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General Internal Medicine

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 (such as cardiology or gastroenterology).

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 clinical focus or practice set up 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, urgent care, or may work in rehabilitation or extended-care settings providing ongoing medical care, among many other individualized practice variations. Some internists may also build a focus in women's health, point of care ultrasound (pocus), addiction medicine, or perioperative medicine. Still others may spend a large amount of effort and time in the setting of medical education, such as in medical schools or residency programs.

The nature of general internal medicine training does uniquely prepare 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, medical education, and patient safety and quality improvement. General internal medicine training also prepares internists well for administrative roles, such as medical directorships, administrative leadership positions including those in hospitals and academic departments, and leadership of medical organizations.

During the years spent in a categorical or combined residency training program, trainees work in a variety of settings that may include university hospitals, community teaching hospitals, intensive care units, subspecialty clinics, hospital outpatient clinics, and community-based physician practices. Residents assume progressive responsibility as they acquire various skills in treating hospitalized patients and gain competency in ambulatory care. All residency training in the United States is supervised through the Accreditation Council on Graduate Medical Education.

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.

Major Professional Societies

  • American College of Physicians (ACP)
  • Society of General Internal Medicine (SGIM)
  • Society of Hospital Medicine (SHM)
  • Alliance for Academic Internal Medicine (AAIM)