Internal med... anything to say about it?

[Knovecc]

hi everyone,

Finishing my MD1, now I have my "defaut" residency choice set as internal med --- may it be general IM or subspecialties.

IM is definitely the most common specialty amongst all the choices, but I don't know much about its lifestyle etc

 

1-Compared to ALL other specialties (FM, Surgeon, Rad, ENT, ...) where would you place IM for its (1)pay/hour efficiency, (2)lifestyle?

you can talk about either gen IM, or subspecialties such as cardio, endocr, GI etc, or both

 

2-Compared to all other residenies, Where would you rank IM (both gen IM AND the subspecialties as long as you know) for the competitiveness/hardness?

 

Thank you very much!!!

[Jochi1543]

Here's the gist of what I've learned from here and on SDN over the years. General IM basically sucks; specialties can be very lucrative and/or have a good lifestyle. The residency itself is tough, both in terms of the amount of info you need to manage and the actual hours of work, and matching into a subspecialty is yet another hassle and another 1-3 years of low income, being under someone's supervision, etc. However, your workload can become easier once you're done training, but things vary widely among specialties. Rheumatology, endocrinology, allergy are some specialties with less stress and better hours. Cardiology, on the other hand, is anything but that. Endocrinology is not very lucrative; gastroenterology can provide you with a very high income.

 

I have no idea how competitive the subspecialties are, I only know some US info (GI is very competitive due to $, endocrine not so much, allergy is competitive mostly due to the fact that there are few fellowships offered, etc). The IM residency itself is not terribly competitive in that lots of spots go unfilled, but just like with FM, there's a huge amount of variation among programs, so great programs attract a lot of competition and others have unfilled spots year after year.

 

 

Anyone who's more well-versed in this area, please add. Otherwise, I'd look into shadowing IM physicians and subspecialists and talk to someone at your school's career services and see if you can get your hands on some stats.

[blinknoodle]

I found that it was competitive to get into specific IM programs (ie Toronto, McMaster) but if you are flexible with location, IM is more medium competitiveness. Yes, there can be some IM spots leftover in round 2.

 

For the IM residency, I would venture to say that it is one of the hardest residencies, especially when the senior on general internal medicine. You will not sleep. You could be dealing with 10 new Emerg consults with crashing patients on the floor. The subspecialties are not as difficult, but count on at least 1:4 call for 3 years.

 

I can't really comment on the competitiveness of subspecialties based on experience, but cardiology and GI are more competitive specialties. However, I also hear that job prospects are limited in areas. I don't think Toronto nephro matched Canadians this year because there are no jobs available with dialysis (which is why nephro is so lucrative). I also heard it is harder to get jobs in GI.

 

Your hours and pay will depend entirely on which subspecialty (or GIM) that you match. Certainly your hours as a resident are much worse than as a staff. As Jochi mentioned, allergy has better hours than interventional cardiology. I hear respirology has nice hours and good job prospects. Same with medical oncology. I don't think GIM is looked down upon as much in Canada as it is in the States, but you would have good job prospects especially if you enjoy team medicine.

 

Hope this helps. Definitely chat with the staff and residents in IM at your school.

[JPJ]

Hi Knovecc. While youre in first year, ignore the defaults. Seek out the hidden gems. Seek out ROPE PAD and find out if one of those is right for you. If it is, then go for it. Youll find that the happiest docs and residents are in the ROPE PAD. Dont ignore these fields even if your med school doesnt expose you to them. Start early.

 

Radiology AND radiation oncology

Ophtho

Path

EM

Psych

Anesthesia

Derm

 

Through these you'll have great jobs with relatively good people, and you'll even get to preserve whatevers left of your twenties in residency. youll have a few free nights to go kLuBbEn or take in a show. Whatever you want.

 

If you do IM or surgery, be prepared to slog. And remember, in these territories, the less competitive you go, the more work you do for less pay. Thats why competitive things are competitive.

 

sorry to hijack this thread, but I feel intrigued by the inclusion of psych in this ROPE PAD series. The general consensus I've heard is that psych is one of the less preferred specialties. In a book I was reading about the memoir of an intern, the author, or somebody he knew, mentioned something along the lines that those who go into psych generally tend to be unconventional med students or medical students at the top of their class who tend to be a bit insane (not literally, of course). Maybe this is because of how psych is practiced in the US because this book was written by a US author. Not that I have anything against psych-I've been told that I should seriously consider psych because I am apparently a good listener and adept at providing constructive feedback, so I have an inclination towards it. But I've also heard that psychiatrists are also more prone to breaching professional boundaries because there is possibly greater potential to become emotionally attached to patients, so I'd be interested to know specifically why its one of the hidden gems. Also, does ENT deserve to be included in this series? I've generally heard good things about the specialty in terms of lifestyle, compensation, variety of procedures done and that its fairly competitive, so just wondering.

