About Internal Medicine

What is Internal Medicine and what does an internist do?

Internal Medicine encompasses the care of all adults, healthy and sick. Internists (as all doctors who complete an internal medicine residency are called) can be generalists or subspecialists, like cardiologists or rheumatologists. If you choose not to subspecialize, you are known as a General Internist. “General Internists handle the broad and comprehensive spectrum of illnesses that affect adults. They are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention.” An internist deals with acute and chronic medical problems and also discusses issues of health maintenance, like cancer screenings, with patients. Patients with multiple problems and medications would typically be seen by an internist. An internist has good working knowledge of multiple disease processes and pharmacology, but also enjoys long term relationships with patients. Visits with an individual patient are usually 15-30 minutes long. Some internists work in the hospital while others work in an office setting. Some do both. A typical internist likes to solve puzzles and figure out the basis of one’s disease. He/she likes to come up with differential diagnoses and enjoys thinking through complex issues. While it is not a required part of an internist’s job, many internists perform procedures, including pap smears, knee aspirations, lumbar punctures, and incisions and draining of abscesses.

How do you become an internist?

To become a General Internal Medicine physician, a student must complete a three-year long internal medicine residency. During that time, a resident will spend about 70% of his/her time in the hospital on subspecialty and general adult services. The resident will work at a continuity clinic and will also spend time in electives such as consult services and outpatient subspecialty clinics. After completing three years of training, the internist can work in the hospital (as a hospitalist) or in private practice.

What is a subspecialist and how do you become one?

Alternatively, an internist may choose to subspecialize. Choices for subspecialties are numerous and include: cardiology, rheumatology, endocrinology, gastroenterology, genetics, hematology-oncology, infectious disease, pulmonary/critical care, nephrology, sports medicine, allergy and immunology and geriatrics. With very few exceptions, subspecializing requires you to complete an internal medicine residency followed by 1-4 years of subspecialty training called a fellowship. The number of years of fellowship depends on the subspecialty and whether or not you are considering an academic or clinical career. Proceduralists tend to have longer fellowships. These would include subspecialties like interventional cardiology (i.e. placing stents and fixing holes in hearts) and gastroenterology (i.e. stopping intestinal bleeding, dilating esophageal strictures and removing gallstones in cases of ascending cholangitis). All subspecialists perform some procedures.

What is the difference between an internist and a family medicine doctor?

General Internists serve as primary care physicians, along with family medicine doctors and pediatricians. The biggest difference between Family Medicine and Internal Medicine is that IM training focuses on adults, with residents spending time between various adult medicine subspecialties. Family Medicine residents spend time with general surgeons, obstetricians, gynecologists, and other family medicine doctors. They perform pediatrics and newborn medicine, and may learn simple surgical procedures and how to deliver a baby. While it is less common to do a fellowship after a family medicine residency, it is very common in Internal medicine, with over half of residents completing a fellowship.

What other options do I have as an internist?

Other options in Internal Medicine include the combined degree programs. Most MD/PhDs will find mentors in Internal Medicine. With so many subspecialties, it is not hard to find a mentor who participates in both research and clinical practice. Another common scenario is to complete the MD/MPH course of study. Many subspecialty fellowships offer the MPH as part of the fellowship. Doctors may opt for this and then work in epidemiology, for state or national health programs, or even for the pharmaceutical industry.

Click here to find out more about career paths in Internal Medicine.