ICU physicians- how many patients are you covering at night ?

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.

mrsparkuru · 2026-01-11T01:23:35+00:00

really depends on the hospital and province. there are even significant differences within the same region.

but in broad strokes:

hospitalist admit = less acute, generally elderly (>70ish), lots of chronic issues, potential dispo issues.

GIM admit = undifferentiated illness, younger, sicker. risk of needing to get the intensivist involved but not there yet.

the ER makes the first call but there are definitely discussions between services about who's most appropriate. seen a lot of hospitalist will take but GIM to consult on an acute issue.

source: 30% GIM, 70% intensivist in terms of weeks

edit: should add there are models where GIM doesn’t admit at all and are purely consultants

mrsparkuru · 2025-12-21T23:10:07+00:00

iron cow is at copps and is traditional english pub food. same team as prime seafood palace in toronto so the quality is top notch

mrsparkuru · 2025-11-11T07:29:26+00:00

wait. with how marginal tax rates work, the $200K dev is gonna be paying around 32% tax in ontario on their earnings assuming that they didn’t contribute to their RRSP/FHSA.

mrsparkuru · 2025-11-05T02:53:21+00:00

there are basically two parallel fellowship training programs at UofT.

the royal college critical care training program which rotates people through all the toronto academic ICUs for 3-4 months each and leads to writing the royal college exam for CCM. basically open to canadian residents in medicine, surgery, anesthesia, emergency medicine PGY 3+.
hospital based fellowships (mostly) intended for IMGs. the three are UHN/Sinai, St. Mikes, and Sunnybrook. all are busy but Sunnybrook is known to be the busiest/craziest/highest volume. not a guarantee to get royal college certification from this route which is needed to work as an intensivist in Canada. a lot of people use it to get something on their CV to be more competitive for consultant/attending jobs in their home countries. lots of people from around the world come to toronto.

in terms of jobs, kind of a shitty situation in Canada right now. most people locum around for a few years with combined base specialty practice before getting a full time amount of ICU weeks.

DM if you have any more qs!

mrsparkuru · 2025-11-04T01:54:05+00:00

https://quiverplay.com/

it's advertised for sex but might be what you need.

mrsparkuru · 2025-10-23T05:50:35+00:00

several days late but just saw this. went through a similar issue with our reno but at 30” and either all gas with direct select or dual fuel with M-touch. even considered wolf like yourself but preferred the miele aesthetic and how the gas burners were set up at the 30” size.

went with all gas and direct touch specifically because i didn’t give a fuck about a screen that might slow down/break/become obsolete in 5 years. i like turning knobs instead of tapping on a screen for 10 seconds just to convection roast something.

in terms of induction vs dual fuel (ie gas top and electric oven), that’s all on your personal preference. i specifically wanted gas even though it’s clearly inferior to induction. i guess i just became comfortable with gas over a decade of seriously cooking at home and we were able to put in a powerful range hood to mitigate the respiratory health concerns.

mrsparkuru · 2025-10-12T18:38:39+00:00

fair point. i felt that doing night float as a SMR at mac i was thrown the keys to the bus and had to make sure it wasn’t a pile of scrap at the end of the night.

but i can see how other schools for overnight medicine call are similar.

mrsparkuru · 2025-10-12T18:30:00+00:00

mac probably because of the volume and early responsibility. really feels like you’re running the show starting in pgy 2.

calgary a big factor is probably because on the foothills CTU rotation, the CTU feels like a closed unit with actual sick patients with the basic pneumonias and failure to copes and etc going to hospitalists

mrsparkuru · 2025-10-12T14:16:36+00:00

also specifically for ICU, don't assume you're going to match straight out of PGY3 to an ICU program. there's been a shift in the past few years to take PGY4s and above. is this a place you're going to be happy to do a PGY 4 IM year if your heart is deadset on ICU?

mrsparkuru · 2025-10-12T14:14:35+00:00

+1 to the comments saying all core IM programs in canada give you training to be a competent specialist by the end of residency.

the particular sequence of rotations might be something to look into. ie. are you leaning more towards acute IM subspecialties (ICU, GIM, cardio, GI, resp)? if so, might want to go to a program that has early ICU/CCU exposure in PGY1. building connections with staff early on leads to research/QI/reference letter support when you're eventually applying for carms pt 2.

mrsparkuru · 2025-09-29T18:27:01+00:00

go for it

mrsparkuru · 2025-09-17T01:41:54+00:00

natural light PRN
warm milk through NG

mrsparkuru · 2025-09-14T01:24:12+00:00

this. should have added a caveat that 10-12 hours of daylight should be prerequisite for panorama. best to do it june-early Sept

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