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ACP Global Perspectives: Canada

Narmin Kassam, BSc, MD, MHPE, FRCPC, FACP

Narmin Kassam, BSc, MD, MHPE, FRCPC, FACP
Governor, ACP Alberta Chapter
Director, Division of General Internal Medicine
University of Alberta

Canada is a country in the northern part of North America. Its ten provinces and three territories extend from the Atlantic to the Pacific and northward into the Arctic Ocean, covering 9.98 million square kilometers, making it the world's second-largest country by total area and the fourth-largest country by land area. It is highly urbanized with 82 per cent of the 35.15 million people concentrated in large and medium-sized cities, many near the southern border.*

*Source - Wikipedia

What inspired you to become a physician?

Fascination and enjoyment of biological systems and incorporating that love of science with the ability to help people and make a difference in society.

What do you enjoy about being an internist?

The problem solving aspect – never knowing what is coming through the door.

What is the role of the internist in Canada? What are the education and training requirements needed to practice internal medicine or one of the subspecialties of internal medicine?

Internists in Canada are subspecialists in Internal Medicine that deal with complexity and frequently undifferentiated disease. We do not practice primary care and patients require a referral to be seen by a General Internist in Canada.

Training is 5 years in total – starting with 3 years of core Internal Medicine and then competitive entry process for residency training in General Internal Medicine (GIM) which is an additional 2 years of training followed by a national examination for licensure. All subspecialties of Internal Medicine complete 3 years of core and then enter their subspecialty including general internists.

What are some of the most significant challenges that physicians throughout Canada face? What are your thoughts on the best way to meet those challenges?

Escalating costs and limited resources. We need to align patient expectations with this reality and we need to focus on Quality Improvement methodology to ensure we are getting maximum value for healthcare dollars spent.

What can other countries learn from your health care system?

Healthcare should be a right and not a privilege. Our universal healthcare system provides safe, effective and efficient care independent of citizen's ability to pay. Although not perfect, our healthcare model is highly valued by the majority of Canadians.

Are enough young physicians in Canada choosing to be internists? What makes them choose (or not choose) to practice internal medicine?

In 2013, the Royal College of Physicians and Surgeons of Canada (our national licensing body) recognized General Internal Medicine as a distinct subspecialty of Internal Medicine. Since that time, interest in GIM has grown exponentially. We are currently the most popular subspecialty chosen by IM residents across Canada. General Internists are valued particularly in small communities across the country for the diversity of care we provide. In larger communities, it General Internists provide value and are uniquely trained to provide care for patients with complex multi-system issues and undifferentiated conditions.

As the Governor of the Alberta Chapter, what types of activities do you organize for physicians in your province?

We put significant effort into highlighting the benefits of an ACP membership particularly as it relates to CME resources. The ACP annual meeting in particular is very popular amongst general internists as it provides a broad array of CME offerings. The ACP journal club, JournalWise and MKSAP are also highly valued resources that our members utilize. Finally, we do a lot of activities with medical students and residents to highlight the benefits of membership.

Can you briefly describe the Choosing Wisely initiative in Canada?

Choosing Wisely Canada (CWC) launched in 2014 under the leadership of Dr. Wendy Levinson and her team at the University of Toronto. The focus is on reducing unnecessary care by educating clinicians and patients on best practice. More information on CWC is available.

What advice would you give to someone who is thinking about going into internal medicine?

If you are the type of individual who thoroughly enjoys problem solving and are comfortable dealing with uncertainty then GIM is the field for you. General Internists enjoy dealing with complexity and take pride in providing a large breadth of clinical expertise in Internal Medicine conditions.

Please share your most memorable ACP international experience.

Having the opportunity to meet and really get to know Internists and hearing about Internal Medicine practice not only from diverse parts of the United States but across the world including South America and Asia.

Back to the November 2017 issue of ACP International