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GeriGIM

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  1. Training in America. NP teams are the norm on the wards and in the ICU. It’s hard for payers (governments, health systems) to see the difference in care provided by an NP v physician. The NPs know there’s a difference. The physicians know there’s a difference. But that difference is hard to measure. It’s easy to measure the difference in labor cost, however. American Inpatient NPs earn about $150k CAD. Inpatient IM about $350-400k. Imagine you’re a healthcare executive trying to cut costs — how do you not replace docs with NPs? Scope creep is inevitable if doctors don’t protect their p
  2. I find the depth of knowledge between an FM and an IM is mostly indistinguishable. GIMs with a particular focus (thrombosis, periop, POCUS, cardio dx, geriatrics) might have more sophistication in their particular focus. And the FMs know peds and OB.
  3. How do most graduating IM residents find jobs in Canada? Health Force Ontario? Unlisted jobs? Networking?
  4. This is frustrating lol. I’ll study hard.
  5. Shoot — if only i knew some recent Canadian IM grads lol. Maybe I’ll reach out to some current Chiefs. Thanks for the tip!
  6. What did you use to study? Q banks? Yup — in America!
  7. I’m writing the Royal College IM cert exam in February. I’m reading horrifying things about this test (“I studied 4-8 hours daily for 12 months”). Just wrote the ABIM exam — wasn’t too bad. How hard is this thing? Is UWorld good prep? I hear prep courses are highly recommended. What’s the fail rate?
  8. How often, if ever, is GIM placing art lines or central venous access during a code? It’s not the norm here (America) for IM-run codes, though I see surgery putting in fem lines for nearly every code.
  9. How’s the mid-level (NP/PA/CRNA) workforce shaping up in Canada, particularly for FM, GIM and ED medicine? Here, in America, mid-levels are increasingly a very desirable (ie cost-effective) alternative to physicians. In fact, nearly all hospitalists/GIM docs supervise at least one mid-level; it’s a requirement of the job. Several smaller hospitals now operate ORs without any physician anesthesiologists. You’d think Canada would want to invest in mid-levels (to minimize health care costs).
  10. What kinda consults are you getting from the hospitalists?
  11. GIM in Canada sounds fun. In America, we're the MRP on all admits --- from the simple CAP PNA to the decompensated cirrhotic. But, we promptly send anyone requiring pressors (centrally) or invasive vents to the ICU. Most hospitals here have ICUs adequately-staffed by intensivists. Some ICUs are co-managed by GIM and intensivists. Very very few ICUs are run solely by GIMs. I can't imagine any GIM in America doing EGDs/scopes/bronchs lol (unless they're in RURAL rural America). Ugh. It sounds like I won't be comfortable in a community-based Canadian hospital right off the bat.
  12. The Royal College requires at least 4 years of training. They'd accept a clinically-focused Chief year (most Chief years in America are administrative jobs). They'd accept any ACGME-accredited fellowship (except sleep medicine). I'm dong a geriatrics fellowship with a focus on pre-op medicine.
  13. Are American-trained internists equipped to work in Canadian hospitals? It sounds like American-trained residents spend considerably less time in the CCU. We, in general, also do fewer procedures. For example, I have never attempted a chest tube and I’m not proficient in central line placement. I cannot intubate. We certainly see sick patients. But we have loads of subspecialty support. I intend to return to Canada, with the intent to practice GIM. Are Canadian GIMs placing tubes and lines all day?
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