GIM and their role in Healthcare Team; please advise

[Corie]

Can someone please advise me on how GIM fits into the system?

 

Specifically, I'm confused about why a family physician would consult a GIM rather than a subspecialist (cardiology, endocrinology, nephro and etc).

 

Furthermore, are there currently a need for community-based GIMs?

 

If you subspecialize, can you still practice GIM or are you limited to practicing within your subspecialty?

 

Thank you.

[ubcredfox]

I send two types of patients to GIM:

 

1. GOMER-types - usually with or without a smell of feces; incoherent; often with belligerent family members, minimum 80 years of age, with vague complaints such as "unease" , "fatigue", "weak and dizzy" always followed by "? dx, please manage."

 

2. "Sense of unease" types - anyone ranging from 10-79, usually $hitty life syndrome positive, and with changing, vague complaints. Most of the patients I send have the cardinal symptom of having pruritis of the anterior teeth with micturition.

[NLengr]

In many smaller hospitals/areas, GIM may provide the only medicine coverage. A city of 25-50k isn't gonna have every single subspecialty around.

 

As far as I know, they were desperate for GIM's several years ago.

[Corie]

Thanks for the replies. Can anyone else comment on the patients that get refered to a GIM please?

 

If you are following patients you met at the community hospital, does that count was a referal is that billed under general practice? Thanks.

 

Also, if you subspecialize, are you still permitted to run a GIM practice?

[The Journey Man]

Thanks for the replies. Can anyone else comment on the patients that get refered to a GIM please?

 

If you are following patients you met at the community hospital, does that count was a referal is that billed under general practice? Thanks.

 

Also, if you subspecialize, are you still permitted to run a GIM practice?

 

Highly depends on location. Basic template, or what the Royal College has in mind:

 

1) Academic Centre - will be an academic hospitalist running CTU, run some type of research/education initiative plus outpatient practice. This will likely include some type of "interest" like vascular medicine, or basically outpatient cardiology stuff or benign hematology. Than they will also run the GIM clinics which will be predominantly patients where the family doc doesn't know what's going on (multiple system complaints) or a condition where the family doc feels out of place. They will do consults in the ER, its a lot of pre-ops as well and inpatient consults can be for anything but a lottimes it when surgeons have screwed up real bad..

 

2) suburb/mid size city - they will do all the above possibly plus cover a lot of bread and butter of subspecialties inpatient and outpatient. Probably will never be primary doc on a patient, the GP would be the hospitalist in this situation. They may even ado things like Scopes, bronchs or echoes if not a lot of people doing them in town and they have the training.

 

3) rural - will probably cover the ICU, be strictly consultant and do everything I mentioned above if they want. Will be the ultimate specialist covering everything

 

Hope that helps

[Corie]

Highly depends on location. Basic template, or what the Royal College has in mind:

 

1) Academic Centre - will be an academic hospitalist running CTU, run some type of research/education initiative plus outpatient practice. This will likely include some type of "interest" like vascular medicine, or basically outpatient cardiology stuff or benign hematology. Than they will also run the GIM clinics which will be predominantly patients where the family doc doesn't know what's going on (multiple system complaints) or a condition where the family doc feels out of place. They will do consults in the ER, its a lot of pre-ops as well and inpatient consults can be for anything but a lottimes it when surgeons have screwed up real bad..

 

2) suburb/mid size city - they will do all the above possibly plus cover a lot of bread and butter of subspecialties inpatient and outpatient. Probably will never be primary doc on a patient, the GP would be the hospitalist in this situation. They may even ado things like Scopes, bronchs or echoes if not a lot of people doing them in town and they have the training.

 

3) rural - will probably cover the ICU, be strictly consultant and do everything I mentioned above if they want. Will be the ultimate specialist covering everything

 

Hope that helps

 

Thanks! That helps clear it up a lot. Can one still practice general internal medicine if subspecialized? Thank you.

[BigM]

Thanks! That helps clear it up a lot. Can one still practice general internal medicine if subspecialized? Thank you.

 

As things are right now you can do a subspecality and still get your GIM certification without extending your training any further. However, they are looking at adding another year onto the GIM residency which would likely mean you need to do additional training on top of the subspeciality to get both.

