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Imagine

The Possibilities An Overview of Careers in Internal AS6100_ImaginePossibilities 8/31/07 2:11 PM Page 2

Imagine the Possibilities Careers in Internal Medicine

During , students are Internal medicine is a specialty that “Internal medicine is always challenging because there is so exposed to a variety of new and relies on the basic sciences and a much information and knowledge exciting areas of medicine—and diverse breadth of knowledge to form we need to know in order to do sometime during those years they the foundation for a successful career our jobs. We look at a bunch of will be expected to choose which in a variety of fields. General internists clues and try to make a area to pursue—their specialty. are crucial in filling a vital need in our diagnosis from the clues. It’s never boring, because every system, serving as the patient is different.” This brochure is intended to provide primary or principal providers of care James McCallum, MD medical students, primarily those in in outpatient (ambulatory) and/or General Internal Medicine South their first or second year, with a high- inpatient () settings. Carolina level overview of internal medicine. Read and discover what an internist Internists can also subspecialize in does, how internal medicine differs such fields as , from other specialties, and the many , , professional opportunities available , infectious disease, and to who select the exciting many others, after completing training field of internal medicine as their in internal medicine. Subspecialists career choice. typically continue to care for patients with serious or complex chronic diseases in their particular , and they also may perform specialized procedures. AS6100_ImaginePossibilities 8/31/07 2:11 PM Page 3

General Internist and Subspecialists Careers in Internal Medicine

An internist is a specialist in internal • General internists handle the broad and comprehensive spectrum of medicine, the largest and most popular of illnesses that affect adults, and are recognized as experts in diagnosis, in all the medical specialties. Internists treatment of chronic illness, and in health promotion and disease diagnose and treat a wide variety of prevention—they are not limited to one type of medical problem or organ medical problems in adults (adolescents system. General internists often care for patients over the duration of their through seniors), and have particular adult lives, providing the an opportunity to establish long and expertise in solving puzzling diagnostic rewarding personal relationships with their patients.

problems and managing complex and Most general internists provide care for their patients in an ambulatory complicated diseases. There are two (office or outpatient) setting, and in an inpatient setting when their patients broad categories of internists — general become hospitalized. Still other general internists choose to care for internists and subspecialists. patients either exclusively in the inpatient setting (often called hospitalists) or exclusively in an outpatient setting.

• Subspecialists in internal medicine have chosen to receive additional, more in-depth training and board certification in the diagnosis and management of diseases of a specific type (e.g., infectious diseases) or diseases affecting a single organ system (e.g., the cardiovascular system). Although subspecialists often see patients for a limited basis in consultation from a general internist or another medical specialist, they too may develop long and rewarding relationships with patients who have ongoing or chronic illnesses that demand continued care.

“Internal medicine is the essence of medicine and the epitome of why one goes to medical school, with its emphasis on basic science, problem- solving aptitude, communication skills, and becoming someone’s doctor.” Andrew R. Hoellein, MD General Internal Medicine Kentucky AS6100_ImaginePossibilities 8/31/07 2:11 PM Page 4

Types of careers Careers in Internal Medicine

What types of careers are available • Medical research, ranging from who wish to impact populations of for internists? bench research (i.e. basic science) people rather than provide direct to applied translational or clinical patient care may pursue a career For most general internists and research. Again, these research working in such settings as public subspecialists, caring for patients is responsibilities can be a primary health departments, their primary daily activity. component of an internist’s schools, or a variety of governmental Nonetheless, there are many other professional activities, or can or other nonprofit organizations. activities available in the field of complement other activities in internal medicine that may suit the What types of services do patient care and/or teaching. If needs of physicians who have internists provide? interested, internists can pursue additional interests. These other • provide personal, comprehensive, research opportunities not only in a activities include: continuing care to adults traditional academic setting, but • treat acute and chronic • Teaching medical students, also through employment in industry medical conditions residents, and/or subspecialty (such as with a pharmaceutical or • care for patients in the hospital fellows. Teaching responsibilities biotechnology company), in a and/or the office can be an important component of national research institution (such as • arrange consultations with other a career that is based in a teaching the National Institutes of Health), or physicians as appropriate hospital or medical school setting. even in a practice setting (through • conduct preoperative evaluations Internists make up the largest participation in large, cooperative for surgical colleagues proportion of medical school faculty clinical studies). • treat episodic, urgent, and of any clinical field. Physicians who • Administration, meaning activities emergent conditions practice in private settings may also related to managing the business • provide comprehensive care provide teaching on a voluntary side of health care. Work in this in women’s health basis while still providing direct area provides opportunities for • perform a variety of procedures patient care. As medical students developing managerial and know from their own school leadership skills. No matter the experiences, internal medicine setting, there is a need for specialists and subspecialists not administrative expertise. Therefore, only provide most clinical education, internists who wish to develop their “Working in internal medicine gives but also the majority of preclinical management skills may pursue you the most options and frankly, education in organ system administrative activities in a variety the most interesting options. You physiology and pathophysiology. of settings, including a multi- have much more flexibility because physician practice or hospital, an your skills are transferable. It academic medical center or medical provides you with an enviable school, or a variety of other health quality of life, more exposure to care-related settings. a wide range of diseases and disorders, and camaraderie with a • Health care delivery and public broader range of people.” health, or activities related to the Nirav Shah, MD overall health and wellness of a General Internal Medicine community or population. Internists New York AS6100_ImaginePossibilities 8/31/07 2:11 PM Page 5

