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