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10 minutes ago, LittleDaisy said:

Thanks ACHQ for posting all the detailed explanation.

Having talked to a few academic GIM staff at University of Toronto, their work-life balance and remuneration is pretty decent! After you passed through the status of clinical associate--> Assistant Professor, or landed a permanent position, you become a part of the group plan. They usually make around 300-400 K with overhead around 5%, I am seriously not kidding! I think that if you have a chance, most people would prefer make 300-400 K per year while having residents doing in-house calls, reviewing consults/teaching during the day; than making 500 K while doing everything yourself, which can easily lead to burnout. 

They are paid around 100 $ per hour per teaching (small group teaching, lectures), it doesn't pay as much as community hospital consults, but I find that it's protective time to take some time away from the crazy ward, and go teach medical students and make an impact. 

Also, if you become an assistant professor, your kids go to UofT for free (doesn't include professional schools like law, MD, pharmacy etc), but that cover a decent 4 years of undergraduate studies. 

Keep in mind, that they also receive some significant money from the Ministry of Health for "teaching stipends" which can result in a few thousands dollars per month depend on how involved you are in teaching.

The caveat is that it's really hard to get in, they do make you work hard for a few years as a "clinical associate" where you have an overhead of 10-20%,. 

 

Thank you for your post. I have my bias's about academic medicine which I will not air here (as I have already made it clear in my other posts). Suffice to say there are differences and pros and cons to each.

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I agree with most of what you said, with a caveat/slight disagreement. IF you are at all geographically (and of course sub-specialty) restricted, the match becomes uber stressful and much more competi

Hello all, I'm starting this thread for those interested in asking questions about GIM (or even Internal medicine in general... see what I did there ) Who am I? PGY-4 Internal Medicine resi

Hey! Thank you so much for doing this! I lol'd at the pun  *After typing this up, I realized it is actually quite long, so I apologize in advance. Feel free to PM me any answers that you thin

1 minute ago, ACHQ said:

 

Thank you for your post. I have my bias's about academic medicine which I will not air here (as I have already made it clear in my other posts). Suffice to say there are differences and pros and cons to each.

I find that they take advantage of the new grads, hiring them for clinical associates usually for 3 years, with annual review of their performance. They tend to push the clinical associates to take more teaching roles/ administrative roles which take a lot of time,  pushing them for research/publications, which can be stressful; by the promise of eventual permanent job position. 

It really depends on how much "scut work" you can take on when you were young. The older academic staff usually love their job, as by then, they are laid back enough to let the residents run the show without double-checking everything, come during the weekdays/weekend AM to review, and get home by 5:30 pm; and asking the young staff to do the teaching/admin, cover most weekends/overnights. 

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  • 1 month later...

Hi, 3rd year medical student interested in IM and potentially GIM. Would you mind sharing how your work-life balance is as a GIM staff compared to residency? I have heard IM residency is very brutal and I am wondering if that becomes better once you are a staff? Also, do you still have to do 1 in 4 call as a staff GIM.

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16 hours ago, MedZZZ said:

Hi, 3rd year medical student interested in IM and potentially GIM. Would you mind sharing how your work-life balance is as a GIM staff compared to residency? I have heard IM residency is very brutal and I am wondering if that becomes better once you are a staff? Also, do you still have to do 1 in 4 call as a staff GIM.

I have not yet started as staff but I do have my schedule for August. I would say there is more time "off" so to speak.

24-26 hour calls don't exist as a staff in GIM anymore (for the most part),  at my centre the GIMers have various types of coverage's (which include evenings and nights):

1. ER consults: these are shifts 8am-4pm, 4pm-12am 12am-8am, with an overlap shift between 6pm-11pm (depending on how busy things are sometimes you stay later but I've been told not by more than an hour usually).

