IM specialist going back to general practice

[frozenarbitor]

Can a internal medicine physician specialized in a sub-specialty such as infectious disease work as a general internal practitioner if he/she can't find a job as a ID specialist?

[NLengr]

If they passed the general internal royal college exam I can't see why not.

[Med0123]

If they passed the general internal royal college exam I can't see why not.

 

in fact a ID specialist does NOT pass the internal medicine royal college exam

 

so no

 

Royal College certification in Internal Medicine requires all of the following:

1. Successful completion of a four-year accredited program in Internal Medicine;

2. Successful completion of the certification examination in Internal Medicine; and

3. Participation in a scholarly project/activity in Internal Medicine.

(http://rcpsc.medical.org/residency/certification/training/intmed_e.pdf)

 

this may be an interesting read for you too http://rcpsc.medical.org/residency/GIM_faq_e.pdf

[Lactic Folly]

I thought all IM residents write the Royal College exam in R4 whether they're doing endocrinology or respirology, etc. We definitely have people who are rheumatologists, nephrologists, etc. doing their share of weeks on CTU each year (general internal medicine teaching service).

[Med0123]

Well you know what? That what I thought too at the beginning but then I saw these .pdf on the RCPSC website and it does say that you need to do a 4 years accredited program in IM... I'll ask the question to my friends and I'll come back to you

[Lactic Folly]

If you read that pdf more closely, B.2. states that the fourth year can be in any of the subspecialty areas.. before you tell the ID specialist they can't practice IM

[Med0123]

If you read that pdf more closely, B.2. states that the fourth year can be in any of the subspecialty areas.. before you tell the ID specialist they can't practice IM

 

ahhhh yea you're right, I didn't read it adequately

[rmorelan]

ahhhh yea you're right, I didn't read it adequately

 

no worries! they definitely can work as generalists (to their comfort level). That is how parts of our hospital actually works (the medicine service in particular isn't all GIMs )

[rmorelan]

oh - it also allows from moonlight in your are training as a IM fellow as well (those specializing in cardio, nephro etc, etc)

[leviathan]

This is actually an interesting question that I don't think anyone has answered yet...and it might vary from province to province.

 

But can an internist open up or work at an outpatient clinic if they're just seeing adult patients? Assuming they are just billing the regular GP codes?

[cheech10]

Much of IM is outpatient work, so of course they can open outpatient clinics, but I think you're actually asking about primary care.

In Ontario at least, they can see primary care patients without referrals, but can only bill GP codes. With a referral, they can bill the more lucrative IM codes.

[leviathan]

Much of IM is outpatient work, so of course they can open outpatient clinics, but I think you're actually asking about primary care.

In Ontario at least, they can see primary care patients without referrals, but can only bill GP codes. With a referral, they can bill the more lucrative IM codes.

 

Yeah, I meant primary care. I wonder if that would be something people would be interested in doing closer to retirement. You could just work at someone's walk-in clinic and have the office staff only book you for adult patients. I'm assuming you wouldn't be allowed to be booked for OBGYN or peds stuff, nor would you feel comfortable doing it.

[thebouque]

If you want to do primary care in Canada go into family medicine.

[leviathan]

If you want to do primary care in Canada go into family medicine.

If you want to do solely primary care for you entire career, this is a fair statement. In the context of what is being discussed in this thread, it is irrelevant and illogical. Maybe it's an English comprehension issue.

[lostintime]

Yeah, I meant primary care. I wonder if that would be something people would be interested in doing closer to retirement. You could just work at someone's walk-in clinic and have the office staff only book you for adult patients. I'm assuming you wouldn't be allowed to be booked for OBGYN or peds stuff, nor would you feel comfortable doing it.

 

But how would they treat the obs/gyn, surgical issues etc? Based on their knowledge in clerkship 50 years ago?

 

I don't see how they can work in a walk-in clinic without having done general primary care for the last 40-50 odd years or even in the last 10 years. Even it's all adults. Same reason why GP's are allowed to work in emerg but any other specialty isn't.

[A-Stark]

Well if they trained *that* long ago, they'd be practising with a grandfathered general license too. Setting aside more recently trained physicians, there are many in practice now that did work as generalists for a period before pursuing a specialist residency.

[thebouque]

If you want to do solely primary care for you entire career, this is a fair statement. In the context of what is being discussed in this thread, it is irrelevant and illogical. Maybe it's an English comprehension issue.

 

Come and spend some time in Canadian hospitals and you'll see what I mean. It's all right if you're clueless about the medical system here since you're studying at Saba (I'm not judging the University itself even though I've never heard of it, I'm just saying that it seems pretty far from here).

 

Addendum: I repeat: if you want to practice in primary care in Canada, you have to do a residency in family medicine. It's the basis of our system. The rotating internship was abolished several years ago. If you want to do both primary care AND specialized medicine, well do 2 residency programs.

[Mandibular]

Come and spend some time in Canadian hospitals and you'll see what I mean. It's all right if you're clueless about the medical system here since you're studying at Saba (I'm not judging the University itself even though I've never heard of it, I'm just saying that it seems pretty far from here).

 

Addendum: I repeat: if you want to practice in primary in Canada, you have to do a residency in family medicine. It's the basis of our system. The rotating internship was abolished sever years ago. If you want to do both primary care AND specialized medicine, well do 2 residency programs.

 

in Quebec, can we do what Moo did in his province : finish fam med, join CCFP and then do community health only for 3 years and join FRCPC?

