General Internal Medicine

[XDXD]

Have been hearing that GIM is very broad and flexible and that one can tailor their practice. 

- Is it possible to do only outpatient medicine in GIM in an urban city via the 4 year GIM route? If so, what would that look like?

- If I am not interested in working in an academic hospital, is there any benefit of doing the 5 year GIM program instead of the default 4 year GIM program?

- What is GIM like in the community in terms of schedule, hours, and pay? When you are on for 7 days, are you home-call for all 7 nights or is there someone who covers the ward overnight? 

[leviathan]

 

On 2/25/2024 at 6:45 AM, XDXD said:

Have been hearing that GIM is very broad and flexible and that one can tailor their practice. 

- Is it possible to do only outpatient medicine in GIM in an urban city via the 4 year GIM route? If so, what would that look like?

- If I am not interested in working in an academic hospital, is there any benefit of doing the 5 year GIM program instead of the default 4 year GIM program?

- What is GIM like in the community in terms of schedule, hours, and pay? When you are on for 7 days, are you home-call for all 7 nights or is there someone who covers the ward overnight? 

Some provinces are a lot more controlling than others with respect to what kind of medicine you can practice (e.g. sorry we don't have any 'need' for more internists in this region of the province, even though theres a 2 year waitlist for IM consults). They're like that in the maritimes where they create artificial 'positions' or 'billing numbers' that need to be given out. 

Outside of those provinces, like BC, if you want to just do clinic you can set that up anywhere you want, regardless of if you are 4 year or 5 year trained. The only caveat would be to make sure that they aren't oversaturated with internists already, though I suspect that is not the case anywhere in the country, especially if you want to fill a specific need for that city for some particular type of referral. 

The benefits of the 5 year program would be an extra year to develop a particular special interest or skillset that would be useful for what you want to do for your practice. It may also be beneficial in case you do want to work in a hospital environment in a competitive city, where the trend is towards hiring 5 year GIM even in community hospitals, and wanting people who can deliver some sort of value-added service to the group to fill a need. 

To answer your last question, the variety of working environments for GIM in community is so diverse that there's no way to tell you what it's like. It would depend how much clinic you did, call, ICU work, whether you have privileges to do stress testing, echos, holters or other cardiology work etc. That said, as an example at my hospital in Nova Scotia, the GIM work would consist of weeks of inpatient coverage 9-5, weeks of clinic 9-5, and 3-4 overnight home call per month covering the CCU and IM inpatients + consults, but not ICU. I do ICU, not GIM, so I don't know what the pay would be for GIM. But knowing how it works, if I had to estimate it would probably be roughly 400-500k/yr for someone that just did GIM without any procedural work or more lucrative billings.