2. Inpatient wards: you only cover 8am to 6pm every day M-Sunday for patients admitted to you (that being said you can deal with most things over the phone after 4-5 and before 6pm, so you can technically go earlier)

3. Med consults: same as above but because you aren't the MRP you can really just leave and not have to worry.

4. Clinics: this is Monday-Friday 8am-4pm (and usually your last patient is like 3pm, so really you are just wrapping up in the last hour).

My schedule for August is roughly as so: 2 evening shifts (one is a friday 4pm-11:59pm, one is a saturday 4pm-11:59pm and these are actually back to back), and 2 overnight shifts (one is a Tuesday 11:59pm- 8am and one is friday 11:59pm- 8am). I have 3 overlap shifts (6pm-11pm) on days I'm otherwise doing nothing, and 2 overlap shifts (6pm-11pm) on days where I'm at the hospital for inpatient work 8am-6pm (although I think I'll be done at least an hour, if not more before 6pm). I have one MRP/inpatient week that is Monday-Sunday 8am-6pm (roughly, but again I don't anticipate I'll be staying that late on most days).

counting the days I have completely off: 15

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  • 4 months later...
On 5/7/2020 at 1:32 PM, ACHQ said:

I have not yet started as staff but I do have my schedule for August. I would say there is more time "off" so to speak.

24-26 hour calls don't exist as a staff in GIM anymore (for the most part),  at my centre the GIMers have various types of coverage's (which include evenings and nights):

1. ER consults: these are shifts 8am-4pm, 4pm-12am 12am-8am, with an overlap shift between 6pm-11pm (depending on how busy things are sometimes you stay later but I've been told not by more than an hour usually).

2. Inpatient wards: you only cover 8am to 6pm every day M-Sunday for patients admitted to you (that being said you can deal with most things over the phone after 4-5 and before 6pm, so you can technically go earlier)

3. Med consults: same as above but because you aren't the MRP you can really just leave and not have to worry.

4. Clinics: this is Monday-Friday 8am-4pm (and usually your last patient is like 3pm, so really you are just wrapping up in the last hour).

My schedule for August is roughly as so: 2 evening shifts (one is a friday 4pm-11:59pm, one is a saturday 4pm-11:59pm and these are actually back to back), and 2 overnight shifts (one is a Tuesday 11:59pm- 8am and one is friday 11:59pm- 8am). I have 3 overlap shifts (6pm-11pm) on days I'm otherwise doing nothing, and 2 overlap shifts (6pm-11pm) on days where I'm at the hospital for inpatient work 8am-6pm (although I think I'll be done at least an hour, if not more before 6pm). I have one MRP/inpatient week that is Monday-Sunday 8am-6pm (roughly, but again I don't anticipate I'll be staying that late on most days).

counting the days I have completely off: 15

How much control do you have over your schedule - in terms of which weeks worked, when your call/evening shifts are? Would it for example repeat the same schedule each month, or more random depending on staffing requirements?

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On 10/1/2020 at 5:03 PM, interestedinrads said:

How much control do you have over your schedule - in terms of which weeks worked, when your call/evening shifts are? Would it for example repeat the same schedule each month, or more random depending on staffing requirements?

At my site it was done manually by the division head, and you could request certain days to work and certain days off and they would do their best to accommodate (but not always possible given the sheer number of request). If you gave no requests than it would be at random.

 

We are moving to a more automated system to do this, where everyone in our division puts in their preferences and a program will spit out a schedule. Well see how well it goes as we are starting it for the Jan 2021- beyond scheduling

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On 2/19/2020 at 9:30 PM, ACHQ said:

Hello all,

I'm starting this thread for those interested in asking questions about GIM (or even Internal medicine in general... see what I did there ;) )

Who am I? PGY-4 Internal Medicine resident, in the "4-year" GIM program. I will be finishing June 30 2020. Come July, I have a job lined up at a large community hospital in the GTA.

Ask away!

FYI I am a Staff now at the said large community hospital (about 2 months and a bit into practice)

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  • 4 weeks later...

