Internal Medicine is the field of practice dedicated to the primary and/or specialty care of the adult patient. Based in primary care, the Internist practices both in the outpatient setting and in the hospital. Disease states range from simple to very complex, and provide continual challenge and academic stimulation.
The Internist is the person most adults think of first and foremost as their personal physician. Most Internists see patients in the outpatient setting for their general medical needs. This includes acute and chronic illnesses, disease prevention, screening, patient education and follow-up care from hospitalization.
Additionally, most Internists see patients in the hospital and manage their acute illnesses. This includes their own patients as well as those referred to them by other practitioners. Internists are qualified to manage complex illness in the critical care area, as well as general medical conditions. The trend has changed some now that hospitals have employed hospitalist to provide the inpatient care. Many internist are now turning the hospital care over to the hospitalist team and remaining in the office setting.
Internists also often serve as experts in complex medical disease and receive referrals from family practice, surgery and other fields. The Internist is trained in many procedures in several disciplines, and can perform these independently. Internists also are trained to meet the special needs of the growing geriatric population, including those in skilled nursing homes, residential facilities and the patient’s home.
The internist cares for all medical needs of the adult patient, from simple to complex, from the outpatient setting into the hospital, and through many of the indicated procedures the patient may need.
Like Osteopathic Medicine, itself, Internal Medicine is “more.” It is more than understanding a single organ system; more than expertise in one set of procedures; more than a concern for one gender, one age, one patient seen one time for one problem. The internist is an expert in health promotion, disease prevention, continuing care and managing patients with advanced disease.
Internists are a valuable resource for in-depth knowledge and information regarding disease processes and management that allows them to serve as consultants assisting family practitioners in the care of their patients.
Although the Internist’s practice is based in primary care, the complexity and severity of illness is generally greater than that in family practice. The management of critically-ill patients is an area of expertise for the Internist, as compared to family practice. Therefore, the Internist can provide full continuity of care to the adult patient whether in the home, ambulatory setting, hospital or critical care unit. These skills particularly enable the Internist to meet the special needs of the elderly, who frequently are medically complex with challenging psycho-social issues.
Internal Medicine training teaches residents how to consult pre- and post-operatively on surgical cases, and to consult for generalist colleagues on diagnostic problems or complex, multi-system diseases The scope and type of procedures in which an Internist is trained are greater than that of the family practitioner, and this enables Internists to provide more complete care for patients in their own practices, or those referred to them by other sources.
Many Internists spend very little time in the hospital if they choose to provide primary outpatient care and consultation. These physicians deal with a similar patient population and are qualified to perform procedures.
Some Internists prefer to restrict the majority of their practices to inpatient care consultation. This type of practice has recently been labeled the “hospitalist.” Nevertheless, the important role of the General Internist as primary care provider to the adult and older patient is well defined.
Internal Medicine residency is the start of a commitment to lifelong learning. Osteopathic (and Allopathic) Internal Medicine requires three years of post-graduate Internal Medicine training. The first year may be taken as a “Medicine Track” internship, which meets the AOA requirements for both the internship and first year of residency training, followed by two more years. If the first post-graduate year is taken in another type of internship, three more years must be completed to be eligible for certification. Family practice also requires three years of training.
If one wishes to proceed further into sub-specialization, that training begins after completion of three years of training, and continues for one to four more years , depending on the subspecialty. Most subspecialists choose to practice a combination of general internal medicine and their subspecialty.
With its strong core curriculum, Internal Medicine training keeps all options open. It is the choice that allows a physician’s career to evolve as interests change over time, and as the market changes to meet America’s health care needs.
General Internal Medicine specialists comprise 40 percent of the primary care physicians in the United States. In the current health-care environment, primary care providers are in demand and carry a great deal of influence in the operation and planning of provider programs. This atmosphere is not likely to change. Opportunities for Internists are wide-open as compared to many other disciplines and specialties.
Internists are the most highly compensated of the three largest primary care specialties (family practice, pediatrics, internal medicine). The need for providers who can care for all of the needs of patients, including critical care and a wide variety of procedures, is great and growing. The reward to the physician able to provide such services is also great, and makes the practice of Internal Medicine a challenging and very satisfying field. As the population ages, Internists will remain in demand. They will be able to select ideal practice locations, and bargain for and receives higher salaries and better benefits.