[AdamP]

sorry to hijack this thread, but I feel intrigued by the inclusion of psych in this ROPE PAD series. The general consensus I've heard is that psych is one of the less preferred specialties. In a book I was reading about the memoir of an intern, the author, or somebody he knew, mentioned something along the lines that those who go into psych generally tend to be unconventional med students or medical students at the top of their class who tend to be a bit insane (not literally, of course). Maybe this is because of how psych is practiced in the US because this book was written by a US author. Not that I have anything against psych-I've been told that I should seriously consider psych because I am apparently a good listener and adept at providing constructive feedback, so I have an inclination towards it. But I've also heard that psychiatrists are also more prone to breaching professional boundaries because there is possibly greater potential to become emotionally attached to patients, so I'd be interested to know specifically why its one of the hidden gems. Also, does ENT deserve to be included in this series? I've generally heard good things about the specialty in terms of lifestyle, compensation, variety of procedures done and that its fairly competitive, so just wondering.

 

someone's reading intern....

[Satsuma]

I believe residency for internal (and any other call heavy residency) will be alot better with the new "home after handover" PAIRO agreement put into effect this year.

 

The nice thing about internal is that there are subspecialties that you can choose that are easier on lifestyle than others. So you get into residency wanting to be a cardiologist and realize they work too much for your liking. You can then pick geriatrics or ID etc. So there is some flexibility in going that route.

[Microbiodude]

How does the subspecialty selection work? Do you do R-1 matching for an internal med position (i.e. your internship) and then apply again for a sub-specialty (i.e. your residency)?

[ploughboy]

How does the subspecialty selection work? Do you do R-1 matching for an internal med position (i.e. your internship) and then apply again for a sub-specialty (i.e. your residency)?

 

Yes, and starting this year the match is being run by CaRMS:

 

http://carms.ca/eng/r4_about_intro_e.shtml

 

 

Random aside: although the pgy-1 year is sometimes still called an internship year, pgy-2s and pgy-3s in IM would probably get really offended if you were to call them interns.

[Microbiodude]

Yes, and starting this year the match is being run by CaRMS:

 

http://carms.ca/eng/r4_about_intro_e.shtml

 

 

Random aside: although the pgy-1 year is sometimes still called an internship year, pgy-2s and pgy-3s in IM would probably get really offended if you were to call them interns.

 

lol ya I know, you're only an intern for your first year right? Then you are called a resident after that.

[flying kumquat]

lol ya I know, you're only an intern for your first year right? Then you are called a resident after that.

 

That's mostly just in the States. Here, an R1/PGY1 is usually referred to as a resident.

[Microbiodude]

That's mostly just in the States. Here, an R1/PGY1 is usually referred to as a resident.

 

oh, well that is definitely good to know. thanks

[thebouque]

The internship in canada has been abolished since 1993 i believe. You're called a resident right off the bat. I think they used to call it a rotatory internship or smthg like that. It's very similar to the off service rotations at the beginning of residency but there's a major difference. In canada, after the rotatory internship, everyone was a GP and then carried on choosing a specialty. Now, people choose their specialty at the end of clerkship and family medicine (new word for GP) has a 2 years residency in itself. In the states, the internship still exists but to be a family physician, they still have to go through 2 more years of residency. Therefore family med is 3 years postgrad in the states vs 2 years here (even though theres lots of R3 options in canada for family medicine).

 

Cheers

[thebouque]

You're right, even though I think (it's just a humble Med1 opinion) that the new 2 years residency is more adapted to family medicine than the rotatory internship. FP's training is better than what GPs had. However, it is probably one of the reason for the shortage. If every1 went through FP, less pple would specialise afterwards. But hey, we need specialists as well (and badly). That's just a vicious cycle.

 

Cheers

[A-Stark]

I think this kind of slagging of family medicine is getting pretty tiresome. It is quite possibly the *most* flexible area to go into. With the PGY-3 options, you could work in Emerg, as a hospitalist, do low-risk obstetrics, or enter sports medicine, counselling, public health (community medicine being a common second specialization), walk-in clinics, a traditional group/private practice, community health centre, or almost any combination thereof.

 

(And I haven't even mentioned low-level, high-billing cosmetic stuff, which I don't really approve of, but which is ultimately an option.)

[juicyprunes]

Just a note about psychiatry (I think there was a question about it several posts ago).

 

I think it's a fabulous career choice for people interested in neuroscience, psychology, pharmacology, psychosocial issues, etc. It's got great hours, great pay, and also lots of flexibility, variety, and high demand. It is part of the training to develop a sense of appropriate distance/boundaries, so I really don't think that's an issue - unless you're the type of person who has some issues with this.

[bayervillager]

I'm really interested in the new "home after handover" agreement. Can anybody comment on whether it has come into effect/been enforced where you are since July 1st?

