Over the past few weeks, I’ve had a chance to interact with some of the first and second year students at my school. We chatted a lot about which subjects they are liking best and which specialties would be a good fit for them. It can be difficult to get a good grasp on what each of the specialties entail, so I want to talk briefly about two that are fairly popular and hopefully can shed some light on their scope of practice.
Internal medicine is the specialty that basically runs a hospital, and these physicians are sometimes referred to as “hospitalists”. Depending on which floor or wing of the hospital they are covering, they may see patients with different requirements and acuities of care but generally manage most needs of the patient. Each hospital has a different way of dividing floors and units, but generally the same principles apply everywhere. Quite a few medical students choose to pursue internal medicine because of the breadth of options it offers.
A residency in internal medicine is three years, but what appeals to many students about this specialty is the variety of fields that can be pursued after residency. These include primary care, cardiology, gastroenterology, nephrology, pulmonology/critical care, and many more! I just recently finished a rotation in the intensive care unit and was able to take care of some of the sickest patients in the hospital. Although internal medicine or “medicine” as it is generally referred to was not my first choice of specialty, I found the ICU to be a fantastic place to learn because of the complexity of patients. As someone going into OB/GYN, I most likely won’t see many patients like that, but it’s always helpful to build a strong foundation of medicine in general. I also really enjoyed my cardiology rotation and even considered becoming a cardiologist at one point. Internal medicine is one of those rare fields for those who either don’t know what they enjoy or who enjoy everything.
Family medicine can also be a “grab-bag” specialty in which physicians treat a broad spectrum of conditions. But unlike internal medicine in which the patient population is restricted to adults, family physicians can see everyone from birth to old age. Family medicine is primarily practiced in the outpatient setting. Though residency training usually occurs in the context of inpatient care, the main focus is learning to manage chronic conditions as outpatient care. It is also possible for family medicine trained physicians to practice as hospitalists but I personally haven’t seen them as much in the acute care setting. (Conversely, internal medicine physicians can also practice outpatient care.)
Family medicine itself is very diverse, though training options after residency are more limited. Fellowships include geriatrics, sports medicine, sleep medicine, adolescent medicine, hospice, and palliative care. There are a few others, but these tend to be the most popular. During my family medicine rotation, I was able to get a solid grasp of how to manage chronic medical problems (which is going to be increasingly important in the future) such as high blood pressure and diabetes. These tend to be the bread and butter of family medicine, so managing them takes diligence, attention to detail, and frequent follow-up. I think family medicine is an incredibly important specialty because if patients are managed well outside of the hospital, they may never need to set foot in the hospital at all. This takes cooperation and effort from the patient as well, but the focus on prevention and wellness is so important.
Both family medicine and internal medicine (fellowships not included) are considered primary care specialties and are incredibly high in demand because of their focus on prevention and treatment of very common conditions. As I’ve mentioned before, I probably would’ve done one of these specialties had I not fallen in love with OB/GYN because of how diverse their scope of practice is. Though I’m happy with my choice, I have incredible respect for these people who help make my job as a future OB easier!