INTRODUCTION TO INTERNAL MEDICINE September 18, 2014 Objectives 1. Prepare for future IMIG Events 2.
Download ReportTranscript INTRODUCTION TO INTERNAL MEDICINE September 18, 2014 Objectives 1. Prepare for future IMIG Events 2.
INTRODUCTION TO INTERNAL MEDICINE September 18, 2014 Objectives 1. Prepare for future IMIG Events 2. Identify what an Internist does 3. Appreciate the different subspecialty options in internal medicine 4. Register for ACP as a student What is Internal Medicine? Who are Internists? Glen Solomon Chair of Internal Medicine Karen Kirkham Internal Medicine Clerkship Director Bruce Scott Internal Medicine/Geriatrics/Palliative Care ICM Preceptors Who are Internists? William Osler Eminent Internist, founder of residencies Robert Lefkowitz and Brian Kobilka Nobel Prize Winners in Chemistry (G-coupled protein receptors) Ken Jeong Intern(al)ational Movie Star Who are Internists? One in four US physicians has ABIM board certification1 Setting: Private practice = 80.9% Academia = 14.9% Both generalists and subspecialists are currently undersupplied2 29.3% experienced difficulty in securing first position 1 2 ABIM Fast Facts sheet 2014 The Complexities of Physician Supply and Demand: Projections Through 2025, Center for Workforce Studies, AAMC, 2008. Internal Medicine: Definition American 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 Focuses 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 Spectrums Outpatient Primary Care Acute Chronic Academic Hospitalist Intensive Care Physician Subspecialist Inpatient *Or any combination of the above Internal Medicine Spectrum Specialized General Rural Primary Care Geriatrician Rheumatologist Electrophysiologist *General rule: as you get more specialized, have less individualization of practice **Family Medicine is that way Internal Medicine Subspecialties To become a subspecialist, must complete a residency in Internal Medicine first Years 1 2 3 4 Medical School 1 2 3 1 2 3 Residency Fellowship (Internal Medicine) (i.e. Gastroenterology) Internal Medicine: Subspecialties American Board of Internal Medicine Certified: • • • • • • Adolescent Medicine Adult Congenital Heart Disease Advanced Heart Failure and Transplant Cardiology Cardiovascular Disease Clinical Cardiac Electrophysiology Critical Care Medicine • • • • • • • • Medical Oncology Nephrology Pulmonary Disease Rheumatology Sleep Medicine Sports Medicine Transplant Hepatology • • Endocrinology, Diabetes, & Metabolism Gastroenterology Geriatric Medicine Hematology Hospice & Palliative Medicine Infectious Disease Interventional Cardiology • • • • • Medical Research Occupational Health Medical-Legal Interactions Tropical Medicine Complementary Medicine • • • Women’s Health Headache To be determined • • • • Non-ABIM Certified: • • • • General Internal Medicine Medical Education Transplant Infectious Disease Transitions of Care General Internists AKA Internists What Do General Internists Do? • Acute 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) Other roles in general medical care for adults Educator Director Advocate Motivator Healer Comforter What Makes a Good General Internist Enjoys: Complex problem-solving/working with mind Long term doctor-patient relationships A focus on being the front line of medicine Acting as head coach/coordinator of care Variety of disease entities Typical Lifestyle • Highly variable • mean patient care hours a week is 491 • Outpatient (PCP) – 10 hour days weekdays – 15-30 patients per day (~15-20 min per patient) • Inpatient (Hospitalist) – Shift work (10-12 hour shifts) – One week on, one week off (26 weeks per year) – 12-20 patients per day (2030 min per patient) 1Medscape Physician Survey Data 2010 Salary Data General Internal Medicine Overall Median = $212,000 Overall Mean = $195,000 Primary Care = $192,000 Academic = $175,000 Hospitalist = $229,000 MGMA Compensation and Production Survey 2012 Satisfaction Data University of Davis study in 2009 surveyed 6590 US physicians, had 53% response rate 1 2 3 4 5 6 7 8 9 10 11 12 13 Pediatric emergency Geriatric medicine Dermatology Pediatrics Internal medicine and pediatrics Other pediatric subspecialty Neonatal and perinatal medicine Allergy and immunology Child and adolescent psychiatry Radiation oncology Cardiovascular diseases Medical oncology Ophthalmology 14 15 16 17 18 19 20 21 22 23 24 25 Occupational medicine Hospitalists Physical medicine and rehabilitation Psychiatry Otolaryngology Other medical subspecialty Critical care internal medicine Endocrinology, diabetes Urology Gastroenterology Infectious diseases Pulmonary diseases Satisfaction Data University of Davis study in 2009 surveyed 6590 US physicians, had 53% response rate 14 Occupational medicine 2 Geriatric medicine 15 Hospitalists 5 8 Internal medicine and pediatrics Allergy and immunology 11 Cardiovascular diseases 12 Medical oncology 34 19 20 21 General Internal Medicine Critical care internal medicine Endocrinology, diabetes 23 24 25 Gastroenterology Infectious diseases Pulmonary diseases Other medical subspecialty 13/25 Main 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 Popular Journals Journal of the American Medical Association (JAMA) New England Journal of Medicine (NEJM) Annals of Internal Medicine Archives of Internal Medicine American Journal of Medicine Journal of General Internal Medicine (JGIM) Subspecialties Internal Medicine: Subspecialties ABIM Certified: • • • • • • Adolescent Medicine Adult Congenital Heart Disease Advanced Heart Failure and Transplant