Family Medicine vs Internal Medicine

[UKdocCadborn]

I have been reading through these forums for the better part of the month and decided to bite the bullet and ask the questions that I have. Thanks in advance for your assistance. 

I am a Canadian born, UK-trained doctor hoping to settle back home in the GTA. I have completed internal medicine training (4 years) in the UK and initially was going down a very academic haem-onc path. However, I have recently realised that the passion I thought I had for research and haem-onc as a whole does not exist and what I really love about being a doctor is seeing and treating sick patients, while keeping it quite general.

In terms of exams and licensing I have done the following: 1) Completed MCCEQ1 (hoping to do the Q2 early 2021 if I can get a spot), 2) Had my internal medicine training verified by the Royal College and have been deemed eligible to sit the royal college internal medicine exams which I plan to do in 2022. (for what it's worth I have done the UK MRCP, but don't think that means much in Canada). 

Due to family and person reasons I cannot come back to Canada until 2025. I am planning on doing a family medicine residency ((MRCGP) in the UK which will take 2.5 years and is directly recognised by the CFCC without any further exams needed. After that I plan to either work as an internal medicine middle grade doctor for 1.5 years/do some locum GP work in the UK. I then plan on doing one of the University of Toronto internal medicine hospitalist fellowships either at TGH or Sunnybrook. Ultimately, I like internal medicine but not so much GP. My main reason for doing family medicine training is to guarantee I can find a job of some description in the GTA, and I have got about four years of time to kill in the UK. My questions were:

1) How difficult do you think it would be for me to get a job as an internist based out of a hospital in the GTA with my credentials (my main concerns is not having done general internal medicine sub-specialty training although I will have done a 1-year Toronto fellowship)?

2) My dream job (if such a thing exists) would be to work as an internist with possibly a special interest in cardiology, mixing my time between hospital medicine and outpatient clinic. Financially, would that be more lucrative than being a family doctor who does some locum internal medicine shifts on the side? 

3) How confident in critical care would a GTA-based internist need to be? I can recognise and treat sick patients and escalate to ITU as needed, but have very minimal experience in intubation/inotropic support/haemofiltration. That is a skill-set I hope to expand on during my year of fellowship at UofT.

Thanks. 

[Edict]

On 12/10/2020 at 11:22 AM, UKdocCadborn said:

I have been reading through these forums for the better part of the month and decided to bite the bullet and ask the questions that I have. Thanks in advance for your assistance. 

I am a Canadian born, UK-trained doctor hoping to settle back home in the GTA. I have completed internal medicine training (4 years) in the UK and initially was going down a very academic haem-onc path. However, I have recently realised that the passion I thought I had for research and haem-onc as a whole does not exist and what I really love about being a doctor is seeing and treating sick patients, while keeping it quite general.

In terms of exams and licensing I have done the following: 1) Completed MCCEQ1 (hoping to do the Q2 early 2021 if I can get a spot), 2) Had my internal medicine training verified by the Royal College and have been deemed eligible to sit the royal college internal medicine exams which I plan to do in 2022. (for what it's worth I have done the UK MRCP, but don't think that means much in Canada). 

Due to family and person reasons I cannot come back to Canada until 2025. I am planning on doing a family medicine residency ((MRCGP) in the UK which will take 2.5 years and is directly recognised by the CFCC without any further exams needed. After that I plan to either work as an internal medicine middle grade doctor for 1.5 years/do some locum GP work in the UK. I then plan on doing one of the University of Toronto internal medicine hospitalist fellowships either at TGH or Sunnybrook. Ultimately, I like internal medicine but not so much GP. My main reason for doing family medicine training is to guarantee I can find a job of some description in the GTA, and I have got about four years of time to kill in the UK. My questions were:

1) How difficult do you think it would be for me to get a job as an internist based out of a hospital in the GTA with my credentials (my main concerns is not having done general internal medicine sub-specialty training although I will have done a 1-year Toronto fellowship)?

