general internal medicine profile … internal medicine profile in the hospital and ambulatory...
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GENERAL INTERNAL MEDICINE PROFILE
GENERAL INFORMATION (Sources: Pathway Evaluation Program, American College of Osteopathic Internists & the Canadian Medical Residency Guide) Internal medicine is a broad-based specialty that has its roots in primary care and is dedicated to providing primary and specialty care to adults. Internists diagnose and manage diseases involving any of the organ systems and are specially trained to manage seriously ill patients suffering from advanced illness and/or diseases of more than one system. Internists provide care in an office setting, in hospitals and on a continuing ambulatory basis. They tend to the general medical needs of their patients in the office, including disease prevention, early detection of disease, screening, patient education and follow-up care from hospitalization.
GENERAL INTERNAL MEDICINE PROFILE
In the hospital and ambulatory setting, internists manage acute and chronic illness of their patients and other patients that have been referred to them by other practitioners such as family physicians. They are also trained to meet the special needs of the geriatric population. Internists are trained in many procedures from many different disciplines and they perform these independently. They may also take additional training and subspecialize in the following areas of internal medicine:
• Critical care medicine • Cardiology • Infectious diseases • Neurology • Respiratory medicine • Rheumatology • Endocrinology and metabolism
• Gastroenterology • General Internal Medicine • Geriatrics • Hematology • Medical oncology • Clinical allergy and immunology • Dermatology
GENERAL INTERNAL MEDICINE PROFILE
In addition to their medical work, internists also organize and co-ordinate their patient’s care and ensure that they gain access to the care they need. After completing medical school, to become an internist requires additional training that takes 4 years. Those who choose to subspecialize are required to complete 2 years of subspecialty training, which they can begin once completing the three core years of the internists program, for a total of 5 years of postgraduate education. For more detailed information on the specialty training requirements go to: http://www.royalcollege.ca/portal/page/portal/rc/credentials/start/routes/traditional_route
Canadian Society of Internal Medicine http://www.csim.ca/en/
Number of physicians and physicians/100,000 population in General Internal Medicine in Canada, 2015
Source: 2015 CMA Masterfile
Province/Territory Physicians Phys/100k pop'n
Newfoundland/Labrador 32 6.1
Prince Edward Island 11 7.5
Nova Scotia 69 7.3
New Brunswick 39 5.2
Quebec 718 8.7
Ontario 1152 8.4
Manitoba 97 7.5
Saskatchewan 73 6.4
Alberta 299 7.2
British Columbia 367 7.9
Territories 1 0.9
CANADA 2858 8.0
Physicians/100,000 population in General Internal Medicine
in Canada, 1995 to 2015
Source: CMA Masterfile
6.8
7.0
7.2
7.4
7.6
7.8
8.0
8.2
8.4
8.6
1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
General Internal Medicine specialists by gender and year in Canada, 1995 to 2015
0
500
1000
1500
2000
2500
3000
3500
1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
Total Males Females
Source: CMA Masterfile
General Internal Medicine specialists by age and gender in Canada, 2015
Source: 2015 CMA Masterfile
Female 32%
Male 68%
Gender
34 and under 16%
35 - 44 19%
45 - 54 24%
55 - 64 19%
65 and over 22%
Age Group
General Internal Medicine specialists by age and gender in Canada, 2015
Source: 2015 CMA Masterfile
213
256
226
114
54
224
263
433
412
558
34 and Under
35-44
45-54
55-64
65 and over
Female Male
Main work setting of General Internal Medicine specialists in Canada, 2014
Source: 2014 National Physician Survey. CFPC, CMA, Royal College
33%
26%
23%
7%
2%
2%
2%
Academic Health Sciences Centre
Private Office/Clinic
Community Hospital
Non-AHSC Teaching Hospital
Community Clinic/Health-centre
Admin/Corp office
Free-standing Lab/Diag Clinic
Practice organization for General Internal Medicine specialists in Canada, 2014
Source: 2014 National Physician Survey. CFPC, CMA, Royal College
22%
8%
6%
64%
Solo Practice
Group Practice
Interprofessional Practice
Hospital-based Practice
NR
Hours worked per week (excluding on-call) by General Internal Medicine specialists in Canada, 2014
Source: 2014 National Physician Survey. CFPC, CMA, Royal College
Activity Hours worked per week
Direct patient care without teaching component 20.9
Direct patient care with teaching component 7.6
Teaching without patient care 2.2
Indirect patient care 5.4
Health facility committees 1.1
Administration 2.3
Research 1.9
Managing practice 1.2
Continued professional development 3.3
Other 1.2
TOTAL HOURS PER WEEK 47.1
Time spent on call in direct patient care = 50 hrs./month
On-call duty hours spent per month by General Internal Medicine specialists in Canada, 2014
Source: 2014 National Physician Survey. CFPC, CMA, Royal College
65%
19%
7% 7%
2%
Up to 120 hrs/month
More than 120, up to 180 hrs/month
More than 180, up to 240 hrs/month
More than 240 hrs/month
No response
Remuneration for General Internal Medicine specialists in Canada
53%
8%
5%
30%
4%
Primary payment method1 in 2013
90% + fee-for-service 90% + salary
90% + other* Blended
NR
* Other includes capitation, sessional, contract and other methods
Average gross clinical earnings for Internal Medicine in 2013/14 (those earning at least
$60,000) = $396,1052
Average percent overhead reported by Internal Medicine specialists in 2010 = 22%3
1 National Physician Survey, 2013, CFPC, CMA, Royal College 2 National Physician Database, 2013/14, CIHI 3 National Physician Survey, 2010, CFPC, CMA, Royal College
Satisfaction among General Internal Medicine specialists in Canada, 2013
8%
7%
1%
3%
8%
19%
11%
19%
47%
41%
26%
12%
Currentprofessional life
Balance ofpersonal
& professionalcommitments
NR Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied
Source: 2013 National Physician Survey. CFPC, CMA, Royal College
General Internal Medicine specialists who are Royal College, CFPC or CMQ certified in Canada, 2014
99%
16% 10%
Royal College CFPC CMQ OutsideCanada
Note: Subset of those who reported a certification. Physicians could indicate more than one certification body.
