What is the difference between a family physician and an internist?

• A family physician is a doctor who has completed a residency in family medicine, whereas an internist has completed a residency in internal medicine. Family medicine and internal medicine have a lot of similarities but also a lot that separates them into two different fields of medicine. Family medicine doctors see all ages of babies, from birth to death. Some family medicine doctors choose to deliver babies as well. Internal medicine doctors only see adults, usually age 18 and older. Family medicine training tends to focus more on outpatient (for example, clinic) services, whereas internal medicine training tends to put a lot more emphasis on inpatient (hospital) services. Most family medicine doctors go right into practice after residency but there are a few fellowship opportunities where they can specialize in adolescents, geriatrics, or sports medicine for example. Many doctors who graduate from internal medicine residency choose to go into a sub-specialty such as cardiology, oncology, nephrology, or pulmonology. So, to answer your question, for your situation of relatively good health, either type of doctor (both also known as primary care doctors) would be more than capable of meeting your needs. It is more important to make sure that they are board certified and that you feel comfortable with them to develop a solid therapeutic relationship.

What is the difference between Family Medicine and Internal Medicine?

At One Medical Group, most of our doctors specialize in either Family Medicine or Internal Medicine.

Family Medicine doctors (a.k.a. Family Practitioners) are the most widely-skilled primary care doctors. They're trained to be able to help patients at every stage of life, from birth through childhood and adulthood, and onward to old age and death. At One Medical, our FPs see adolescent patients; generally age 14 and older.

Internal Medicine doctors (a.k.a. Internists) focus on adult and elderly patients. Their specialty training doesn't involve obstetrics, gynecology or pediatrics. Their training emphasizes the management of chronic, complex or severe illnesses, especially for patients who require hospitalization. Internists are most comfortable seeing patients age 18 and older.

Family Practice MD vs. General Internal Medicine MD ~ difference?

The main difference is the post med school training and their patient base. 

A family practice doc after med school completes a 3 year family medicine residency. Their job is basically primary care for anyone ranging from infants to the elderly. These guys you usually find working out of clinics or offices, they can be in hospital but generally are not. If you think of the small town doc who can do everything from deliver a baby or care for the dying, that's a family practice doc. 

An General Internist go through a 3 year residency in Internal Medicine. There primary goal is diagnosis and non-surgical treatment of specifically adults. They can be primary care similar to the family practice doc except only in adults or they can be in a more acute care setting in hospitals like in the ICU. After their residency, an internal medicine doc can then specialize into various fields like Gastroenterology, cardiology, neurology, endocrinology etc. etc. 

One more thing, a General Practitioner or GP is not equivalent to either of these fields. A GP has completed a 1 year internship post medical school and has not done any further training. Calling an Internist or Family doc, a "GP", is actually derogatory and you are insulting them.



Family practice MD deals with everything from pediatrics to geriatrics and everything from pregnancy and cancer to broken bones and cut fingers. They're called GPs or general practicioners. They tend to make a lot of referrals to other specialists after making an initial diagnosis. The GP is likely to set a broken wrist or stitch up a laceration. 

The internist, on the other hand, is more of a specialist, limiting practice to the major circulatory, pulmonary, neurological, and digestive systems - that means heart and blood system, lungs, nerves, and stomach and intestines. He tends to stay away from stuff like cuts and bruises, broken bones, etc. The internist is likely to work with ulcers, pinched nerves, and polyps.

Internal Medicine vs Family Practice

There are two types of doctors who generally act as primary care providers: internal medicine doctors, called internists, and family practitioners.

What They Have In Common

Both types of doctors are qualified to act as primary care physicians. They have attended medical school, completed a three-year residency (supervised medical practice), and have been licensed by the Colorado State Medical Board to practice in the state. Either is a reasonable choice for a primary care physician.

When a Family Practitioner Might Be Right for You

A family practice doctor is trained to deal with the care of people from, essentially, birth to death. Their training includes some pediatrics (care of children), and some obstetrics/gynecology (care of women’s reproductive health), as well as the care of adult health problems.

A family practitioner might be right for you if you are looking for a doctor that you and your kids can attend together, or if you are looking for a doctor that can transition your teen from their pediatrician to an adult primary care provider.

When an Internist Might Be Right for You

An internal medicine doctor, or internist, has been trained to deal with the full range of health problems that affect adults. An internist has received an education that is generally focused on preventing, detecting, monitoring, and treating health conditions experienced by adults. They can help you keep yourself in optimum health, identify when something’s wrong, and make sure you get the right treatment, whether they provide that treatment themselves or refer you to a specialist.

An internal medicine doctor is recommended for most adults because of their skill and training at diagnosing sometimes complex health conditions. They know how to put together a wide variety of information to figure out when you need additional care. They are trained in dealing with severe chronic illnesses and can identify when you might be afflicted by multiple illnesses and recommend appropriate care.

The choice between family medicine and internal medicine

My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient’s health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles of my electronic residency application form and formulated my personal statement: family medicine or internal medicine?

