September 18 2014 Prepare for future IMIG Events Identify what an Internist does Appreciate the different subspecialty options in internal medicine Register for ACP as a student Objectives What is Internal Medicine ID: 904278
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Slide1
INTRODUCTION TO INTERNAL MEDICINE
September 18, 2014
Slide2Prepare for future IMIG Events
Identify what an Internist does
Appreciate the different subspecialty options in internal medicineRegister for ACP as a student
Objectives
Slide3What is Internal Medicine?
Slide4Glen Solomon
Chair of Internal Medicine
Karen KirkhamInternal Medicine Clerkship DirectorBruce ScottInternal Medicine/Geriatrics/Palliative Care
Who are Internists?
ICM Preceptors
Slide5William Osler
Eminent Internist, founder of residencies
Robert Lefkowitz and Brian KobilkaNobel Prize Winners in Chemistry (G-coupled protein receptors)Ken JeongIntern(al)ational Movie Star
Who are Internists?
Slide6Who are Internists?
One in
four
US physicians has ABIM board certification
1
Setting:
Private practice = 80.9%
Academia = 14.9%
Both generalists and subspecialists are currently undersupplied
2
29.3% experienced difficulty in securing first position
1
ABIM Fast Facts sheet
2014
2
The Complexities of Physician Supply and Demand: Projections Through 2025, Center for Workforce Studies, AAMC, 2008.
Slide7American College of Physicians:
“Physicians for Adults” (2009)
“Physicians who specialize in the prevention, detection and treatment of illnesses in adults.” (2011)
“Specialists
who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness
.” (2013)
Comes from German for “Interior Doctor,” applied to someone who uses laboratory results to diagnose diseases
Internal Medicine: Definition
Slide8Focuses on chronic and acute disease processes
Wide range of practice environments
Urgent care -> Hospitals -> Clinics -> Work abroad
Diverse subspecialties
Cardiology to Complementary Medicine
Passed the American Board of Internal Medicine Certification Exam
Internal Medicine: Definition
Slide9Acute
Internal Medicine Spectrums
Chronic
Intensive Care Physician
Inpatient
Outpatient
Hospitalist
Primary Care
Academic
*Or any combination of the above
Subspecialist
Slide10General
Internal Medicine Spectrum
Specialized
Geriatrician
Electrophysiologist
Rheumatologist
Rural Primary Care
*General rule: as you get more specialized, have less individualization of practice
**Family Medicine is that way
Slide11To become a subspecialist, must complete a residency in Internal Medicine first
Internal Medicine Subspecialties
1
3
4
2
1
3
2
1
3
2
Medical School
Residency
(Internal Medicine)
Fellowship
(i.e. Gastro-
enterology
)
Years
Slide12American Board of Internal Medicine Certified:
Internal Medicine: Subspecialties
Adolescent Medicine
Adult Congenital Heart Disease
Advanced Heart Failure and Transplant Cardiology
Cardiovascular Disease
Clinical Cardiac Electrophysiology
Critical Care Medicine
Endocrinology, Diabetes, & Metabolism
Gastroenterology
Geriatric MedicineHematology
Hospice & Palliative MedicineInfectious DiseaseInterventional CardiologyMedical OncologyNephrologyPulmonary DiseaseRheumatologySleep MedicineSports MedicineTransplant Hepatology
Non-ABIM Certified:
General Internal Medicine
Medical Education
Transplant Infectious Disease
Transitions of Care
Medical Research
Occupational Health
Medical-Legal Interactions
Tropical Medicine
Complementary Medicine
Women’s Health
Headache
To be determined
Slide13General Internists
AKA Internists
Slide14Acute care
Inpatient setting/ ICU
MI, stroke, respiratory failure, renal failure, etc.
Chronic disease care
Outpatient setting, nursing home, hospice
DM, HTN, hyperlipidemia, CAD, CHF, COPD, etc.
Adult wellness/checkups
Screening for disease
Counseling on healthy behaviors (smoking, EtOH)
Subspecialty care (organ-system specific)Consultant to other specialties (Surgery, Ob/Gyn)What Do General Internists Do?