Source: 2014 National Physician Survey. CFPC, CMA, Royal College
Number of General Internal Medicine specialists who retired during the THREE year period of 2012
to 2014
1 5
73 79
1 9
1
11
< 35 35-44 45-54 55-64 65 + Unknown Total
Age Group
Males Females
Source: CMA Masterfile – year over year comparisons Note: “Retired” is based on giving up licence and therefore excludes those who have retired from clinical practice but are still licensed; those younger than 45 may include physicians who have temporarily given up their licence but return to practice at a later date.
Faculty of Medicine
Ministry funded
Total Faculty of Medicine
Ministry funded
Total
Memorial U N&L 31 31 McMaster U 85 96
Dalhousie U 49 55 UWO 104 120
U Laval 78 78 NOSM 25 25
U Sherbrooke 93 93 U Manitoba 48 53
U Montréal 120 120 U Sask 69 69
McGill U 106 120 U Alberta 92 102
U Ottawa 81 81 U Calgary 96 98
Queens U 59 63 UBC 158 173
U Toronto 201 224 Canada 1495 1601
Total and Ministry funded postgraduate MD trainees in 2014/15 – Internal Medicine (including subspecialties)
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
Faculty of Medicine
Ministry funded
Total Faculty of Medicine
Ministry funded
Total
Memorial U N&L 0 0 McMaster U 5 5
Dalhousie U 2 8 UWO 1 6
U Laval 7 19 NOSM 0 0
U Sherbrooke 1 17 U Manitoba 0 9
U Montréal 7 15 U Sask 0 5
McGill U 0 19 U Alberta 3 12
U Ottawa 1 5 U Calgary 4 10
Queens U 0 5 UBC 4 11
U Toronto 9 24 Canada 44 170
Total and Ministry funded postgraduate MD trainees in 2014/15 – General Internal Medicine
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
253
5
243
26 0
250
500
First year Exits frompostgrad
Female
Male
435
22
61
9 0
250
500
First year Postgradexits
IMG
GCMS
First year and exiting postgraduate-MD trainees in 2014/15 – Internal Medicine (including subspecialties)
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
IMG – International Medical Graduates GCMS – Graduates of Canadian Medical Schools
41
24
46
39
0
50
100
First year Exits frompostgrad
Female
Male 75
52
12
11
0
50
100
First year Postgradexits
IMG
GCMS
First year and exiting postgraduate-MD trainees in 2014/15 – General Internal Medicine
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
• Total of 496 first year Internal Medicine trainees representing 33% of all Internal Medicine trainees.
• Total of 1495 Internal Medicine trainees representing 12% of all Ministry funded trainees.
• Total of 102 visa trainees in Internal Medicine.
• Total of 31 Internal Medicine trainees completed postgraduate training in 2014.
Postgraduate-MD trainees in 2014/15 – Internal Medicine (including subspecialties)
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
• Total of 87 first year General Internal Medicine trainees representing 58% of all General Internal Medicine trainees.
• Total of 149 General Internal Medicine trainees representing 1% of all Ministry funded trainees.
• Total of 3 visa trainees in General Internal Medicine.
• Total of 63 General Internal Medicine trainees completed postgraduate training in 2014.
Postgraduate-MD trainees in 2014/15 – General Internal Medicine
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
1
8
13
3
5
7
4
0
5
10
15
Location of 2013 Postgraduate-MD exits in 2015 – Internal Medicine (including subspecialties)
Of the 41 exits in 2013, 37 (90%) were known to be practising in Canada
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
2 1
12
19
1
3
10
1
4
0
10
20
Location of 2013 Postgraduate-MD exits in 2015 – General Internal Medicine
Of the 53 exits in 2013, 48 (91%) were known to be practising in Canada
Source: 2014/15 Annual Census of Post-MD Trainees, CAPER
Stress associated with finding employment at end of residency
6%
7%
20%
43%
50%
42%
25%
8%
Other spec res
FM resident
NR/NA Not stressful Somewhat stressful Very stressful
Source: 2012 National Physician Survey of residents. CFPC, CMA, Royal College
Links to the organizations supplying information for this document
National Physician Survey http://www.nationalphysiciansurvey.ca Canadian Medical Association http://www.cma.ca/pdc Association of Faculties of Medicine of Canada http://www.caper.ca/ Royal College of Physicians and Surgeons of Canada http://www.royalcollege.ca/portal/page/portal/rc/credentials/start/routes/traditional_route
College of Family Physicians of Canada http://www.cfpc.ca Canadian Institute for Health Information http://www.cihi.ca
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