yr GIM program with the 5th year exam completed. Now the 5th yr requires another specialty exam just for GIM (this is not the same one as the one in 4th yr where everybody wrote). 

 

As for the question about how useful the 5th yr exam is, nobody knows at this moment. Royal college claims that nobody is grandfathered. The reason I wrote it is just to avoid being asked to write it in 10 yrs time when a substantial of internists would have written it at that time.

 

If you want to work in academic center, it favors a 5th yr program, while in community hospitals, it is not an issue.

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  • 1 month later...

There are some confusing and frustrating rules around challenging the GIM certification without actually doing the new 5-year program. The short version is that if you're still in training, you can't. I realized this too late, and have had a "learning experience" (read: I'm screwed) about how PER-Sub (Practice Eligibility Route for Subspecialists) works. You can find the details on the Royal College website, but here is a summary.

 

There are 4 ways to write the GIM exam:

 

1) Complete 4 years of Internal Medicine, Apply for PER-Sub through the Royal College after 5 years in practice - This option is only available to residents who completed their training prior to July 2013. 4-year Internal Medicine graduates who finished after July 2013 do not and will never have this option. Graduates who finished before this date have lifelong eligibility to write, provided that an assessment of their practice shows that they are functioning as a General Internist. This seems ridiculous, but it's true and there is no getting around it.

 

2) Complete 2 additional years of nonaccredited GIM training prior to July 2015 - If you're still in residency doing the 4th year, you're too late for this one. The fourth year can not be counted as one of those nonaccredited years, so you will not finish under the deadline.

 

3) Complete a 4th year in Core Internal Medicine and a 5th year in an Accredited Royal College GIM Program - This is acceptable to the Royal College, but requires a program with an open spot that will allow you to join them as a 5th year. Although theoretically possible, I don't know how this could actually be accomplished. This is probably the last, best option for those of us who entered a 4th year not realizing that Option #1 had an expiry date in the fine print.

 

4) Just apply to GIM in the first place. Thank yourself later.

 

5) 4th year and hope for the best. Maybe you'll get one of the remaining jobs. If you want to go far away from academic centres or do mainly outpatient work, this is probably an OK option. For now.

 

Hope this helps anyone who is undecided.

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There are some confusing and frustrating rules around challenging the GIM certification without actually doing the new 5-year program. The short version is that if you're still in training, you can't. I realized this too late, and have had a "learning experience" (read: I'm screwed) about how PER-Sub (Practice Eligibility Route for Subspecialists) works. You can find the details on the Royal College website, but here is a summary.

 

There are 4 ways to write the GIM exam:

 

1) Complete 4 years of Internal Medicine, Apply for PER-Sub through the Royal College after 5 years in practice - This option is only available to residents who completed their training prior to July 2013. 4-year Internal Medicine graduates who finished after July 2013 do not and will never have this option. Graduates who finished before this date have lifelong eligibility to write, provided that an assessment of their practice shows that they are functioning as a General Internist. This seems ridiculous, but it's true and there is no getting around it.

 

2) Complete 2 additional years of nonaccredited GIM training prior to July 2015 - If you're still in residency doing the 4th year, you're too late for this one. The fourth year can not be counted as one of those nonaccredited years, so you will not finish under the deadline.

 

3) Complete a 4th year in Core Internal Medicine and a 5th year in an Accredited Royal College GIM Program - This is acceptable to the Royal College, but requires a program with an open spot that will allow you to join them as a 5th year. Although theoretically possible, I don't know how this could actually be accomplished. This is probably the last, best option for those of us who entered a 4th year not realizing that Option #1 had an expiry date in the fine print.

 

4) Just apply to GIM in the first place. Thank yourself later.

 

5) 4th year and hope for the best. Maybe you'll get one of the remaining jobs. If you want to go far away from academic centres or do mainly outpatient work, this is probably an OK option. For now.

 

Hope this helps anyone who is undecided.

 

Does this mean a Sub-specialist cannot do GIM with the new training in place?

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Nah, you could open or work in a GIM clinic if you wanted, as long as you have the internal medicine license, you can work pretty much where you want (if others will hire you to do GIM, maybe.. Some hospitals want subspecialists to cover GIM call). However, most people in subspecialty prefer working in their subspecialty, as it is their area of expertise, and the one they're most comfortable in. 

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Nah, you could open or work in a GIM clinic if you wanted, as long as you have the internal medicine license, you can work pretty much where you want (if others will hire you to do GIM, maybe.. Some hospitals want subspecialists to cover GIM call). However, most people in subspecialty prefer working in their subspecialty, as it is their area of expertise, and the one they're most comfortable in. 

 

Yeah I know what you mean, but considering the job markets for some subspecialties, a fall back was being able to do GIM while waiting for a job in their subspecialty

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It means that people completing the accredited 5-year GIM programs will have a credential that no one else has. Right now there are (a few) centres where this new credential is a requirement. There are others (probably most) where it might be a competitive edge. There are still others where 4 versus 5 years makes no difference at all.

 

The real risk in doing a 4-year program is long-term career mobility. If there is an oversupply of 5-year-trained GIM subspecialists in a few years' time, then it may become increasingly difficult for 4-year-trained staff (or non-GIM subspecialists) to get GIM jobs.

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Hi,

 

I recently graduated from a 5yr GIM program and had written the GIM subspecialty exam after the 5th year. I was in the first cohort group to write this new GIM subspecialty exam. 

 

It is quite true that so far there is no difference between 4th and 5th year for community IM jobs. As for academic centers, they always prefer to hire GIM 5th year anyway (even before this new exam comes up).

 

Nobody really knows the impact for the 5th year vs the 4th yr program down the road in the future. The only difference after writing the 5th yr GIM subspecialty exam is that I can call myself a "Royal College certified General Internist", while my colleagues who only did the 4 yrs can only call themselves "General Internist". Again, I have no idea how the word "Royal College certified" is helping me, other than just a name. 

 

Depending on which province you work, GIM internists can bill a bit more than subspecialists seeing IM consults. There is currently a bit more incentive for IM trained internists to do internal medicine than subspecialists, especially in the city. There is no difference in terms of billing between a graduate from a 4th yr vs a 5th yr program, at least for now. 

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