Cardiology Cardiovascular Disease Clinical Cardiac Electrophysiology Critical Care Medicine • • • • • • • • Medical Oncology Nephrology Pulmonary Disease Rheumatology Sleep Medicine Sports Medicine Transplant Hepatology • • Endocrinology, Diabetes, & Metabolism Gastroenterology Geriatric Medicine Hematology Hospice & Palliative Medicine Infectious Disease Interventional Cardiology • • • • Transitions of Care Medical Research Occupational Health Medical-Legal Interactions • • • Tropical Medicine Headache To be determined • • • • Non-ABIM Certified: • • • General Internal Medicine Medical Education Transplant Infectious Disease Fellowships Emerging Traditional Allergy/immunology Cardiology Endocrinology Gastroenterology General internal medicine Hematology/oncology Infectious disease Nephrology Pulmonary/critical care Rheumatology Addiction medicine Adolescent medicine Geriatrics Hospice & palliative care Sleep medicine Sports medicine Women’s health Relative Competitiveness Less More Infectious Disease Allergy/Immunology Cardiology Endocrinology Nephrology Gastroenterology Geriatrics Rheumatology Pulmonary/Critical Care Hematology/Oncology Fellowship Length Practice Environment Hours Salary* Procedures Allergy/ Immunology 2 years Predominately outpatient Office (Outpt) hours 195K Allergen skin tests, desensitizations Cardiology 3-4 years Inpatient/Outpatient Long 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 consults 200K Thyroid biopsy Gastro-enterology 3 years Inpatient/Outpatient Long inpt hrs with call balanced with outpt office hrs 405K EGDs, Colonoscopys, Liver biopsy, ERCP, etc. Geriatrics 1 year Predominately outpatient Predominately outpt hrs, with inpt consults 185K MOCAs, SLUMS Heart Failure/Txp 1 year More outpatient More routine than cardiologist, mostly outpt, with inpt consults ? Echocardiograms Heme/Onc 3 years More outpatient Outpt office hrs, some inpt hrs with call 320K Chemotherapy administration Hospice/Palliative Care 1 year Mostly outpatient Outpt hours with call 180K Paracentesis, thoracentesis Infectious Disease 2 years More outpatient Generally long hours due to combination of outpt hrs and inpt consults 160K Anoscopy Nephrology 3 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 Other Fellowships Have fewer trainees due to: more esoteric level of interest lack of ACGME funding, so can be balanced with some clinical duties vanguard of medical profession Addiction Medicine 1 year in length Board certification available Can be done after IM, FP, and psychiatry residencies Main disease entities: Alcohol Illicit drugs Tobacco Adolescent Medicine • 1-3 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 General Internal Medicine 2-3 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 Sleep Medicine 1 year in length ABIM certification available Can be done after IM residency or Pulm/Critical Care fellowship Most commonly combined with Pulm/CC Main disease entities: sleep apnea, narcolepsy, insomnia Sports Medicine 1 year in length Can be done after IM, FP, or Peds residency Board certification available Usually work closely with orthopedic surgeons Practice settings: Outpatient clinic Team physician Women’s Health 1-2 years in length Clinical or academic focus No board certification available Main disease entities: breast cancer, uterine cancer, ovarian cancer, menopause, reproductive health Generally combined with clinical duties Other Possibilities Clinical nutrition Clinical decision making Medical informatics Quality improvement & patient safety Applied epidemiology (CDC) Clinical research (NIH, Robert Wood Johnson) Complementary & alternative medicine Advice for Students Take care of older adults as Attend Ohio or National much as you can ACP Meeting Focus M4 electives in following areas: Cardiology Pulmonary/critical care Emergency medicine Get good evaluations in your M3 & M4 medicine clerkships Be open to all possibilities (no rush to decide!) Resources for Further Exploration www.acponline.org www.sgim.org http://services.aamc.org/careersinmedicine/ www.hospitalmedicine.org/ Your faculty advisors! Questions for Our Panel? Internal Medicine Interest Group Events: ACP Ohio Subspecialty Panel EKG Workshop for R2s Simulation Lab Match Panel Internal Medicine Experience Elective Research Projects October November January February Late March Spring All Year Watch for emails from your IMIG Officers for more information Internal Medicine Interest Group • ACP Ohio – October 16th and 17th • Poster sessions, didactics, quiz bowl, even political meetings • $65 for students, 1 hr drive • Subspeciality Panel - November • Panel of various subspecialist for Q&A • Cardiologists, Gastroenterologists, etc. Watch for emails from your IMIG Officers for more information Internal 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 year Watch for emails from your IMIG Officers for more information Internal 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 Internal Medicine Interest Group • Research Projects - All Year • This year, tapping the Internal Medicine Research Chief to coordinate research projects • Jehangir Ansari - [email protected] • Will identify researchers and tie in students with appropriate projects Watch for emails from your IMIG Officers for more information References How to Choose a Medical Specialty (3rd edition) by Anita Taylor. 2. The Ultimate Guide to Choosing a Medical Specialty (2nd edition) by Brian Freeman. 3. Physician compensation data. http://www.acponline.org/private/pmc/physcomp_d ata.htm 1.