General Internal Medicine - Canadian Medical Association

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Internal medicine is a broad-based specialty that has its roots in primary care and is dedicated to ... complete 2 years of subspecialty training, which they can begin once completing the three core .... Average gross clinical earnings for Internal ...
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 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

Source: 2015 CMA Masterfile

8.6

Physicians/100,000 population in General Internal Medicine in Canada, 1995 to 2015

8.4 8.2 8.0 7.8 7.6 7.4 7.2 7.0 6.8

1995

1997

Source: CMA Masterfile

1999

2001

2003

2005

2007

2009

2011

2013

2015

General Internal Medicine specialists by gender and year in Canada, 1995 to 2015 3500 3000 2500 2000

1500 1000

500 0 1995

1997

1999

2001

Total Source: CMA Masterfile

2003

2005

Males

2007

2009

2011

Females

2013

2015

General Internal Medicine specialists by age and gender in Canada, 2015 Gender

Age Group

Female 32% Male 68%

Source: 2015 CMA Masterfile

65 and over 22%

55 - 64 19%

34 and under 16% 35 - 44 19%

45 - 54 24%

General Internal Medicine specialists by age and gender in Canada, 2015 65 and over

55-64

45-54

35-44

34 and Under

54

558

114

412

226

433

256

263

213

224

Female

Source: 2015 CMA Masterfile

Male

Main work setting of General Internal Medicine specialists in Canada, 2014 Academic Health Sciences Centre

33%

Private Office/Clinic

26%

Community Hospital

23%

Non-AHSC Teaching Hospital

7%

Community Clinic/Health-centre

2%

Admin/Corp office

2%

Free-standing Lab/Diag Clinic

2%

Source: 2014 National Physician Survey. CFPC, CMA, Royal College

Practice organization for General Internal Medicine specialists in Canada, 2014

22% 8% 64%

Solo Practice Group Practice

6%

Interprofessional Practice Hospital-based Practice NR

Source: 2014 National Physician Survey. CFPC, CMA, Royal College

Hours worked per week (excluding on-call) by General Internal Medicine specialists in Canada, 2014 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

Source: 2014 National Physician Survey. CFPC, CMA, Royal College

On-call duty hours spent per month by General Internal Medicine specialists in Canada, 2014 2%

7%

7% Up to 120 hrs/month

19%

More than 120, up to 180 hrs/month

65%

More than 180, up to 240 hrs/month More than 240 hrs/month No response

Time spent on call in direct patient care = 50 hrs./month

Source: 2014 National Physician Survey. CFPC, CMA, Royal College

Remuneration for General Internal Medicine specialists in Canada Primary payment method1 in 2013 4%

Average gross clinical earnings for Internal Medicine in 2013/14 (those earning at least $60,000) = $396,1052

30% 53% 5% 8%

Average percent overhead reported by Internal Medicine specialists in 2010 = 22%3

90% + fee-for-service

90% + salary

90% + other*

Blended

NR

* Other includes capitation, sessional, contract and other methods 1

National Physician Survey, 2013, CFPC, CMA, Royal College National Physician Database, 2013/14, CIHI 3 National Physician Survey, 2010, CFPC, CMA, Royal College 2

Satisfaction among General Internal Medicine specialists in Canada, 2013

Balance of personal & professional commitments

3% 7%

19%

19%

41%

12%

1% Current professional life

8%

NR

8%

11%

Very dissatisfied

47%

Dissatisfied

Neutral

Source: 2013 National Physician Survey. CFPC, CMA, Royal College

26%

Satisfied

Very satisfied

General Internal Medicine specialists who are Royal College, CFPC or CMQ certified in Canada, 2014 99%

16%

Royal College

CFPC

CMQ

10% Outside Canada

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 Males

Females 79

73

1

< 35

35-44

45-54

5

11

9 1

55-64 Age Group

1

65 +

Unknown

Total

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.

Total and Ministry funded postgraduate MD trainees in 2014/15 – Internal Medicine (including subspecialties) Faculty of Medicine

Ministry funded

Total

Memorial U N&L

31

31

Dalhousie U

49

U Laval

Faculty of Medicine

Ministry funded

Total

McMaster U

85

96

55

UWO

104

120

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

Source: 2014/15 Annual Census of Post-MD Trainees, CAPER

Total and Ministry funded postgraduate MD trainees in 2014/15 – General Internal Medicine Faculty of Medicine

Ministry funded

Total

Memorial U N&L

0

0

Dalhousie U

2

U Laval

Faculty of Medicine

Ministry funded

Total

McMaster U

5

5

8

UWO

1

6

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

Source: 2014/15 Annual Census of Post-MD Trainees, CAPER

First year and exiting postgraduate-MD trainees in 2014/15 – Internal Medicine (including subspecialties) 500

500

61

243

250

Female

250

IMG

435

GCMS

Male 253

0 First year

26 5 Exits from postgrad

0 First year

9 22 Postgrad exits

IMG – International Medical Graduates GCMS – Graduates of Canadian Medical Schools

Source: 2014/15 Annual Census of Post-MD Trainees, CAPER

First year and exiting postgraduate-MD trainees in 2014/15 – General Internal Medicine 100

100

12

46

11

50 39

Female

50

IMG 75

Male

GCMS 52

41 24

0

0 First year

Exits from postgrad

Source: 2014/15 Annual Census of Post-MD Trainees, CAPER

First year

Postgrad exits

Postgraduate-MD trainees in 2014/15 – Internal Medicine (including subspecialties) • 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.

Source: 2014/15 Annual Census of Post-MD Trainees, CAPER

Postgraduate-MD trainees in 2014/15 – General Internal Medicine • 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.

Source: 2014/15 Annual Census of Post-MD Trainees, CAPER

Location of 2013 Postgraduate-MD exits in 2015 – Internal Medicine (including subspecialties) 15

13

10

8

7 5

5

3

4

1 0

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

Location of 2013 Postgraduate-MD exits in 2015 – General Internal Medicine 19

20

12

10

10

2

4

3 1

1

1

0

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

FM resident

7%

Other spec res

6%

NR/NA

42%

43%

20%

Not stressful

8%

50%

Somewhat stressful

25%

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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