Career Development: Medical Specialties: Internal Medicine

Formal training of physicians is divided into three phases: premedical education, medical school, and graduate medical education. In internal medicine, the requisite part of graduate medical education is a three-year residency program. Following successful completion of residency training, the graduate may begin practice as a general internist or may choose to train further in one of the subspecialties of internal medicine. At the completion of residency training, the American Board of Internal Medicine (ABIM) offers a special test that certifies expertise in internal medicine. Although not required, passing this test is beneficial to an internal medicine career, and most graduates take this examination to become “board certified” in medicine. A similar examination is offered by ABIM following completion of a subspecialty fellowship.

Specialty training is called fellowship training, and usually adds two to three years of training beyond the residency training. Generally, applications for fellowship training are submitted during the second year of internal medicine residency training. The following is a list of subspecialties that require preliminary training in internal medicine:

• Allergy and Immunology, Cardiovascular Disease, Endocrinology, Diabetes and Metabolism, Gastroenterology, Hematology, Infectious Disease, Medical Oncology, Nephrology, Rheumatology and Pulmonary Disease

Certificates of added qualifications recognize special expertise in areas of internal medicine. To receive a certificate of added qualification generally requires an additional two years of training after residency or fellowship. These areas are: Adolescent Medicine, Clinical Cardiac Electrophysiology, Clinical and Laboratory Immunology, Critical Care Medicine, Geriatric Medicine, Interventional Cardiology, and Sports Medicine.

Training in Combined Programs
The American Board of Internal Medicine (ABIM ) also offers Internal Medicine board certification for the respective portion of the following combined programs:
Dermatology/Internal Medicine
Emergency Medicine/Internal Medicine
Emergency Medicine/Internal Medicine/Critical Care Medicine
Family Practice/Internal Medicine
Internal Medicine/Neurology
Internal Medicine/Nuclear Medicine
Internal Medicine/Pediatrics
Internal Medicine/Physical Medicine and Rehabilitation
Internal Medicine/Preventive Medicine
Internal Medicine/Psychiatry
Career Counseling
See “Careers in Internal Medicine: Imagine the Possibilities” booklet which is available free in the Office of Student Programs (OSP) or the Internal Medicine Department.

For information about specific residency and subspecialty fellowship programs, contact the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) Student, Resident, Fellow Website at http://www.acponline.org/srf/index.html. ACP-ASIM is the nation’s largest specialty medical society and is composed of more than 115,00 board-certified physicians, residents, and medical students. Founded in 1915, its mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.

Training outside the traditional core disciplines of internal medicine
After completing an internal medicine residency, many physicians go on to further training. Many enter the traditional subspecialty areas of Allergy and Immunology, Cardiovascular Disease, Endocrinology, Diabetes and Metabolism, Gastroenterology, Hematology, Infectious Disease, Medical Oncology, Nephrology, Rheumatology and Pulmonary Disease. Some physicians, however, continue their training outside the traditional core disciplines of internal medicine. These related areas (among them addiction medicine, adolescent medicine, clinical decision making, clinical nutrition, clinical pharmacology and therapeutics, critical care medicine, geriatric medicine, gerontology, medical informatics, occupational and environmental medicine, physical medicine and rehabilitation, preventive medicine and public health, primary care sports medicine, and tropical medicine) have a significant impact on the practice of internal medicine and offer challenging and dynamic career opportunities in patient care, teaching and research. Some disciplines, such as physical medicine and rehabilitation and public health, offer opportunities to practice exclusively within the specialty. Advanced training in other disciplines, such as adolescent medicine and tropical medicine, can enhance general internal medicine practice. Expertise in many of these specialty areas is likely to become increasingly important as the health care marketplace moves toward a system of managed care. See www.acponline.org/srf/scp.htm for more information.

Residency training information:

• Duration of training (number of years): Three years
• Number of programs nationally: 293 programs
• Number of entering residency positions per year: 5,629
• Types of fellowships or subspecialties: All medicine subspecialties
• Type of Match: Regular
• Overall competitiveness: Very Competitive (difficult match for "average" student) in "salt water" cities, Moderately Competitive (good chance of matching for average student) in large cities and Not Very Competitive (average student very likely to match) for most other programs

Primary faculty contact person for M1 and M2 students:

• Dr. Robert Lash (rwlash@umich.edu)
  Phone: 936-8279

Medical Student Club or Interest Group:

• Contact: Mary Edwards (edwardsm@umich.edu)

Shadowing or mentoring experiences available to M1 or M2 students:

• None

Resources:

• ACP - ASIM (http://www.acponline.org)

Suggested journals, books, or other information for interested students:

• Annals on Internal Medicine
• New England Journal of Medicine