Hey ACHQ, thanks for your detailed responses. MDhopeful11 here. I am a current PGY2 in IM at UofT. I am debating between the 4 and 5 year GIM. I am leaning towards the 4 year because I def want to work in a community setting (I like seeing my own patients!). Although I love to teach, research really isn't my cup of tea. 

How have your two months into practice as a staff been? Has it been an exponential learning curve?

A few specific questions:
1) Do you anticipate any difference in hiring 4 vs 5 year grads in the upcoming years at community sites? 

2) Do you have any opportunity to teach at your current site?

3) What do you recommend in terms of networking for jobs as a PGY3/PGY4? Would you recommend doing a formal elective at the site and/or locuming? When would optimal timing be? Also, how does one know which site is actually hiring GIMs (sorry if this is a super obvious/silly question...)? 

4) How has the work life balance been? How many weekends/month do you work? 

5) Do you feel well supported when you're working? Do you feel overwhelmed by the # of consults you are expected to do? 

5) Honestly, no one ever talks about billing during residency. I am curious to see billing codes. Do you have any resource where I can see them? Or perhaps can you please share the average amount you would bill for a consult/follow up etc? 

6) Does your hospital take an overhead? Do they give you a stipend for working certain hours? 

Thanks so much!

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18 hours ago, Synth1 said:

You are only working on half the days in a given month?!?

well I filled my schedule with extra work so I ended up having 10 days off (not counting post call days, and including the weekends I wasn't working)

On 10/27/2020 at 3:40 PM, MDhopeful11 said:


How have your two months into practice as a staff been? Has it been an exponential learning curve?

Busy when on service, but I find myself becoming more efficient which is nice. The medicine is the same and tbh I find the complete autonomy liberating and makes it more enjoyable. There is a lot logistics to learn (billings/how you get paid, hospital dynamics etc...) but that's with any transition. 


A few specific questions:
1) Do you anticipate any difference in hiring 4 vs 5 year grads in the upcoming years at community sites? 

- No. 99% of those in the community have done the 4 year program. No one really cares.

 

2) Do you have any opportunity to teach at your current site?

- There are, but you have to be more active in seeking them out. I actually let the education lead know I was interested about having residents, and 2-3 months in I have yet to work with one. That being said our site doesn't get a ton of residents.

 

3) What do you recommend in terms of networking for jobs as a PGY3/PGY4? Would you recommend doing a formal elective at the site and/or locuming? When would optimal timing be? Also, how does one know which site is actually hiring GIMs (sorry if this is a super obvious/silly question...)? 

- Doing a formal elective is key. Most places wont hire you unless they know you somehow, and its easy to do that as an elective resident. Locuming helps too if you have already finished. Optimal timing is usually 6-8 months prior to your desired start date (ideally Oct-Feb of your final year). Most knowledge of sites that are hiring has been via word of mouth unfortunately.


4) How has the work life balance been? How many weekends/month do you work? 

- I've been working extra cause I want/need to make more $ hahaha. I think if I wasn't picking up extra work I would have a good amount of time off a month (mostly during weekdays). Regardless of that though, at baseline I have to generally work 2 weekends a month, usually one of those weekends is both days of MRP/hospitalist rounding which is ~8am-4pm (could finish earlier or later depending on the list), the other weekend is usually ED consult shift on either saturday or sunday (and sometimes both days).

 

5) Do you feel well supported when you're working? Do you feel overwhelmed by the # of consults you are expected to do? 

- Its a bit diff in terms of support when your staff... that being said most people are friendly and happy to give their opinion, and at my site there are lots of sub-specialists (home call) and in-house ICU to give support if needed. I can't think of anyone who wouldn't feel overwhelmed, especially when its busy by the # of consults, because generally you are on your own to see all the consults. That being said when you get thrown into the fire you manage and figure it out.

