Choice for the internist?

[Moty]

I know internists do general medicine, but how hard, if possible, is it to get an internist job in an IM-specialty group practice? Or, if you are hired by a hospital as an internist, can you choose which IM specialty ward you'd like to focus on, despite having no fellowship? If yes, how common is it in the U.S.?
I'm asking after a conversation with an African based pediatrician. She was telling me it's possible in her hospital. She wanted to deal with mostly pulmonology cases because of interest on it and as a possible future consideration for a fellowship, but was asked to work in the 'allergy clinic' instead where there's a bigger shortage.

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[Nivakia]

she needs to have a pulmonary fellowship then, because the hospital will require a hospitalist to pull their weight

 

[Moty]

Nivakia,

Or, if you are hired by a hospital as an internist, can you choose which IM-specialty ward you'd like to focus on, despite having no fellowship? If yes, how common is it in the U.S.?

 

[Nivakia]

there is no pulmonary ward, you have to see pts for the hospital as they come.

 

[Moty]

there is no pulmonary ward, you have to see pts for the hospital as they come.

In other words, in private practice, an internist cannot work in an IM single-specialty group?

 

[Nivakia]

if you are in private practice you are probably required to pull your weight even more. Since the hospital contracts your group, your group will demand that you see sufficient number of people to stay competitive. Unless you are doing outpatient and only admits your own patients, which limits the pool of pulmonary pts even more

 

[Moty]

I'm glad it's a possibility. Say we're talking about an IM-specialty with a wider pool of patients: is it a common thing to do in the U.S.?

 

[Nivakia]

But you cant be sure when your pulm patient will come doing your shift. What if you are swamped with other pts and a bunch pulm patients come in? You cant just drop the others who may be more critical.

 

[Moty]

I'm not sure if I get you. Can't I just say be an internist who attends to a certain specialty exclusively and not anything I am not interested in? Is it possible to be known as 'oncology internist' or 'rheumatology internist', for example?

 

[Raryn]

I'm not sure if I get you. Can't I just say be an internist who attends to a certain specialty exclusively and not anything I am not interested in? Is it possible to be known as 'oncology internist' or 'rheumatology internist', for example?

No. It is not.

In the hospital, outside of a few very specific circumstances, medical wards are just that: medical wards. There is usually no "pulmonology internist" team, no "oncology internist" team, etc. You take patients as they come in, no matter their presentation. Occasionally, the largest academic centers might have it granulated out that way, with there being a specific hospitalist who is assigned to say, the neurosurgical patients or the transplant patients on the general medical wards, but that is a special circumstance and very rarely seen outside of said centers. An internist is a generalist. Period. If you want to routinely see a specific patient population, you do a fellowship and actually get trained in that patient population.

 

[Moty]

Well explained. Thanks. I think Nivakia ran away from my endless questioning.

No. It is not.

In the hospital, outside of a few very specific circumstances, medical wards are just that: medical wards. There is usually no "pulmonology internist" team, no "oncology internist" team, etc. You take patients as they come in, no matter their presentation. Occasionally, the largest academic centers might have it granulated out that way, with there being a specific hospitalist who is assigned to say, the neurosurgical patients or the transplant patients on the general medical wards, but that is a special circumstance and very rarely seen outside of said centers. An internist is a generalist. Period. If you want to routinely see a specific patient population, you do a fellowship and actually get trained in that patient population.

 

[Siggy]

Well explained. Thanks. I think Nivakia ran away from my endless questioning.

I think it's a little unfair to say "ran away." When I post, I don't wait around to see if a follow up question is posted. I go somewhere else (either online or in real life) and come back when I come back. Now if it had been a day or so, then maybe, but expecting a reply in 30 minutes or less is unrealistic. SDN is a hobby, not a job.

 

[IMreshopeful]

For the most part I agree with what's been said. Internist/hospitalist = generalist. I doubt you'll get to see such things in private practice.

At my academic center we do however have hospitalists who cover our IMC (which while gen med can be seen as a pseudo-critical care area), low-acuity oncology patients, renal and lung transplant patients, etc so they are defacto "subspecialty" hospitalists. Usually the people doing the oncology hospitalist position are doing it as a bridge to fellowship however and not as a career. I suspect this kind of thing has to be more common in academic centers though anyway.

 

[sluggs]

Where I trained, very sick onc patients were on an "oncology Hospitalist" service run by IM with an onc consultant for chemo, radiation, etc.. This is a rarity, and not likely to be seen much, or with other specialties

 

[Moty]

I think it's a little unfair to say "ran away." When I post, I don't wait around to see if a follow up question is posted. I go somewhere else (either online or in real life) and come back when I come back. Now if it had been a day or so, then maybe, but expecting a reply in 30 minutes or less is unrealistic. SDN is a hobby, not a job.

Of course. My comment isn't to be taken seriously.

 

[Moty]

Where I trained, very sick onc patients were on an "oncology Hospitalist" service run by IM with an onc consultant for chemo, radiation, etc.. This is a rarity, and not likely to be seen much, or with other specialties

Usually the people doing the oncology hospitalist position are doing it as a bridge to fellowship however and not as a career

This is great.

 

[gutonc]

I'm not sure if I get you. Can't I just say be an internist who attends to a certain specialty exclusively and not anything I am not interested in? Is it possible to be known as 'oncology internist' or 'rheumatology internist', for example?

Of course you can. But you will have completed a fellowship in oncology, or rheumatology. And you will be known as the "oncologist" or "rheumatologist".

 

[Moty]

Of course you can. But you will have completed a fellowship in oncology, or rheumatology. And you will be known as the "oncologist" or "rheumatologist".

I meant without fellowship, but thanks.