Are you considering a career as an internal medicine doctor? With so many specialties to choose from, it’s one of the hardest choices medical students have to make.
This guide will cover the pros and cons of becoming an internal medicine doctor, from the intellectual stimulation and career flexibility to the administrative burdens and extended rounding.
There are so many different factors to account for when choosing a specialty, including how many years you’ll spend in residency, whether or not you want to focus on procedures, the level of patient interaction you’ll have, the setting you’ll practice in, the people you’ll work with, your work-life balance, your compensation, and more.
This series delves into the career of an internal medicine doctor from the perspective of Dr. Kevin Jubbal. He outlines the factors he considered and explains why he ultimately chose not to pursue internal medicine as his specialty. That said, rest assured that this guide presents both sides of the story, outlining the pros and cons of pursuing a career in internal medicine.
For a completely objective and unbiased look at internal medicine, including more details into the daily life of an internal medicine doctor and the exact steps to take to become one, also check out our guide to How to Become an Internal Medicine Doctor (So You Want to Be).
What I liked About Internal Medicine
1 | Extensive Variety
Internal medicine is, quite simply, the heart of medicine—and within internal medicine, there’s tremendous variety in what you’ll encounter. Most of what you learn in medical school remains directly relevant throughout your career, so you won’t feel like all that time spent studying and solving UWorld questions went to waste.
This stands in stark contrast to many other specialties, particularly surgical subspecialties that focus intensively on one part of the body, leading practitioners to overlook much of their broader medical knowledge (as exemplified by the stereotype of orthopedic doctors who are unfamiliar with “body medicine”).
The bread-and-butter cases you’ll see depend heavily on how you practice after internal medicine residency. Whether you pursue a fellowship in gastroenterology, cardiology, endocrinology, or another subspecialty, or work in inpatient or outpatient settings, your daily experiences will span multiple organ systems.
There’s also procedural variety. Although these procedures aren’t nearly as complex or stimulating as surgery, you’ll still work with your hands performing central lines, intubations, paracentesis, and other interventions. Some hospitals even maintain internal medicine proceduralist services to assist with procedures throughout the facility.
2 | Intellectual Stimulation
As an internist, you’re on the front lines as a primary care physician, with patients presenting multiple concerns simultaneously. Each patient presents unique challenges, requiring you to utilize all that you have learned in medical school and residency to treat the person in front of you. Complex cases occasionally make you feel like a detective (or Dr. House) solving medical mysteries, providing the intellectual excitement that initially draws many to medicine.
Internal medicine demands more critical thinking than many other medical areas. Your patient may have comorbidities that preclude specific treatments, and as the attending physician, you must be aware of the patient’s complete medical history to provide appropriate recommendations. This comprehensive approach to patient care requires constant mental engagement and problem-solving skills.
3 | Relationships
In outpatient settings, internal medicine allows you to follow patients longitudinally over extended periods, building meaningful relationships. Developing these connections with patients can be incredibly rewarding and contribute significantly to job satisfaction and a sense of purpose in your work.
This longitudinal care aspect is often lacking in other fields, such as surgical subspecialties and anesthesia, where patient interactions are typically brief and procedure-focused.
3 | Flexibility
After completing your internal medicine residency, numerous career paths open depending on your interests. If you discover a subspecialty you enjoy during residency, you can pursue a two- or three-year fellowship to specialize in fields like cardiology, gastroenterology, oncology, or nephrology.
Alternatively, you can skip fellowship and begin attending practice after only three years of residency, which is the shortest residency length of any specialty.
This flexibility extends to practice settings as well. If you prefer outpatient care, you can establish a primary care clinic, serving as patients’ central healthcare hub for vaccinations, wellness check-ups, chronic disease management, and new concerns that require specialist referrals. Hospital-focused physicians can work as hospitalists, admitting patients with general medical problems and coordinating their overall care while consulting specialists as needed.
Hospitalist work schedules offer unique advantages, with many working “seven days on, seven days off” rotations—essentially earning an average of over $300,000 for working half the year. However, those seven consecutive days involve long, intensive shifts from clock-in to clock-out. Nocturnist positions offer similar work with night hours, typically paying at least 15% more than standard hospitalist roles due to the less desirable schedule.
Academic medicine provides opportunities for research and teaching residents and medical students. If you enjoy comprehensive rounds, you can spend four, five, or even six hours teaching trainees about optimal patient care and evidence-based medicine. Rural medicine provides an opportunity to deliver essential healthcare services to underserved populations, thereby addressing significant healthcare disparities.
What I Didn’t Like About Internal Medicine
1 | Rounding
While the intellectual stimulation and puzzle-solving aspects of internal medicine are appealing, these medical mysteries can sometimes require many hours to resolve. Internal medicine physicians are notorious for their lengthy rounding sessions, particularly in academic settings where teaching medical trainees is a primary emphasis.
While discussing various treatment options for each patient is essential for education, extended rounds can become brutal when your attending decides to initiate hour-long discussions about topics like sodium management after you’ve been rounding since the wee small hours of the morning.