Becoming an internist Careers in Internal Medicine

Becoming an internist Critical Care—For developing skills in Combined programs, such handling the unique activities and as medicine-, medicine- Following successful completion of a issues related to care for patients who , or medicine-emergency four-year, accredited medical school are hospitalized in intensive care, medicine, are attractive to individuals curriculum, those interested in cardiac care, and respiratory care with a strong interest in a career becoming an internist will enter a units. Provides needed experience and embracing more than one specialty. training program called “residency.” skills in caring for seriously ill patients. Selecting a combined residency will Residency in internal medicine usually add additional time to training, and will lasts three years, and residents work in Medical —For not be available at all training . a variety of settings, including developing skills and understanding university hospitals, community about the specific competencies teaching hospitals, hospital outpatient needed for each of the major internal clinics, and community physicians’ medicine subspecialty categories. offices. Residents in internal medicine —For “Deciding on internal medicine is assume progressive responsibility as developing skills in the emergency not limiting, but instead opens a they acquire various skills in treating care of patients and the necessary wide array of possibilities. It is hospitalized patients (handling acute judgment to determine which patients impossible not to find a niche or illness, intensive care, and cardiac require hospitalization. area within internal medicine that care) and gain competency in you will find challenging and . Procedures—For developing skills to satisfying enough to make it your perform procedures such as lumbar life's work. From internal Residency training provides puncture, joint aspiration, central medicine, people have gone on to experiences in: venous line placement, paracentesis, be clinicians, researchers, public and thoracentesis. Ambulatory Patient Care—For officials, educators, ethicists, developing skills in handling the Residency training in internal writers, etc.” typical types of illnesses and issues medicine provides students with a R. Dobbin Chow, MD, FACP that internists confront daily in their variety of educational opportunities General Internal Medicine practice. Practice settings include after completion of a “core Maryland hospital-based general medicine curriculum” that includes inpatient clinics, general internists’ offices, and and outpatient general medicine, subspecialty clinics or practices. subspecialty medicine, critical care medicine, geriatric medicine, and Hospitalized Patient Care—For emergency medicine. Elective developing skills in handling the types rotations can include subspecialty of illnesses and clinical problems that rotations, primary care rotations (such internists confront in hospital settings. as in , , palliative Builds experience following patients care, office gynecology, and office through a hospitalization and during orthopedics), and international the transition related to follow-up care rotations. At least one third of residency after discharge. training will occur in an ambulatory care setting. AS6100_ImaginePossibilities 8/31/07 2:11 PM Page 6

Subspecialty Careers in Internal Medicine

area with a plan to focus their future 2Hematology is usually combined with activities on diseases of one type of for a combined - organ system. Subspecialty training, oncology fellowship. called fellowship, usually adds two 3Pulmonary disease is usually to three years after medical residency. combined with critical care for a Applications for fellowship are combined pulmonary disease and \ generally submitted during the second critical care fellowship. year of the internal medicine residency. Subspecialties of internal Further specialization after medicine include: subsubspecialty fellowship training is also available through one-year • and What is an internal 3 additional fellowships in: •Cardiology •Critical Care medicine subspecialty? •Gastroenterology • Clinical Cardiac Electrophysiology 1 2 • Interventional Cardiology Once general internal medicine •Hematology • Infectious 2 • Transplant residency training has been completed, Disease •Nephrology •Oncology Pulmonary Disease3 •Rheumatology a physician may begin to practice “Internists are needed everywhere– Sleep Medicine1 internal medicine. Alternatively, many cities, suburbs, and rural areas.” physicians wish to obtain further 1One year fellowship after three years subspecialty training in a more limited Jacqueline W. Fincher, MD, FACP of residency. General Internal Medicine Georgia

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Becoming an internist Careers in Internal Medicine

