Internal Medicine (Gim Vs Subspec)

[johnstickienote]

Hi everybody

Please excuse my ignorance on this topic. I am just wondering how pursuing a residency in IM works and what the actual training looks like. My understanding is that when you are matched to CaRMS, you match to a 3 year IM residency. After that, do you have to apply again to pursue a subspecialty like Endo or Cardio or is that indicated right out of the gate after med? How does this work for GIM?

Are there cases where people match right out of med for a subspecialty, or does everybody have to go through 3 yrs of general IM first?

 

In the case of Peds subspecialty IM, do you have to pursue 3yrs of Peds before you subspecialize,or can you still work in Peds as a regular subspecialist?

Thanks! And I am sorry if these are dumb questions.

[thatonekid]

For IM, you match to a internal program. In your 3rd year, you can do the subspecialty match. If you want to do general IM, you can just continue on and not enter the subspecialty match or do the 5 year GIM program. Everyone goes through the same general first 3 years.

 

The peds question is a bit trickier to answer. Technically, as a IM subspecialist, you can see kids. But it really depends on where you work. If you're at a tertiary care centre, the pediatricians are likely seeing the kids rather than the internists. 

[Maxime]

During your 3rd year of IM, you have to apply to Carms for the GIM subspecialty match... You can't just continue your training. Same thing applies to Cards, endo... 

 

Normally internists do not see kids. They have no paediatrics exposure at all during their residency. Doing subspecialty training will expose you to kids (I did 2 months of Paeds/Congenital), however adult care is still the VAST majority of what you will see. Concerning Paeds subspecialty in IM, no idea.

[keith_015]

Disagree with above. You are tied to 4 years of funding at your home institution when you match to IM. Should you not subspecialize (including the 2 year GIM), you default to 1 year of "GIM". You do not have to apply to the 2 year GIM. The 2 year is up and coming, and has become popular.

 

In communities away from academic centres, IM's WILL see peds if there are no subspecialists trained in that area. I have done a community ID rotation and done a few consults on children, and community Allergy clinics where about half the practice is pediatric aged.

[thatonekid]

Disagree with above. You are tied to 4 years of funding at your home institution when you match to IM. Should you not subspecialize (including the 2 year GIM), you default to 1 year of "GIM". You do not have to apply to the 2 year GIM. The 2 year is up and coming, and has become popular.

 

In communities away from academic centres, IM's WILL see peds if there are no subspecialists trained in that area. I have done a community ID rotation and done a few consults on children, and community Allergy clinics where about half the practice is pediatric aged.

 

There's also been lots of talk about phasing out the 4 year GIM program in favour of the 2 year GIM fellowship sometime in the future.

[keith_015]

There's also been lots of talk about phasing out the 4 year GIM program in favour of the 2 year GIM fellowship sometime in the future.

 

I see that slowly happening. Problem is, what do you do with those who don't match? At least 1 year IM would be better than being relegated to 2nd iteration for subspecialties less popular or those without jobs. I hope they are thinking this through.

[Tacrolimus]

I have two main questions:

#1: Is the 2nd CaRMS match seen as a barrier for internal medicine? I mean, going through one after med school sounds stressful, but having to worry about another one after three years probably produces a lot of anxiety. But at the same time, isn't Internal a great option as you get three more years to decide on a potential subspecialty?

#2: I also do not want to specialise in one field, and think GIM is the way to go. You are constantly seeing patients with multiple diseases and having to manage complex patients in an acute setting. I like that aspect, but I want to hear from any IM residents on this forum. What are the pros/cons?

Okay, now back to enjoying my summer.