2) My dream job (if such a thing exists) would be to work as an internist with possibly a special interest in cardiology, mixing my time between hospital medicine and outpatient clinic. Financially, would that be more lucrative than being a family doctor who does some locum internal medicine shifts on the side? 

3) How confident in critical care would a GTA-based internist need to be? I can recognise and treat sick patients and escalate to ITU as needed, but have very minimal experience in intubation/inotropic support/haemofiltration. That is a skill-set I hope to expand on during my year of fellowship at UofT.

Thanks. 

1) Don't think it would be that hard, there are plenty of jobs, certainly you could get a hospitalist job, because that requires family medicine training alone. Do you have a UK IM license? Does 4 years of training get you fully certified in IM that would be recognized as equivalent to the Canadian FRCPC IM?

Getting a job as an internist may be not possible without a license in internal medicine (either UK full IM license or Canadian FRCPC IM). Your pay would likely be a hospitalist's pay and you would bill as a family physician in that case.  

2) All this depends on if you are a licensed Internist or a licensed GP. 

3) You would need to be quite confident, in the GTA, there are limited critical care jobs and even fully trained ICU doctors have trouble finding ICU time. The fellowship you are asking about doesn't sound like it would provide you with any ICU experience. It doesn't have call either, so it really would be mostly for you a chance to network and get your foot in the door and see how the Canadian system works. I doubt you would learn much. 

[UKdocCadborn]

Thanks very much for your reply. 

To reply in line: 

1) Yes I do have a UK IM license. Once I pass the Royal College IM exams (which I have been deemed eligible to sit based on my UK training), I will be eligible for the Canadian FRCPC IM. This is what the royal college have told me. 

2) I should be a licensed internist in that case. 

3) This was exactly my concern and thanks a lot for answering that so honestly. I can definitely still skill up here in the UK in critical care. There is no shortage of critical care fellowships atm, due to Covid. But, I think that fellowship at UoFT is not going to be great for my training as you said. 

Thank you so much for your helpful reply. 

[UKdocCadborn]

In case anyone ever stumbles upon this thread again and is in a similar situation, thought I would update my progress. 

I ended up applying for Internal Medicine Residency through CaRMS and found out I matched yesterday. The reason for my decision was I wanted to make sure I felt comfortable as an internist in Canada which I don't think I would have with my UK training to date alone. 

I also ended up getting rejected from one of the hospitalist UofT fellowship programs I applied for. 

[shikimate]

11 minutes ago, UKdocCadborn said:

In case anyone ever stumbles upon this thread again and is in a similar situation, thought I would update my progress. 

I ended up applying for Internal Medicine Residency through CaRMS and found out I matched yesterday. The reason for my decision was I wanted to make sure I felt comfortable as an internist in Canada which I don't think I would have with my UK training to date alone. 

I also ended up getting rejected from one of the hospitalist UofT fellowship programs I applied for. 

Congratulations!

I was wondering in your old post you mentioned your UK training actually counts for Royal College exam purpose, so does that shorten duration of your residency?

Will CBD allow you to progress much faster?

What's your opinion of the 4 years of UK IM residency? You mentioned you don't fell comfortable practicing here with your UK training so far?

[UKdocCadborn]

HI thanks a lot for your message. 

I haven't really explored that aspect with the program as of yet. I will just have to see how I get along I suppose once I start. I don't think my training will end up being shortened at all. Maybe if I race through my competencies it could be but it is not something I am too bothered about. 

With respect to my UK training, if I were to break it down in a bit more detail I did: 2 years of a rotating internship (spent a lot of time in internal medicine specialties but a very junior role), I then did 2 years of core internal medicine residency. I then elected not to apply for specialist registrar training which is where I would have gained a lot more skills. In the UK there is a very firm divide between intensive care training and internal medicine training and therefore, I am lacking confidence with respect to vas caths, CVC's, and never have intubated . With that being said, I could have done a year of intensive care in the UK and that probably would have been a good way to up skill. Also, if I had fully completed my UK specialist registrar training, I think I would have been confident enough to work in Canada. However, this was another five years which adds up to the same amount of time as IM residency + fellowship in Canada. 

