Can an internal medicine subspecialist practice internal medicine?

[yeetus]

I not even in medical school yet but I was just curious about the pathways for specializing. Cardiology and GI are preceded by internal medicine, so does that mean a cardiologist could practice IM in addition to cardiology? Or are they restricted to their subspecialty as their knowledge of IM might be forgotten?

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[PorkChopsOG]

Yes. There are nephrologists/ID docs who work as hospitalists. You just have to remain board certified in internal medicine.

 

[NewYorkDoctors]

Yes if you maintain board certification you can practice whatever you want.

ID tends to be the pmd for their hiv patients
Nephro for esrd
Cardiology for complex heart patients

Anyone can pick up hospitalist shifts for extra pay

Some academic internists or family practice physicians will argue that a specialist will never be able to be a good primary care physician becuase of their inherent biases and tendency to focus on going to procedures rather than hand holding , doing SBIRTs , reviewing social determinants and health , and doing other PCMH tasks . My response is “they hate us cuz they ain’t us “

 

[Kaustikos]

Some academic internists or family practice physicians will argue that a specialist will never be able to be a good primary care physician becuase of their inherent biases and tendency to focus on going to procedures rather than hand holding , doing SBIRTs , reviewing social determinants and health , and doing other PCMH tasks . My response is “they hate us cuz they ain’t us “

Nevermind their tendency to use antibiotics to treat everything including sunburn.

 

[AlbinoHawk DO]

Yes if you maintain board certification you can practice whatever you want.

ID tends to be the pmd for their hiv patients
Nephro for esrd
Cardiology for complex heart patients

Anyone can pick up hospitalist shifts for extra pay

Some academic internists or family practice physicians will argue that a specialist will never be able to be a good primary care physician becuase of their inherent biases and tendency to focus on going to procedures rather than hand holding , doing SBIRTs , reviewing social determinants and health , and doing other PCMH tasks . My response is “they hate us cuz they ain’t us “

At my hospital it is very common for ID/Nephro to pick up a weekend hospitalist shift here and there

 

[Redpancreas]

Yes, it’s very possible and I’ve seen every IM subspecialty do it.

Cards: HF patients, complex anatomy
GI: Cirrhosis/IBD
Nephrology: Dialysis patients
Heme/Onc: Sickle Cell, many cancer pts.
ID: HIV patients.
Rheum: Advance AI diseases
Pulm: Severe COPD’ers
Etc.

I have seen physicians do this with and without formal board certification in IM. I am not sure if it is exactly required but I imagine there may be some confusion if you are not listed as XYZ and Internal Medicine.

 

[InternistDO]

It happens fairly commonly as described above, especially in the Northeast where the big academic centers are concentrated. My personal bias is that if specialists have enough time to do primary care then it's probably a sign there are entirely too many specialists in the area and they've run out of useful stuff to do.

 

[NewYorkDoctors]

It happens fairly commonly as described above, especially in the Northeast where the big academic centers are concentrated. My personal bias is that if specialists have enough time to do primary care then it's probably a sign there are entirely too many specialists in the area and they've run out of useful stuff to do.

I only wish the local community GI actually bothered to PRACTICE hepatology and not just put in on their wall to show off. But alas, any cifrrhotic gets referred to the academic transplant hepatologist instantly. Local community GI only wants to scope for dollars in their office and do not want to waste time in the hospital doing high risk variceal banding.

 

[Kaustikos]

It happens fairly commonly as described above, especially in the Northeast where the big academic centers are concentrated. My personal bias is that if specialists have enough time to do primary care then it's probably a sign there are entirely too many specialists in the area and they've run out of useful stuff to do.

Alternatively, the specialty you join has a good enough group with people that can split your schedule where you have a good lifestyle or opportunity to pay off your loans at an early age. Most hospitals in my specialty offer a similar approach to hospitalist medicine if there are enough ID doctors and it's not in a high-patient environment (20-30 patients/day) and/or you have PAs/NPs helping out (spare me the lecture on their taking over our jobs).

 

[InternistDO]

Alternatively, the specialty you join has a good enough group with people that can split your schedule where you have a good lifestyle or opportunity to pay off your loans at an early age. Most hospitals in my specialty offer a similar approach to hospitalist medicine if there are enough ID doctors and it's not in a high-patient environment (20-30 patients/day) and/or you have PAs/NPs helping out (spare me the lecture on their taking over our jobs).

I think for hospital medicine it's a bit easier to split your job, especially in a field like ID that is still fairly general IM focused. But also let's not pretend there's any other reason for this split practice other than the criminal under-payment of ID and nephrology attendings. There's a reason you never see cardiologists splitting their time on the general med floors.

 

[Kaustikos]

I think for hospital medicine it's a bit easier to split your job, especially in a field like ID that is still fairly general IM focused. But also let's not pretend there's any other reason for this split practice other than the criminal under-payment of ID and nephrology attendings. There's a reason you never see cardiologists splitting their time on the general med floors.

Uh...criminal underpayment is not remotely accurate compared to Nephrology. Recommend reading the Nephrology threads in subspecialty but nowadays there's a HUGE demand for ID inpatient. Average pay is at least 300k with generous moving cost and bonus. Yes, it's lower than a hospitalist, but you don't go into ID for the pay. And, from my experience and other colleagues, the training is substantially better than other specialties and the day-to-day lifestyle is also better.*


*Just don't be an idiot and work in NYC. How they treat ID there is CRIMINAL.

 

[InternistDO]

Uh...criminal underpayment is not remotely accurate compared to Nephrology. Recommend reading the Nephrology threads in subspecialty but nowadays there's a HUGE demand for ID inpatient. Average pay is at least 300k with generous moving cost and bonus. Yes, it's lower than a hospitalist, but you don't go into ID for the pay. And, from my experience and other colleagues, the training is substantially better than other specialties and the day-to-day lifestyle is also better.*


*Just don't be an idiot and work in NYC. How they treat ID there is CRIMINAL.

That's good to hear about ID. I'm in the NE where the pay is still significantly below general IM so my perception is a bit skewed. I think we're saying basically the same thing though--it's fine to do hospitalist medicine on the side if you want to, but a subspecialty should not be obligated to do so in order to make a reasonable salary.

 

[Kaustikos]

That's good to hear about ID. I'm in the NE where the pay is still significantly below general IM so my perception is a bit skewed. I think we're saying basically the same thing though--it's fine to do hospitalist medicine on the side if you want to, but a subspecialty should not be obligated to do so in order to make a reasonable salary.

Right. Certain states/cities definitely are better than others. Examples - NYC and Boston - NYC I know is horrible. Use Doximity when looking and it's insulting. But Western MA or Worcester. Or Upstate NY (Rochester). Midwest is also great outside of Chicago. So, it's definitely where you want to practice. But over 70% of the job postings are generally great relative to where you live. Oh, CA is also bad.

 

[DrMetal]

I foresee a day when subspecialists (in the hospital) are not only allowed to but will be expected to practice general hospital medicine. There's an AF with RVR in the ER? A cardiologist can admit and be the sole attending. There's a GIB? A GI can admit.

The days of the general internist/hospitalist are numbered. It's just not financially sustainable. Sucks for me. I hope it lasts at least another 15-20 years (that's my work lifespan).

 

[NonNocere]

Like others said, yes.