Subspecialty and Combined Training Careers

Although this section of IMpact it is worth emphasizing what makes internal medicine unique. Internal medicine physicians see things differently. Holistically. And in a unique way that allows them to analyze, lead, and humanize health care in a variety of different settings and roles. See all the career opportunities internal medicine can provide.

Critical Care Medicine

The Discipline

Critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease. Critically ill patients require intensive care by a coordinated team. The critical care specialist (sometimes referred to as an “intensivist”) may be the primary provider of care or a consultant. The intensivist needs to be competent not only in a broad range of conditions common among critically ill patients but also with the technological procedures and devices used in intensive care settings. The care of critically ill patients also raises many complicated ethical and social issues, and the intensivist must be competent in areas such as end-of-life decisions, advance directives, estimating prognosis, and counseling of patients and their families.

Most physicians trained in critical care medicine work in hospital-based settings, usually in intensive care units. Within internal medicine, critical care medicine training is most commonly coupled with a pulmonary medicine fellowship since pulmonologists frequently oversee care of patients in intensive care units. However, other internal medicine physicians, such as cardiologists and general internal medicine physicians practicing hospital medicine, may seek training in critical care medicine to facilitate their work with severely ill patients.


When combined with subspecialty training in pulmonary medicine (pulmonary and critical care medicine), a three-year fellowship is required after which the trainee is eligible for subspecialty certification in both pulmonary medicine and critical care medicine.

For other internal medicine physicians, different routes of training in critical care medicine are available:

  • A two-year accredited fellowship in critical care medicine after the internal medicine residency
  • Two years of fellowship training in advanced general internal medicine (that include at least six months of critical care medicine) plus one year of accredited fellowship training in critical care medicine
  • Two years of accredited fellowship training in a subspecialty of internal medicine (three years for cardiovascular disease or gastrointestinal disease) plus one year of accredited clinical fellowship training in critical care medicine.

Certification in critical care medicine is jointly administered by the American Board of Internal Medicine, the American Board of Surgery, the American Board of Pediatrics, and the American Board of Anesthesiology.

Training Positions

In this 2023-2024 academic year, there are 64 Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs in critical care medicine (internal medicine) with 374 trainees.

Major Professional Societies

  • Society of Critical Care Medicine
  • American Thoracic Society
  • American College of Chest Physicians

See all the career pathways open to internal medicine physicians.

Back to the December 2023 issue of ACP IMpact