introduction to internal medicine
Download
Skip this Video
Download Presentation
INTRODUCTION TO INTERNAL MEDICINE

Loading in 2 Seconds...

play fullscreen
1 / 43

INTRODUCTION TO INTERNAL MEDICINE - PowerPoint PPT Presentation


  • 462 Views
  • Uploaded on

INTRODUCTION TO INTERNAL MEDICINE . September 18, 2014. Objectives. Prepare for future IMIG Events Identify what an Internist does Appreciate the different subspecialty options in internal medicine Register for ACP as a student. What is Internal Medicine?. Who are Internists?.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'INTRODUCTION TO INTERNAL MEDICINE' - bradford-jerry


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
objectives
Objectives

Prepare for future IMIG Events

Identify what an Internist does

Appreciate the different subspecialty options in internal medicine

Register for ACP as a student

who are internists
Who are Internists?

ICM Preceptors

  • Glen Solomon
    • Chair of Internal Medicine
  • Karen Kirkham
    • Internal Medicine Clerkship Director
  • Bruce Scott
    • Internal Medicine/Geriatrics/Palliative Care
who are internists1
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 internists2
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 ABIM Fast Facts sheet 2014

2 The Complexities of Physician Supply and Demand: Projections Through 2025, Center for Workforce Studies, AAMC, 2008.

internal medicine definition
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 definition1
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
Internal Medicine Spectrums

Outpatient

Primary Care

Chronic

Academic

Hospitalist

Intensive Care Physician

Inpatient

Acute

*Or any combination of the above

Subspecialist

internal medicine spectrum
Internal Medicine Spectrum

Specialized

Geriatrician

Rheumatologist

Electrophysiologist

Rural Primary Care

*General rule: as you get more specialized, have less individualization of practice

**Family Medicine is that way

General

internal medicine subspecialties
Internal Medicine Subspecialties

Years

1

4

1

1

3

3

2

2

3

2

Residency

(Internal Medicine)

Medical School

Fellowship

(i.e. Gastro-

enterology)

To become a subspecialist, must complete a residency in Internal Medicine first

internal medicine subspecialties1
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 Medicine
  • Hematology
  • Hospice & Palliative Medicine
  • Infectious Disease
  • Interventional Cardiology
  • Medical Oncology
  • Nephrology
  • Pulmonary Disease
  • Rheumatology
  • Sleep Medicine
  • Sports Medicine
  • Transplant 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
  • American Board of Internal Medicine Certified:
general internists

General Internists

AKA Internists

what do general internists do
What Do General Internists Do?
  • Other roles in general medical care for adults
    • Educator
    • Director
    • Advocate
    • Motivator
    • Healer
    • Comforter
  • 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)
what makes a good general internist
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
Typical Lifestyle
  • 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 (20-30 min per patient)
  • Highly variable
    • mean patient care hours a week is 491

1Medscape Physician Survey Data 2010

salary data
Salary Data
  • General Internal Medicine

MGMA Compensation and Production Survey 2012

  • Overall Median = $212,000
  • Overall Mean = $195,000
  • Primary Care = $192,000
  • Academic = $175,000
  • Hospitalist = $229,000
satisfaction data
Satisfaction 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 medicine

8 Allergy and immunology

9 Child and adolescent psychiatry

10 Radiation oncology

11 Cardiovascular diseases

12 Medical oncology

13 Ophthalmology

14 Occupational medicine

15 Hospitalists

16 Physical medicine and rehabilitation

17 Psychiatry

18 Otolaryngology

19 Other medical subspecialty

20 Critical care internal medicine

21 Endocrinology, diabetes

22 Urology

23 Gastroenterology

24 Infectious diseases

25 Pulmonary diseases

satisfaction data1
Satisfaction Data

University of Davis study in 2009 surveyed 6590 US physicians, had 53% response rate

14 Occupational medicine

15 Hospitalists

19 General Internal Medicine

20 Critical care internal medicine

21 Endocrinology, diabetes

23 Gastroenterology

24 Infectious diseases

25 Pulmonary diseases

2 Geriatric medicine

5 Internal medicine and pediatrics

Allergy and immunology

11 Cardiovascular diseases

12 Medical oncology

13/25

34 Other medical subspecialty

main organizations
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
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)

internal medicine subspecialties2
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 Medicine
  • Hematology
  • Hospice & Palliative Medicine
  • Infectious Disease
  • Interventional Cardiology
  • Medical Oncology
  • Nephrology
  • Pulmonary Disease
  • Rheumatology
  • Sleep Medicine
  • Sports Medicine
  • Transplant 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
  • ABIM Certified:
fellowships
Fellowships

Emerging

Traditional

  • Addiction medicine
  • Adolescent medicine
  • Geriatrics
  • Hospice & palliative care
  • Sleep medicine
  • Sports medicine
  • Women’s health

Allergy/immunology

Cardiology

Endocrinology

Gastroenterology

General internal medicine

Hematology/oncology

Infectious disease

Nephrology

Pulmonary/critical care

Rheumatology

other fellowships
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
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
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
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
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
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
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
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
Advice for Students
  • Take 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!)
resources for further exploration
Resources for Further Exploration

www.acponline.org

www.sgim.org

http://services.aamc.org/careersinmedicine/

www.hospitalmedicine.org/

Your faculty advisors!

internal medicine interest group
Internal 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
  • Elective
  • Research Projects All Year

Watch for emails from your IMIG Officers for more information

internal medicine interest group1
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 group2
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 group3
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 group4
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
References

How to Choose a Medical Specialty (3rd 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

ad