Other roles in general medical care for adults
Educator
Director
Advocate
Motivator
Healer
Comforter
Slide15What Makes a Good General Internist
Enjoys:
Complex problem-solving/working with mindLong term doctor-patient relationshipsA focus on being the front line of medicineActing as head coach/coordinator of care
Variety of disease entities
Slide16Highly variable
mean patient care hours a week is 49
1Typical Lifestyle
Inpatient (Hospitalist)
Shift work (10-12 hour shifts)
One week on, one week off (26 weeks per year)
12-20
patients per day (20-30
min per patient)
Outpatient (PCP)
10
hour days weekdays15-30 patients per day (~15-20 min per patient)1Medscape Physician Survey Data 2010
Slide17Salary Data
Overall Median = $212,000
Overall Mean = $195,000Primary Care = $192,000Academic = $175,000Hospitalist = $229,000
MGMA Compensation and Production Survey 2012
General Internal Medicine
Slide18Satisfaction Data
University of Davis study in 2009 surveyed 6590 US physicians, had 53% response rate
1 Pediatric emergency
2 Geriatric medicine
3 Dermatology
4 Pediatrics
5 Internal medicine and pediatrics
6 Other pediatric subspecialty
7 Neonatal and
perinatal medicine8 Allergy and immunology9 Child and adolescent psychiatry10 Radiation oncology11 Cardiovascular diseases
12 Medical oncology13 Ophthalmology14 Occupational medicine
15 Hospitalists16 Physical medicine and rehabilitation17 Psychiatry18 Otolaryngology19 Other medical subspecialty20 Critical care internal medicine21 Endocrinology, diabetes22 Urology23 Gastroenterology24 Infectious diseases25 Pulmonary diseases
Slide19Satisfaction Data
2 Geriatric medicine
5 Internal medicine and pediatrics
Allergy and immunology
11 Cardiovascular diseases
12 Medical oncology
14 Occupational medicine
15 Hospitalists
19 General Internal Medicine
20 Critical care internal medicine
21 Endocrinology, diabetes
23 Gastroenterology24 Infectious diseases25 Pulmonary diseases34 Other medical subspecialtyUniversity of Davis study in 2009 surveyed 6590 US physicians, had 53% response rate
13/25
Slide20Main Organizations
American College of Physicians (ACP)
Society of General Internal Medicine (SGIM)Society of Hospital Medicine (SHM)Each subspecialty has its own national organization
Each organization has its own annual national meeting
Slide21Popular Journals
Journal of the American Medical Association (JAMA)
New England Journal of Medicine (NEJM)Annals of Internal MedicineArchives of Internal MedicineAmerican Journal of Medicine
Journal of General Internal Medicine (JGIM)
Slide22Subspecialties
Slide23ABIM Certified:
Internal Medicine: Subspecialties
Adolescent Medicine
Adult Congenital Heart Disease
Advanced Heart Failure and Transplant Cardiology
Cardiovascular Disease
Clinical Cardiac Electrophysiology
Critical Care Medicine
Endocrinology, Diabetes, & Metabolism
Gastroenterology
Geriatric MedicineHematology
Hospice & Palliative MedicineInfectious DiseaseInterventional CardiologyMedical OncologyNephrologyPulmonary DiseaseRheumatologySleep MedicineSports MedicineTransplant Hepatology
Non-ABIM Certified:
General Internal Medicine
Medical Education
Transplant Infectious Disease
Transitions of Care
Medical Research
Occupational Health
Medical-Legal Interactions
Tropical Medicine
Headache
To be determined
Slide24Allergy/immunology
Cardiology
Endocrinology
Gastroenterology
General internal medicine
Hematology/oncology
Infectious disease
Nephrology
Pulmonary/critical care
RheumatologyFellowships
Addiction medicine
Adolescent medicine
Geriatrics
Hospice & palliative care
Sleep medicine
Sports medicine
Women’s health
Traditional
Emerging
Slide25Relative Competitiveness
Slide26Fellowship
Length
Practice
Environment
Hours
Salary*
Procedures
Allergy/ Immunology
2 years
Predominately outpatient
Office (
Outpt) hours195KAllergen skin tests, desensitizationsCardiology3-4 yearsInpatient/OutpatientLong inpt hrs
with call balanced with
outpt
office
hrs
400K
Percutaneous
coronary angioplasty, echocardiograms, stress tests, etc.
Electrophysiology
1
additional year on Cards
Inpatient/Outpatient
More
routine than cardiologist, mostly
outpt
procedures
450K
EP studies
Endocrinology
2 years
Predominately outpatient
Outpt hours with minimal inpt consults200KThyroid biopsyGastro-enterology3 yearsInpatient/OutpatientLong inpt
hrs with call balanced with outpt office hrs405KEGDs, Colonoscopys, Liver biopsy, ERCP, etc.Geriatrics1 yearPredominately outpatientPredominately outpt hrs, with inpt consults185KMOCAs, SLUMS
Heart Failure/Txp1 yearMore outpatientMore routine than cardiologist, mostly outpt, with inpt consults?EchocardiogramsHeme/Onc3 yearsMore outpatient
Outpt office
hrs, some inpt hrs with call320KChemotherapy administrationHospice/Palliative Care1 yearMostly outpatientOutpt hours with call180KParacentesis, thoracentesisInfectious Disease
2 years
More outpatientGenerally long hours due to combination of
outpt hrs and
inpt consults
160KAnoscopy
Nephrology3 years
Inpatient/Outpatient
Generally long hours due to combination of
outpt
hrs
/dialysis management and
inpt
consults and call
260K
Dialysis, catheter placement,
kidney biopsies, etc.
