Careers in internal medicine (IM) and family medicine (FM) can be very alike, but despite many similarities, important differences exist. If you’re considering a future in either of these fields, this article will explain the difference between them. We’ll walk you through how the training, scope of practice, and professional opportunities vary between the two and help you make an informed decision for your career trajectory.

What is the Difference Between Internal Medicine and Family Medicine?

1. Residency

IM and FM training programs are both usually three years long and feature a combination of inpatient and outpatient components. As an IM resident, you’ll spend the majority of your time inpatient rotating through general medicine services, critical care units, and different subspecialty services like cardiology and oncology. You will also recruit a panel of outpatients who will follow with you for routine primary care and have rotations in an Emergency Department (ED) to gain exposure to acute care and triage. In the process, you will learn skills as you care for a wide variety of patients except for pediatric, surgical, and obstetric patients.

While FM residents similarly will work on inpatient services and in the ED, they usually spend much more time in an outpatient context seeing their own established patient panels. During inpatient blocks, FM residents like IM residents rotate through general medicine and medical subspecialty services. However, they also spend time on many other services that IM residents usually don’t cover like inpatient pediatrics, the newborn nursery, labor and delivery units, and even some surgical services like orthopedics and general surgery. While you may only spend a few weeks on any one of these rotations, you gain exposure to many different disciplines.

2. Scope of Practice

The difference between IM and FM residency training directly informs the scope of practice of these two specialties. Individuals who specialize in IM are equipped to handle seemingly every aspect of adult patient care. However, IM physicians are notably not trained to care for pediatric or obstetric patients and are generally unable to reserve time in an operating room (OR) to perform surgery. Even if you are not in an OR, you may still be able to do many procedures after IM training like colonoscopies, cardiac catheterizations, or kidney biopsies, particularly if you have any subspecialty fellowship training. Simply put, IM physicians are skilled in the management of conditions affecting adults that are treated with medical treatments or straightforward procedural interventions.

The scope of practice for FM physicians intersects in many ways with that of IM physicians, in particular those that focus on outpatient primary care. However, because of your additional training in obstetrics and pediatrics, you become qualified after FM residency to conduct well-child visits, provide obstetric care, and even deliver children including by caesarian delivery. While FM physicians are often able to obtain hospital privileges to work as a hospitalist or staff an ED like IM physicians, they usually work in a clinic space seeing outpatients. They are particularly adept at engaging with the community to treat a wide variety of conditions and serve a critical role in controlling chronic diseases like hypertension and diabetes and providing preventative care like age-appropriate malignancy screening and vaccinations to proactively keep patients healthy.

3. Options for Subspecialization

A large distinction between the two specialties involves the paths after residency for fellowship and further subspecialization. New IM physicians can either begin practicing as generalists or gain additional experience in certain fields like infectious diseases or pulmonary and critical care medicine. This will entail extra training, but it provides the skills to practice with a narrower scope and more expertise. Of important note, however, many of these fellowships are accessible almost exclusively after an IM residency and are usually not an option after an FM residency.

Conversely, most FM fellowships focus on honing your skills as a generalist and gaining more experience delivering certain facets of primary care. Options include sports medicine, maternal health, sleep medicine, and pain medicine. As an example, if you plan to do the full scope of primary care but want to have an emphasis in your future practice on obstetrics, you may consider a maternal health fellowship. Simply put, fellowships in IM are intended to refine the breadth of your practice to become an expert in a certain area, while FM fellowships complement the broad knowledge you need to be a generalist and equip you to provide even better primary care.

Which Specialty Should I Pursue?

If you’re considering a career in IM or FM, the decision ultimately turns on whether you want to become a subspecialist. If you plan, for example, to do cardiology or gastroenterology, you should do an IM residency. Conversely, if you want to provide outpatient primary care, either trajectory is reasonable with the only notable difference being that you would finish FM training with additional pediatric and obstetric skills.

Identifying what you want your career to be and accordingly choosing a specialty can feel like a momentous decision. At the same time nevertheless, it starts simply with reading about the opportunities available to you, reflecting on your professional interests and goals, and talking to family and friends to find the path that will eventually excite you most to go to work each day.

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.

Further Reading

• How to Choose a Medical Specialty: The Ultimate Guide
• How to Become a Family Medicine Physician
• Interview with a PGY1 Internal Medicine Resident
• Medical Students: Which Specialty is Best for Work-Life Balance?
• Residency Interview Tips & Tricks: The Ultimate Guide