I'm a little embarrassed that I do not know this. But, I'd been thinking about what I want to do within IM (for the record, I'm leaning towards rheum or ID). But, I spoke with a general internist in academics to get a feel for what his life was like. Overall, it was a good talk and he also mentioned he felt like rheum & ID are a lot closer to being a generalist than others (say cards or GI, where the focus is much more within your specific organ system).

The thing I can't believe that I don't know by now is how much general medicine do subspecialists do in academic medicine. I realize in academics patient care may be a relatively small percent of time (for what I'd like to do, I've heard ballparks of 20-40% of your time being clinical). But, can someone explain a little bit about how much time specialists do doing consults in their field, and outpatient vs. inpatient? I didn't really think about it at the time I was doing my inpatient medicine on the gen med floors, but obviously we had attendings from most (if not all) of the subspecialties.

Are there rough guidelines for how much time you have general medicine versus your specialty? Or do you negotiate that individually? :confused:

Are there rough guidelines for how much time you have general medicine versus your specialty? Or do you negotiate that individually? :confused:

It definitely depends on the hospital you're in. If the place has hospitalists, you'll only do consult/specialty wards. My institution has a County/University setup with most attendings working both places. I know some (very senior) who do one consult month a year and others who do as much as 3 months each of gen med floor and specialty consult. This is in addition to private and resident/fellow clinics. Some will also cover their own patients when admitted to University but not at County which is completely resident run.

I think the amount of research you do will have a significant bearing as well. If you're pulling down 2 or 3 R-01's, nobody's going to expect you to do more than a month of specialty a year and maybe a half-day clinic a week. If you're doing little or no research, you'll be expected to do more clinical and formal teaching. If you're starting out and you have a good research program going w/ a K-award in place, you'll usually get an 80/20 split to start (research/clinical) and then go from there. The general/specialty split is totally institution dependent.

Hope that was helpful.

BE