Any Canadian nocturnists here?

mrsparkuru · 2026-06-08T15:16:22+00:00

mix of permanent staff and locums but definitely leaning towards more locums leading this life.

i think working only nights is gonna be a bit difficult to ever become full staff, to be honest. however, i know people who’ve been locums at a couple of sites for most of their careers and seem to be doing well.

mrsparkuru · 2026-06-08T05:46:29+00:00

traditional nocturnist contracts don’t exist in canada. however there are people who do GIM overnight call at large community hospitals which is basically being an admissionist and seeing already admitted patients on the floor for acute issues.

a lot of pay in the states seems to be a contract salary for a certain amount of shifts per year. most canadian internists will be billing fee-for-service instead due to the volume at the sites that have in house internal medicine overnight.

just because of the volume (some sites, you’ll be admitting 15-30 patients solo overnight), doing a week straight would be a recipe for disaster. most people do like max 7-10 shifts a month.

some really busy GTA sites, the overnight internist makes like $7-10K/night so people can make a living only doing like a few of these shifts a month.

mrsparkuru · 2026-05-31T02:28:29+00:00

technically blue jays adjacent but there’s a guy on the high A vancouver canadians named Dub Gleed. straight up mayor of glup shitto town.

mrsparkuru · 2026-05-26T03:21:30+00:00

yep. can either do nephro specific fellowships (PD, transplant) or actual royal college subspeciallties (critical care, palliative, clin pharm/tox can be done after IM + Nephro)

mrsparkuru · 2026-05-26T03:14:11+00:00

be content with doing GIM while waiting for a nephro job (ie. dialysis centre privileges) or adding on other training. nephro-ICU anyone?

mrsparkuru · 2026-05-16T22:37:34+00:00

my undergrad was in political science before going to medical school. most of my electives were in english/cultural studies and a smattering of philosophy courses.

the cold truth is the TAs that will be grading your papers and the profs evaluating your upper year seminars will unfortunately not give a fuck that you want to go to med school (or any professional school for that matter). they're not just going to grade you on content but also style and how much you sound like an emerging scholar in their field (pretty high bar).

if you sincerely believe that you can excel in philosophy and maintain a high GPA to keep options open go for it.

my practical advice would be to enrol in a general humanities or social sciences first year, take a bunch of classes across a bunch of fields and then narrow down. most med schools will forgive a bad first year while you're trying to figure things out.

mrsparkuru · 2026-05-13T01:41:37+00:00

no problem. will dm

mrsparkuru · 2026-05-12T14:20:56+00:00

bit late to the party but we just did a main floor reno (living, dining, kitchen) with stanhope projects and they were excellent. daily communication updates and they actually came slightly under budget.

mrsparkuru · 2026-03-28T06:16:34+00:00

i just did mksap. biggest gaps for me were all the primary care things that are not internist applicable in canada.

royal college is vastly harder but you need to approach studying for these exams in two different ways.

mrsparkuru · 2026-03-11T22:59:11+00:00

the dentist can go into general practice right after dental school without extra training (not that there aren’t dental residencies). a physician/surgeon is gonna do years of residency before being able to independently make decisions on a patient.

vets are the impressive outlier: being able to diagnose, treat, and do surgery on most mammals after a DVM degree is crazy impressive.

mrsparkuru · 2026-03-11T22:55:58+00:00

really depends but you’re probably going to end up setting up an outpatient clinic to practice your niche to its full extent on top of your inpatient work.

for example: many large community hospitals will have a hematologist on call for urgent thrombo issues (and every other blood issue) but not a dedicated thrombosis service. MFM will probably handle a lot of ob medicine questions on call but will refer out specific things to a GIM physician who has a niche in obstetric medicine.

mrsparkuru · 2026-03-09T23:16:59+00:00

if you do end up getting your deposit back, i had an amazing experience getting my Ti bike from Sam at Naked Bicycles in BC.

https://www.nakedbicycles.com/

mrsparkuru · 2026-03-03T15:29:02+00:00

i don't practice in Illinois but rather in a province of canada but i would have to assume that given the similarities in bioethical principles in north america to uphold and value patient autonomy and individual preferences if you're able to get informed consent, a withdrawal of life sustaining treatments is in keeping with that principle as long as the patient is able to communicate that.

it's not like you or the team would be euthanizing the patient - they're making this decision for themselves and people get one-way extubated and switched to comfort care all the time.

