You know you’re destined for a career in medicine, and you have your sights set on working in primary care. The wide variety in daily duties, different types of ailments, and the relationship-building that occurs with recurring patients are all job aspects you find attractive — not to mention the opportunity to help ease the impending primary care physician shortage.
But you’re still unsure of which primary care specialty you should be seeking. Like many, you’re unsure of the difference between internal medicine and family medicine. Clearing up these commonly confused areas of practice can help you plan your primary care career path.
We spoke with a handful of physicians to help you understand these two primary care specialties. Keep reading for a side-by-side comparison of internal medicine versus family medicine.
Internal medicine vs. family medicine: Origins of practice
If you want to understand the differences between internal medicine and family medicine, first take a look at how these two areas of the field were formed.
Internal medicine emerged in the late 1800s as the medical field grew increasingly scientific. Scientific methods were applied to an array of adult diseases. At the same time, pediatrics began to develop as another branch of medicine. Internal medicine continued to grow as a field solely devoted to adult patients.
Family medicine emerged with the primary care movement in the 1960s. As medicine became more and more granularly specialized, the medical field pushed for more continuity of care. Advocating for the importance of long-term doctor-patient relationships, family medicine emerged to serve the social unit of an entire family, as opposed to segmenting care by a certain age, organ, or type of treatment.
Internal medicine vs. family medicine: Patient demographics
A key differentiator in internal medicine and family medicine can be found within their patient demographics: The types of patients they treat is what separates the two areas of medicine.
"Internal medicine focuses exclusively on adult medicine, while family medicine typically sees all the members of a family."
“Internal medicine focuses exclusively on adult medicine, while family medicine typically sees all the members of a family — children as well as adults,” explains Dr. Linda Girgis, FAAFP, who is an alum of St. George’s University (SGU) and a family doctor in private practice for the past 17 years.
As you can see, the ages of patients is one differentiator between internal and family medicine. Where these physicians care for their patients is another.
“Many internists end up working in hospitals, while most family medicine doctors work in outpatient settings,” says family physician Dr. Lisa Doggett, MPH, FAAFP.
"Many internists end up working in hospitals, while most family medicine doctors work in outpatient settings."
Dr. Girgis also points out that internists can do both inpatient and outpatient medicine, though many now work as hospitalists and just see inpatients.
Internal medicine vs. family medicine: Similarities in duties
Another key to understanding internal medicine versus family medicine is in what they do, both in their day-to-day work and the type of care they provide. First, take a look at some of the things that both internal medicine and family medicine physicians can expect to do on a daily basis.
"Internists and family practitioners both diagnose and treat patients within the confines of their training and comfort levels."
“In the most basic sense, internists and family practitioners both diagnose and treat patients within the confines of their training and comfort levels,” says internist Dr. Bernard Remakus, Internist and author.
He outlines a few of the typical duties one can expect to find in both internal and family medicine:
• Performing minor office procedures, such as abscess drainages, removal of foreign bodies from the skin and eyes, laceration repair, uncomplicated fracture care, and excision of skin lesions
• Executing diagnostic procedures such as sigmoidoscopy, proctoscopy, and minor gynecological testing
• Administering nerve blocks, joint injections, and trigger point injections
“Most primary care physicians, however, perform only a few of these procedures on a routine basis, or choose to perform none of these procedures,” Dr. Remakus adds.
Internal medicine vs. family medicine: Differences in duties
Now let’s outline a few differences in these primary care specialties. In general, family physicians focus on preventive medicine in an outpatient setting, while internists work more with inpatients, though they can work in clinics as well.
"Family practitioners typically provide more ‘well-patient’ services in the office setting."
“While internists typically diagnose and treat medical problems of greater complexity than family practitioners in both the office and hospital settings, family practitioners typically provide more ‘well-patient’ services in the office setting and don’t treat as many hospitalized patients,” Dr. Remakus explains.
He stresses that this is a generalization, as family practitioners do also treat some seriously ill patients and patients with complex problems, while internists can also treat patients who are essentially healthy.
