Advice on FM hospitalist vs GIM

[coffeeaddict]

Hi everyone,

 

I am deciding between doing a FM + 1 in hospitalist vs GIM. Could anyone provide further insight into the scope of practice for FM+1 in hospitalist and what the job market is like for it in Toronto.

 

Thank you!

[freewheeler]

Do you feel a compulsive need for others to think you are the smartest person in the room? Do you love working inhumane hours? Do you have the personality of a walking textbook? 

If yes to the above do GIM.

Otherwise do hospitalist which is a dumping ground for internal medicine when their ward is getting full.

[JohnGrisham]

10 hours ago, freewheeler said:

Do you feel a compulsive need for others to think you are the smartest person in the room? Do you love working inhumane hours? Do you have the personality of a walking textbook? 

If yes to the above do GIM.

Otherwise do hospitalist which is a dumping ground for internal medicine when their ward is getting full.

Failure to cope, failure to thrive, "I dont know what they mean by dizziness, CT-head was normal, lets just admit to hospitalist".  Literal dumping ground of everything, as well not only when GIM is full but when GIM doesn't even want to touch it because its not acute enough or warrant their expertise.

Also, GIM is not always inhumane hours depending on centre. In the few centres ive been exposed to..GIM is not bad at all. Much better compensated as well with often fairly straight forward consults mixed into the more complex ones (especially if coming from the ED). Its getting through 4-5years of training that turns off many people.

[RadCdn]

FM residency is way more humane, but pay in GIM will be significantly higher. If you are one of those people who can work well with little sleep, then you'll do fine in an IM residency. 

Lifestyle of GIM can be better than FM. In GIM you don't have to see such a high volume of patients for a good income.

[blah1234]

I have more GIM friends that wish they just did FM hospitalist than FM friends that wish they did GIM. That being said I think both are fine jobs in the long run. Both jobs probably get mundane over time despite the differences in bread and butter. The residency intensity of IM isn't for everyone though. 

[ZBL]

GIM is the devil. That’s the difference. 

[ACHQ]

On 8/25/2019 at 1:09 AM, coffeeaddict said:

Hi everyone,

 

I am deciding between doing a FM + 1 in hospitalist vs GIM. Could anyone provide further insight into the scope of practice for FM+1 in hospitalist and what the job market is like for it in Toronto.

 

Thank you!

Depends where you want to practice.

I can only speak for the GTA. Most (almost all) Acute care  hospitals in the GTA have a GIM hospitalist model now. A few still have some FM hospitalist.

This change in the model of care is due to multiple factors, as over time more people end up wanting to do GIM and in turn have taken on more hospitalist roles, I have also heard from division heads that the FM's are moving away from it (due to their own reasons).

As mentioned above, some places will have less acute type of patients that FM hospitalists care for. I can't really comment cause I haven't seen the FM hospitalist list before, but GIM lists definitely have several non-acute patients (I think this relates more to having such high volumes that you just do end up with some non-acute patients).

If you are flexible in location, are ok with doing low acuity work (rehab hospitals, LTC homes, Complex continuing care, ALC transition hospitals/wards etc...), and like other things FM offers (FM clinics), then do FM + 1 in hospitalist. 

If you like other aspects of GIM work that is NON-hospitalist, i.e. ER admit service (which imo is the best part of GIM), GIM consult service, GIM clinics, than GIM is the way to go. 

[toastman]

I'm a new FM hospitalist at a major tertiary care centre in  a major Canadian city. Feel free to ask me questions. Did not do a +1. 

[foozer93]

13 hours ago, toastman said:

I'm a new FM hospitalist at a major tertiary care centre in  a major Canadian city. Feel free to ask me questions. Did not do a +1. 

What are your hours like, how are you paid? Yearly salary? hrly rate? are you doing anything else other than hospitalist?

[medigeek]

On 8/29/2019 at 12:42 AM, toastman said:

I'm a new FM hospitalist at a major tertiary care centre in  a major Canadian city. Feel free to ask me questions. Did not do a +1. 

what sort of complexity do you manage?

[toastman]

On 8/29/2019 at 1:43 PM, foozer93 said:

What are your hours like, how are you paid? Yearly salary? hrly rate? are you doing anything else other than hospitalist?

made a lot..pretty much making more than what i did in a whole year of residency in 4 weeks ... worked a lot tho

[toastman]

On 8/30/2019 at 11:41 PM, medigeek said:

what sort of complexity do you manage?

lots of acuiety..chfes, copdes, palliative pts, pna, sepsis etc

[toastman]

On 8/29/2019 at 1:43 PM, foozer93 said:

What are your hours like, how are you paid? Yearly salary? hrly rate? are you doing anything else other than hospitalist?

doing clinic as well and urgent care

[anonymouspls]

1 hour ago, toastman said:

made a lot..pretty much making more than what i did in a whole year of residency in 4 weeks ... worked a lot tho

So you're making around 60K a month? Are you also working in a rural community? 