The ultimate determining factor for me was that I wanted to pursue sub-specialty training, and I was not eligible to apply via CaRMS for the MSM match. That is why I decided on my path and I am excited to in a way re train as I feel I still have so much to gain!

[zoxy]

1 hour ago, UKdocCadborn said:

With respect to my UK training, if I were to break it down in a bit more detail I did: 2 years of a rotating internship (spent a lot of time in internal medicine specialties but a very junior role), I then did 2 years of core internal medicine residency. I then elected not to apply for specialist registrar training which is where I would have gained a lot more skills.

 

On 12/29/2020 at 8:01 AM, UKdocCadborn said:

Thanks very much for your reply. 

To reply in line: 

1) Yes I do have a UK IM license. Once I pass the Royal College IM exams (which I have been deemed eligible to sit based on my UK training), I will be eligible for the Canadian FRCPC IM. This is what the royal college have told me. 

2) I should be a licensed internist in that case.

Congrats on matching!

But I'm surprised about some of the stuff you're saying.

So the Royal College was willing to certify you as a FRCPC IM even though you hadn't done your registrar training? Isn't registrar training what is considered to be the equivalent of specialty training in Canada and the US. If I'm not mistaken, four years of post medical school training is not enough for independent practice in the UK, but the Royal College was willing to grant FRCPC status despite this?

I was told that UK training is longer because the first two foundation years are generally very broad and because of the 48 hours per week cap on hours worked.

So a Canadian high school student could do a six year undergrad medical degree in the UK and then the four years of training that you did and qualify as a FRCPC IM physician by the age of 28? All of this without worrying about the 15 percent chance of getting into medical school after a four year undergrad here in Canada.

This sounds like a great backdoor into medicine in Canada. Average age of graduation from medical school in English Canada is around 28. I think foreigners who attended UK medical schools are eligible for training in the UK, unlike Ireland and Australia.

[UKdocCadborn]

5 minutes ago, zoxy said:

 

Congrats on matching!

But I'm surprised about some of the stuff you're saying.

So the Royal College was willing to certify you as a FRCPC IM even though you hadn't done your registrar training? Isn't registrar training what is considered to be the equivalent of specialty training in Canada and the US. If I'm not mistaken, four years of post medical school training is not enough for independent practice in the UK, but the Royal College was willing to grant FRCPC status despite this?

I was told that UK training is longer because the first two foundation years are generally very broad and because of the 48 hours per week cap on hours worked.

So a Canadian high school student could do a six year undergrad medical degree in the UK and then the four years of training that you did and qualify as a FRCPC IM physician by the age of 28? All of this without worrying about the 15 percent chance of getting into medical school after a four year undergrad here in Canada.

This sounds like a great backdoor into medicine in Canada. Average age of graduation from medical school in English Canada is around 28. I think foreigners who attended UK medical schools are eligible for training in the UK, unlike Ireland and Australia.

Ultimately all I can do is disseminate the information as it has been given to me on this 2 year path of navigating the correct route for me. The royal college independently went through my entire training record and made their decision. You can look this up under the approved jurisdiction pathway. 

Registrar training is considered the equivalent of fellowship training. E.g. a person who has completed the training I have could then train as a haematology registrar, or a renal registrar etc. In order to reach the status which I have, I have had to pass the UK MRCP exams. You can have a look at the pass statistics online as they are notoriously difficult. It is a 3 part exam with a final OSCE which consist of patients with clinical signs rather than standardised patients. I would not think these exams are to dis similar from the also challenging FRCPC IM exams (this based on speaking to colleagues who have done both). 

With respect to "backdoor", I did not set off on this route in order to find a "backdoor." I actually am a British citizen and I studied in the UK with the intention of staying here to practice medicine long term. However, circumstances change and I had to adapt in order to try and find the career and training that most suited me. 

