Message from the President

We Are General Internists

Benjamin Chen MD

The Canadian Society of Internal Medicine (CSIM) achieved a key milestone in December 2010: Royal College of Physicians and Surgeons of Canada (RCPSC) recognition of general internal medicine (GIM) as a distinct subspecialty. Much more work has been done since then, such as developing objectives of training for a new 2-year GIM training program, and additional challenges remain, for example, upgrading training programs across the country, developing a GIM examination for the new RCPSC Certificate in GIM, and attracting the best and brightest into careers in GIM. But it is clear that GIM in Canada has entered an exciting new era. Regular readers of this journal will appreciate that these successes have been through the tireless efforts of many general internists over many years.

With RCPSC recognition comes the opportunity for practising general internists to obtain an additional RCPSC certificate in GIM, through the PER-sub and GIM examination processes. The first GIM examination will be held in September 2014, with subsequent examinations offered yearly. A detailed Frequently Asked Questions page explaining these steps is posted on the redesigned website, and I encourage everyone to consider the opportunity.

For those practising general internists who choose not to write the GIM examination at this time, it is clear that we may not claim to be RCPSC-certified in GIM. Nevertheless, several have asked whether we may continue to call ourselves general internists. In considering this issue, CSIM – as the national specialty society for internal medicine and for GIM – recently endorsed operational definitions of GIM and of general internist that are based solely on one’s competencies and scope of practice:

General Internal Medicine is a subspecialty of Internal Medicine which embraces the values of generalism, is aligned with population needs, and promotes the practitioners’ ability to adapt their practice profile when population needs change.

General Internists are prepared to diagnose and manage patients with common and emergency internal medicine conditions, and are able to do so when the individual has multiple conditions and with limited access to other subspecialists. General Internists provide comprehensive care of the adult patient in an integrated fashion as opposed to an organ-centred or disease-centred approach. They are prepared to maintain stability of patients with multisystem disorders over the long-term or during physiological stresses such as during pregnancy or the peri-operative period.

General Internists advocate for their individual patients as well as for all patients within complex healthcare delivery systems, by aiming to optimize and not maximize care, including prevention of other conditions. General Internists recognize that the practice of medicine is tightly linked to the art and science of health care delivery and, by virtue of their pivotal role, are uniquely placed to engage in quality improvement, patient safety, and healthcare systems initiatives.

Or to paraphrase the duck test: if an internist considers himself/herself a general internist, practises like a general internist, cares for patients like a general internist, and communicates like a general internist, then he/she must be a general internist. CSIM has been celebrating general internists for decades, notwithstanding a lack of RCPSC recognition or certification, and CSIM will continue to represent all general internists in Canada.

To continue this conversation, please write to this journal, contribute or comment on the new blog, or contact me directly at