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IM Subspecialities:

    Allergy and Immunology

    Cardiology

    Endocrinology

    Gastroenterology

    Geriatrics

    Hematology

    Oncology

    Infectious Diseases

    Nephrology

    Respirology

    Rheumatology

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Endocrinology

Introduction

Endocrinology is the subspecialty of internal medicine focusing on diseases of the endocrine organs and hormone system. The endocrine system is a collection of glands responsible for secreting hormones that regulate functions such as metabolism, growth and development and tissue function. The major endocrine glands include the pancreas, thyroid gland, parathyroid gland, adrenal gland, pineal gland, pituitary gland, ovaries, and testes. Training to become an endocrinologist requires completion of an internal medicine residency followed by a 2 year residency in adult endocrinology and metabolism. Pediatric endocrinology and metabolism is a 2 year residency entered after the completion of a pediatrics residency program. Note that reproductive endocrinology is not entered through internal medicine, but rather though an obstetrics and gynecology residency.

Endocrinologists are responsible for the assessment, diagnosis, treatment, and monitoring of patients with suspected or known endocrine disorders. Laboratory methods are relied on extensively to guide clinical decision making, to a greater extent than in other specialties. Endocrinologists must have extensive knowledge of clinical biochemistry, and be able to distinguish between disease and normal human variation. Due to the wide variety of conditions that fall within the sub-specialty, the potential patient population encountered by endocrinologist is very diverse with respect to age, disease, and severity of illness. The large range of conditions allows for further sub-specialization for those interested in a specific endocrine condition or who wish to treat a specific patient population.

The majority of endocrinologists in Canada have a clinic based practice within an academic centre and work in a group or multidisciplinary practice structure. Due to the types of conditions treated and monitored by endocrinologists, they often work within a multidisciplinary team that may include registered dieticians, occupational therapists, physical therapists and disease-specific practitioners (i.e. bone densitometry technologists, certified diabetes educators) to provide holistic care to patients. Most endocrine conditions are chronic, and clinicians are therefore responsible for the development of long term management plans and fostering a strong physician-patient relationship.

Common Disease and Disorders

Diabetes
Type I diabetes occurs when the pancreas produces very little or no insulin, the result of destruction of the insulin-producing cells in the pancreas. In contrast, individuals with type II diabetes produce sufficient amounts of insulin, but cells are resistant to the insulin produced. Endocrinologists can diagnosis, treat, and develop a management plan (consisting of medication and lifestyle interventions) to help individuals manage their disease. Endocrinologists also work with primary care physicians who manage diabetes as part of their family practice, in these situations more complex cases would be referred to the endocrinologist while.

Thyroid Disease
Hyperthyroidism, hypothyroidism, thyroid cancer, Grave’s Disease, Hashimoto’s disease nodules and goiter are all thyroid-related conditions that are seen by endocrinologists. An endocrinologist may perform a physical exam, thyroid function tests (to measure the levels of thyroxine, triiodothyronine, and thyroid stimulating hormone), ultrasonography, fine-needle aspiration biopsy, or send patients to radiology for a thyroid scan. The results of these investigations will help the endocrinologist determine next steps, whether it be further investigation, medical management or surgery.

Osteoporosis
Hyperthyroidism, hypothyroidism, thyroid cancer, Grave’s Disease, Hashimoto’s disease nodules and goiter are all thyroid-related conditions that are seen by endocrinologists. An endocrinologist may perform a physical exam, thyroid function tests (to measure the levels of thyroxine, triiodothyronine, and thyroid stimulating hormone), ultrasonography, fine-needle aspiration biopsy, or send patients to radiology for a thyroid scan. The results of these investigations will help the endocrinologist determine next steps, whether it be further investigation, medical management or surgery.

Lipid Metabolic Disorders
Endocrinologists may evaluate and treat individuals with lipid disorders including high triglycerides, high cholesterol, or low high-density lipoproteins in relation to diabetes, hypothyroidism, polycystic ovary syndrome (PCOS), metabolic syndrome, and Cushing’s Syndrome. Clinicians have access to specialized diagnostic tests and treatments, and will work in partnership with registered dieticians to manage dyslipidemia.

Adrenal Disorders
The adrenal glands are located on top of each kidney and secrete mineralocorticoids, glucocorticoids and androgens which help regulate blood pressure, glycogen and lipid metabolism and sex hormone production respectively. Cushing’s Syndrome, Addison’s Disease, congenital adrenal hyperplasia, and adrenal tumors are adrenal disorders that may present to an endocrinologist. Endocrinologists can order an adrenocorticotropic hormone (ACTH) stimulation test or adrenal vein sampling (AVS) to diagnose adrenal gland disorders. Some conditions can be managed medically, others will be referred to surgery.

Further Advanced Training Opportunities

Fully trained endocrinologists have the opportunity to pursue further education and advanced training both nationally and internationally through fellowships areas such as osteoporosis, metabolic bone disease, endocrine oncology, and advanced diabetes.

Gender Breakdown
55 responses (2014 National Survey Results)

Age Breakdown
55 responses (2014 National Survey Results)
Hours Breakdown (Excluding on-call activities)
49 responses (2014 National Survey Results)

Activity Hours Worked (mean)
Direct patient care without a teaching component 19.23
Direct patient care with a teaching component 7.84
Teaching/ educating without direct patient care 2.57
Indirect patient care 7.26
Health facility committees .98
Administration 1.71
Research 6.89
Managing your practice 1.38
CME/ CPD (Continuing Professional Development) 3.02
Other actvities .37
Total Hours 51.25

Average number of on-call work hours per month: 105.94
39 responses; reported as mean (2014 National Survey Results)


Adult Endocrinology Residency Programs in Canada

Contact information for Program Directors can be accessed on the Royal College’s website here: Open in new tab

University of British Columbia
Vancouver, British Columbia

University of Calgary
Calgary, Alberta

University of Ottawa
Ottawa, Ontario

University of Alberta
Edmonton, Alberta

McGill University
Montréal, Quebec

Université de Montréal
Montréal, Quebec

University of Manitoba
Manitoba, Winnipeg

Université de Sherbrooke
Sherbrooke, Quebec

Western University
London, Ontario

Dalhousie University
Halifax, Nova Scotia

McMaster University
Hamilton, Ontario

University of Toronto
Toronto, Ontario

Page Author(s): Stephanie Fong (2018)
© 2017 Internal Medicine Interest Group (IMIG) - Schulich School of Medicine and Dentistry