[Corie]

As things are right now you can do a subspecality and still get your GIM certification without extending your training any further. However, they are looking at adding another year onto the GIM residency which would likely mean you need to do additional training on top of the subspeciality to get both.

 

Thanks BigM.

 

This is the same thing the retarded CCFP did with family medicine. Look what good it did them.

 

Can you explain please? Isn't FM still 2 years?

[leviathan]

My plan is to do a mix of GIM + critical care, so I hope they don't plan on extending the requirements for GIM work.

[Satsuma]

Twenty years ago it used to be one year and common to all MDs. The rate of graduates entering a family practice (or general practice as it was known then) was around 50%. It has sharply dropped because of the change to two years. I suspect that lengthening GIM will result in a similar outcome.

 

The CCFP and some of the GIM academic types believe increasing training length gives their fields more "prestige". What it really does is dissuade people who would have done it had the training been a reasonable length and did not result in career stagnation.

 

Well, 20 years ago, you could practice for awhile, start your family etc., find out what area interested you further and specialize then. And still moonlight while you were doing your specialty.

 

I am not sure the extra year of training for FM is what makes people less interested in it. I think it is the fact that you are kind of stuck and can't really specialize after. I know alot of people in my med school class felt this way when choosing their specialty. You think, yeah maybe family would be ok, but I'm not really sure. So I'll pick this other specialty, that is 4-5 years. I'm not so sure about it either, but if I change my mind, it is easier to switch to another specialty or change into fam med. But realistically, you have to really hate your program to want to bother switching. In my mind that is what screwed fam med over.

[jerkstore]

This is it. You're right on the mark when it comes to "family medicine avoidance". In its current form it is a career dead-end. Any medical students who are unsure about their residency choice prior to carms will not rank family highly due to its lack of flexibility.

 

If you match to urology but want to switch to family later, you can, whereas the opposite will never happen.

 

I thought it had huge flexibility because of all the fellowships (anesthesia, ER, obstetrics, etc.).

[NLengr]

I thought it had huge flexibility because of all the fellowships (anesthesia, ER, obstetrics, etc.).

 

Those aren't Royal College Fellowships, so you get some extra knowledge, but in many places you get passed over for a RCPSC person.

 

For example, if I want to live in Southern Ontario, my ability to get a job as a GP-Anes is probably zero.

 

Family is a tough racket in our current system. Unfortunately, the CCFP doesn't seem to be interested in fixing the problems.

[bones]

This is it. You're right on the mark when it comes to "family medicine avoidance". In its current form it is a career dead-end. Any medical students who are unsure about their residency choice prior to carms will not rank family highly due to its lack of flexibility.

 

If you match to urology but want to switch to family later, you can, whereas the opposite will never happen.

 

 

Actually, I have met several family physicians who have switched into other residencies, and these weren't family physicians who did family medicine years ago and had a general license.

 

I've seen switches into:

1) Radiology (was done via the military route, which is one option)

2) Urology

3) ENT

4) Psych

5) Gen Surg

 

Every province has spots set aside for retraining of family physicians into other specialities. Sometimes there are return of service agreements involved, but often not. Beyond this, I don't know many of the details, but one could use Google to find out more about this.

 

If one is really not keen on continuing as a family physician, they can apply to train in something else. Although there are not a ton of spaces each year, there are not a ton of people who apply to do this.

[A-Stark]

As things are right now you can do a subspecality and still get your GIM certification without extending your training any further. However, they are looking at adding another year onto the GIM residency which would likely mean you need to do additional training on top of the subspeciality to get both.

 

I don't think that's true - not that the extra year hasn't become a reality, but that the 4-year IM certification still exists and has zero prospect of disappearing because subspecialists will still be needed to cover CTU and medicine call even in many larger community hospitals.

[futureGP]

uncontrolled hypertension is something that comes to mind... for a GIM consult

[futureGP]

This is it. You're right on the mark when it comes to "family medicine avoidance". In its current form it is a career dead-end. Any medical students who are unsure about their residency choice prior to carms will not rank family highly due to its lack of flexibility.

 

If you match to urology but want to switch to family later, you can, whereas the opposite will never happen.

 

exactly how I feel about family right now (Though my alias says otherwise)

 

the idea of a 'career dead-end' really bothers me