What professional arrangements are A Final Note might be turned up, or not, as one’s available for an internist? Dr. Marsh is a distinguished professor, circumstances dictate. Internists can either be in private cardiologist, and educator whose Another route might be to pursue practice or employed by a group, career spans more than 30 years. training as a general internal medicine organization, or hospital. They may Below he explains how internal hospitalist. One might work intensively practice alone (solo practice), as a medicine provides physicians with in the hospital in four 12-hour shifts member of a single specialty or multi- many different opportunities for a per week, sometimes nights or specialty group, as a hospitalist, or as successful and rewarding career that weekends. But when the shift is over, an academician in a medical school. balances work with personal fulfillment. there are no on-call responsibilities, and there is considerable personal time. Some will work in research for an For a physician, a rewarding life academic medical center, government, In future years, this role could be requires both professional and modulated as appropriate. or industry. Some will hold personal fulfillment, and as one administrative positions in industry or completes medical school, projecting The traditional subspecialty route is government, or in public health how one can achieve those goals over also possible, with two to four years settings or academic institutions. the next 50 years or so is daunting. of additional subspecialty training after internal medicine residency. The So—What is an internist? During years three and four of medical school often much is in flux—personal professional aspect of the additional An internist is what most patients view relationships, perhaps marriage, starting training years may be moderate, or as “a real doctor,” someone who is and raising a family, where in the world intense, depending on the specialty there for them to prevent disease, who one will live—not small questions. This and program. One might then work is highly skilled and dedicated to is combined with what kind of doctor 40-50 hours per week in some diagnosing and treating disease, and to be and what kind of lifestyle to seek specialties or 75 hours per week in who will stay with them and see them in the near and distant term. some intense and financially rewarding through an illness. subspecialties like interventional A career in internal medicine opens cardiology or gastroenterology. So—Why be an internist? many doors, and closes very few. As our years increase, in almost all Many internists feel they have the Moreover, internal medicine and its internal medicine specialties there is most intellectually rewarding and subspecialties often afford the chance the opportunity to “rebalance” life and personally satisfying job in the world. to make adjustments to the balance of work, and to keep working in the They can touch one life at a time, and life and work over time. What is just specialty that is one’s passion. In make it better, or touch many lives right at the age of 30 may need choosing internal medicine, one and improve health for many. adjustment at the age of 50. The flexibility afforded in internal medicine decides in the fourth year of medical is often greater than in many other school, “who will I be,” but can keep specialties. For example, one can redefining “how will I be” as one’s “What I love about internal medicine pursue general internal medicine career progresses. is the opportunity to make an training and head toward an office- impact. You really get to educate based practice in a large group or your patients and make a difference HMO with little or no night and in someone’s life.” weekend calls—an almost 8–5 job. This might be ideal for early stages of Pamela Zee, MD James D. Marsh, MD, FACP General Internal Medicine family development outside of work. New Jersey As years go by, the work intensity AS6100_ImaginePossibilities 8/31/072:11PMPage8 Self-Assessment Program Web site. ACP OnlinefeaturesaMedicalKnowledge “members only”sectionsof ACP Online,theCollege’s student e-newsletter. They alsohave accesstospecial Medical StudentMembersreceive allergy andimmunology, andgeriatrics. pulmonary disease,criticalcare,infectiousdiseases, endocrinology, hematology, oncology, rheumatology, including cardiology, gastroenterology, nephrology, general internalmedicineandrelatedsubspecialties, including medicalstudents.Membersarephysicians in ACP membershipincludesmorethan120,000members, of medicine. excellence andprofessionalisminthepractice AbouttheAlliance for InternalMedicine Academic the qualityandeffectiveness ofhealthcareby fostering largest medicalspecialtysociety. Itsmissionistoenhance The American CollegeofPhysicians (ACP) isthenation's CollegeAbout theAmerican ofPhysicians and much more. questions, anonlinemedicalstudentmentoringprogram,

BUSINESS REPLY MAIL FIRST-CLASS MAIL PERMIT NO 1036 PHILADELPHIA PA POSTAGE WILL BE PAID BY ADDRESSEE ® (MKSAP Member Records Section American College of Physicians ® IMpact 190 N Independence Mall West ) Quiz,samplecase Philadelphia, PA 19106-9124 , ACP’smedical their divisions. faculty andstaffindepartmentsofinternalmedicine and academicbusinessadministrators aswellother residency, andfellowship program directors;division chiefs; represents departmentchairs andchiefs; clerkship, Internal Medicine. Through theseorganizations, AAIM Directors inInternalMedicine,andthe Administrators of the Association ofSpecialtyProfessors,theClerkship the Association ofProgram DirectorsinInternalMedicine, AAIM consistsofthe Association ofProfessorsMedicine, States andCanada. at medicalschools andteaching hospitalsintheUnited organizations representingdepartmentsofinternalmedicine consortium offive academicallyfocusedspecialty The Alliance for Academic InternalMedicine(AAIM)isthe