For patients and students alike, one of the most misunderstood and perplexing doctor differentiations is that of a family medicine care physician and an internal medicine physician. Both fall under the primary care niche of medicine, but they each stem from two very different patient care focuses, often work in different environments, and involve very different training.
As a primary care medical student, you’ve already chosen a path to diagnose and treat an array of ailments and build long-lasting patient relationships. Now, it’s time to fine-tune your choice by deciding between internal medicine vs family medicine. The particular field you choose largely dictates the how, who, where, and what of your practice. So, let’s breakdown the differences between an internist and family doctor to help you with the due diligence of planning your career path.
How It All Began: Internal Medicine
Many internal medicine and family medicine students go through training without ever learning the origins and history of their speciality. How can one go forward in innovation and development within their field without first understanding where it all derived and the forces that shaped where it’s at today?
Internal medicine didn’t have a formal certifying body until 1936, which is when the American Board of Internal Medicine was established. Thomas Sydenham initiated the notion of internal medicine as a scientific process back in the 17th century. Heretofore, physicians worked from the theory that disease causation was an imbalance of the humours. Sydenham introduced the possibility of a different culprit – a variety of distinct diseases. His work was the framework of today’s disease classification system, which is based on symptoms.
William Osler, often called the father of internal medicine, was able to
differentiate internal medicine from all other medical disciplines by applying a scientific perspective to the methodologies used by his predecessors and peers. Many of the concepts continue to be used in modern medicine, such as: “A good physician treats the disease; the great physician treats the patient who has the disease.”
In the beginning, the internal medicine doctor had few tools beyond diagnosis and prognosis. A surgeon could simply remove the diseased body part, but the internist had no effective solutions to offer. The 20th century’s innovative disease-specific therapies and medications ushered change to the niche. The internal medicine doctor became as effective in curing as they were in diagnosing and offering palliative care.
Specialty branches began to break off – oncologists, cardiologists, orthopedics, etc, and the internist became the speciality of doctors dealing with all problems of the adult patient.
How It All Began: Family Medicine
In the 1800s, healthcare was largely unstructured. As there were no organized training or official schools of medicine, apprenticeship kept medicine alive from generation to generation. It was a far cry from today’s many educational resources for formal training and systems to ensure quality of ethics and care.
The doctor would travel to attend to the entire family’s medical needs in-house or from a central location. From delivering babies to attending to acute, traumatic, infectious, and chronic ailments, the family doctor was the sole source of ‘professional’ healthcare. Many were astounding clinicians, but, in being unregulated and unorganized, many did harm.
To organize, purify, and regulate medical education and practice, the AMA was established in 1846. JAMA followed in 1882. The Flexner Report in 1910 ushered in the age of specialities and subspecialties and their official boards. The first board was in 1917 for ophthalmology. As schools became more standardized and devoted to particular career paths, granular specialties flourished and the general practitioner was often seen as ‘lesser-than.’
Between 1920 and 1960, general practitioners were in severe shortage, and there was little continuity of care. The Millis Report, The Folsom Report and the Willard Report set the stage for the revamp of the general physician. The cumulative result was the call for a doctor to focus on the whole body, whole health, and whole family – family medicine. By 1969, the specialty American Boards approved Family Practice as a broadly encompassing speciality.
Unlike other fields, family medicine does not segment care by age, organ, treatment type, or any other caveat. As such, the family medicine doctor is at the epicenter of wholistic care.
Internal Medicine vs. Family Medicine: Overlaps And Differentiations
As you can see from above, one of the key differences between an internal medicine doctor and a family medicine doctor is who they serve. An internist almost exclusively serves the adult patient population. Meanwhile, the family medicine doctor attends to patients of all ages – seniors, adults, teens, toddlers, and even infants – to offer medical care to the entire family.
The where of practice is also a common distinguishing factor between internal medicine vs family medicine. While some internists choose to offer a private practice in a clinical setting, many work in hospitals as inpatient specialists. The family medicine doctor most commonly works in clinics providing outpatient care.
The two disciplines often coordinate services. An adult patient, for example, may be seen by his/her family medicine physician for diagnosis, management and treatment of an acute infectious disease. Complications may arise that require more extensive, inpatient treatment at a hospital. The patient then falls under the care of the hospital’s internal medicine doctor. Once inpatient services are no longer necessary, the internal medicine doctor releases the patient back into the care of their family medicine doctor.
There can be quite a bit of overlapping in day-to-day duties between internal medicine vs family medicine. Both diagnose, treat, and manage an array of medical conditions. They do so in regard to their specific training, knowledge, comfort levels, and preferences. Some such duties may include:
- Wellness checks and yearly physicals
- Proactive preventative measures
- Chronic disease management
- Acute ailment management
- Diagnostic and lab procedures
- Administrating injectables – nerve blocks to antibiotics and vaccines.
- Minor invasive procedures, such as foreign object removal from the skin and eyes, stitches, fracture care, and wound care
The main difference is in where such duties are performed. The family medicine doctor is most often in the outpatient clinical setting. An internal medicine doctor may offer some are all services in a split outpatient/inpatient practice, or remain in a single vein of either outpatient or inpatient practice.
