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Frequently Asked Questions About Internal Medicine
Why is it called “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.
What is the difference between an “internist” and an “intern”?
An “internist” is a physician who practices internal medicine, while an “intern” is a term used to describe a physician-in-training who has completed medical school and is in their first year of post-graduate training.
Although those practicing in a subspecialty area of internal medicine are often referred to by the name of their practice area (e.g. a physician practicing gastroenterology is called a gastroenterologist), and the term “internist” is frequently used to describe a physician practicing general internal medicine, it is important to realize that all internal medicine physicians, whether a generalist or subspecialist, share a common core of training and are all considered “internists”.
How is internal medicine structured and what is involved in training?
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.
How does internal medicine differ from family medicine?
This is perhaps one of the most confusing questions for many students (and patients alike), particularly when referring to internists who practice general internal medicine.
Family medicine developed out of the general practitioner movement in the 1970s in response to the growing level of specialization in medicine that was seen as increasingly threatening to the doctor-patient relationship and continuity of care. Conceptually, family medicine is built around a social unit (the family) as opposed to either a specific patient population (adults, children, or women), organ system (otolaryngology or urology), or nature of an intervention (surgery). Family physicians are trained with the intent to be able to deal with the entire spectrum of medical issues that might be encountered by a family unit. Thus, family physicians are educated to manage both children and adults, with additional training in certain elements of obstetrics, gynecology and surgery.
Much of the confusion arises because the majority of patients seen by family physicians are adults, thus overlapping with the patient population focused on by internists. A general estimate is that a typical family medicine practice might see 10-15% children, meaning that 85-90% of patients will be adults, the same population seen by internists.
Despite this overlap and the fact that both family physicians and internists may function as primary care physicians, there are significant differences between internal medicine and family medicine.
The focus of training differs significantly between the two disciplines. Because internal medicine deals only with the adult patient population, the training in adult medical issues is focused, comprehensive, and deep. In addition to considerable work with a general medical population, internal medicine education also provides substantial exposure to all of the subspecialty areas of internal medicine, even if one chooses not to formally pursue additional subspecialty training. In addition to training in ambulatory (outpatient) medicine, internists also spend a significant amount of their educational time in inpatient settings, including work in intensive care settings. This prepares internists extremely well to care for very complicated and critically ill people in both ambulatory and inpatient settings. This uniquely positions internists to function as hospitalists and as ‘co-managers’ with other specialists and subspecialists in overseeing the care of patients with multiple medical issues.
What kind of income do internists make and how does this compare to other medical specialties?
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:
|Discipline||Average Income - 2015*|
|Obstetrics and Gynecology||$249,000|
|General Internal Medicine||$196,000|
*Medscape Physician Salary Survey, 2015
Is it possible to balance internal medicine practice and my personal life?
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.
What does the future of internal medicine look like?
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.
What are the best sources for more information about internal medicine?
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.