I found rounding extremely tedious, especially when it devolved into prolonged debates about minor treatment differences recommended by various research papers.
This contributed to my preference for surgical specialties, where rounds are brief and focused before moving to the operating room. Surgical goals are more straightforward: admit the patient, provide specific management, perform surgery if indicated, and follow up until discharge. Some surgical specialties avoid admissions entirely, with patients admitted to medicine while surgical teams follow as consultants.
2 | Getting Dumped On
Internal medicine frequently becomes the default admission service for other specialties. Orthopedics, surgery, cardiology, and other departments often work diligently to have hospitalists admit their patients rather than managing admissions themselves.
Admitting patients involves substantial administrative work and supervision responsibilities that subspecialty teams prefer to avoid. They’d rather follow patients as consultants, seeing them once daily or as needed, while preventing discharge planning and administrative tasks.
This dynamic creates significant inefficiencies. You’re admitting patients who may primarily need specialized care, occupying hospital beds that could serve patients with general internal medicine problems while essentially babysitting another service’s patients. More time is spent following these patients, writing notes, and handling administrative tasks when that effort could be better spent serving patients requiring your direct expertise.
You’ll also need to coordinate multiple consultants and their recommendations. Sometimes you’ll spend time tracking down subspecialists to see your patients. When two consultant teams recommend conflicting approaches, rather than resolving differences themselves, you’re caught in the middle managing contradictory recommendations.
3 | Bread & Butter
While complex cases are engaging in any specialty, you must also consider routine cases, as these comprise the majority of daily practice. The bread-and-butter depends on your clinical setting, such as a hospital or a clinic.
Clinic work typically involves less complexity and urgency, focusing on the straightforward management of wellness checks, infections, diabetes, hypertension, and referrals for complex presentations that require specialized care.
While clinic work is essential, I personally find it more tedious and monotonous, with less interesting routine cases. Patients frequently present with chronic disease flare-ups, like COPD exacerbations, or require ongoing management of conditions like hypertension. Recovery often takes extended periods, and you’re typically controlling rather than curing diseases.
This management style requires tremendous patience from providers and can become frustrating. Despite successful motivational interviewing and apparent progress, seeing the same patient six months later with no diabetes management improvement is disheartening. The missing piece is often patient effort in implementing lifestyle changes, leaving limited additional interventions available.
Primary care medicine frequently involves repeatedly advising patients to eat healthier, exercise more, and stop smoking, with variable patient compliance leading to disease stagnation or worsening. There are only so many times you can tell a COPD patient they need to quit smoking.
4 | Administrative Obstacles
Internal medicine involves substantial administrative and charting responsibilities. While some burden stems from serving as the “dumping ground” for subspecialties, significant charting exists beyond this role. More time is spent placing orders, writing follow-up notes, and coordinating between different teams compared to other specialties.
A particularly challenging aspect of being the primary team involves managing social work components of patient care. Some physicians describe feeling like “glorified social workers,” which is obviously an exaggeration, but contains some truth. This responsibility typically affects residents more than attendings.
A major inpatient internal medicine component is “dispo” (disposition)—determining post-discharge patient placement. Depending on your hospital, you may be responsible for coordinating appropriate discharge locations. Sometimes patients improve medically but face delays in coordinating nursing home or rehabilitation facility placement, requiring them to remain on the inpatient service until disposition is arranged correctly.
You must find facilities with available slots that accept the patient’s insurance. Meanwhile, daily rounding continues while patients remain in the hospital—an incredibly contaminated environment where extended stays increase infection and complication risks.
If You’re Considering Internal Medicine
So, should you become an internist?
It depends on what you’re looking for and what aspects of medicine genuinely excite you.
There are pros and cons to every specialty, and what’s important is identifying what motivates you to get out of bed in the morning and what challenges you’re willing to accept. What trade-offs align with your career goals, and what aspects of patient care would provide long-term satisfaction?
If you enjoy critical thinking, appreciate the variety of medical conditions, value building long-term patient relationships, desire career flexibility, and find fulfillment in being a medical detective solving complex cases, internal medicine could be an excellent fit.
However, you must be prepared for extended rounding sessions, significant administrative burdens, serving as the admission service for other specialties, and the patience required for managing chronic diseases where cure is often less achievable than control.
Internal medicine is often considered the “default” specialty with the broadest scope of practice. Some physicians are strongly drawn to its breadth and intellectual challenges, while others choose it after being unable to identify other specialties that resonated with them. If you’re considering internal medicine, remember it’s a vast field with numerous practice variations, so ensure you experience the different ways internists can practice.
Internal medicine is an excellent specialty for those who enjoy the critical thinking aspects of medicine, possess patience for managing chronic diseases, and aren’t deterred by administrative responsibilities. The field’s flexibility allows you to shape your career according to your interests and lifestyle preferences, whether through subspecialty fellowship training or various practice settings.
If you want to learn more about internal medicine, check out So You Want to Be an Internal Medicine Doctor.