Another difference between these two specialties is family medicine’s focus on preventive care in the outpatient setting.
"Most family doctors focus exclusively on outpatient medicine. Preventative medicine is a big part of family medicine."
“Most family doctors focus exclusively on outpatient medicine. Preventative medicine is a big part of family medicine. We can see a healthy newborn in one visit and step into the next to find a 90-year-old with complicated medical problems,” Dr. Girgis says. “Some family doctors are quicker to refer patients to specialists if needed, while some like to do as much as they can themselves.” She says some family physicians, for example, choose to perform minor skin surgeries, while some prefer to refer these patients to other specialists. Some even deliver babies, while the vast majority do not.
Internal medicine vs. family medicine: Residencies and training
Another difference between internal medicine and family medicine is in their training and residencies. After completing medical school courses, aspiring physicians in both internal medicine and family medicine begin their residencies. However, the nature of their residencies differs. Internal medicine residencies are typically hospital-based, while family medicine residencies are primarily office-based.
"Internal medicine residents take care of hospitalized patients for three years."
“Internal medicine residents take care of hospitalized patients for three years, with ample training in emergency medicine, critical care, and medical sub-specialty care,” Dr. Remakus explains. “Family practice residents usually receive approximately one year of that same inpatient training, and then split the remaining two years of training among pediatrics, OB/GYN, and other outpatient medical disciplines.”
While these are the general differences between the two, keep in mind that residencies may vary based on a number of factors.
“Residency programs for both internal medicine and family medicine vary somewhat depending on their location, and the scope of training may be different in rural versus urban settings and in different regions of the country,” Dr. Doggett points out.
Another difference between the residencies of internal and family medicine is the call schedule, with internal medicine taking calls at hospitals.
"Internal medicine residents usually have a more rigorous call schedule throughout their three-year training with calls taken exclusively in the hospital."
“Internal medicine residents usually have a more rigorous call schedule throughout their three-year training with calls taken exclusively in the hospital,” Dr. Remakus says. “Family practice residents also take calls in the hospital while they are rotating through internal medicine and obstetrics, but most of their calls during their second and third years are taken from home.”
Lastly, the ability for a physician to further specialize lends itself more to internal medicine than it does family medicine, according to Dr. Girgis. “Internists can extend their training into a whole host of specialties, while the choices for family physicians are limited.”
Internal medicine vs. family medicine: Comparing skill sets
In general, family physicians are trained to diagnose and treat an entire spectrum of medical issues for patients of all ages. Internal medicine physicians, on the other hand, develop deeper training on common adult health conditions.
Because the training and education of internal medicine focuses solely on adults in both general medicine and the internal medicine subspecialties, internists develop a comprehensive and deep expertise. This allows them to diagnose a wide variety of diseases that commonly affect adults and to handle complicated cases where multiple conditions affect a single patient.
"Family physicians have a broader scope, and usually feel comfortable caring for people of all ages and types of problems."
“Internal medicine residents spend more time in hospital settings learning to care for adults with complex medical problems. Their depth of experience in this setting is greater than that of most family physicians,” Dr. Doggett explains. “Family physicians have a broader scope, and usually feel comfortable caring for people of all ages and types of problems.” She adds that in her experience, family medicine doctors do more outpatient procedures like skin biopsies, IUD placement, and joint injections. They also tend to have more training in women’s health and pediatrics as well as certain specialties like orthopaedics.
Both types of physicians encounter a variety of conditions in different types of patients. No two shifts are the same, so critical-thinking skills are crucial to assess a completely new set of symptoms with each patient. Internists tend to face more serious ailments, so the ability to work under pressure is also imperative. Family physicians must also possess strong relational skills as they often form bonds with patients and their families over time.
Weighing your options
When it comes time to choose internal medicine versus family medicine, only you can make that decision. It all comes down to your own personal preferences. This comparison should help you feel more equipped to take the next step in your medical career.
But before choosing a specialty, you must first choose the school from which you’ll acquire your training. Learn more about the factors you should consider when weighing you options in our article, “How to Choose a Medical School: 9 Things to Evaluate Before Accepting.”
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