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Medical Student Perspectives: What are the Differences between Internal Medicine and Family Medicine?
When I tell my peers I want to practice primary care medicine, most of them assume I mean that I will be training in a family medicine residency. I inevitably have to clarify and say that "no, I just plan to practice general internal medicine, for adults". That there is this ambiguity even among medical students, who are at the peak of their exposure to the differences among fields, concerns me, and so, I thought I would attempt to clarify the differences between family medicine and internal medicine in philosophy, education, and practice.
The American Academy of Family Practice (AAFP) defines family medicine as a "medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity."1 Family medicine aims to provide initial, continuing and comprehensive care, while centering this process on the patient-physician relationship in the context of the family. These physicians emphasize disease prevention and health promotion, and when referral is indicated, the physician remains the coordinator of patient care. The family doctor serves as a patient advocate in dealings with specialists, third-party payers, employers and others. Ideally, this leads to decreased disintegration of patient care in inpatient settings, higher patient satisfaction, and increased cost-effectiveness.2
The Accreditation Council for Graduate Medical Education (ACGME) requires that all family medicine residency training programs address a large breadth of topics: adult medicine, pediatrics, maternity care, gynecology, care of the surgical patient, musculoskeletal and sports medicine, emergency care, mental health, community medicine, skin, diagnostic imaging and nuclear medicine, and management of health systems.3 Though all family medicine residencies provide trainees with a shared core of information, individual physician implementation of this knowledge base is shaped by physician preference, patient need, and the local medical market. Provision of obstetric services is falling among family physicians4 , for example, due to insurance company payment practices and the increasing cost of malpractice insurance. Without the introduction of pediatric patients through the maternity care process, many family physicians report seeing their patient population age until it is almost exclusively adult. In the right environment, family physicians have some of the greatest flexibility regarding practice type of any specialty. They can be found teaching in medical schools and residencies, working in emergency rooms and urgent care settings or on the floors, providing maternity care, serving internationally, engaging in public health careers, doing research. Additionally, fellowships are available in geriatrics, sports medicine, emergency medicine and ob-gyn.
Broadly, internists are "doctors for adults". The specialty of internal medicine is comprised of physicians trained in adult medicine who provide the majority of health care to adults in the hospital and/or in the office. They provide comprehensive acute and chronic care (primary care) to adolescents, adults, and the elderly. This includes women's healthcare, depression, and anxiety. The internist is not trained in maternity care, though he is trained in office gynecology. They also do not treat pediatric patients or neonates, though they may see older adolescents. Like the other generalist specialties, they may arrange consultations with other physicians and conduct preoperative evaluations for surgical colleagues.5
Specialists in internal medicine complete a 3-year residency and go on to treat patients with a variety of medical conditions. Subspecialists in internal medicine complete the 3-year residency and a 2-3 year fellowship in the area of interest. Subspecialties open to internal medicine residents include adolescent medicine, allergy and immunology, cardiology, sleep medicine, infectious disease, gastroenterology, and geriatrics, among many others. During residency, internists are trained in critical care and exposed to the internal medicine subspecialties and neurology, as well as given the opportunity to gain experiences in a breadth of fields that may benefit their practice. A short list of additional experiences includes psychiatry, dermatology, ophthalmology, office gynecology, palliative medicine and rehabilitation medicine.6 Like family medicine physicians, the internist may provide care to adults as broadly or narrowly as he likes. Currently, the majority of internal medicine trained physicians go on to complete subspecialty training, though recent years have seen a small increase in residency graduates electing to stay in general internal medicine. Additionally, the internal medicine graduate may practice in academic or private settings, engage in research, clinical or public health careers, work primarily in the office or in the hospital, or a combination of the two.
I hope this discussion has been useful to you in highlighting some of the differences between internal medicine and family medicine. Both fields serve a huge need and the demand for services is high. For more information about family medicine, see Responses to Medical Students' Frequently Asked Questions about Family Medicine" in American Family Physician, 7/1/07. For more information about internal medicine, see "Imagine the Possibilities: An Overview of Careers in Internal Medicine" (ACP, ).
Dana C. Mueller
Council of Student Members Representative, Central Atlantic Region
University of Virginia School of Medicine, 2011
1. AAFP. "Family Medicine, Definition of." Accessed 11/26/2010. Available at http://www.aafp.org/online/en/home/policy/policies/f/fammeddef.html.
2. AAFP. "Family Medicine, Scope and Philosophical Statement." Accessed 11/26/2010. Available at http://www.aafp.org/online/en/home/policy/policies/f/scopephil.html.
3. ACGME. "ACGME Program Requirements for Graduate Medical Education in Family Medicine." Accessed 11/26/2010. Available at http://www.acgme.org/acWebsite/downloads/RRC_progReq/120pr07012007.pdf.
4. Neale, Todd. "Family Physicians Doing Less Prenatal Care." MedPage Today. Accessed 11/26/2010. Available at http://www.medpagetoday.com/OBGYN/GeneralOBGYN/13140.
5. ACP. "ACP: Fostering Excllence and Professionalism in the Practice of Internal Medicine". Accessed 11/26/2010. Available at http://www.acponline.org/medical_students/resources/interest_groups/ms_pp.htm.
6. ACGME. "ACGME Program Requirements for Graduate Medical Education in Internal Medicine." Accessed 11/26/2010. Available at https://www.acgme.org/acWebsite/downloads/RRC_progReq/140_internal_medicine_07012009.pdf.