Internal medicine physicians, or internists, are medical school graduates who've completed a three-year residency in wellness care and the diagnosis and treatment of diseases in adults. General internists often serve as primary-care doctors, but unlike family practitioners, they don't do surgery or practice pediatrics or obstetrics. After the internal medicine residency, many internists take fellowship training to qualify for a sub-specialty, such as oncology.

Residency and Fellowships

A general internist residency is broad-based, including rotations such as general medicine, ambulatory care, cardiology, emergency medicine, neurology, infectious diseases and geriatrics. Residents typically can choose among additional optional rotations such as endocrinology and radiology.

After residency, internists who wish to qualify as sub-specialists must complete an additional one to three years of fellowship. The number of sub-specialties depends on the hospital, but the American College of Physicians lists 13 areas, including adolescent medicine, geriatrics, infectious disease and sports medicine. Additional sub-specialties focus on a particular organ, such as cardiology (heart), nephrology (kidneys) or pulmonology (lungs). Internists can also sub-specialize in allergy and immunology, endocrinology, gastroenterology, hematology, oncology and rheumatology.

What They Do

General internists are superior diagnosticians, or experts at finding what's wrong. They refer patients to other specialists as necessary and coordinate patient care with other physicians. Preventive services, such as physical exams and cancer screenings, are among their many duties.

General internists treat infections, cancer, digestive diseases, reproductive problems, respiratory diseases, heart disease and vascular disease. Internists also treat mental health problems and skin, ear and eye conditions. They use nonsurgical methods of treatment. For example, they prescribe medications and advise patients on lifestyle factors, including diet. Some internists perform certain procedures, such as draining abscesses.

Sub-specialists typically focus on their area of interest, but they also treat the entire patient. For example, a cardiologist treating a heart patient may also provide preventive care, such as flu shots.

Practice Settings

Internists can work in an office practice, a hospital or both. If they focus on office practice, they may care for a patient over her entire adult lifetime, sometimes treating multiple illnesses in one patient.

Internists who limit their practice to the hospital are known as hospitalists. These doctors usually work 12-hour shifts overseeing the care of hospitalized patients and enforcing standards of quality and safety. They also help ensure that hospital resources are allocated for efficiency.

Licensing and Certification

All internal medicine physicians must complete the requirements for state licensing, including passing written and hands-on national exams. Internists can receive optional certification in general internal medicine by passing exams from the American Board of Internal Medicine.

Physicians who have completed a sub-specialty fellowship can pass another exam for sub-specialty certification.

Physicians and Surgeons salary

• Median Annual Salary: $208,000 or more ($100/hour)