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Internal Medicine vs. Family Medicine: Diagnosing

There are many primary care specialties, so choosing one can be difficult for future doctors. Distinguishing between internal medicine versus family medicine, both often called “general practice doctors,” can be particularly tricky.

We spoke with a handful of physicians to help clarify what differentiates these two primary care specialties and created this side-by-side comparison.

INTERNAL MEDICINE VS. FAMILY MEDICINE: PATIENT DIFFERENCES

One primary difference between internal medicine and family medicine can be found within their patient demographics. This is one of the clearest ways the two areas of medicine differ.

“Internal medicine focuses exclusively on adult medicine, while family medicine typically sees all the members of a family—children as well as adults,” explains Dr. Linda Girgis, a family physician and graduate of St. George’s University (SGU).

Where physicians care for their patients is another way in which these two primary care specialties differ.

“Many internists end up working in hospitals, while most family medicine doctors work in outpatient settings,” explains family physician Dr. Lisa Doggett.

INTERNAL MEDICINE VS. FAMILY MEDICINE: SIMILARITIES AND DIFFERENCES IN DUTIES

Another key to understanding internal medicine versus family medicine is evaluating the specific work they typically do. First, it can be helpful to learn about some of the responsibilities that both internists and family physicians share. Dr. Bernard Remakus, an internist and author, outlines a few of the procedures that physicians in either field may perform:

  • Conducting minor office procedures, such as draining abscesses, removing foreign bodies from the skin and eyes, repairing lacerations, and performing uncomplicated fracture care
  • Executing diagnostic procedures, such as sigmoidoscopy, proctoscopy, and minor gynecological testing
  • Administering nerve blocks, joint injections, and trigger point injections

“Most primary care physicians, however, perform only a few of these procedures on a routine basis or choose to perform none of these procedures,” Dr. Remakus adds.

As for how duties differ, family physicians tend to focus on preventive medicine in an outpatient setting. Internists, conversely, work more with inpatients, though they can work in clinics as well.

“While internists typically diagnose and treat medical problems of greater complexity than family practitioners in both the office and hospital settings, family practitioners typically provide more ‘well-patient’ services in the office setting and don’t treat as many hospitalized patients,” Dr. Remakus explains.

He stresses that this is a generalization as family practitioners do also treat some seriously ill patients and patients with complex problems. On the other hand, internists can also treat patients who are essentially healthy.

“Preventive medicine is a big part of family medicine.”

Another difference between these two specialties is family medicine’s focus on avoiding health issues further down the road, which may or may not involve collaborating with other physicians. “Preventive medicine is a big part of family medicine,” Dr. Girgis says. “Some family doctors are quicker to refer patients to specialists if needed, while some like to do as much as they can themselves.”

INTERNAL MEDICINE VS. FAMILY MEDICINE: POSTGRADUATE TRAINING

The training required to practice is another difference between family medicine and internal medicine. After completing medical school, aspiring physicians in both fields begin residency. However, the nature of their postgraduate training differs, particularly when it comes to the setting.

“Internal medicine residents take care of hospitalized patients for three years, with ample training in emergency medicine, critical care, and medical sub-specialty care,” Dr. Remakus explains. “Family practice residents usually receive approximately one year of that same inpatient training and then split the remaining two years of training among pediatrics, OB/GYN, and other outpatient medical disciplines.” He also adds that internal medicine residents typically have a more rigorous call schedule, though this isn’t always the case.

While these are the general differences between the two, keep in mind that a resident physician’s experience will depend on a number of factors.

“Residency programs for both internal medicine and family medicine vary somewhat depending on their location, and the scope of training may be different in rural versus urban settings and in different regions of the country,” Dr. Doggett points out.

Lastly, the ability to further specialize lends itself more to internal medicine than it does family medicine, according to Dr. Girgis. “Internists can extend their training into a whole host of specialties, while the choices for family physicians are limited,” she says.

INTERNAL MEDICINE VS. FAMILY MEDICINE: COMPARING SKILL SETS

Family physicians are trained to diagnose and treat an entire spectrum of medical issues for patients of all ages. Internists develop a comprehensive and deep expertise of common adult health conditions, according to a comparison of internal medicine and family medicine from the American College of Physicians.

This allows them to diagnose a wide variety of diseases that commonly affect adults and to handle complicated cases where multiple conditions affect a single patient.

“Family physicians have a broader scope,” Dr. Doggett explains, “and usually feel comfortable caring for people of all ages and types of problems.” She adds that in her experience, family physicians do more outpatient procedures like skin biopsies, IUD placement, and joint injections. They also tend to have more training in women’s health and pediatrics as well as certain specialties, such as orthopedics.

Both types of physicians encounter a variety of conditions in different types of patients. The US Department of Labor lists critical-thinking skills as crucial for both internists and family physicians, which makes sense given both providers must assess a completely new set of symptoms with each patient. Internists tend to face more serious ailments, so the ability to work under pressure is also imperative. Family physicians must also possess strong relational skills as they often form bonds with patients and their families over time.

WEIGHING YOUR OPTIONS

When choosing internal medicine versus family medicine, it really comes down to personal preferences. But before any aspiring physician can select a specialty, it’s important to focus on attending a medical school that can provide the foundational education students need to be successful.

Learn more about how to compare options in our article, “How to Choose a Medical School: 9 Things to Evaluate Before Accepting.”

*This article was originally published in May 2018. It has since been updated to reflect information relevant to 2021.

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