IM vs. FM

[averagemedstudent]

I finished 5 years of my IM training in the UK and now I am planning to apply to CaRMS - FM or IM.  Now, I believe that I have skills and competencies to manage complex patients but my educational credentials are not being recognized. I'm currently 30 years old and debating whether to apply to FM or IM in CaRMS next cycle.  

If I go through the FM residency route - will I be able to see complex patient and work them up if I have competency to do so from my prior training. I'm interested in working-up complex patients in outpatient settings.  How are the billing codes in FM vs. IM? Will I be remunerated fairly if I work as a family doctor and try to work up complex patients or is it better to do the IM residency again to be remunerated fairly like an IM doctor.. I'd appreciate any insight.

[JohnGrisham]

8 minutes ago, averagemedstudent said:

I finished 5 years of my IM training in the UK and now I am planning to apply to CaRMS - FM or IM.  Now, I believe that I have skills and competencies to manage complex patients but my educational credentials are not being recognized. I'm currently 30 years ago and debating whether to apply to FM or IM in CaRMS next cycle.  

If I go through the FM residency route - will I be able to see complex patient and work them up if I have competency to do so from my prior training. I'm interested in working-up complex patients in outpatient settings.  How are the billing codes in FM vs. IM? Will I be remunerated fairly if I work as a family doctor and try to work up complex patients.. I'd appreciate any insight.

Can you provide more clarity?

You say "30 years ago" do you mean you finished your IM training 25 years ago? 

Have you talked to the respective provinces you want to work in, in how your IM training may be evaluated? General Internal Medicine in canada is a 4-5 year pathway.  Perhaps you can post more information on your UK royal college qualifications, and those that have come from the UK to Canada may be able to chime in.

Anecdotally, sometimes there is a way to do a Fellowship in Canada, and backdoor into full-licensure without redoing the core residency, this may or may not be applicable to you however.

If you do end up having to re-do your residency training in Canada, and choose to do FM as your focus, for sure you can do complex patients - more likely in the hospital setting as a Hospitalist. You can see complex patients in an outpatient practice for sure, but often the renumeration in a Fee for service model may not make it worthwhile, but if you are proficient, and quick, then it could still be feasible to make good money AND see complex patients. You could work in a province with salaried models, and choose to provide care to more complex patients etc. 

You will make good money either route, just different styles and will depend on province, setting, and how hard your willing to work. too variable
 

[averagemedstudent]

2 minutes ago, JohnGrisham said:

Can you provide more clarity?

You say "30 years ago" do you mean you finished your IM training 25 years ago? 

Have you talked to the respective provinces you want to work in, in how your IM training may be evaluated? General Internal Medicine in canada is a 4-5 year pathway.  Perhaps you can post more information on your UK royal college qualifications, and those that have come from the UK to Canada may be able to chime in.

Anecdotally, sometimes there is a way to do a Fellowship in Canada, and backdoor into full-licensure without redoing the core residency, this may or may not be applicable to you however.

If you do end up having to re-do your residency training in Canada, and choose to do FM as your focus, for sure you can do complex patients - more likely in the hospital setting as a Hospitalist. You can see complex patients in an outpatient practice for sure, but often the renumeration in a Fee for service model may not make it worthwhile, but if you are proficient, and quick, then it could still be feasible to make good money AND see complex patients. You could work in a province with salaried models, and choose to provide care to more complex patients etc. 

You will make good money either route, just different styles and will depend on province, setting, and how hard your willing to work. too variable
 

Sorry it should be 30 years old!

Given the fees for service model, would it be possible to make good money if you see complex patients and spend time with them or do most FM doctors see more patients that are less complex.

[bearded frog]

Obviously billing varies by province but you can see Ontario's billing codes now and compare for yourself: https://www.health.gov.on.ca/en/pro/programs/ohip/sob/

FM usually gets a bonus on billing for complex patients and long visits but usually its not as lucrative as seeing two simple patients in the same time frame. I would assume that IM bills more for the equivalent visit as a consult service, but I am not at all familiar with IM billing. The question you must ask yourself is that financial (and logistical, its going to be harder to be a FD that sees exclusively complex patients) difference worth the extra two years (and I'm assuming more difficult match) into IM.

In your situation, as an IMG, I think i would apply to both and take what I could get.

[JohnGrisham]

19 hours ago, averagemedstudent said:

Sorry it should be 30 years old!

Given the fees for service model, would it be possible to make good money if you see complex patients and spend time with them or do most FM doctors see more patients that are less complex.

Thanks for clarifying, so you are a fresh graduate from a 5 year IM pathway in the UK, and you are currently 30 years old. In that case, I would strongly look into the alternate pathways outside of CaRMS. UK training is generally accepted in Canada, as  I have worked with more than a few recent grads, it will just take a fair amount of work to dig into what exactly do they require, and for you to make up deficiencies in training schemes in your home jurisdiction. Again, look into what provinces you want to work in and get asking them what you would need to do. You will also need to do the Canadian Royal College exams once your training makes you eligible for them. 

Ultimately it may take just as long as re-doing your IM residency in Canada, but maybe not and certainly would save you the hassle of being a junior resident all over again. Not to mention how difficult CaRMS is, as an IMG. That said, given your prior training, maybe you'll be favoured in the CaRMS match, as you would automatically be fairly competent right away. Though if you are in independent practice, they may see your "Free thinking" as a liability to potentially be a miserable resident who doesn't like "taking orders" anymore. This is all anecdotal, and who really knows - no one does. 

Before all this is even relevant, do you have Canadian PR or citizenship? That is a requisite in even applying for CaRMS.

You have much work to do, so better to send some emails and make some phone calls to get more clear information.

[UKdocCadborn]

On 5/2/2021 at 10:15 PM, averagemedstudent said:

I finished 5 years of my IM training in the UK and now I am planning to apply to CaRMS - FM or IM.  Now, I believe that I have skills and competencies to manage complex patients but my educational credentials are not being recognized. I'm currently 30 years old and debating whether to apply to FM or IM in CaRMS next cycle.  

If I go through the FM residency route - will I be able to see complex patient and work them up if I have competency to do so from my prior training. I'm interested in working-up complex patients in outpatient settings.  How are the billing codes in FM vs. IM? Will I be remunerated fairly if I work as a family doctor and try to work up complex patients or is it better to do the IM residency again to be remunerated fairly like an IM doctor.. I'd appreciate any insight.

Hi there, I think you have a very similar situation to me. I completed 5 years of postgraduate medical training in the UK (foundation, core medical training and then a year of clinical research fellow). I have just matched to internal medicine through CaRMS. I am also a very similar age to you. I am happy for you to send me a message and connect.