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Hi i'm thinking about IM and i'm wondering what the actual practice of it is like in urban centres and community settings. Focusing on GIM, btw.

 

Is there acute care (in the sense that a patient will come in with life-threatening symptoms and you can save their life?)

And what sort of population variety do you see? Is practice truly almost all 70+?

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Hey, it depends where you want to practice.

In urban centres, academic hospitals, the GIM takes care of patients with multiple diseases...and yes most of your patients will be 70+ or 80+.....the role of GIM is a bit limited in academic hospitals, since all the IM subspecialists are there and they want to have consultations too :P  For acute care, it is usually the intensivists (3 year of IM + 2 year of acute care) who handle the life-threatening patients. But if  you have a special interest, you could always go for additional training. 

For community settings, the GIM functions mostly as consultants. I.E, you will mostly like to see complex cases. Your tasks will be more important, since there aren't many IM subspecialists around. Nevertheless, the patients will be 70+  ;)  

I am not an IM resident though, just halfway through my junior clerkship... :)

Hi i'm thinking about IM and i'm wondering what the actual practice of it is like in urban centres and community settings. Focusing on GIM, btw.

 

Is there acute care (in the sense that a patient will come in with life-threatening symptoms and you can save their life?)

And what sort of population variety do you see? Is practice truly almost all 70+?

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:P  For acute care, it is usually the intensivists (3 year of IM + 2 year of acute care) who handle the life-threatening patients. But if  you have a special interest, you could always go for additional training. 

 

 

Intensivists can come from very different specialties (i.e. anesthesia, surgery, IM, Resp).

The role of GIM in academic hospital varies. Can't speak for all centres, but where I train, GIM admits most medical patients with non-cardio/non-resp/non-acute-hematologic-emergency. We see a lot of variety and can manage most of non-super-rare-conditions without the help of external consultants.

Life-threatening emergencies are also part of our training as we rotate through ICUs/CCUs/Code blues... not as much as intensivists/critical care, but we get our share.

 

As LittleDaisy wrote, the practice in the community varies regarding the location and specifically with the presence (or absence) of other medical consultants. 

The population we treat is generally > 70, but we see also much younger patients with interesting diseases that are at the opposite of the bread and butter (Heart failure, Htn, DM, COPD...).

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  • 2 months later...

GIM in academic setting is mostly

1. Attending on CTUs

2. Preop clinics

3. Attending on Medicine consults (e.g. from surgical services)

4. GIM clinics (multiple issues usually)

 

GIM in community depends on size of city

1. Small to medium city

1) attend on ICU/CCU/monitored beds

2) consult on complex patients under hospitalists (mostly family MDs)

3) outpatient GIM clinic which is pretty much any type of referral from family medicine and depends on availability of subspecialists in the city i.e. if no cardiologists, you are doing stress tests and seeing cardiology referrals)

 

2. Large city community hospital

Can be mostly attending on inpatient wards, hospitalist service, preop clinic +/- your own referral clinic.

 

 

Depending on how you play your cards, efficiency, type of referrals, where you work, billing can be anywhere from 350 to 600k

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  • 2 weeks later...

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