Geriatrics - Care of the Elderly vs. Internal Route

[brady23]

Hey guys,

Just had a question about the routes to geriatrics.

I'm someone who enjoys outpatient geriatrics (ex: memory & fall clinics) more than inpatient geriatrics (taking care of acute elderly patients on the wards). 

Is it possible to do outpatient geriatrics 100% after internal medicine, because most of the geriatricians I've seen practice in a combination of inpatient & outpatient settings? I imagine it might not be feasible to do 100% outpatient geriatrics which is why I think the Care of the Elderly route may be more appropriate for me, but would love to hear your thoughts!

 

[A-Stark]

I'm mainly familiar with the Dal group. All of them cover their geriatric inpatient units (progressive/transitional/rehab care) and most also participate in medicine call as well. You can certainly have a purely outpatient private practice but the income potential would be limited. Otherwise your institution would likely have varying degrees of coverage required for your position. 

[strawberryjams]

Do geriatricians make the same amount of money as a family doctor/more money with the family +1 route? 

[brady23]

1 hour ago, strawberryjams said:

Do geriatricians make the same amount of money as a family doctor/more money with the family +1 route? 

I think geriatricians make more than a family doctor with the +1 route - this could be because they also have a significant amount of inpatient geriatrics where they take care of sicker patients on the wards compared to the +1 route where it'd be primarily a family practice with some geriatric work on the side.

[strawberryjams]

I read somewhere they make 460k because they do more GIM consults (more volume), so they make comparable money to a geriatrician. 

[brady23]

2 minutes ago, strawberryjams said:

I read somewhere they make 460k because they do more GIM consults (more volume), so they make comparable money to a geriatrician. 

In Ontario? From what I've heard, you don't even need to do a +1 in Care of the Elderly to do inpatient geriatric work (lots of FPs do inpatient geriatric work or house calls without any +1), you can still do hospitalist medicine as an FM doc

But yes, the more inpatient work you do, the more money you make I would think - but a Geriatrician would be able to bill more, so if the FM & Geriatrician is doing the same amount of inpatient work, the geriatrician will be making more money 

[strawberryjams]

Thank you! Yes I was curious if there is any benefit to doing internal med especially if you can still do geriatrics as a FM and have similar income. Most jobs I see ask for +1 in geriatrics after FM. They consider internal med and FM+1 equivalent for certification, especially for hospital jobs.

[brady23]

6 minutes ago, strawberryjams said:

Thank you! Yes I was curious if there is any benefit to doing internal med especially if you can still do geriatrics as a FM and have similar incom.

No problem! A geriatrician definitely can bill more. If you want to do FM geriatric work, then yes, internal med will get you more money (ex: if both a geriatrician and FM doc see 6 geriatric patients, the geriatrician can bill more)

But both an FM and geriatrician can also do GIM, so they both can see 12 general inpatients as well and again, the geriatrician bills more.

So basically, a geriatrician will make more money doing the same work as a FM. The only reason to do a +1 in Care of the Elderly is if you're interested in FM, because 75-90% of your work will be FM related with maybe 10-25% doing other stuff.

If you want to do inpatient work, may as well do internal because you get to bill more for the same amount of work 

[strawberryjams]

Thank you so much! Are you considering the same residency? appreciate your help.

[brady23]

52 minutes ago, strawberryjams said:

Thank you so much! Are you considering the same residency? appreciate your help.

Yes I am! But I prefer outpatient geriatrics, so I'm not sure if the internal medicine route is for me, I'm leaning towards Care of the Elderly via the FM route!

How about yourself? 

[strawberryjams]

I was leaning towards the same thing. Outpatient geriatrics trhough the FM+1

[brady23]

2 minutes ago, strawberryjams said:

I was leaning towards the same thing. Outpatient geriatrics trhough the FM+1

Interesting! Let me know if you find any info about this, I couldn't really find much other than word of mouth from some geriatricians in my school!

[ACHQ]

20 hours ago, brady23 said:

Hey guys,

Just had a question about the routes to geriatrics.

I'm someone who enjoys outpatient geriatrics (ex: memory & fall clinics) more than inpatient geriatrics (taking care of acute elderly patients on the wards). 

