Clinical career options for general internal medicine physicians are extremely broad and flexible. Two of the most recognizable types of practice pursued by general internal medicine physicians are primary care general internal medicine in which the internal medicine physician 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 internal medicine physicians care for both ambulatory and hospitalized patients), and that it is common for general internal medicine physicians to change their clinical focus or practice set up over the course of their careers.
Additionally, a large number of general internal medicine physicians engage in practice that does not fit into the traditional categories of primary care general internal medicine or hospital medicine. For example, some internal medicine physicians 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 internal medicine physicians 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 internal medicine physicians for academic and administrative activities. Academic general internal medicine physicians are heavily engaged in medical education, both with medical students and internal medicine residents. Research pursued by general internal medicine physicians 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 internal medicine physicians 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 internal medicine physicians 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.