6) Honestly, no one ever talks about billing during residency. I am curious to see billing codes. Do you have any resource where I can see them? Or perhaps can you please share the average amount you would bill for a consult/follow up etc? 

- Yes, its extremely frustrating. I basically spent my 4th year of GIM learning how to bill.

http://www.health.gov.on.ca/en/pro/programs/ohip/sob/

above is the schedule of benefits. The easiest examples I can give are the ER: New consult is $157, during the day (0700-1700) you can add a premium of $20, during the evening (1700-2359) its $60, and overnight (2400/0000 - 0659) its $100, any time on weekends or holidays its $75. If you end up admitting a patient its 30% premium.

so during the day a consult+admission from the ER is $224.10, in the evening its $264.10, weekends/holidays its $279.10, and overnight its $304.10.

if you just do a consult and discharge the patient from the ER its: day- $177, evening- $217, weekends/holidays- $232, overnight- $257

7) Does your hospital take an overhead? Do they give you a stipend for working certain hours? 

- Hospitals don't take over-head for GIM. My site gives a stipend for ED consult shifts and MRP/Hospitalist work, it is a flat stipend for the day worked.

Answers bolded

 

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  • 5 months later...

Hey @ACHQ,

Sorry to revive a sorta dead topic. Just was wondering if you anticipate the job market to change for GIM (im still really early in my training, but one of my fears is not being able to find a job) and how pay has been at your current type of lifestyle.

Thanks!

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On 3/31/2021 at 8:42 AM, sanoori said:

Hey @ACHQ,

Sorry to revive a sorta dead topic. Just was wondering if you anticipate the job market to change for GIM (im still really early in my training, but one of my fears is not being able to find a job) and how pay has been at your current type of lifestyle.

Thanks!

Its hard to know what the job market will be 5-10 years down the road. I do see things tightening up a bit in GIM in the GTA specifically. Right now is still decent as some hospitals are looking, but when you are out its hard to predict.

 

Re: pay with my current lifestyle. I would say pretty damn good. I was picking up alot of extra work so my pay is relatively higher with less days off, but I almost always have for sure 2 full weekends off AND between 3-5 weekdays off, not including post call days.

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Hi @ACHQ, thank you so much for all the insights you have provided!

I'm a 4th year medical student who is still deciding between IM and FM, and part of the reason is that I'm interested in clinic-based subspecialties (rheum, endo, etc.) and am unsure how I'd feel about GIM if I end up not matching. 

Looking at the thread, though, it looks like it's possible to do pure outpatient work as a GIM doc with a decent income. I was just wondering, what is the job market like for outpatient GIM clinics? 

Thanks!

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If I may chime in regarding this:

17 hours ago, ihsh said:

I'm interested in clinic-based subspecialties (rheum, endo, etc.) and am unsure how I'd feel about GIM if I end up not matching. 

Having just gone through the match (matched to 5 year GIM and unsure if I would've prefered to go unmatched and do 4-year, but that's another storty), the chances of not matching in Carms 2.0 is quite low. I think if you're trying to decide between FM/IM, maybe approach it from the perspective of would I rather do FM in 2 years or endo/rheum in 5 years with 3 years of a more difficult specialty? i.e. I think you should go by the assumption that you will match to your subspecialty of choice. It is waaaay less stressful and less competitive than the R1 CaRMS match. I know people who applied for GI (generally competive) didn't match, applied for rheum/endo in 2nd round with no electives and matched...

