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Historically, internal medicine and family medicine developed from very different backgrounds. Internal medicine grew out of the increasing application of scientific knowledge into the practice of medicine starting in the late 1800s. This “scientific” approach to medicine was unique at the time and was progressively applied to the wide spectrum of diseases that commonly affect adults. With the growth and development of pediatrics as a separate specialty devoted to the care of children in the early 1900s, internal medicine continued its primary focus on adult patients.
The specialty of family medicine grew out of the general practitioner movement in the late 1960s in response to the growing level of specialization in medicine that was seen as increasingly threatening to the primacy of the doctor-patient relationship and continuity of care. Conceptually, family medicine is built around a social unit (the family) as opposed to either a specific patient population (i.e. adults, children, or women), organ system (i.e., otolaryngology or urology), or nature of an intervention (i.e., surgery). Consequently, family physicians are trained with the intent to be able to deal with the entire spectrum of medical issues that might be encountered by the members of a family unit.
However, there are significant differences in the training and clinical approach of internists and family physicians. Although the length of basic training for both is three years, internal medicine focuses only on adults. Required internal medicine training centers on common general medical conditions, but also includes significant experience in each of the internal medicine subspecialties (such as endocrinology, rheumatology, and infectious diseases) and neurology. Trainees must also gain adequate experience in psychiatry, dermatology, ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, palliative medicine, sleep medicine, geriatrics, and rehabilitation medicine to comprehensively care for adults.
Internal medicine training must also take place in both outpatient and inpatient settings. Most training programs also require hospital-based work with additional training on inpatient subspecialty services such as cardiology, hematology-oncology, intensive care medicine or gastroenterology.
These differences between internal medicine and family medicine training result in unique skill sets for each discipline and different strengths in caring for patients. Because internal medicine education focuses only on adults and includes experience in both general medicine and the internal medicine subspecialties, training in adult medical issues is comprehensive and deep. The general and subspecialty nature of training equips internists to develop expertise in diagnosing the wide variety of diseases that commonly affect adults and in managing complex medical situations where multiple conditions may affect a single individual.