How much would you say you would be making if you were doing exactly what you're doing now but for 48-50 hours 5 days a week?

[member_225]

54 minutes ago, ysera said:

So you're making around 60K a month? Are you also working in a rural community? 

How much would you say you would be making if you were doing exactly what you're doing now but for 48-50 hours 5 days a week?

believe none of what you hear and only half of what you see 

[toastman]

On 9/1/2019 at 11:49 PM, ysera said:

So you're making around 60K a month? Are you also working in a rural community? 

How much would you say you would be making if you were doing exactly what you're doing now but for 48-50 hours 5 days a week?

i was working in a major canadian city. dont care if you believe me or not. i can show you my billing submissions privately if you like. For the month of August with 6 days off in total I billed 62k+ from all sources. Many of my days were 13 hour minimums, lots of 24-36 hour periods. Not sustainable long term. 

[Wachaa]

6 hours ago, toastman said:

i was working in a major canadian city. dont care if you believe me or not. i can show you my billing submissions privately if you like. For the month of August with 6 days off in total I billed 62k+ from all sources. Many of my days were 13 hour minimums, lots of 24-36 hour periods. Not sustainable long term. 

 

As a GP myself, 62k for that amount of work is very attainable.

I know quite a few people think you need to go rural or into a specialty for that kind of pay, but really you just need to put in the hours/ volume (fee for service).

[blah1234]

24 minutes ago, Wachaa said:

 

As a GP myself, 62k for that amount of work is very attainable.

I know quite a few people think you need to go rural or into a specialty for that kind of pay, but really you just need to put in the hours/ volume (fee for service).

This is a doable number if you work a lot. I agree it's not sustainable in the long run though. I've seen too many people burn out from this job instead of keeping a sustainable pace. 

[IMislove]

So if you went more rural, easier to obtain that without working as many crazy hours? Rural being idk, 50k or less people? @Wachaa

[Wachaa]

20 minutes ago, IMislove said:

So if you went more rural, easier to obtain that without working as many crazy hours? Rural being idk, 50k or less people? @Wachaa

Yes and no. Overall, if rural is something you're interested in, then go for it. Besides the more interesting medicine, there are incentives and bonuses that make it financially worthwhile.

But as alluded to earlier, if you're willing to work hard, you can make a lot while staying in the city and enjoying the lifestyle that comes with staying in urban centres.

I have friends who did rural locums and none of them would call it a walk in the park. You're on call frequently, dealing with serious cases, and have less backup, which can also lead to high stress. In the city, if a patient is more acute and sick I'd send them to ER. In rural... you might be the one to still see them in the ER or admit them. You might be on call to take care of them all night also. All the while you have clinic and other responsibilities at the same time.

To tie this back to the original topic, FM hospitalist and GIM can both do in hospital work or outpatient work at their choosing. The level of complexity can differ greatly depending on the city/ centre that you're at. If you're a GP you can do hospitalist without additional training, but in major centres would likely be looking after bread and butter cases (an elective or rotation would give you a very good idea). GIM would be more of a consulting service but certainly do admitting as well.

[yonas]

[DELETED]

[Hospitalist2019]

Hello,

I am currently completing one of the few GIM fellowships in Canada as a family physician. I feel like I am in a unique position to answer the pros and cons of doing FM Hospitalist vs GIM. 

Please send me a PM and we can chat. 

[lovekimchi123]

Wait what. I didnt know this was an option? Where at and how many years?

[Hospitalist2019]

Please send me a PM and we can chat. Thanks.

[LittleDaisy]

On 9/3/2019 at 11:38 AM, toastman said:

i was working in a major canadian city. dont care if you believe me or not. i can show you my billing submissions privately if you like. For the month of August with 6 days off in total I billed 62k+ from all sources. Many of my days were 13 hour minimums, lots of 24-36 hour periods. Not sustainable long term. 

That's a lot but good for you if you love your work ! How many weeks do most FM hospitalists do in a major-sized city? I think that most people work 2 weeks straight and 2 weeks off per month? Am I correct?

I agree that working a lot after graduation to pay off debt aggressively might be a good idea, but I can't see myself doing that long term as I realize that I get older and sleep has become a major factor of my productivity and wellness  

In Toronto, for community hospitals, they prefer GPs with +1 degree,  but I've seen a few young staff got hired without extra training.

 I think that if you have enough training during residency and feel comfortable managing acute care patients and happen to  know people in the group, you can get hired from a word of mouth. I personally believe that you learn the most during the first 5 years as a staff, because for once, you are it and you get to make the major decisions, which pushes you even further!