With regards to outpatient clinics, someone who is done can correct me if I'm wrong, but you can do whatever you want e.g. you can do GIM and set up a clinic with a focus on endo or rheum, tell GPs in the area that you've done extra training in those and get referrals for them. Also, here is a similar thread talking about purely outpatient practices: 

 

With regards to the job market, it would be whereever you can set up shop and if there is a need in that community. e.g. maybe not the best idea to have a GIM run rheum clinic in a town with 5 established rheumatologists

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18 hours ago, skyuppercutt said:

If I may chime in regarding this:

Having just gone through the match (matched to 5 year GIM and unsure if I would've prefered to go unmatched and do 4-year, but that's another storty), the chances of not matching in Carms 2.0 is quite low. I think if you're trying to decide between FM/IM, maybe approach it from the perspective of would I rather do FM in 2 years or endo/rheum in 5 years with 3 years of a more difficult specialty? i.e. I think you should go by the assumption that you will match to your subspecialty of choice. It is waaaay less stressful and less competitive than the R1 CaRMS match. I know people who applied for GI (generally competive) didn't match, applied for rheum/endo in 2nd round with no electives and matched...

With regards to outpatient clinics, someone who is done can correct me if I'm wrong, but you can do whatever you want e.g. you can do GIM and set up a clinic with a focus on endo or rheum, tell GPs in the area that you've done extra training in those and get referrals for them. Also, here is a similar thread talking about purely outpatient practices: 

 

With regards to the job market, it would be whereever you can set up shop and if there is a need in that community. e.g. maybe not the best idea to have a GIM run rheum clinic in a town with 5 established rheumatologists

I agree with most of what you said, with a caveat/slight disagreement. IF you are at all geographically (and of course sub-specialty) restricted, the match becomes uber stressful and much more competitive. Most individual schools have very few spots per sub-specialty, and the ones with more spots are usually places most people want to match to... personally I applied to a sub-specialty but only to 1 location (you can probably guess which locations...) because I was geographically restricted, I knew the risk of going unmatched but thought I'd be happy with GIM. I ended up not matching and doing the 4 year GIM, and it worked out better for me (in hindsight) but just be careful, because if you know now that you only want to match to a certain location and dont want to do GIM as a back up, then one thing will have to give.

Also the R4 match is a one shot done deal. After round 2 (which is just a smattering of various unfilled spots and is completely unpredictable), its over. Your career specialty is chosen, your location is locked and you have to live with it. There are no transfers, not allowed to do the R4 CaRMS match again, nothing. So keep this in mind.

 

Also just a personal insight into outpatient practice and job prospects/flexibility etc... that I have learned as a staff due to the pandemic. Outpatient practice is considered job prospect wise always good because you can just set up shop and just put the "word out" that you are accepting referrals. BUT with the pandemic I have seen that many physicians that are either purely outpatient based, or have a heavy outpatient based practice take a huge hit financially. Its a bit better now with virtual visits, but still not at the pre-pandemic volumes/pay. So just keep that in mind. I thank god every day I have a job in medicine which can withstand even a pandemic.

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Completely agree. If you want a competitive speciality (this year, cardiology, GI and ICU) or a competitive location, or there just happens to be a lot of people wanting a spot for a specialty at your school, the MSM match can be very competitive! Typically around 15% of candidates a year don't match in the MSM. 

12 hours ago, ACHQ said:

 

I agree with most of what you said, with a caveat/slight disagreement. IF you are at all geographically (and of course sub-specialty) restricted, the match becomes uber stressful and much more competitive. Most individual schools have very few spots per sub-specialty, and the ones with more spots are usually places most people want to match to... personally I applied to a sub-specialty but only to 1 location (you can probably guess which locations...) because I was geographically restricted, I knew the risk of going unmatched but thought I'd be happy with GIM. I ended up not matching and doing the 4 year GIM, and it worked out better for me (in hindsight) but just be careful, because if you know now that you only want to match to a certain location and dont want to do GIM as a back up, then one thing will have to give.

Also the R4 match is a one shot done deal. After round 2 (which is just a smattering of various unfilled spots and is completely unpredictable), its over. Your career specialty is chosen, your location is locked and you have to live with it. There are no transfers, not allowed to do the R4 CaRMS match again, nothing. So keep this in mind.

