Internal medicine has its roots in the German medical tradition of the late 1800s. At that time, basic science fields such as bacteriology, physiology, and pathology had advanced to the point where they were beginning to significantly impact the understanding of the disease and the clinical care of patients. Before then, much of medicine was observational; simply describing clinical findings, with most treatments based either on tradition or otherwise untested theories. There arose among physicians during those years a group of individuals who committed themselves to use this new scientific information and understanding of disease to expand the scientific foundations upon which medicine is based and developing rational therapies utilizing this knowledge. As opposed to the approach of studying the ‘external’ manifestations of disease (the predecessor to today’s specialty of dermatology), these physicians focused on the “inner” diseases, leading to the designation of their practice as the German Innere Medizin, or “internal medicine”, and those who practiced it as “internists”. With the tremendous expansion of the knowledge of the “internal” diseases over the years, this group of physicians known as internists grew rapidly into what is internal medicine today.
An “internist” is a physician who practices internal medicine, while an “intern” is a term used to describe a physician-in-training who has completed medical school and is in their first year of post-graduate training.
Although those practicing in a subspecialty area of internal medicine are often referred to by the name of their practice area (e.g. a physician practicing gastroenterology is called a gastroenterologist), and the term “internist” is frequently used to describe a physician practicing general internal medicine, it is important to realize that all internal medicine physicians, whether a generalist or subspecialist, share a common core of training and are all considered “internists”.
Basic training in internal medicine is three years of residency (frequently called ‘categorical’ training) following medical school. A number of other specialties (such as anesthesia, dermatology, radiology, and others) have their residents undergo one year of internal medicine training (referred to as ‘preliminary’ training) before moving on to more focused education in their respective fields.
Following completion of three years of training, residents are eligible for board certification in internal medicine. About half of the country’s internal medicine residents choose to practice in General Internal Medicine. General internists are capable of functioning in a number of different roles. For example, many focus on ambulatory practice and may serve as primary care physicians, following patients longitudinally for their ongoing medical care. Others may spend a majority of their time caring for hospitalized patients in the role of hospitalist (approximately over 90% of hospitalists are general internists). Many general internists care for both ambulatory and hospitalized patients in a wide variety of practice models.
Others choose to pursue additional training beyond the basic three years of residency training, subspecializing in a particular area of interest within internal medicine.
For even more information about this subject, please read our “Structure of Internal Medicine” and “Internal Medicine Subspecialties” pages.
This is perhaps one of the most confusing questions for many students (and patients alike), particularly when referring to internists who practice general internal medicine.
Family medicine developed out of the general practitioner movement in the 1970s in response to the growing level of specialization in medicine that was seen as increasingly threatening to the doctor-patient relationship and continuity of care. Conceptually, family medicine is built around a social unit (the family) as opposed to either a specific patient population (adults, children, or women), organ system (otolaryngology or urology), or nature of an intervention (surgery). Family physicians are trained with the intent to be able to deal with the entire spectrum of medical issues that might be encountered by a family unit. Thus, family physicians are educated to manage both children and adults, with additional training in certain elements of obstetrics, gynecology, and surgery.
Although it is never easy to predict the future of medicine, it is clear that that aging of the American population, coupled with medicine’s ability to successfully manage acute and chronic disease while maintaining a good quality of life, will require physicians skilled in managing individuals with complex medical problems in a comprehensive manner. Internal medicine training is particularly suited to providing team-based care that bridges outpatient and inpatient settings and coordinating care across multiple physicians (such as occurs with the patient-centered medical home). For similar reasons, the need for subspecialist internists will continue to grow. With changes in the US health care system focusing on comprehensive, team-based care of all patients, internal medicine appears to be well positioned to continue its primary leadership role into the future.