What is Internal Medicine residency like?

[brady23]

36 minutes ago, hamham said:

Every word you said is entirely true.

But in my opinion (and I want to emphasize it's ENTIRELY MY OPINION), the extra work you have to put in (I'm referring to the endless extra hours you have to put in for CTU calls as a junior and a senior) in order to HOPEFULLY get a chance to be involved in academics/teaching/research/interesting cases is not worth it.

"HOPEFULLY" b/c academic jobs are now limited and there is no guarantee that you would be able to get an academic job after you finish your GIM fellowship. The extra hours, coupled with the huge job insecurity (I am quite inflexible and can't see myself living outside of major urban centres like Toronto, Vancouver, Calgary, Montreal), are the factors that turned me off from IM, despite the fact that I love medicine.

Does GIM have a poor job market (i.e. you can't be picky about where you want to go)? 

I agree with what everything you said.

[hamham]

6 minutes ago, brady23 said:

Does GIM have a poor job market (i.e. you can't be picky about where you want to go)? 

I agree with what everything you said.

Haha.. Since you are in Toronto, why don't you find out for yourself?

Ask your staff whether there are any academic job openings for GIM at Mt Sinai and UHN, and if so, how many applications they receive for each available spot.  

[brady23]

7 minutes ago, hamham said:

Haha.. Since you are in Toronto, why don't you find out for yourself?

Ask your staff whether there are any academic job openings for GIM at Mt Sinai and UHN, and if so, how many applications they receive for each available spot.  

I see - you meant academic openings and not GIM openings. There's definitely a lot of opportunities for teaching at the Toronto sites from what I've seen and heard, which is why I was curious. Yes, there's competition for academic postings, but nothing out of the ordinary imo. Could start off small as leading a CBL session, and move on up from there. 

[psychiatry2017]

2 hours ago, Edict said:

While true, I do think GIM offers opportunities hospitalists do not get. GIM staff generally are the ones responsible for the academic part of IM, including running CTUs, teaching students, doing GIM research and many will participate in medical school education. In addition, GIM has the lock on interesting cases while in academic hospitalst hospitalists are mainly there to take care of ALC patients, of course you could work in community hospitals and see all kinds of patients. 

Imo, if you are interested more in community, do FM and hospitalist, you save 3 years. If you are more interested in academics/interesting cases/research, then you should do GIM and do the 5 years. 

 

Humm....I think that if you want to full-time hospitalist work as a Family doctor, you have to be willing to go very far & rural.

Anywhere 3 hours within Toronto, all the community hospitals have fully-fledged 4-year GIM internists running the ward & ICU, rarely you will be able to get a full-time position as a GP. You tend to get the boring pneumonia & social admit cases from the GIM colleagues.

 In Ontario, the community internists and community hospitalists (FM) get paid roughly the same (with FM stipends), why not hire the guy with more training who can run the entire ICU?

[A-Stark]

2 hours ago, Edict said:

Imo, if you are interested more in community, do FM and hospitalist, you save 3 years. If you are more interested in academics/interesting cases/research, then you should do GIM and do the 5 years. 

Community GIM is about way more than doing inpatient work. I feel like this is a major misconception; CTU is not GIM. 

1 hour ago, hamham said:

Every word you said is entirely true.

But in my opinion (and I want to emphasize it's ENTIRELY MY OPINION), the extra work you have to put in (I'm referring to the endless extra hours you have to put in for CTU calls as a junior and a senior) in order to HOPEFULLY get a chance to be involved in academics/teaching/research/interesting cases is not worth it.

"HOPEFULLY" b/c academic jobs are now limited and there is no guarantee that you would be able to get an academic job after you finish your GIM fellowship. The extra hours, coupled with the huge job insecurity (I am quite inflexible and can't see myself living outside of major urban centres like Toronto, Vancouver, Calgary, Montreal), are the factors that turned me off from IM, despite the fact that I love medicine.

I don't think the putatively more "slack" FM residencies are going to give you adequate training to assess and manage the undifferentiated patient. What's more, short of focusing on the likes of UHN exclusively as your aspiration, there are lots of jobs in GIM. On a more specific note, Toronto, Vancouver, Calgary, and Montreal are all very, very different (and with very different hospital systems). I don't know why there's this focus on academic jobs - I suppose they're great if you like institutional politics and focusing on non-clinical interests. 

40 minutes ago, hamham said:

Haha.. Since you are in Toronto, why don't you find out for yourself?

Ask your staff whether there are any academic job openings for GIM at Mt Sinai and UHN, and if so, how many applications they receive for each available spot.  

Lots more to Toronto than Sinai and UHN. It's fair to say that academic jobs at those hospitals are hard to come by for any specialty. Not sure why you seem to be singling out GIM (and still it's probably much easier than for ICU, GI, Cardio...). 

