What is Internal Medicine (and Where Does It Lead)?
- Jan 03, 2023
So, you wanna be an internist? You’ve come to the right place! Internists work everywhere from the clinic to the ICU, in global health and public policy, with rural and urban communities, as generalists and specialists, and in every other work style imaginable! The versatility of internal medicine training is its best attribute, but it can also be an overwhelming specialty for those entering the field. Let us be your guide.
What is internal medicine?
Internal medicine is the specialty focused on taking care of adult patients with non-surgical problems. It is a very broad specialty by nature, but can lead to sub-subspecialized work by pursuing additional fellowship training. Internal medicine focuses on the medical management of problems in the heart, lungs, GI tract, endocrine organs, immune system, and bone marrow. It even includes specialties that cross organ systems like rheumatology, allergy/immunology, and oncology.
Where does internal medicine lead?
As an internist, you may work as a primary care physician (PCP) managing a broad swath of outpatient conditions or an intensivist taking care of the sickest of the sick. You may do minimally invasive but highly technical procedures like cauterizing acute GI bleeds or stenting clogged arteries during a heart attack.
Alternatively, you may prefer the detective work of an infectious disease specialist or the puzzle of seemingly-disparate symptoms that excites a rheumatologist. Additionally, you may prefer a short-term interaction with your patients as a hospitalist or enjoy lifelong relationships as a PCP. You may split your time between patient care and cutting-edge research like many oncologists. Or, you may prefer to do pure clinical work as a private practice physician.
You may even like a mix of everything which could land you in an academic position teaching classes, mentoring medical students, and shaping residency programs. Further, internal medicine could lead you to work in urban practice, care for a rural population, or travel halfway around the world for global and public health endeavors. Maybe you feel called to a very humanistic role in medicine, such as a palliative care physician or addiction specialist. The opportunities with internal medicine training are truly endless!
How do I get there?
The training for internal medicine is a three-year residency program. During this time, you will take the USMLE Step 3 like all other residents in the United States. At the end of your training, you will also take a board certification exam through the American Board of Internal Medicine (ABIM). Luckily for you, the bulk of Step 3 is internal medicine. In fact, many residents elect to take both Step 3 and their board certification exam around the same time.
Internal medicine residency
Of course, residency training is much more than just preparing for your board exam. The most important goal of internal medicine residency is to build your clinical muscles so you’ll be well-equipped to take care of adult patients. Your first year of internal medicine residency (“intern year”) will be heavily hospital-based and tends to be the most time intensive. As an intern, the main skills you’ll hone throughout the year are efficiency and organization. You’ll be responsible for pre-rounding patients, putting in orders, talking to consultants, admitting and discharging patients, and updating families. Intern year is challenging not just because of the overwhelming amount of medicine you learn, but also because you are getting an education in how the hospital works. The learning curve is steep, but your residents, chiefs, attendings, and program director are there to support you!
Your second or third years, also known as your “senior resident” or “upper level” years, have a different focus than your intern year. You’re now the leader of the team and overseeing all of the patients. Your job is less task-oriented and more focused on critically thinking about your patients and their medical management. You set the team expectations and have a strong influence on team morale. Intern year is in your rearview mirror, and with that, you are happily working fewer hospital shifts. Your time is now occupied by electives, a larger PCP panel, and deciding which direction you’d like to take your career.
Next steps after residency
The conventional advice is to settle on your career plans by halfway through your second year of residency. Once you decide on either pursuing a subspecialty fellowship or general medicine, you can start taking steps toward manifesting that dream.
For those pursuing subspecialty training, that means you will need to seek out research opportunities and work to publish articles and present at conferences. If you have an eye toward general medicine, you might start reaching out to local PCP practices or hospitalist groups to set yourself up for your first job as an attending. Overall, your upper-level years in internal medicine residency come with more flexibility and elective time than your intern year, but also with an exponential increase in accountability, growth, and decision-making.
Where can I train in internal medicine?
Now that we’ve discussed the what and how of internal medicine training, let’s discuss the where. Your training environment will vary drastically depending on your residency program. Community programs tend to see more “bread-and-butter” medicine cases, whereas large academic programs will attract more complex cases requiring specialty care.
No matter where you train, however, you should feel very comfortable handling common inpatient internal medicine complaints by the end of residency. These include COPD exacerbation, diabetes complications, sepsis, pulmonary embolism, pancreatitis, GI bleeding, heart attacks, heart failure exacerbations, and much more. In many residency programs, you will staff specialty services in addition to general medicine wards. This gives you the opportunity to work with, for example, cardiologists, nephrologists, and oncologists while getting concentrated experience in treating those pathologies.
Of course, you will also spend plenty of time getting comfortable with critically ill patients in the medical and cardiac ICUs. Though internal medicine doesn’t typically attract the most procedural-minded physicians, depending on your program there may be plenty of opportunities to place arterial and central lines, lumbar punctures, pleurocentesis (draining fluid from the lungs), and paracentesis (draining fluid from the abdomen).
You will also become the PCP for a group of patients in the community, where you spend much of your time in the outpatient clinic setting. This is a tremendous amount of responsibility! You will see these patients many times throughout your three years in residency and they will look to you for advice and support. You will need to actively follow up with these patients and their needs, whether it’s refilling medications, calling them to address questions, or coordinating their care.
Should I pursue internal medicine?
Hopefully, you’ll gain experience with all different specialties during medical school before you hone in on a favorite. If you’ve ruled out wanting to be a surgeon or work only with kids, internal medicine probably has an exciting path—or many paths—to offer you. Take time to ask the physicians you rotate with how they ended up in their current positions. You may be surprised at how circuitous their careers have been as their interests have continued to evolve. Fortunately, in a specialty as diverse and dynamic as internal medicine, you’re guaranteed to find something you love!
Looking for more of a clear breakdown and side-by-side comparison of each medical specialty? Find your path in medicine with the FREE Medical Specialties Breakdown Guide! Go beyond the data with qualitative insights from residents, practicing physicians, and med school tutors who have been in your shoes.
About the Author
I'm originally from the Northeast but attended college and medical school in Virginia. I just started residency in Internal Medicine this past year and am enjoying tutoring with Blueprint in my free time! I have always felt drawn to mentoring, especially when it comes to helping students like me who have no family in medicine to guide them. Now as a tutor at Blueprint, I’ve spent hundreds of hours teaching students at all levels. I think a lot about medical education and am excited to share my reflections on all things medical school and residency. In practice, I enjoy general medicine and as a bilingual physician find it especially rewarding to care for Spanish-speaking patients. When I’m not in the hospital, I enjoy salsa & bachata dancing, traveling to South America, dogs, and spicy food.