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INTRODUCTION TO INTERNAL MEDICINE
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INTRODUCTION TO INTERNAL MEDICINE

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  1. INTRODUCTION TO INTERNAL MEDICINE September 18, 2014

  2. 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

  3. What is Internal Medicine?

  4. Who are Internists? ICM Preceptors • Glen Solomon • Chair of Internal Medicine • Karen Kirkham • Internal Medicine Clerkship Director • Bruce Scott • Internal Medicine/Geriatrics/Palliative Care

  5. 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

  6. 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.

  7. 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

  8. 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

  9. Internal Medicine Spectrums Outpatient Primary Care Chronic Academic Hospitalist Intensive Care Physician Inpatient Acute *Or any combination of the above Subspecialist

  10. 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

  11. 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

  12. 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:

  13. General Internists AKA Internists

  14. 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)

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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)

  22. Subspecialties

  23. 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:

  24. 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

  25. Relative Competitiveness

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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!)

  35. Resources for Further Exploration www.acponline.org www.sgim.org http://services.aamc.org/careersinmedicine/ www.hospitalmedicine.org/ Your faculty advisors!

  36. Questions for Our Panel?

  37. 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

  38. 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

  39. 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

  40. 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

  41. Internal 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

  42. 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