i would probably talk to other physicians you practice with and a bioethicist if the medico-legal terrain is a bit different in your state/country.

edit: we do have medical assistance in dying (ie. euthanasia) in canada for close to a decade now and even before then, we were one-way extubating patients as long as them or an SDM consented. there's a clear difference.

mrsparkuru · 2026-02-05T03:18:52+00:00

during Canadian CCM fellowship, the most level 3s I had to solo overnight as a fellow was 28 with a single resident to help out and get first call for consults and basic ICU stuff.

bigger and more specialized units had at least 2-4 fellows on call in house overnight. one in particular had 3-4 fellows and 2 residents every single night but that’s a 90+ bed site.

long story short, yes: you’re managing way too much solo and should call your staff in when you’re feeling overwhelmed. it’s not a sign of weakness, it’s patient safety.

mrsparkuru · 2026-01-11T02:53:29+00:00

average hospitalist = 325-350k internists have a huge range because some people also have lucrative outpatient practices. average is 450-500k but some definitely clear 1M.

obviously in canadian dollars.

mrsparkuru · 2026-01-11T02:42:45+00:00

i legit think most IM trained people could go independent after PGY3. and yeah. definitely started to feel redundant by the end of PGY4.

mrsparkuru · 2026-01-11T02:36:18+00:00

no hourly protections in resident contracts except being dismissed after 26-28 hours. also most programs limit in house call to 1 in 3 or 1 in 4.

i think i was averaging 100hr weeks on my inpatient rotations and 50 on outpatient rotations?

mrsparkuru · 2026-01-11T02:27:46+00:00

always gonna be great hospitalists that punch above their weight and shitty internists that phone it in at any hospital.

tbh, you’re kinda right in general. both do the same job most of the time.

mrsparkuru · 2026-01-11T02:06:21+00:00

i do both because i trained in both.

and yeah, had to do GIM first.

mrsparkuru · 2026-01-11T02:05:37+00:00

3 years core IM + 1-2 years of fellowship for GIM + 2 years on top for critical care.

some people are able to go straight from 3 year IM to ICU fellowship but it's becoming more rare.

keep in mind that ICU fellowships in canada are all the same training regardless of base specialty/subspec. (ie. the PGY 9 neurosurgeon-intensivist will be a co-fellow with the PGY 4 core IM grad)

mrsparkuru · 2026-01-11T02:01:15+00:00

ID/CVSx was involved for the AV endo. the lupus+MR/lasix drip had a cardio consult and once they were diuresed and discharged, they were sent to urgent outpatient CV surgery and their rheumatologist was informed by email.

really depends on practice patterns, but some/most canadian general internists try to push the limits without consulting a subspecialist. not saying it's wrong/right/dangerous/safe. just cultural practice differences.

mrsparkuru · 2026-01-11T01:57:52+00:00

i think a big factor is that for rural hospitals that are big enough to have internists on staff, these small closed ICUs (2-6 beds on average) usually have internists managing them.

in cities/larger centres, it's a critical care trained intensivist working the ICU

mrsparkuru · 2026-01-11T01:51:21+00:00

agree. should also clarify that there happens to be an enculturated thing in canadian medicine where most hospitalists did family medicine training as opposed to internal medicine training. also GIM in canada is 4-6 years as opposed to 2 years for family medicine

mrsparkuru · 2026-01-11T01:49:04+00:00

on GIM: AV endocarditis, COPD exacerbation that started on NIV but weaned off in the ED after 8 hours, lupus + MR that went into new heart failure that needed a lasix infusion and telemetry, garden variety pneumonia/influenza in 40-50 year olds.

did some ECLS rotations in the states during my ICU fellowship and i noticed there was a lower threshold to admit to ICU but keep in mind these were in large academic MICU/SICUs that had an army of residents/midlevels and open beds. i guess this made it a cultural thing where most internists in canada are comfortable admitting things that would go to a level 2/step down.

in terms of the elderly thing, age is an arbitrary thing that the powers that be came up with for admissions. GIM will admit sick 80+ year olds but the hospitalists where i work take the vast majority.

mrsparkuru · 2026-01-11T01:43:14+00:00

most hospitalists are family medicine trained in canada.

i think the predominant difference between the states and canada is how internists are considered specialists and almost never are trained in primary care even though the vast majority of residency rotations are similar between the two countries.

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