 

I believe residency for internal (and any other call heavy residency) will be alot better with the new "home after handover" PAIRO agreement put into effect this year.

[thebouque]

I think this kind of slagging of family medicine is getting pretty tiresome. It is quite possibly the *most* flexible area to go into. With the PGY-3 options, you could work in Emerg, as a hospitalist, do low-risk obstetrics, or enter sports medicine, counselling, public health (community medicine being a common second specialization), walk-in clinics, a traditional group/private practice, community health centre, or almost any combination thereof.

 

(And I haven't even mentioned low-level, high-billing cosmetic stuff, which I don't really approve of, but which is ultimately an option.)

 

No one was slagging off family medicine we were discussing the old internship

[Lactic Folly]

Home after handover is going to depend on the service. There is an option for programs to opt out if they feel this will be unmanageable.

[Satsuma]

Home after handover is going to depend on the service. There is an option for programs to opt out if they feel this will be unmanageable.

 

True.

But my understanding is that is only temporary, letting the programs ease into things. So programs can opt out but must clearly demonstrate why they cannnot comply and show that they are working on taking steps so that it can work in the future.

[ploughboy]

I'm really interested in the new "home after handover" agreement. Can anybody comment on whether it has come into effect/been enforced where you are since July 1st?

 

I'm currently on a service that was very good about sending residents home post-call even before 24+2 started, so it's hard to speak from personal experience. Some of my friends are on services which haven't signed up for 24+2, and they look pretty tired the few times I see them.

 

And, of course, some of the hardcore surgical specialties apparently still expect their on-service residents (ie residents in that specialty, like a gen sx resident on a gen sx rotation) to be in the OR the afternoon of their post-call day, contract be damned. I don't know that for a fact, but I can see that happening.

[ploughboy]

True.

But my understanding is that is only temporary, letting the programs ease into things. So programs can opt out but must clearly demonstrate why they cannnot comply and show that they are working on taking steps so that it can work in the future.

 

During the CaRMS tour, the new contract came up a couple of times in my conversations with program directors (2 different PDs in geographically separated cities, but not PDs for the specialty I matched to). Per the PDs, rumour has it that certain specialties were muttering about adding an extra year to certain residencies to compensate for residents not getting enough exposure to certain cases if they go home in the morning post-call.

 

I don't know if this is just a rumour based on grumblings from disgruntled staff. Has anybody heard anything similar?

[Satsuma]

During the CaRMS tour, the new contract came up a couple of times in my conversations with program directors (2 different PDs in geographically separated cities, but not PDs for the specialty I matched to). Per the PDs, rumour has it that certain specialties were muttering about adding an extra year to certain residencies to compensate for residents not getting enough exposure to certain cases if they go home in the morning post-call.

 

I don't know if this is just a rumour based on grumblings from disgruntled staff. Has anybody heard anything similar?

 

Yeah...I have heard staff mention things like adding an extra year. But nothing really serious. I mean, anest and obs have been managing fine with home after 24hrs, so I am sure other programs can manage.

 

And I can say, emphatically, that staying post-call has never had any learning value for me whatsoever. Far too tired to retain or absorb anything.

 

Hard core programs existed before this agreement and certainly if they weren`t letting their residents go home by noon before, they aren`t going to be letting them go after handover! I remember on a neurosurg elective, seeing residents post-call in the OR still operating at 15h30!!

But maybe home after handover will result in them maybe getting out by noon?? I dunno...hopefully those programs will become fewer and residents will collectively stand up for themselves. (though I suppose you will always come accross the odd resident who likes the punishment and feels they are more dedicated than anyone else and will stay no matter what).

[Jochi1543]

During the CaRMS tour, the new contract came up a couple of times in my conversations with program directors (2 different PDs in geographically separated cities, but not PDs for the specialty I matched to). Per the PDs, rumour has it that certain specialties were muttering about adding an extra year to certain residencies to compensate for residents not getting enough exposure to certain cases if they go home in the morning post-call.

 

I don't know if this is just a rumour based on grumblings from disgruntled staff. Has anybody heard anything similar?

 

That's ridiculous...Canada already has longer residencies than the US in quite a few specialties. What's it gonna be now, 6 years for your average residency? Gimme a break. I think it's disgruntled staff being bitter about the fact that the new residents will have it slightly better than they did.

[A-Stark]

I don't think you need even invoke the safety argument. It's simply unreasonable to expect ANYONE to work more than 24 hours straight. Where else would that be tolerated?

[Lactic Folly]

I've heard from residents who would like the option to stay post-call if there is an opportunity to do a procedure that they don't get very often (especially if they have gotten some rest - not all call nights are completely sleepless). However, the difficulty here is creating an unspoken expectation for others who would prefer to go home.