Subspecialties for internal medicine residents

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Gap medics students with a doctor in a Tanzanian hospital. If you are starting a residency in internal medicine after graduating from medical school, you can choose to focus on general internal medicine or choose a subspecialty. You don’t have to select your subspecialty right out of the gate, but it is never too early to learn what options are available in order to determine what subspecialty is the right fit.

First steps

Before you start working towards a subspecialty, you will need to complete an internal medicine residency. Internal medicine doctors are specialists who diagnose and treat a variety of diseases and illnesses that affect adults. Sometimes internal medicine is referred to as general medicine, possibly because internists treat many types of illnesses and conditions.

After earning a four-year undergraduate degree and attending medical school for four years, internal medicine specialists move into their residency. Postgraduate training for internists includes a one-year internship and three years as an internal medicine resident. After finishing residency, physicians can take the written and oral exam in order to become board certified in internal medicine.

Choosing an internal medicine subspecialty

For those who are interested in working in additional areas of medicine, more training is required. Internal medicine doctors have several options to further their expertise and focus on a subspecialty. When choosing your subspecialty, there are many things to take into consideration.

Of course, you want to consider your interests and what clinical rotations you enjoyed the most. It is also helpful to think about the years of additional training you are willing to take on. Some subspecialties require more training than others.

Your personality and strengths and weaknesses are also something to consider when selecting your subspecialty. Choosing an internal medicine subspecialty that matches your personality and talents may increase your chances to excel at your selection.  

Different subspecialties may also have varied salaries. Although money alone is not the best reason to choose a subspecialty, it’s normal to take the salary into consideration.

When you’re choosing your career path, sometimes you need to trust your gut. If you have a pull towards a certain subspecialty and it feels like the right fit, you may want to trust your instincts. Keep in mind that your subspecialty does not need to be set in stone. If you choose a subspecialty and later you realize it’s not what you want to do, it is not impossible to change directions.

Internal medicine subspecialties

According to the American College of Physicians, there are 13 subspecialties of internal medicine. Consider some of the most popular subspecialties of internal medicine listed below.  

Medical oncology: Medical oncologists diagnose and treat people with different types of cancers. The responsibilities of an oncologist may include ordering various tests to confirm a diagnosis and stage of disease. Oncologists also determine a treatment plan, which may include surgery, chemotherapy or radiation therapy. Monitoring patients during the course of their illness, treating side effects and providing patient education is also part of the job of an oncologist.

Doctors interested in becoming board certified in oncology will be required to complete an additional two years of training in a medical oncology fellowship. Some oncologists treat a variety of cancers while others choose to specialize further and focus on a specific type of cancer, such as lung or breast cancer.

Geriatrics: Although all patients are different, older adults may have different concerns and needs than those of younger patients, which is why a geriatrician can be helpful.  Doctors who specialize in geriatrics focus on the health and well-being of older people. They may diagnose and treat a wide variety of conditions that may affect the elderly. Geriatric doctors may treat with patients with conditions like dementia, sensory impairments and strokes.

In order to become a geriatric specialist, internal medicine doctors need to complete a minimum of a one-year geriatric fellowship. Training will include the legal, ethical and psychosocial needs that may be relevant to an elderly population.   

Pulmonary: Pulmonologists treat patients with illnesses or conditions affecting the lungs. Pulmonary doctors treat and diagnose patients with diseases such as chronic obstructive pulmonary disease, asthma and cystic fibrosis. They also treat patients who have infectious diseases affecting the pulmonary system, such as pneumonia and other lung infections.

After becoming board certified in internal medicine, those interested in becoming pulmonologists need to complete a two to three-year post-residency fellowship in pulmonary.  

Gastroenterology: Gastroenterologists treat people with diseases and conditions affecting the digestive tract. Responsibilities may include diagnosing and treating patients with conditions like ulcers, colitis and reflux disease. Although they do not perform surgery, gastroenterologist may perform procedures, such as endoscopies, in order to examine the intestines.

In order to become board certified in gastroenterology, physicians will need to complete a two to three-year fellowship after their internal medicine residency.

Rheumatology: Rheumatologists are focused on treating conditions that affect the bones and joints. Rheumatology doctors need to be mini-detectives. There are over 100 different diseases that can affect the joints and muscles, and many have similar symptoms. Physicians specializing in rheumatology must first identify the cause of a patient’s symptoms and make a diagnosis. Rheumatologists may treat patients with conditions like osteoporosis, gout, and rheumatoid arthritis. Patients with lupus, back pain and fibromyalgia may also visit a rheumatologist.

The path to becoming a rheumatologist starts similarly to other subspecialties of internal medicine. After completing a three-year residency and becoming board certified as an internist, a two to three-year rheumatology fellowship needs to be completed.

Cardiology: Cardiologists diagnose and treat people with various types of heart, circulatory or blood vessel conditions and diseases. Cardiologists may treat diseases like high blood pressure, coronary artery disease and congenital heart defects. They may order and perform a variety of diagnostic tests, such as echocardiograms, exercise stress tests and cardiac catheterization.

Board certification in cardiology involves first completing an internal medicine residency. After becoming an internist, a minimum of a three-year fellowship in cardiology must also be completed. 

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