Internists

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Internists (in US elsewhere, especially in Commonwealth nations, such specialists are often called Physicians.) are specialists in Internal Medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases. Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized and would see any complex nonsurgical problem; this style of practice has become much less common.

In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys.

Internists have a lengthy clinical and scientific training in their areas of medical interest and have special expertise in the use of prescription drugs or other medical therapies (as opposed to surgery). While the name "Internal Medicine" may suggest that internists only treat problems of internal organs, this is not the case. Internists are trained to treat patients as whole people, not as mere organ systems.

Definition of an internist[]

Internists are trained to diagnose severe, chronic illnesses and situations where several different illnesses may strike at the same time. They also help patients understand preventive medicines, men's and women's health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. Most older adults in the United States see internists as their primary medical practitioners.

Education and training of internists[]

Main article: Medical education

The training and career pathways for internists vary considerably across the world.

First, they must receive the "entry-level" education required of any medical practitioner in the relevant jurisdiction. The entry-level for medical education programs are tertiary-level courses, undertaken at a medical school attached to a university.

Programs that require previous undergraduate education are usually four or five years in length. Hence, gaining a basic medical education may typically take eight years, depending on jurisdiction and university. Following completion of entry-level training, newly graduated medical practitioners are often required to undertake a period of supervised practice before the licensure, or registration, is granted, typically one or two years. This period may be referred to as, "internship" or "conditional registration." Then, internists require specialist training in internal medicine or one of its' subspecialities. In North America, this postgraduate training is often referred to as residency training; in Commonwealth countries, such trainees are often called registrars.

Training in medical specialties typically takes from three- to 10 years, and sometimes more, depending on specialty and jurisdiction. A medical practitioner who completes specialist training in internal medicine (or in one of its subspecialties) is an internist, or a medical specialist in the older, narrower sense. In some jurisdictions, training in internal medicine is begun immediately following completion of entry-level training, or even before. In other jurisdictions, a medical specialist must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, an internist typically takes 12 or more years after commencing basic medical training — five to eight years at university to obtain a basic medical qualification and up to another six years to become a medical specialist. Internal Medicine subspecialists may also practice general internal medicine, but a particular subspecialty, i.e., cardiology or pulmonology licensure is granted after completing a fellowship (Additional training of 2-3 years).

Subspecialties of internal medicine[]

In the United States, there are two organizations responsible for certification of subspecialists within the field, the American Board of Internal Medicine, and the American Osteopathic Board of Internal Medicine.

The following are the subspecialties recognized by the American Board of Internal Medicine.[1]

Cardiology, dealing with disorders of the heart and blood vessels
Endocrinology, dealing with disorders of the endocrine system and its specific secretions called hormones
Gastroenterology, concerned with the field of digestive diseases
Hematology, concerned with blood, the blood-forming organs and its disorders
Infectious disease, concerned with disease caused by a biological agent such as by a virus, bacterium or parasite
Medical oncology, dealing with the study and treatment of cancer
Nephrology, dealing with the study of the function and diseases of the kidney
Pulmonology, dealing with diseases of the lungs and the respiratory tract
Rheumatology, devoted to the diagnosis and therapy of rheumatic diseases.
Adolescent medicine
Clinical cardiac electrophysiology
Critical care medicine
Geriatric medicine
Interventional cardiology
Sleep medicine
Sports medicine
Transplant hepatology

Internists may also specialize in "allergy" and "immunology." The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.

The American College of Osteopathic Internists recognizes the following subspecialties.[2]

In addition to the above, in Canada, General Internal Medicine itself is considered a subspecialty. This usually involves 1-2 years of additional fellowship training above and beyond the 3-year core internal medicine training shared by all other subspecialists. This differs significantly from the system in the U.S. Canadian General Internal Medicine specialists frequently have procedural (ie: bronchoscopy, echocardiography, colonoscopy etc...) or research training (ie: epidemiology, public administration, medical teaching, etc...) incoporated into their 5-year postgraduate course.

Medical diagnosis and treatment[]

Medicine is mainly focused on the art of diagnosis and treatment with medication, but many subspecialties administer surgical treatment:

Cardiology: angioplasty, cardioversion, cardiac ablation, intra-aortic balloon pump
Gastroenterology: endoscopy and ERCP
Pulmonology: Bronchoscopy
Nephrology: dialysis
Critical care medicine: mechanical ventilation

References & Bibliography[]

Key texts[]

Books[]

Papers[]

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Allyn, R. (1979). A library for internists III: recommended by the American College of Physicians. Annals of internal medicine, 90(3), 446-448.
Allyn, R. (1982). A library for internists IV. Recommended by the American College of Physicians. Annals of internal medicine, 96(3), 385-401.
Allyn, R., & Stearns, N. S. (1973). A library for Internists. Recommended by the American College of Physicians. Annals of internal medicine, 79(2), 293-322.
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Internal Medicine Society of Australia and New Zealand
Western US Internal Medicine Positions
The American Board of Internal Medicine - The largest certifying board for internists and related subspecialists in the USA
Canadian Society of Internal Medicine
The American College of Osteopathic Internists
Henry Ford Hospital Internal Medicine
American College of Physicians - The Leading Professional Organization for Internal Medicine

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Internists

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Definition of an internist[]

Education and training of internists[]

Subspecialties of internal medicine[]

Medical diagnosis and treatment[]

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