Discover your future in Internal Medicine

The General Internist Career Path

Internal Medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.

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The Subspecialist Career Path

Subspecialists in internal medicine have chosen to receive additional, more in-depth training and board certification in the diagnosis and management of diseases of a specific type or diseases affecting a single organ system.

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The Hospitalist Career Path

Hospitalists are providers who dedicate most of their career to the care of hospitalized patients. They focus on clinical management, with an added eye to quality, safety, and utilization.

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My Kind of Medicine:
Real Stories of ACP Internists

Farzanna S. Haffizulla, MD, FACP

Dr. Farzanna S. Haffizulla

Internist in Private Practice

Saad Z. Usmani

Dr. Saad Z. Usmani

Director of Clinical Research

Joshua M. Liao, MD

Dr. Joshua M. Liao

Internal Medicine Resident

Saad Z. Usmani

Dr. Saad Z. Usmani

Director of Clinical Research

Joshua M. Liao, MD

Dr. Joshua M. Liao

Internal Medicine Resident

Dr. Valerie J. Lang

Dr. Valerie J. Lang

Associate Professor of Medicine

Dr. David Fleming

Dr. David Fleming

ACP President with Dr. Robert Centor, ACP Chair, Board of Regents

Dr. Kent J. DeZee

Dr. Kent DeZee

Program Director, General Medicine Fellowship

Dr. Erik Wallace

Dr. Erik Wallace

Associate Dean

Dr. Suchitra Behl

Dr. Suchitra Behl

Consultant for FORTIS C-DOC

Dr. Aysha Khoury

Dr. Aysha Khoury

Clinical Decision Unit Internist

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MKSAP 5 - Question of the Week

A 54-year-old woman is evaluated because of a chronic cough and dyspnea on exertion of 6 years' duration. She has smoked 1.5 packs of cigarettes daily for 38 years. On physical examination, she has prolonged expiratory time and wheezes. Spirometry shows a FEV1 of 2.2 L (66% of predicted) and an FEV1/FVC ratio of 0.65.

This patient likely has chronic obstructive pulmonary disease (COPD), based on her clinical findings and pulmonary function results (FEV1 <80% and FEV1/FCV <0.7). In the Lung Health Study, 6000 smokers with mild to moderate COPD were randomized to receive smoking intervention plus ipratropium bromide, smoking intervention plus placebo, or no intervention. Lung function was monitored for 5 years. The smoking intervention arms were both associated with a decreased rate of decline in lung function. The use of a bronchodilator had a small beneficial effect on lung function. The benefit did not persist after patients stopped using the bronchodilator. In a subsequent study, the Lung Health Study II, inhaled corticosteroids did not improve the rate of decline in lung function.

Among those who quit smoking, lung function improved during the first year by an average of 2%. Women who successfully quit smoking improved by 3.7%, compared with men, who improved by 1.6%. In the smoking intervention group, among those who quit smoking, the subsequent rate of decline in lung function was 31 mL per year, a normal value, compared with continuing smokers, whose lung function declined at a rate of 63 mL per year.

Key Point

  • Smoking cessation is associated with a decreased rate of decline in lung function.
Q. If she is successful in stopping her cigarette smoking, which of the following changes in lung function can be expected?
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Doctor's Dilemma™

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