Frequently Asked Questions About Internal Medicine

Internal medicine has its roots in the German medical tradition of the late 1800s. At that time, basic science fields such as bacteriology, physiology and pathology had advanced to the point where they were beginning to significantly impact the understanding of disease and the clinical care of patients. Before then, much of medicine was observational, simply describing clinical findings, with most treatments based either on tradition or otherwise untested theories. There arose among physicians during those years a group of individuals who committed themselves to using this new scientific information and understanding of disease to expand the scientific foundations upon which medicine is based and developing rational therapies utilizing this knowledge. As opposed to the approach of studying the ‘external’ manifestations of disease (the predecessor to today’s specialty of dermatology), these physicians focused on the “inner” diseases, leading to the designation of their practice as the German innere Medizin, or “internal medicine”, and those who practiced it as “internists”. With the tremendous expansion of the knowledge of the “internal” diseases over the years, this group of physicians known as internists grew rapidly into what is internal medicine today.

Basic training in internal medicine is three years of residency (frequently called ‘categorical’ training) following medical school. A number of other specialties (such as anesthesia, dermatology, radiology, and others) have their residents undergo one year of internal medicine training (referred to as ‘preliminary’ training) before moving on to more focused education in their respective fields.

Following completion of three years of training, residents are eligible for board certification in internal medicine. About half of the country’s internal medicine residents choose to practice in General Internal Medicine. General internists are capable of functioning in a number of different roles. For example, many focus on ambulatory practice and may serve as primary care physicians, following patients longitudinally for their ongoing medical care. Others may spend a majority of their time caring for hospitalized patients in the role of hospitalist (approximately over 90% of hospitalists are general internists). Many general internists care for both ambulatory and hospitalized patients in a wide variety of practice models.

Others choose to pursue addition training beyond the basic three years of residency training, subspecializing in a particular area of interest within internal medicine.

For even more information about this subject, please read our "Structure of Internal Medicine" and "Internal Medicine Subspecialties" pages.

What internists make depends greatly on a number of factors, including what type of internal medicine you might practice (i.e. general internal medicine or a subspecialty, and which specific subspecialty), where you practice (i.e. in the community or at a teaching hospital, and geographical location), and other factors specific to your own practice situation (such as full-time vs. part-time, hospital-based vs. ambulatory, employed vs. private practice, etc.). The following table gives representative income figures for a number of types of internal medicine practice settings (in italics) with comparison income information for other medical specialties:

*Medscape Internist Compensation Report, 2023

In last year's report, internal medicine physicians' average income was $264,000.

The top-earning specialties are virtually unchanged in the past 10 years with the exception of plastic surgery, which began its rise toward the top around 2017.

ACP has collaborated with Resolve to offer a number of services to help maximize your earning potential, including a tool to compare real physician salaries and contract details. Learn more about this free ACP membership benefit.

There is a fairly common perception that the practice of internal medicine and its subspecialties require extraordinary sacrifice and are incompatible with what many would consider an ideal lifestyle.

There is no question that internists work hard on behalf of their patients. The opportunity to provide care for both sick and well individuals in the context of a meaningful doctor-patient relationship is indeed one of the great rewards of internal medicine practice, and at times may be very time consuming. However, doing so does not mean that how you practice and the demands of your profession are beyond your control or are incompatible with most physician lifestyles.

In reality, there are likely as many practice styles and arrangements as there are internists. The breadth of what internists do provides a wide range of practice opportunities that usually allow development of a professional arrangement that would be compatible with your desired lifestyle. Part-time and shared positions, limitation of practice activities (such as providing ambulatory care without hospital work), and the ability to tailor practices to meet outside commitments are all common in internal medicine. Simply asking practicing internists to talk about how they manage their career goals with their personal lifestyles will be helpful in understanding the range of options available.

Learn more about what a typical day is like for an IM specialist/subspecialist.

Although it is never easy to predict the future of medicine, it is clear that that aging of the American population, coupled with medicine’s ability to successfully manage acute and chronic disease while maintaining a good quality of life, will require physicians skilled in managing individuals with complex medical problems in a comprehensive manner. Internal medicine training is particularly suited to providing team-based care that bridges outpatient and inpatient settings and coordinating care across multiple physicians (such as occurs with the patient-centered medical home). For similar reasons, the need for subspecialist internists will continue to grow. With changes in the US health care system focusing on comprehensive, team-based care of all patients, internal medicine appears to be well positioned to continue its primary leadership role into the future.

The American College of Physicians (ACP) is the national internal medicine specialty society. Their website contains much information about internal medicine and its subspecialties, as well as helpful information for medical students. Student membership in the ACP is free and carries with it a number of benefits and resources that may be of use to you in your medical school training.

If you are interested in specific subspecialties of internal medicine, each has its own association (such as the American College of Cardiology and the American Society of Nephrology). Visiting these websites and talking to internal medicine physicians who practice in these areas would be helpful in understanding what these individuals do and what is involved in training.