Doing GIM work as a subspecialist?

[redbeanbun]

Was talking to an R5 (endocrinology) who told me that he also does GIM call shifts for extra $$. Is that common? And do any specialists continue to do this after they're done training? I've never heard of people doing that before, plus I thought that if you do subspecialize after R3 you wouldn't technically be "qualified" as GIM because you only do 3 years of core internal medicine whereas GIM is 4-5 years? Would love to hear about anyone else's experience & more info about this, thank you! 

[ACHQ]

17 hours ago, redbeanbun said:

Was talking to an R5 (endocrinology) who told me that he also does GIM call shifts for extra $$. Is that common? And do any specialists continue to do this after they're done training? I've never heard of people doing that before, plus I thought that if you do subspecialize after R3 you wouldn't technically be "qualified" as GIM because you only do 3 years of core internal medicine whereas GIM is 4-5 years? Would love to hear about anyone else's experience & more info about this, thank you! 

Yes its common especially among PGY5+ in a Medicine sub-specialty program. It gets less common for sub-specialists to do GIM call due to a variety of reasons (mostly evenings/nights/weekend work, have their own busy practice/specialty etc...), but I know some colleagues who still do it. Its still very common for ICU/Critical care trained in Medicine to do GIM call on top of their own ICU schedules.

 

As for "qualified". The Royal college grants you certification in Internal medicine, and all that is required is 3 years of Core IM training + 1 year of either GIM or a sub-specialty. 

[redbeanbun]

5 hours ago, ACHQ said:

Yes its common especially among PGY5+ in a Medicine sub-specialty program. It gets less common for sub-specialists to do GIM call due to a variety of reasons (mostly evenings/nights/weekend work, have their own busy practice/specialty etc...), but I know some colleagues who still do it. Its still very common for ICU/Critical care trained in Medicine to do GIM call on top of their own ICU schedules.

 

As for "qualified". The Royal college grants you certification in Internal medicine, and all that is required is 3 years of Core IM training + 1 year of either GIM or a sub-specialty. 

Thank you very much for your reply! That helps clarify things for me a lot. 

[bk2skl]

A majority of the sub-specialists at my school also cover GIM, it must be location dependent.

GI, Resp, ICU, rheum, nephro, endo - they all definitely do. I don't think any of the cardiologists or oncologists do, but I could be wrong.

[The Ace of Spades]

Definitely location-dependent. Some smaller centers only do GIM call so all specialists must participate, there is no specialty-specific call. I would imagine you'd be pretty comfortable doing GIM outpatient stuff if you were in that system. Myself, I only do my subspecialty call. I haven't done GIM work in 5+ years. I would not be comfortable working up adrenal nodules or managing hyperthyroid patients any longer. Could I do it? Probably. Is it worth it? Not to me and definitely not to my patients.

[futureGP]

I am a subspecialist in GTA. During my fellowship after I got my IM RC, definitely locumed a ton of GIM shifts (overnight, weekend rounding etc) which were lucrative.

 

If you get hospital privileges at most hospitals (i.e. you have hospital resources to use which could be anything from clinic space with nurse, endoscopy time or ICU weeks etc), there will be requirement to cover GIM in someway. Depending on your subspecialty’s ‘deal’ with the GIM group, it could mean your subspecs participate in GIM call schedule in anyway. Some common exceptions are geriatrics (generally they are in such high demand that for recruitment purposes most Dept of Medicine don’t require GIM coverage), cardiology (as most cardiology groups are MRP on their own cardio patients and will be first call overnight) and/or any other subspecs where they take on MRP. 
That said a lot of it is negotiations between dept of medicine and each subspec division / how much coverage needed etc.

 

it is not uncommon for subspecs in the community to do GIM call. A lot of the time it is because they have to as part of hospital privileges contract but other times it is for financial reasons as GIM overnight can be quite lucrative. 
 

that said I think most subspecs after 5-10 years of practise will probably stop GIM work if they could. Clinic life becomes very attractive and relatively lucrative and less taxing compared to inpt work esp when you start having kids.

[redbeanbun]

On 2/24/2023 at 11:20 PM, futureGP said:

I am a subspecialist in GTA. During my fellowship after I got my IM RC, definitely locumed a ton of GIM shifts (overnight, weekend rounding etc) which were lucrative.

 

If you get hospital privileges at most hospitals (i.e. you have hospital resources to use which could be anything from clinic space with nurse, endoscopy time or ICU weeks etc), there will be requirement to cover GIM in someway. Depending on your subspecialty’s ‘deal’ with the GIM group, it could mean your subspecs participate in GIM call schedule in anyway. Some common exceptions are geriatrics (generally they are in such high demand that for recruitment purposes most Dept of Medicine don’t require GIM coverage), cardiology (as most cardiology groups are MRP on their own cardio patients and will be first call overnight) and/or any other subspecs where they take on MRP. 
That said a lot of it is negotiations between dept of medicine and each subspec division / how much coverage needed etc.

 

it is not uncommon for subspecs in the community to do GIM call. A lot of the time it is because they have to as part of hospital privileges contract but other times it is for financial reasons as GIM overnight can be quite lucrative. 
 

that said I think most subspecs after 5-10 years of practise will probably stop GIM work if they could. Clinic life becomes very attractive and relatively lucrative and less taxing compared to inpt work esp when you start having kids.

Thank you for this detailed response! I also hope to be in the GTA and what you described is very similar to the kind of career I would like to have myself (would like to subspecialize within IM but do GIM work for at least the first 5-10 years of my career). Very glad to hear that is a reality.