The Discipline
Basic training in internal medicine is a three-year (frequently termed “categorical”) residency training program. Following completion, individuals are prepared for board certification in internal medicine and prepared to practice general internal medicine.
General internal medicine training equips individuals to handle the broad spectrum of illnesses that affect adults, and general internists are recognized as experts in diagnosis, treatment of chronic illness, and comprehensive health promotion and disease prevention. Due to the broad yet intensive nature of core internal medicine training, general internists are not limited to one type of medical problem or organ system; this is also the reason that basic internal medicine training is required as the foundation to prepare those who desire to pursue additional subspecialty training in internal medicine.
Clinical career options for general internists are extremely broad and flexible. Two of the most recognizable types of practice pursued by general internists are primary care general internal medicine in which the internist follows a panel of patients longitudinally over time and provides preventive, acute, and chronic care, most often in the ambulatory setting, and hospital medicine (“hospitalist”) in which clinical work is focused on caring for patients requiring hospital-level care. However, it is important to realize that many other practice and career options are available, that none are mutually exclusive (for example, many general internists care for both ambulatory and hospitalized patients), and that it is common for general internists to change their practice focus over the course of their careers.
Additionally, a large number of general internists engage in practice that does not fit into the traditional categories of primary care general internal medicine or hospital medicine. For example, some internists build clinical practices in which they work within a multispecialty practice and provide comanagement of patients with complex medical issues, or may work in rehabilitation or extended-care settings providing ongoing medical care, among many other individualized practice variations.
Training
The nature of general internal medicine training also prepares general internists for academic and administrative activities. Academic general internists are heavily engaged in medical education, both with medical students and internal medicine residents. Research pursued by general internists may include evaluation of treatment interventions, effectiveness of medical care systems, public health, and safety and quality improvement. General internal medicine training also prepares internists well for administrative roles, such as medical directorships and leadership of medical organizations.
During the three year residency training program in internal medicine, trainees work in a variety of settings including university hospitals, community teaching hospitals, intensive care units, subspecialty clinics, hospital outpatient clinics, and community physician practices. Residents assume progressive responsibility as they acquire various skills in treating hospitalized patients and gain competency in ambulatory care.
For general internists who are interested in an academic career that includes a research component, a number of academic medical centers also offer general internal medicine fellowships following residency training.
Training Positions
In the 2018-2019 academic year, there are 540 Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs in internal medicine with 28,621 trainees.
Major Professional Societies
- American College of Physicians
- Society of General Internal Medicine
Back to the March 2019 issue of ACP IMpact