As a general rule, the family medicine practitioner often provides more wellness services within the confines of a clinic, which are designed to manage disease before it becomes an applicable diagnosis to a particular patient. Meanwhile, the internal medicine doctor is most often dealing with the complexities of chronic disease and acute disease complications.
Of course, the above is based on the collective. An internal medicine doctor can offer wellness services just as a family medical doctor can deal with serious illness. However, as a whole, the family medicine doctor’s day-to-day is highly focused on educating patients on preventative outpatient measures to achieve wellness and well-being.
Again, both family medicine and internal medicine practitioners are considered “primary care doctors.” The difference is in the patient. The greatest source of confusion between internal medicine and family medicine doctors is in their patients. If an internal medicine doctor so chooses, he/she may get dual training in both internal medicine and pediatrics to see both adults and children and offer wholistic “family care.” Otherwise, an internist only sees adult patients, which is most often the case. As such, the internist specializes in medical conditions of the adult human. Likewise, a family medicine doctor can treat the entire family, or they can serve any select individual.
Due to seeing patients from the entire age spectrum, a family medicine doctor must have a more broad knowledge and training base. In one exam room, a 90-day-old baby may be waiting for a cough check, and a 90-year-old Alzheimer’s disease patient may be in the next room with a possible UTI.
Both disciplines have to decide how far to take their services. While some opt to do as much as they can for a patient before handing them over to a discipline further specializing in their exact disease process or medical issue, others prefer to stick with the basics and refer complex patients to an appropriate speciality.
The training and residences differ for family verses internal medicine. Both complete the required medical school courses. Both complete residencies, but the nature is very different.
The vast majority of internal medicine residencies are based in the hospital setting, and the focus is emergency medicine; critical care; surgery; intensive care; medical sub-speciality care, such as cardiology and gastroenterology; and so forth. They’ll most often do this for all three years.
Meanwhile, the vast majority of family medicine residencies take place in the clinical offices. While one year is usually devoted to the same inpatient care as the internist, the other two years of residency typically come from various outpatient sources, such as pediatrics, internal medicine, obstetrics and gynecology, urology, psychology, radiology, and so forth.
Of course, the specifics of residency in either case often hinge upon the doctor’s geographical location and whether the setting is urban or rural. The direction is always to provide unique skill sets within each discipline. The result is different strengths and weaknesses in caring for particular subsets of patients.
Students considering internal medicine should also be prepared for a more demanding call schedule, especially if all three years of residency are exclusive to the hospital setting. If the family medicine doctor uses two years of residency for outpatient, then their call schedule is likely the least demanding. It’s usually home-based for after-hour calls.
However, students should keep in mind that the nature of family medicine residency doesn’t lend itself to ease in further specializing. Internists can more easily extend their training to an array of specialties by already being in the hospital setting.
The work schedule of internal medicine and family doctors also differ greatly.
With the majority of internal medicine doctors working in hospitals and immediate care facilities, they have varied shift hours when working a floor position. Some internal doctors specialize in consulting, whereby they’re on-call for a hospital, long-term care facility, or rehab facility to solve complex diagnostic situations or cases where multiple adult pathologies are impacting a patient. Some also choose to operate private practices that coordinate with a hospital for outpatient/inpatient variations of care. In any case, they typically keep consistently long hours.
The family doctor is most often found in a clinical setting with set hours of operation. An influx of new and existing patients schedule appointments during those hours, and the practice’s doctors rotate taking at-home call cycles for after-hours emergencies. Some clinics also rotate doctors through after-hour clinics that offer patients access to a doctor on a first come, first serve basis. The work schedule for the family medical doctor is generally shorter and more organized than that of an internal medicine doctor.
Depth Verses Width
The best way to distinguish between family medicine doctors and internal medicine doctors is width verses depth in primary care.
Through education, training, and residency internists are able to develop a deep expertise within adult medicine. They’re at the center of scientific demand for the most comprehensive adult health diagnostic tools, therapies, and treatments. Multiple and complex disease management is streamlined by expertise understanding in the interactions of each upon the adult human body. Depth.
The family doctor offers a broader, multi-directional knowledge base that’s applied to patients of all ages and conditions. Their abilities encompass more types of problems from both the obscure to common, and they’re trained more diversely to cover a broader array of subtypes, such as pediatric and teen to male and female health. Width.
Internal Medicine vs. Family Medicine: What’s Right For You?
As you can see, both internal medicine and family medicine doctors cover a lot of ground. While the internist will need to work well with expedient pressure, and the family doctor will need an empathetical bedside manner to establish trust and bonding, critical-thinking skills are a must for both.
When it comes to selecting a primary care speciality, allow your call of duty and personal preferences to best guide you. Where, to who, and how do you feel you’re most suited to practice internal medicine or family medicine?
The above comparison has hopefully helped you answer such vital questions and feel confident in taking the next step in your medical career.
Now, it’s time to find the right school and internships to get you started in your internal medicine or family medicine career. Contact us today for expert admissions consulting and/or to discover how a healthcare internship can help you decide what your future will look like in the medical field.