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9 hours ago, ACHQ said:

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.

Wow that sounds like really great variety even in the clinic setting. Sounds like you have a great set up! Thanks for this response :)

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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

ummm not sure this is accurate for the GTA (or even Ontario)   I, myself, did the 4 year GIM program. I work at a large tertiary centre (non-academic) in the GTA. Outside of the *true* acade

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

Hi! I'm a PGY3 internal med in Quebec. I'm having difficulty choosing between PGY4 GIM vs GIM PGY5. 

I'm an older applicant and tired of residency. To me the PGY5 is a money grab to force residents to get paid for nothing for an extra year. My goal is to work in a community hospital within the limits of a big city eg. Toronto GTA or Vancouver. 

The issue is that Quebec is the only province where in order to work here you need to go a GIM PGY5. 

I was wondering if someone who did PGY4 have a community hospital job and how they found the job finding process? Did they feel that many jobs asked for the PGY5 GIM? Did you have to go more rural? 

I'm also interested in pall care aand was wondering if there are any GIM who  have incorporated this into their practice? There is a pall care fellowship that's two years but to me that's way too long. I don't get why fam med get certified after one year but IM is forced to do 2? 

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Hi! I'm a PGY3 internal med in Quebec. I'm having difficulty choosing between PGY4 GIM vs GIM PGY5. 

I'm an older applicant and tired of residency. To me the PGY5 is a money grab to force residents to get paid for nothing for an extra year. My goal is to work in a community hospital within the limits of a big city eg. Toronto GTA or Vancouver. 

The issue is that Quebec is the only province where in order to work here you need to go a GIM PGY5 so there's this mindset that you have to do a PGY5. I'm told by the gim pgy5 in Quebec that it's future proofing and will result in higher paid billing codes. 

I was wondering if someone who did PGY4 have a community hospital job and how they found the job finding process? Did they feel that many jobs asked for the PGY5 GIM? Did you have to go more rural? 

I'm also interested in pall care aand was wondering if there are any GIM who  have incorporated this into their practice? There is a pall care fellowship that's two years but to me that's way too long. I don't get why fam med get certified after one year but IM is forced to do 2? 

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3 hours ago, Jj16 said:

Hi! I'm a PGY3 internal med in Quebec. I'm having difficulty choosing between PGY4 GIM vs GIM PGY5. 

I'm an older applicant and tired of residency. To me the PGY5 is a money grab to force residents to get paid for nothing for an extra year. My goal is to work in a community hospital within the limits of a big city eg. Toronto GTA or Vancouver. 

The issue is that Quebec is the only province where in order to work here you need to go a GIM PGY5 so there's this mindset that you have to do a PGY5. I'm told by the gim pgy5 in Quebec that it's future proofing and will result in higher paid billing codes. 

I was wondering if someone who did PGY4 have a community hospital job and how they found the job finding process? Did they feel that many jobs asked for the PGY5 GIM? Did you have to go more rural? 

I'm also interested in pall care aand was wondering if there are any GIM who  have incorporated this into their practice? There is a pall care fellowship that's two years but to me that's way too long. I don't get why fam med get certified after one year but IM is forced to do 2? 

For sure its a money grab, but if you want to work in many centres, the 5 year GIM is becoming much more common and you will be boxed out if you don't just get the extra year. Most people use the extra year to get a "niche" area of interest, i.e. HTN, DM, IM-OB, Palliative without doing full 2 year fellowship for community related work etc. 

 

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20 minutes ago, who_knows said:

Can someone comment please, what is the point of doing 5 years of GIM if one can complete 3 years of IM and 2 years of specialty and then be qualified to do either specialty (if there is a job) or just GIM?

I don't think most centres would allow the individual in that situation to work in GIM without having the 4th or 5th year GIM. 

I had seen in the past Cardios and Nephros doing CTU type internal medicine work in hospital, but even that seems to be slowly phasing out. Very centre dependent. 

I think the 3 year base internal medicine doesn't allow for much anymore, as there are now more than enough people with the 4 year GIM, and now 5 year GIM. 

This is the perspective from major centres of course. Smaller centres the world is your oyster.

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1 hour ago, sterntaler said:

Does 4 vs 5 years matter if you are mainly interested in doing GIM clinics? 

Centre dependent, my understanding is no - not a big difference for outpatient. The main thing is, most people tend to do a mix of inpatient and outpatient, and its the inpatient piece that may be affected. Its much easier to do post-ER GIM clinics via hospital for example, and then build up a roster of patients this way for a constant referral stream...then rely solely on family docs to refer to you. Again, very province dependent.

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13 hours ago, JohnGrisham said:

For sure its a money grab, but if you want to work in many centres, the 5 year GIM is becoming much more common and you will be boxed out if you don't just get the extra year. Most people use the extra year to get a "niche" area of interest, i.e. HTN, DM, IM-OB, Palliative without doing full 2 year fellowship for community related work etc. 

 

ummm not sure this is accurate for the GTA (or even Ontario)

 

I, myself, did the 4 year GIM program. I work at a large tertiary centre (non-academic) in the GTA. Outside of the *true* academic centres (UHN, Mount Sinai, St. Michaels, Sunnybrook, Womens College), as of right now, it makes no difference if you do the 4 vs 5 year program. The 5 year program only pumps out like 5-7 grads a year at UofT and they are the largest program. All the places I interviewed at (large centres non-academic) did not once care or mention that they preferred the 5 year GIM. Even if you have a niche, most 4 years can build that niche in afterwards if need be (but at larger centres there are always subspecialist to take those patients anyways). I don't see this changing anytime soon. Most places don't care about the academic BS associated with doing the 5 year program and just want clinicians that are good at their job and good to work with.

 

As per doing the 5 year vs 4 year program if you are just interested in GIM clinics, there is even less incentive to do the 5 year program, as most clinic work is done outside of a hospital, meaning you can just join a clinic and start seeing patients. Even at hospitals the GIM group at non-academic centres in the GTA would not care. That being said no hospital would let you just do clinics and get out of doing call etc...

 

11 hours ago, who_knows said:

Can someone comment please, what is the point of doing 5 years of GIM if one can complete 3 years of IM and 2 years of specialty and then be qualified to do either specialty (if there is a job) or just GIM?

The 5 year GIM program is geared towards a more academic career. That is the only reason to really do it. Now there are some GIM's that do the 5 year program and end up in the community (not all of them can do academics).

There are some sub-specialists in some places that do some GIM work. Its not as common as before as volumes in all sub-specialties are quiet high. Full time GIM work commands alot of time, so doing another sub-specialty can be tough, but some people do it, but yes its not as common anymore. At my centre its mostly GIM/ICU, but there are some that do GIM/Resp, GIM/Nephro, GIM/ID. The vast majority of these people are doing GIM call only though, but some do hospitalist as well. So if you wanted to really do that then you could you just have to crave out your schedule carefully and have buy in from the various departments.

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