[thebouque]

in Quebec, can we do what Moo did in his province : finish fam med, join CCFP and then do community health only for 3 years and join FRCPC?

 

You'll have to double check, but I was told that in Quebec, if you're FRCPC, you're not allowed to practice as a family physican anymore even though you've done both residencies. But double check. You can still work with patients if you're in public health (environmental / work related diseases etc).

[Maxime]

I've never heard of FM + 3 years in Québec. Everybody passes through the regular route (there may be people that are hired though with FM + 3 years. It gives you FRCPC, which is all you need. The training program doesn't exist in Sherbrooke, and almost certain it doesn't exist in Montreal, Laval or McGill.

 

Maxime

 

Addendum: In Quebec, you can't have 2 billing codes (can't bill cardiology and internal, as an example). Having do training in both fields (family and IM), I think it would be unsafe for any specialist (in this case GIM) to be doing family med (especially for the obstetrics/pediatrics/psychiatry parts), and they probably shouldn't be doing this if they haven't been working in the field for a while (however, can't think of one GIM who would even consider this, as FM often has pretty heavy social cases, it's much less lucrative, cases less interesting and it's not in what they were trained).

[thebouque]

Max, what do you mean by FM + 3 years?

[leviathan]

But how would they treat the obs/gyn, surgical issues etc? Based on their knowledge in clerkship 50 years ago?

If you read the other part of the thread, I mentioned that they could easily book only adult patients.

 

I don't see how they can work in a walk-in clinic without having done general primary care for the last 40-50 odd years or even in the last 10 years. Even it's all adults. Same reason why GP's are allowed to work in emerg but any other specialty isn't.

You don't think an internal med specialist can handle general adult medical issues? They would do a much better job than a GP. For OBGYN, peds, psych issues I agree they would be unable to cope, but adult medicine is their specialty.

[leviathan]

Come and spend some time in Canadian hospitals and you'll see what I mean. It's all right if you're clueless about the medical system here since you're studying at Saba (I'm not judging the University itself even though I've never heard of it, I'm just saying that it seems pretty far from here).

I've been training in Canada for the last year, so I'm not 'clueless' about anything. Maybe things are different in Quebec, but in the rest of Canada, internists are specialists in adult medicine. If one of them wanted to semi-retire from practice and just deal with simple adult medical issues in a clinic setting, and bill the regular GP rate (and not specialist rate) they're more than prepared to do so. It sounds from what Cheech said that they're also legally allowed to do so.

 

Addendum: I repeat: if you want to practice in primary care in Canada, you have to do a residency in family medicine. It's the basis of our system. The rotating internship was abolished several years ago. If you want to do both primary care AND specialized medicine, well do 2 residency programs.

Again, I think maybe this is an English comprehension issue? I never said anything about working as a general practitioner for surg,psych,peds,obgyn patients. Just adult medicine.

[cheech10]

Here's how it works in Ontario:

 

You get licensed by the College (CPSO). This is a general license to practice medicine independently "in the areas of medicine in which [you are] educated and experienced."

 

You get a billing number from OHIP. Mine has a xxxxxx-13 suffix, identifying me as an internist. This is so OHIP can compare your billing codes and volumes to others in your field. It DOES NOT limit you to billing codes from your field only. http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html is the Schedule of Benefits, that lists all the fee codes. The General Preamble tells you what documentation is needed in the hospital chart to bill types of codes (general assessment vs specific assessment vs partial vs consult). The rest of it is a listing of codes. What you see is that many codes are in "specialty" sections of the Schedule of Benefits (eg. nasal packing is in ENT, foley insertion in urology, NG insertion in GI). Obviously, these are common procedures, and can't be limited to subspecialists only, so that is a major clue that the chapters are for organization only, and not to limit what you can bill.

 

What about billing things outside your field? I suppose OHIP could look up your billings and see that you are billing a lot of things outside your field, but it's not that simple. For example, I am classed as an internist, but my practice is 100% ICU. Almost all my billings are ICU codes, which is very different from other internists. I also bill a lot of anaesthesia codes (intubation, procedural sedation), cardiology codes (cardioversion), and more. None have ever been denied payment, nor have I been told I can't bill them.

 

Bottom line, in Ontario, you can practice however you want, as long as you are comfortable with your training and experience in that field. I submit that general adult medicine, for outpatients, is well within the scope of internal medicine training, so there should be no problems running an outpatient adult primary care clinic.

[lostintime]

I've been training in Canada for the last year, so I'm not 'clueless' about anything. Maybe things are different in Quebec, but in the rest of Canada, internists are specialists in adult medicine. If one of them wanted to semi-retire from practice and just deal with simple adult medical issues in a clinic setting, and bill the regular GP rate (and not specialist rate) they're more than prepared to do so. It sounds from what Cheech said that they're also legally allowed to do so.

 

 

Again, I think maybe this is an English comprehension issue? I never said anything about working as a general practitioner for surg,psych,peds,obgyn patients. Just adult medicine.

 

I've never heard of this model in reality, would be interesting to see the logic behind why anyone would want to bill for less unless no one wants to refer any patients to them as a specialist. It doesn't seem to make a lot of sense for specialists to open up their own clinic and bill GP codes, retirement or not, unless no one was referring to them. And what would they say on their door- simple issues only? Make it some random walk-in but specify they don't cover obs/gyn, surgical, psych, etc? Sure we're all supposed to learn primary care, but the way training works, internists don't even do a family medicine rotation in their residency. Doesn't seem responsible to call yourself primary care all of a sudden.