Is it possible to do outpatient geriatrics 100% after internal medicine, because most of the geriatricians I've seen practice in a combination of inpatient & outpatient settings? I imagine it might not be feasible to do 100% outpatient geriatrics which is why I think the Care of the Elderly route may be more appropriate for me, but would love to hear your thoughts!

 

 

You have to ask yourself this question:

- Do you like Internal medicine? If you only like the Geriatrics portion of IM and nothing else, going through 3 years of core Internal Medicine with the rigors of call and the royal college exam is not worth it. What if you weren't able to match to Geri?? Would you be happy being GIM? If the answer is no then I wouldn't do Internal medicine. Core Internal medicine's goal is to train Internists, not subspecialists (even if we want to be a subspecialist). Also something big that often people forget is, if you want to be a good sub-specialist you should be a good internist first.

You should only do a specialty that you see yourself interested in (for any specialty). Otherwise you will hate your life. The only reason I can tolerate residency in Internal medicine is because I generally enjoy what I do.

[brady23]

1 hour ago, ACHQ said:

 

You have to ask yourself this question:

- Do you like Internal medicine? If you only like the Geriatrics portion of IM and nothing else, going through 3 years of core Internal Medicine with the rigors of call and the royal college exam is not worth it. What if you weren't able to match to Geri?? Would you be happy being GIM? If the answer is no then I wouldn't do Internal medicine. Core Internal medicine's goal is to train Internists, not subspecialists (even if we want to be a subspecialist). Also something big that often people forget is, if you want to be a good sub-specialist you should be a good internist first.

You should only do a specialty that you see yourself interested in (for any specialty). Otherwise you will hate your life. The only reason I can tolerate residency in Internal medicine is because I generally enjoy what I do.

Thank you! I'm pretty sure I'm going to end up doing FM +1 in COE, just wanted to make sure I wasn't closing any doors! 

[ACHQ]

5 hours ago, brady23 said:

Thank you! I'm pretty sure I'm going to end up doing FM +1 in COE, just wanted to make sure I wasn't closing any doors! 

Seems like you just finished first year (from your signature).  Things will become alot more clear when you do clerkship. 

[blacktowel]

I am a family medicine resident in Edmonton. Here, there are plenty of +1s who work exclusively geriatrics. They tend to make more than regular FPs. I've also seen them work in as much capacities as geriatricians. It seems here, and in many other parts of Canada, they are considered equivalent as far as scope (internal residency prepares you better for acute patients and research theoretically, but it hasn't affected the scope of practice here). It's true if you can see yourself in family medicine, go for the +1 route. If you prefer internal medicine and inpatients, go the internal route. How you decide between the two year difference in residency is up to you :)

[strawberryjams]

45 minutes ago, blacktowel said:

I am a family medicine resident in Edmonton. Here, there are plenty of +1s who work exclusively geriatrics. They tend to make more than regular FPs. I've also seen them work in as much capacities as geriatricians. It seems here, and in many other parts of Canada, they are considered equivalent as far as scope (internal residency prepares you better for acute patients and research theoretically, but it hasn't affected the scope of practice here). It's true if you can see yourself in family medicine, go for the +1 route. If you prefer internal medicine and inpatients, go the internal route. How you decide between the two year difference in residency is up to you

is it easy to find jobs in geriatrics in edmonton?

[brady23]

3 hours ago, blacktowel said:

I am a family medicine resident in Edmonton. Here, there are plenty of +1s who work exclusively geriatrics. They tend to make more than regular FPs. I've also seen them work in as much capacities as geriatricians. It seems here, and in many other parts of Canada, they are considered equivalent as far as scope (internal residency prepares you better for acute patients and research theoretically, but it hasn't affected the scope of practice here). It's true if you can see yourself in family medicine, go for the +1 route. If you prefer internal medicine and inpatients, go the internal route. How you decide between the two year difference in residency is up to you :)

Thank you - this was helpful! It's great to hear that in Edmonton, there is a good scope of practice for +1s in Care of the Elderly, I'm not sure what the situation in Ontario is though.