 

Also just a personal insight into outpatient practice and job prospects/flexibility etc... that I have learned as a staff due to the pandemic. Outpatient practice is considered job prospect wise always good because you can just set up shop and just put the "word out" that you are accepting referrals. BUT with the pandemic I have seen that many physicians that are either purely outpatient based, or have a heavy outpatient based practice take a huge hit financially. Its a bit better now with virtual visits, but still not at the pre-pandemic volumes/pay. So just keep that in mind. I thank god every day I have a job in medicine which can withstand even a pandemic.

 

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On 4/5/2021 at 10:27 PM, ACHQ said:

Its hard to know what the job market will be 5-10 years down the road. I do see things tightening up a bit in GIM in the GTA specifically. Right now is still decent as some hospitals are looking, but when you are out its hard to predict.

 

Re: pay with my current lifestyle. I would say pretty damn good. I was picking up alot of extra work so my pay is relatively higher with less days off, but I almost always have for sure 2 full weekends off AND between 3-5 weekdays off, not including post call days.

Thank you so much! Sounds like it was a good match for you and happy things are looking good. 

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  • 3 weeks later...

Hi @ACHQ, thank you for this very informative page. I am an MSI3 consider GIM. I have completed by CTU rotation which i enjoyed in terms of variety as well as complexity, but I have heard that GIM/hospitalist inpatient wards can become "dumping grounds" for patients they can't find room for/don't fit elsewhere. Can you comment on it?

Also, I have yet to have GIM outpatient experience so I was wondering what kind of things you encounter in the urgent care clinics/ GIM outpatient clinics. Do you still get a lot of variety and diagnostic dilemmas in the outpatient setting?

Thanks!

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1 minute ago, UBCmedclass2022 said:

Hi @ACHQ, thank you for this very informative page. I am an MSI3 consider GIM. I have completed by CTU rotation which i enjoyed in terms of variety as well as complexity, but I have heard that GIM/hospitalist inpatient wards can become "dumping grounds" for patients they can't find room for/don't fit elsewhere. Can you comment on it?

Also, I have yet to have GIM outpatient experience so I was wondering what kind of things you encounter in the urgent care clinics/ GIM outpatient clinics. Do you still get a lot of variety and diagnostic dilemmas in the outpatient setting?

Thanks!

Your first point is universally sort of true for hospital medicine in general in north america. There is institutional variation but if you're doing inpatient medicine then you should like most aspects of inpatient medicine. 

As for the second, you can have challenging diagnostic workups as a family doctor as well. Don't have to be GIM for that. 

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12 minutes ago, medigeek said:

Your first point is universally sort of true for hospital medicine in general in north america. There is institutional variation but if you're doing inpatient medicine then you should like most aspects of inpatient medicine. 

As for the second, you can have challenging diagnostic workups as a family doctor as well. Don't have to be GIM for that. 

I have just found that the bread and butter of family medicine (MSK, derm, etc.) to not be interesting to me, hence, I'm asking about GIM outpatient. What I'm trying to ask is what kind of complaints do GIM see as outpatients? Mostly hypertension, diabetes, etc. or is there still a lot of variety?

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Just now, UBCmedclass2022 said:

I have just found that the bread and butter of family medicine (MSK, derm, etc.) to not be interesting to me, hence, I'm asking about GIM outpatient. What I'm trying to ask is what kind of complaints do GIM see as outpatients? Mostly hypertension, diabetes, etc. or is there still a lot of variety?

Pretty much same stuff you'd see in FM for adults except it's more concentrated in one area (depending on the doctor) or sometimes more broad if they so wish. 

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39 minutes ago, UBCmedclass2022 said:

I'm asking about GIM outpatient. What I'm trying to ask is what kind of complaints do GIM see as outpatients? Mostly hypertension, diabetes, etc. or is there still a lot of variety?

