Differences between Internal Medicine in Canada vs United States

[Gavanshir]

I've recently heard that the practice of internal medicine in Canada is different from that in the US. Mainly that in Canada, it is a consult service whereas in the US, internists manage the A-Z for inpatients. Does anyone have any insight into these differences? Thank you.

[A-Stark]

Internists work in primary care in the US and might run a generalist primary care outpatient practice exclusively. General internal medicine covers inpatients at larger academic centres, but in the community they might cover a smaller ICU and follow select patients on the floor as consultants. The rest of their time might be spent in the stress lab or reading echos or doing any number of invasive procedures (the smaller the centre, the more likely they'll be doing bronchs, GI endoscopy, etc.).

[shimshim]

Can you please define to me what consult service is, I am having trouble understanding this ? Please ?

[A-Stark]

In many/most community hospitals, general internists do not admit patients to the floor (only ICU/CCU), but will be consulted to advise admitting physicians (usually a GP or GP-hospitalist) on patient care. So they're consultants rather than attending physicians for floor patients.

[Stegalls]

Can you please define to me what consult service is, I am having trouble understanding this ? Please ?

 

When someone needs your expertise, they call you and you see the patient, and give your recommendations. 

[RadCdn]

I've never really understood the role of General Internists in Canada. If GP hospitalists are admitting, how much more expertise can a General Internist provide? Don't GP hospitalists then just consult renal, GI, etc, for specific advice.

 

In America, internists admit the patient and if more expert advice is needed, we consult the sub-specialists.

[Flow Cytometry]

GP hospitalists = usually admit patients with social issues or who are stable.

Internists = admit sicker, more acute patients. 

 

This is for both academic and community hospitals, although less hospitalists in academic centers. 

 

Internists are MRPs when the sick patients are admitted. 

 

Also not all hospitals have renal, etc.... 

[rmorelan]

GP hospitalists = usually admit patients with social issues or who are stable.

Internists = admit sicker, more acute patients. 

 

This is for both academic and community hospitals, although less hospitalists in academic centers. 

 

Internists are MRPs when the sick patients are admitted. 

 

Also not all hospitals have renal, etc.... 

 

the line can be blurry with hospitalists for sure, but yeah absolutely in general the hospitalists have specific areas they work in and gain experience or work with lower acuity patients. For instance there are GP hosptialists that run the oncology floor at Ottawa during the day, and GP hospitalists that run geriatric floors at other centres I have been at. It isn't surprising there is some overlap - there often is in the Canadian system actually - but general internists are supposed to be able to manage the sicker patients due to their greater training. The generalist may not need to consult other services at all actually while the hospitalists probably should be more.

 

Some general internists in Canada don't actually work through the hospital though - they can run a private office and accept referrals from family doctors. The bottom line is to control costs and introduce appropriate work flow family doctors in Canada act as the gateway to other services. It prevents overbilling from specialists as the cases have already been screened by the family doctors.