16 minutes ago, psychiatry2017 said:

Humm....I think that if you want to full-time hospitalist work as a Family doctor, you have to be willing to go very far & rural.

Anywhere 3 hours within Toronto, all the community hospitals have fully-fledged 4-year GIM internists running the ward & ICU, rarely you will be able to get a full-time position as a GP. You tend to get the boring pneumonia & social admit cases from the GIM colleagues.

 In Ontario, the community internists and community hospitalists (FM) get paid roughly the same (with FM stipends), why not hire the guy with more training who can run the entire ICU?

Community internists do not get paid "roughly the same" but have access to consultation billing codes and lucrative things like stress testing and echo. 

[hamham]

3 minutes ago, A-Stark said:

I don't think the putatively more "slack" FM residencies are going to give you adequate training to assess and manage the undifferentiated patient.

I don't think it's fair for someone who did not complete an FM residency program to make this comment.

5 minutes ago, A-Stark said:

What's more, short of focusing on the likes of UHN exclusively as your aspiration, there are lots of jobs in GIM.

I don't know about you, but I know for a fact that there are definitely limited GIM jobs in places where I want to live in future.

6 minutes ago, A-Stark said:

On a more specific note, Toronto, Vancouver, Calgary, and Montreal are all very, very different (and with very different hospital systems). I don't know why there's this focus on academic jobs - I suppose they're great if you like institutional politics and focusing on non-clinical interests. 

Edict brought up the advantages of completing a GIM residency over an FM residency, one of which is the opportunity to work in an academic centre (so that one can be involved in academics/teaching/research/interesting cases). That is why we are having this conversation.

9 minutes ago, A-Stark said:

Lots more to Toronto than Sinai and UHN. It's fair to say that academic jobs at those hospitals are hard to come by for any specialty. Not sure why you seem to be singling out GIM (and still it's probably much easier than for ICU, GI, Cardio...). 

There are too many academic hospitals in Toronto, and I am only listing UHN and Sinai as examples b/c those are one of the largest academic centres in Toronto. No one is saying that Toronto is only about UHN and Sinai. 

You should read some of the earlier posts in this thread before making such comments. Clearly, we are comparing GIM to FM hospitalist b/c both of these specialties involved care for the undifferentiated patient in a hospital setting, and we are trying to figure out whether GIM is worth all the extra years of training and job insecurity, when compared to FM.

 

 

[psychiatry2017]

17 minutes ago, A-Stark said:

Community GIM is about way more than doing inpatient work. I feel like this is a major misconception; CTU is not GIM. 

I don't think the putatively more "slack" FM residencies are going to give you adequate training to assess and manage the undifferentiated patient. What's more, short of focusing on the likes of UHN exclusively as your aspiration, there are lots of jobs in GIM. On a more specific note, Toronto, Vancouver, Calgary, and Montreal are all very, very different (and with very different hospital systems). I don't know why there's this focus on academic jobs - I suppose they're great if you like institutional politics and focusing on non-clinical interests. 

Lots more to Toronto than Sinai and UHN. It's fair to say that academic jobs at those hospitals are hard to come by for any specialty. Not sure why you seem to be singling out GIM (and still it's probably much easier than for ICU, GI, Cardio...). 

Community internists do not get paid "roughly the same" but have access to consultation billing codes and lucrative things like stress testing and echo. 

Community internists do get paid more for sure! But in the grand scheme of things, if you work rurally as a GP as a full-time hospitalist, you get paid fairly well!

[GrouchoMarx]

if youre dead set on Toronto there arent many specialties that will give you the option of starting off there, or even ever practicing there.

 

some of my friends are board certified nephro and Gi fellows and theyre stuck doing GIM work in brampton or scarborough, or locums, until a dialysis clinic spot opens up. these are lucrative spots so thats not going to happen with any frequency.

i think family or derm or psych are your only real options if you want to practice in toronto without worry, and family just because its low acuity. you wont make any money doing it though. that leaves psych or derm. psych is doable. good luck with getting into derm lol. but ive seen dumbasses and animal torturing sociopaths get into derm so you dont have to be a genius to do it. just persistent and lucky.

have you been to calgary? it sounds like youre from toronto. calgary is nothing like ontario. i spent some time out there and i did not like it. its a country vibe. lots of people but nothing to do. everythings spread out into endless suburbs. 

 

 

[A-Stark]

20 minutes ago, hamham said:

I don't think it's fair for someone who did not complete an FM residency program to make this comment.