There can be a lot of variety depending on the internist and their interests. I was on outpatient clinics last week and on consultant had 14 patients that he was following for HTN: 4 new consults for HTN (one was already on 3 meds and the other 3 were on a low dose ACEi) and 10 follows for whom he was titrating their meds. 

Another physician saw about 20 patients. 5 pregnant women because they run a medicine/OB clinic, 10 or so followups for HTN, diabetes, proteinuria, CHF, post-discharge followup, and 5 new consults for nephrotic range proteinuria (referred to nephro for a biopsy), thrombocytopenia, dyspnea (did covid swab+CXR, who couldn't see GP because of virtual clinics), anemia and HTN. So very very varied. 

Another physician had a half day clinic with like 12 patients. Of which I saw someone with cirrhosis+overloaded already on lasix, but developed an AKI, a patient with vasculitis (referred to rheum, cause dat shit is scary), a patient with PMR (but no GCA), someone with CHF, and a patient with fatigue (but normal TSH and hemoglobin). So also pretty varied. 

As an internist, you can decide to be broad and accept lots of different referrals or focus on just a couple of conditions and be known for those. So totally up to you how you want to run your (future) clinic :D

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13 hours ago, skyuppercutt said:

There can be a lot of variety depending on the internist and their interests. I was on outpatient clinics last week and on consultant had 14 patients that he was following for HTN: 4 new consults for HTN (one was already on 3 meds and the other 3 were on a low dose ACEi) and 10 follows for whom he was titrating their meds. 

Another physician saw about 20 patients. 5 pregnant women because they run a medicine/OB clinic, 10 or so followups for HTN, diabetes, proteinuria, CHF, post-discharge followup, and 5 new consults for nephrotic range proteinuria (referred to nephro for a biopsy), thrombocytopenia, dyspnea (did covid swab+CXR, who couldn't see GP because of virtual clinics), anemia and HTN. So very very varied. 

Another physician had a half day clinic with like 12 patients. Of which I saw someone with cirrhosis+overloaded already on lasix, but developed an AKI, a patient with vasculitis (referred to rheum, cause dat shit is scary), a patient with PMR (but no GCA), someone with CHF, and a patient with fatigue (but normal TSH and hemoglobin). So also pretty varied. 

As an internist, you can decide to be broad and accept lots of different referrals or focus on just a couple of conditions and be known for those. So totally up to you how you want to run your (future) clinic :D

Roughly how long would it take to build up this kind of volume when you're fresh out of training? I also imagine it might be difficult to find clinic space to do this? I don't see many job postings offering space for GIM outpatient. 

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16 hours ago, UBCmedclass2022 said:

Hi @ACHQ, thank you for this very informative page. I am an MSI3 consider GIM. I have completed by CTU rotation which i enjoyed in terms of variety as well as complexity, but I have heard that GIM/hospitalist inpatient wards can become "dumping grounds" for patients they can't find room for/don't fit elsewhere. Can you comment on it?

Also, I have yet to have GIM outpatient experience so I was wondering what kind of things you encounter in the urgent care clinics/ GIM outpatient clinics. Do you still get a lot of variety and diagnostic dilemmas in the outpatient setting?

Thanks!

The medicine wards can sometimes be dumping grounds, and unfortunately we (internal medicine) are too nice to fight too much about it. That being said the majority of stuff you see on the wards is bread and butter medicine.

 

I do mostly urgent GIM clinics linked to a hospital, so I see alot more acuity than say a private GIM practice in the community. Generally speaking most of the stuff we see in clinic are patients that go to the ER and need a work up/diagnosis but don't need to be admitted for it vs post hospital discharge follow up. Examples include (but not limited to): New onset CHF, dyspnea, Anemia/thromobocytopenia, elevated LFTs, malignancy work up, New/uncontrolled diabetes, new cirrhosis, worsening chronic condition that doesn't need admission but titration of meds (stable but decompensated CHF or Cirrhosis or COPD etc...) Random incidental lab findings that need work up.

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