Internal Medicine

What is an Internal Medicine physician?

An internal medicine physician or an “internist” is a physician whose discipline focuses on the care of adults. Typically, the age group of patients are 18 years and older. An internist would be trained to treat all the broad and comprehensive diseases that they may encounter. Many of these diseases, such as diabetes mellitus and hypertension, are chronic and require long-term monitoring. General internists may practice in a variety of settings from ambulatory clinics to acute hospital care or rehabilitation facilities. Some internists have chosen to focus on their primary care practice while others only see patients in the hospital as a “hospitalist.” There are many who remain involved in both realms.

In addition to practicing general internal medicine after completion of residency, internists also have the option to subspecialize. According to the American College of Physicians (ACP), currently there are 10 subspecialities available. These include: allergy and immunology, cardiology, endocrinology, gastroenterology, hematology, infectious disease, nephrology, oncology, pulmonary disease and rheumatology. These fellowships require one to three years to complete after residency. In addition to the specialties listed above, there are critical care fellowships that may be combined with pulmonary disease. Many oncology programs are combined with hematology. Lastly, internal medicine residents are eligible to apply for geriatric fellowships as well.

Why did I choose Internal Medicine residency?

I learned from rotations in medical school that I wanted to work with the adult population. Given that I would have the chance to learn about a variety of body systems and perhaps subspecialize, an internal medicine residency was ideal. Knowing that I would have a choice of practice settings while still developing my medical acumen and expertise was a plus.

A day in the life of an internal medicine resident

An internal medicine resident would spend most of his/her time in the inpatient setting. Schedules vary from program to program but are usually in a monthly rotation format. During the three years of residency, a resident will spend the most time on the inpatient medicine service. While on the medicine service, a resident will be scheduled to cover the day and night shifts which are divided up equally. Weekend shifts are divided up among the residents. The frequency of weekend shifts typically depends on the number of residents in the program.

While on inpatient medicine service, the shifts are usually 12 hours. This may vary but 7am is a frequent starting time. The night shift would give sign out to the morning shift regarding events overnight. Morning report happens afterwards and the day shift residents would then round on the patients. These same residents or another team would be responsible for admissions and discharges during the day. In terms of call, there is no home call for inpatient medicine. Typically a resident is in-house while on night or weekend shift. The reason is hospital codes are primarily run by the internal medicine residents or they are the first responders. There’s almost always a senior resident present who would lead the team during the day or night. These are the people that interns and junior residents will work with the most and learn a lot from.

On other months, the resident would be on subspecialty rotations. Required ones include cardiology, hematology/oncology, critical care, etc. Most programs give the resident at least one month of doing an optional rotation of his/her choice.

The ambulatory aspect of an internal medicine residency involves having continuity clinic that is usually twice a week. The resident would have a panel of patients that he/she would be responsible for and follow during residency. These visits would be overseen by attending physicians who would co-sign the notes. I’ve certainly enjoyed seeing these patients. It’s fulfilling to see a patient who may have started seeing me for uncontrolled diabetes mellitus and ultimately gained control of their disease and became a more healthful person overall by the time I leave the program.

How to become an Internal Medicine resident

Internal medicine residencies are not among the most competitive residencies. However, depending on the reputation or location, certain programs are more competitive. If there are subspecialty fellowships available at the same site, these programs tend to draw the most competitive applicants. In general, you should do well in medical school as well as on board exams. Research is encouraged but not a must. If you feel that you will be pursuing a fellowship after residency, starting out with a competitive application during residency will certainly help later on.

How long does it take to become a fully licensed internal medicine physician?

You must complete a Bachelor degree prior to starting medical school, which is 4 years. An internal medicine residency is 3 years. Once you’ve completed an internal medicine residency, you’ll become eligible to take the internal medicine boards. Passing the boards is necessary for practice and credentialing. All totaled, 11 years is necessary for one to become a fully trained and licensed internal medicine physician. One may choose to receive more training on top of this to specialize.

Anny Wu, D.O.

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