Pulmonary
/ Critical Care
3 years
Predominately
inpatient
Long
inpt
hrs
, predominately in shifts (some nights)
275K
Intubation,
tPA
adminstration
, bronchoscopy, etc.
Rheumatology
2
years
Predominately outpatient
Outpt
hours with minimal
inpt
consults
220K
Joint
aspirations, immunosuppressive therapy
Slide27Have fewer trainees due to:more esoteric level of interest
lack of ACGME funding, so can be balanced with some clinical duties
vanguard of medical professionOther Fellowships
Slide281 year in length
Board certification available
Can be done after IM, FP, and psychiatry residenciesMain disease entities:Alcohol
Illicit drugs
Tobacco
Addiction Medicine
Slide291-3 years in length
Board certification given jointly by ABIM and ABP
Main disease entities: substance abuse, eating disorders, acne, STDs, pregnancy, depression, mgmt. of chronic disease that begins in childhood
Practice settings:
High school & university-based clinics
Mobile clinics
Outpatient clinics
Adolescent Medicine
Slide302-3 years in length
Training to become academic internist
Two tracks:Clinician-investigator
Clinician-educator
Usually associated with master’s degree (tuition provided)
Only 20-30% clinical time
General Internal Medicine
Slide311 year in lengthABIM certification available
Can be done after IM residency or
Pulm/Critical Care fellowshipMost commonly combined with Pulm/CCMain disease entities: sleep apnea, narcolepsy, insomnia
Sleep Medicine
Slide321 year in length
Can be done after IM, FP, or
Peds residencyBoard certification availableUsually work closely with orthopedic surgeons
Practice settings:
Outpatient clinic
Team physician
Sports Medicine
Slide331-2 years in lengthClinical or academic focus
No board certification available
Main disease entities: breast cancer, uterine cancer, ovarian cancer, menopause, reproductive healthGenerally combined with clinical dutiesWomen’s Health
Slide34Clinical nutrition
Clinical decision making
Medical informaticsQuality improvement & patient safetyApplied epidemiology (CDC)
Clinical research (NIH, Robert Wood Johnson)
Complementary & alternative medicine
Other Possibilities
Slide35Take care of older adults as much as you can
Focus M4 electives in following areas:
Cardiology
Pulmonary/critical care
Emergency medicine
Attend Ohio or National ACP Meeting
Get good evaluations in your M3 & M4 medicine clerkships
Be open to all possibilities (no rush to decide!)
Advice for Students
Slide36www.acponline.orgwww.sgim.org
http://services.aamc.org/careersinmedicine/
www.hospitalmedicine.org/Your faculty advisors!Resources for Further Exploration
Slide37Questions for Our Panel?
Slide38Internal Medicine Interest Group
Events:
ACP Ohio October
Subspecialty Panel
November
EKG Workshop for R2s
January
Simulation Lab
February
Match Panel Late March Internal Medicine Experience
Spring ElectiveResearch Projects All YearWatch for emails from your IMIG Officers for more information
Slide39Internal Medicine Interest Group
ACP Ohio – October 16
th
and 17
th
Poster sessions, didactics, quiz bowl, even political meetings
$65 for students, 1
hr
drive
Subspeciality
Panel - NovemberPanel of various subspecialist for Q&ACardiologists, Gastroenterologists, etc.
Watch for emails from your IMIG Officers for more information
Slide40Internal Medicine Interest Group
EKG
Workshop - January
Opportunity to practice EKGs prior to Cardiology Exam
Likely will offer again in the Spring prior to clinical rotations (after STEP 1, obviously)
Target audience is R2s
Simulation Lab
– February
Opportunity to learn and practice some skills such as
central line placement, IV’s, ultrasound, intubation.
Very fun and relaxed environment and useful skills that will be used in 3rd yearWatch for emails from your IMIG Officers for more information
Slide41Internal Medicine Interest Group
Match Panel - Late March
Panel of R4s who have matched explaining process and tips and tricks
Educational experience to give some guidance on what it takes to match into Internal Medicine and how students of
Boonshoft
do it
Internal
Medicine
Experience Elective – Spring
Elective experience in Internal Medicine and IM subspecialties at Kettering Hospital
Paid elective ($200)2 week elective and counts towards the Boonshoft elective requirement
Watch for emails from your IMIG Officers for more information
Slide42Internal Medicine Interest Group
Research Projects - All Year
This year, tapping the Internal Medicine Research Chief to coordinate research projects
Jehangir
Ansari -
dr.jehangir.ansari@gmail.com
Will identify researchers and tie in students with appropriate projects
Watch for emails from your IMIG Officers for more information
Slide43How to Choose a Medical Specialty
(3
rd edition) by Anita Taylor.The Ultimate Guide to Choosing a Medical Specialty (2nd edition) by Brian Freeman.
Physician compensation data. http://www.acponline.org/private/pmc/physcomp_data.htm
References