I have worked with and supervised numerous FM residents to say nothing of seeing referrals and taking outside calls from actual family docs. Most are pretty good but there’s a reason why primary care involves making referrals too. What’s more, there is something to be said for putting in more time and hours. What you get out of residency is about what you put in - and what you put in studying. 

20 minutes ago, hamham said:

You should read some of the earlier posts in this thread before making such comments. Clearly, we are comparing GIM to FM hospitalist b/c both of these specialties involved care for the undifferentiated patient in a hospital setting, and we are trying to figure out whether GIM is worth all the extra years of training and job insecurity, when compared to FM.

And I’m saying it’s not at all comparable. That’s my point - that the comparison itself is silly given that GIM is not at all about doing routine low acuity inpatient work. That’s what FM hospitalists do. And they consult when they need to and the ACS and overdose and sick patients go to IM and the unit. 

[A-Stark]

7 minutes ago, GrouchoMarx said:

some of my friends are board certified nephro and Gi fellows and theyre stuck doing GIM work in brampton or scarborough, or locums, until a dialysis clinic spot opens up. these are lucrative spots so thats not going to happen with any frequency.

[...]

have you been to calgary? it sounds like youre from toronto. calgary is nothing like ontario. i spent some time out there and i did not like it. its a country vibe. lots of people but nothing to do. everythings spread out into endless suburbs. 

Nephro in particular is often organized in local oligopolies to the benefit of rent-seeking senior staff (often organized like a law firm where new staff get scraps allocated like junior associates). 

I do like Calgary but outside a few areas it just goes on and on. Foothills, anyway, has a fairly large number of FM hospitalist patients with IM cherry picking more “interesting” patients. 

Mostly though large hospitals are terrible places to work. Sadly I need to go back to one of those downtown Toronto hospitals in about 7 hours. 

[hamham]

2 hours ago, A-Stark said:

I don't think the putatively more "slack" FM residencies are going to give you adequate training to assess and manage the undifferentiated patient.

1 hour ago, A-Stark said:

Most are pretty good but there’s a reason why primary care involves making referrals too. What’s more, there is something to be said for putting in more time and hours. What you get out of residency is about what you put in - and what you put in studying. 

Part of the training as a generalist (whether it's FM, FM hospitalist or even GIM) is to acquire the ability to manage the undifferentiated patient by making appropriate referrals. Even GIM refer to Cardio, GI or Rheum when necessary.

I believe all FM residencies in Canada will provide you with adequate training on that, regardless of which program you attend.

1 hour ago, A-Stark said:

And I’m saying it’s not at all comparable. That’s my point - that the comparison itself is silly given that GIM is not at all about doing routine low acuity inpatient work. That’s what FM hospitalists do. And they consult when they need to and the ACS and overdose and sick patients go to IM and the unit. 

I think you are missing the entire point. I never once claim that GIM is about doing routine low acuity inpatient work. In fact, most people chose to go into IM, and then GIM, because of the opportunity to see interesting cases (as rightly pointed out by Edict) and manage complex undifferentiated patients, who are certainly far more complicated than those managed by FM hospitalists.  But IN MY MOST HUMBLE OPINION, the fact that both specialties involve "care for the undifferentiated patient in an inpatient setting" provides sufficient grounds for us to draw comparison between both of them.

I am not expecting you to agree with me on this of course, especially since you are GIM. I would like to think that you went through all that extra training b/c you felt that it was all worth it, and that it has made you more capable of handling highly acute, complex patients than any other FM hospitalist. But not everyone thinks like you, and there are definitely others who feel they will be equally as happy as an FM hospitalist as they would as a GIM internist.  .  

[hamham]

1 hour ago, GrouchoMarx said:

i think family or derm or psych are your only real options if you want to practice in toronto without worry, and family just because its low acuity. you wont make any money doing it though. 

I definitely won't be making ophthalmology, cardiology or GI money. But b/c of my unique language proficiency, I am lucky to have been offered a chance to join a group just a little north of Toronto. I can definitely drive to work daily while I continue to live in Toronto with my family. Gross salary promised is ~350k per annum at least, more if I work harder. To me, that's sufficient for me and my family. 

 

[goleafsgochris]

I'm neurology and I found a (community) job in Toronto without difficulty

[Organomegaly]

17 hours ago, hamham said:

Every word you said is entirely true.

But in my opinion (and I want to emphasize it's ENTIRELY MY OPINION), the extra work you have to put in (I'm referring to the endless extra hours you have to put in for CTU calls as a junior and a senior) in order to HOPEFULLY get a chance to be involved in academics/teaching/research/interesting cases is not worth it.

"HOPEFULLY" b/c academic jobs are now limited and there is no guarantee that you would be able to get an academic job after you finish your GIM fellowship. The extra hours, coupled with the huge job insecurity (I am quite inflexible and can't see myself living outside of major urban centres like Toronto, Vancouver, Calgary, Montreal), are the factors that turned me off from IM, despite the fact that I love medicine.