 

 

[zoxy]

35 minutes ago, UKdocCadborn said:

Ultimately all I can do is disseminate the information as it has been given to me on this 2 year path of navigating the correct route for me. The royal college independently went through my entire training record and made their decision. You can look this up under the approved jurisdiction pathway. 

Registrar training is considered the equivalent of fellowship training. E.g. a person who has completed the training I have could then train as a haematology registrar, or a renal registrar etc. In order to reach the status which I have, I have had to pass the UK MRCP exams. You can have a look at the pass statistics online as they are notoriously difficult. It is a 3 part exam with a final OSCE which consist of patients with clinical signs rather than standardised patients. I would not think these exams are to dis similar from the also challenging FRCPC IM exams (this based on speaking to colleagues who have done both). 

With respect to "backdoor", I did not set off on this route in order to find a "backdoor." I actually am a British citizen and I studied in the UK with the intention of staying here to practice medicine long term. However, circumstances change and I had to adapt in order to try and find the career and training that most suited me. 

 

 

I'm not blaming you for anything and I'm grateful that you're disseminating information. No one should blame someone for doing what's best for themselves. In fact, if I were in your shoes, I wouldn't even bother with four years of residency if I were able to get FRCPC status right now. But if you want to go though with it on order to sub-specialize, the more power to you.

I'm just surprised that the royal college would approve this. They live off of making people from other countries jump through hoops, even ones trained in ACGME programs in the US. In fact, the whole point of the royal college is to make it difficult for non Canadian trained physicians to practice in Canada. Otherwise, the provincial governments would run over Canadian physicians without a second thought. Look at the Kenney government in Alberta taking out 179 ads to attract foreign physicians to Alberta after they fell out with doctors over contract renegotiation. Or the Wynne Government in Ontario that unilaterally cut physician pay when the contract ran out and was trying to impose a global budget cap on them. 

I guess they royal college takes the royal part of their name too seriously and is willing to accommodate British and Antipodean trainees more than folks from other advanced countries.

 

[UKdocCadborn]

8 minutes ago, zoxy said:

I'm not blaming you for anything and I'm grateful that you're disseminating information. No one should blame someone for doing what's best for themselves. In fact, if I were in your shoes, I wouldn't even bother with four years of residency if I were able to get FRCPC status right now. But if you want to go though with it on order to sub-specialize, the more power to you.

I'm just surprised that the royal college would approve this. They live off of making people from other countries jump through hoops, even ones trained in ACGME programs in the US. In fact, the whole point of the royal college is to make it difficult for non Canadian trained physicians to practice in Canada. Otherwise, the provincial governments would run over Canadian physicians without a second thought. Look at the Kenney government in Alberta taking out 179 ads to attract foreign physicians to Alberta after they fell out with doctors over contract renegotiation. Or the Wynne Government in Ontario that unilaterally cut physician pay when the contract ran out and was trying to impose a global budget cap on them. 

I guess they royal college takes the royal part of their name too seriously and is willing to accommodate British and Antipodean trainees more than folks from other advanced countries.

 

The one caveat I would give is, I never did go ahead and sit the FRCPC IM exam and subsequently get the FRCPC IM title. However, I did directly email the royal college credentials dept who stated that if I successfully passed the exam I would get that title but who knows if there would have been a hoop at the point. I haven't actually met a physician who has got licensed via the approved jurisdiction pathway, which also made me a bit nervous. 

I completely agree about the many hoops and this also contributed to me applying for residency as I wanted to be a part of the system and trained in a Canadian Hospital setting. 

 

[stephenpeters2]

SMH. You are willing to go through another 4 years of residency with long grueling hours to get to the same position that your are currently in?  There are no hoops if you are trained in UK, USA or Australia. All 3 recognize each other training.  

Please take EDICT advise.  

You need a mentor to guide you because the gold at the end of the rainbow you are waiting for is not there.  Maybe is  an ego thing but is definitely not a rational or if i may be bold , smart decision.  

Smart Advice.  Drop out,  get a hospitalist job and move on.