Primary care physicians are in high demand—in fact, this sector of medicine has been hit the hardest by the nation’s doctor shortage
If you’re interested in helping to fill the gap, there are several primary care specialties future physicians can choose from. Two of the most common are internal medicine and family medicine. Because both can be referred to as “general practice doctors,” it can be tricky to distinguish the differences between the two.
So what are the differences between family practice versus internal medicine? We spoke with a handful of physicians to help clarify what differentiates these primary care specialties. The breakdown of internal medicine vs. family medicine and what is needed for both fields includes:
- Typical patients
- Job duties
- Skills internal and family physicans need
- Training needed
What is the difference between internal medicine and family medicine?
General practice doctors—whether in internal or family medicine—often serve as a patient’s first point of contact when it comes to discussing health concerns. These physicians possess an extensive ability to treat common medical conditions—and, when necessary, they’re able to perform diagnostic tests that may lead to specialist referrals.
But when you dig deeper into these primary and family care specialties, what are the distinct differences between internal medicine and family medicine?
Who do these physicians treat?
One of the main differences between internal medicine and family medicine has to do with their typical patient demographics.
“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, a family physician and graduate of St. George’s University (SGU) Medical School
Where physicians care for their patients is another way in which these two primary care specialties differ. “Many internists end up working in hospitals, while most family medicine doctors work in outpatient settings,” explains family physician Dr. Lisa Doggett.
What are their job duties?
Another key to understanding internal medicine practitioners (also called “internists”) vs. family medicine physicians is evaluating the specific work they do. First, it can be helpful to learn about some of the responsibilities that both internists and family physicians share.
Dr. Bernard Remakus, an internist and author, outlines a few of the procedures that physicians in either field may perform:
- Conducting minor office procedures, such as draining abscesses, removing foreign bodies from the skin and eyes, repairing lacerations, and performing uncomplicated fracture care
- 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.
As for how duties differ, family physicians tend to focus on preventive medicine in an outpatient setting. Conversely, internists work more with inpatients—though they can work in clinics as well.
“While internists typically diagnose and treat medical problems of greater complexity than family practitioners in both the office and hospital settings, family practitioners provide more ‘well-patient’ services in the office setting and don’t treat as many hospitalized patients,” Dr. Remakus explains.
He does stress, however, that this is a generalization as family practitioners do also treat some seriously ill patients and patients with complex problems. On the other hand, internists can also treat patients who are essentially healthy.
Another difference between these two specialties is family medicine’s focus on avoiding health issues further down the road, which may or may not involve collaborating with other physicians. “Preventive medicine is a big part of family medicine,” Dr. Girgis emphasizes.
Family physicians are trained to diagnose and treat an entire spectrum of medical issues for patients of all ages.
Family physicians have a broader scope,” Dr. Doggett explains. “They usually feel comfortable caring for all types of problems for people of all ages.” She adds that, in her experience, family physicians 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, such as orthopedics.
Meanwhile, internists develop a comprehensive and deep expertise of common adult health conditions. 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.
Both types of physicians encounter a variety of conditions in a range of different patient demographics. There are different critical-thinking skills both internists and family physicians because both providers must assess a completely new set of symptoms with each patient.
Family physicians must also possess strong relationship skills as they often form bonds with patients and their families over time. Internists tend to face more serious ailments, so the ability to work under pressure is imperative.
What postgraduate training do you need for general practice?
The training required to practice is another difference between family medicine and internal medicine. After completing medical school, aspiring physicians in both fields begin medical residency. However, the nature of their postgraduate training differs—particularly when it comes to the setting.
“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.” He also adds that internal medicine residents typically have a more rigorous call schedule, though this isn’t always the case.
While these are the general differences between the two, keep in mind that a resident physician’s experience will depend 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.
Lastly, the ability 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,” she says.
Find the right primary care path
When choosing between a career in internal medicine vs. family medicine, it really comes down to personal preferences. Now that you have a better idea of what makes these two specialized paths different from one another, you’re better equipped to decide which is right for you.
But before any aspiring physician can select a specialty, it’s important to focus on attending a medical school that can provide the foundational education students need to be successful.
Learn more about how to compare options in our article “How to Choose a Medical School: 9 Things to Evaluate Before Accepting”
*This article was originally published in May 2018. It has since been updated to reflect information relevant to 2023.