 

Yes, it's becoming harder. However, I have seen GIM fellows hired at McMaster (a major academic centre and one of the most research intensive schools in the country) without a Masters/PHD on the basis of educational interests and merits in teaching. These are recent hires. The decision to pursue academic or community medicine, and subsequently which discipline, is a highly personal one. I'm personally someone who follows my dreams -- yes there is a component of idealism in that. For me, to settle on family medicine for fear of the job market would leave me wondering "what if?" for most of my life. I'd be fine settling for a community general internal medicine job. They exist in abundance last I checked not far from major academic centres. 

[NLengr]

On 05/02/2018 at 2:49 AM, A-Stark said:

 

Mostly though large hospitals are terrible places to work.

That's why the staff there have their slaves (oh, sorry, I mean residents or fellows). Let's them avoid a lot of the unpleasantness of working there. It also let's then avoid many aspects of patient care and clinical practice if they want to. 

 

I'm a rural surgeon at a small regional referral hospital hours and hours away from the tertiary care center in my area. My job is great. 

[Aconitase]

On 2018-01-13 at 2:30 AM, bearded frog said:

I think very few people want to be general interests, everyone is shooting for their specialty of interest, so all the IM residents are hating their life trying to get that sub specialty match. As opposed to other specialties where you generally do what you sign up for off the bat, at least after off-service heavy years.

It’s not that bad  

 

You barely do GIM in year 3. It’s more like 2 tough years. You also get lighter rotations with minimal call (ie endocrine, rheum, Ext). 

 

It remains popular since high paying jobs in ICU, cardio, GI, nephro all require it as a prerequisite 

[#YOLO]

10 hours ago, Aconitase said:

It’s not that bad  

 

You barely do GIM in year 3. It’s more like 2 tough years. You also get lighter rotations with minimal call (ie endocrine, rheum, Ext). 

 

It remains popular since high paying jobs in ICU, cardio, GI, nephro all require it as a prerequisite 

but these jobs dont exist i know too many underemployed nephrologists...a good amount that are doing any dialysis at all. 

[Aconitase]

6 hours ago, #YOLO said:

but these jobs dont exist i know too many underemployed nephrologists...a good amount that are doing any dialysis at all. 

Yeah and now someone was saying ICU had no jobs either. 

 

Why do they train cardio/GI/nephro/ICU if no jobs? Should we all be doing GIM or endo instead ?

[#YOLO]

5 hours ago, Aconitase said:

Yeah and now someone was saying ICU had no jobs either. 

 

Why do they train cardio/GI/nephro/ICU if no jobs? Should we all be doing GIM or endo instead ?

cuz most are IMGs or saudis now a days. also some ppl acutally like the field. ICU now a days is an add on to make urself more marketable..alot the fellows are already trained in nephro, cardio, surg etc. why do endo? good lifestyle, super chill...but i cant grasp doing 5 years of resi to make the same as a gp for the most part...everyone is doing GIM now a days. its super competitive. 

[Aconitase]

4 hours ago, #YOLO said:

cuz most are IMGs or saudis now a days. also some ppl acutally like the field. ICU now a days is an add on to make urself more marketable..alot the fellows are already trained in nephro, cardio, surg etc. why do endo? good lifestyle, super chill...but i cant grasp doing 5 years of resi to make the same as a gp for the most part...everyone is doing GIM now a days. its super competitive. 

So most residents are IMGs in this fields ? I thought cardio and GI were competitive? I know nephro isn’t bc no one wants to share dialysis billing (why would you lol). If ICU is also in there then truly the only decent paying option left is GIM and now they even want us to do 5 years for that !

[Snowmen]

2 hours ago, Aconitase said:

So most residents are IMGs in this fields ? I thought cardio and GI were competitive? I know nephro isn’t bc no one wants to share dialysis billing (why would you lol). If ICU is also in there then truly the only decent paying option left is GIM and now they even want us to do 5 years for that !

5 year for a specialty. Shocking.

[Aconitase]

24 minutes ago, Snowmen said:

5 year for a specialty. Shocking.

GIM used to be 4. Why does it now need to be 5?

[#YOLO]

1 hour ago, Aconitase said:

GIM used to be 4. Why does it now need to be 5?

cheap labour.

[Aconitase]

34 minutes ago, #YOLO said:

cheap labour.

I hope this is not the only reason

[hero147]

More likely due to credentialism and a declining job market. As more and more people opt for the 5 year GIm program, the people who do the 4 year program may find it harder to obtain positions in mid to large-sized cities.