I loved both rotations during third year. Family medicine because it was broad, all-inclusive, and promoted an ethos of family — and community-centered care that aligned with my ideological predispositions. Internal medicine because it was cerebral, stretching the limits of my medical knowledge and pushing me to think creatively about a patient’s symptoms to get to the bottom of what her body was telling us.

Between my third and fourth years of medical school, I pursued a master’s in public health and a policy fellowship. For nine months, my mind was opened to entirely new health concepts I hadn’t entertained before. The social determinants of health were drilled into me, while the concept of community organizing for health ignited my desire for change in the health care system. I was sure at the end of this degree that I would apply in family medicine and treat the community as my patient, one family at a time.

But here I am, one year later, coming to the end of my intern year in an internal medicine primary care program. Why the switch? Did I lose the values that initially drew me to family medicine? No. The simple answer is I see medicine as a tool for two distinct purposes that I want to fulfill — and I found a residency program that fulfills both.

The first purpose is social change. Many diseases, especially chronic ones like diabetes and heart disease, afflict the poor more than any other group. Chronic diseases are the embodiment of the extreme inequality present in this society. They can be improved with conscientious and thorough care on the part of health professionals dedicated to the underserved and prepared to advocate on their behalf. This ethos is promoted by many family medicine programs, which emphasize the physician’s responsibility to the community and the family as well as the individual patient. Many family medicine residencies are located in areas of need and specifically aim to produce primary care physicians to improve health care outcomes in these areas.

In contrast, internal medicine programs are known for emphasizing preparation for fellowship and sub-specialization. Less than 30 percent of internal medicine residents choose primary care as a field. In some programs, this generates a culture that is unfriendly to primary care generally and a lack of mentors in primary care. There is also a very strong emphasis on hospital work in many internal medicine programs, to the detriment of the primary care experience. Thankfully, I was able to find an internal medicine program that values primary care preparation and social disparities in health more than the sub-specialties, which is a perfect fit for my worldview.

The second distinct purpose of medicine that fascinates me is the diagnosis and treatment of difficult symptoms that don’t have an easy explanation. Internal medicine has an ethos of dealing with these sorts of issues that I found compelling. Moreover, required rotations through the medical subspecialties bolster knowledge about rarer diseases and complications I may confront, and improve my facility with physical exam and history-taking skills in specialist areas. In this sense, I appreciate the focus on adults only, which allows me the breathing room to delve deep into these biomedical topics and to think carefully before I have to refer. I can also devote more time to pressing problems that affect adults only, like addiction medicine and geriatrics, both of which figure prominently in my residency curriculum.

I still occasionally think about family medicine, and the trade-offs I made in choosing internal medicine. I do not get as much variety as a family physician does, and I can feel the atrophy of the pediatrics and obstetrics parts of my brain. I’m also subjected to more hospital work than I would like. My love is the clinic. But I don’t regret my choice and still feel both fulfilled and challenged on a daily basis by the social and biological diseases that confront my health system.

Hugo Torres is an internal medicine resident who blogs at Primary Care Progress.

Medical Student Perspectives: What are the Differences between Internal Medicine and Family Medicine?

When I tell my peers I want to practice primary care medicine, most of them assume I mean that I will be training in a family medicine residency. I inevitably have to clarify and say that “no, I just plan to practice general internal medicine, for adults”. That there is this ambiguity even among medical students, who are at the peak of their exposure to the differences among fields, concerns me, and so, I thought I would attempt to clarify the differences between family medicine and internal medicine in philosophy, education, and practice.

The American Academy of Family Practice (AAFP) defines family medicine as a “medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.”1 Family medicine aims to provide initial, continuing and comprehensive care, while centering this process on the patient-physician relationship in the context of the family. These physicians emphasize disease prevention and health promotion, and when referral is indicated, the physician remains the coordinator of patient care. The family doctor serves as a patient advocate in dealings with specialists, third-party payers, employers and others. Ideally, this leads to decreased disintegration of patient care in inpatient settings, higher patient satisfaction, and increased cost-effectiveness.2

The Accreditation Council for Graduate Medical Education (ACGME) requires that all family medicine residency training programs address a large breadth of topics: adult medicine, pediatrics, maternity care, gynecology, care of the surgical patient, musculoskeletal and sports medicine, emergency care, mental health, community medicine, skin, diagnostic imaging and nuclear medicine, and management of health systems.3 Though all family medicine residencies provide trainees with a shared core of information, individual physician implementation of this knowledge base is shaped by physician preference, patient need, and the local medical market. Provision of obstetric services is falling among family physicians4 , for example, due to insurance company payment practices and the increasing cost of malpractice insurance. Without the introduction of pediatric patients through the maternity care process, many family physicians report seeing their patient population age until it is almost exclusively adult. In the right environment, family physicians have some of the greatest flexibility regarding practice type of any specialty. They can be found teaching in medical schools and residencies, working in emergency rooms and urgent care settings or on the floors, providing maternity care, serving internationally, engaging in public health careers, doing research. Additionally, fellowships are available in geriatrics, sports medicine, emergency medicine and ob-gyn.

Broadly, internists are “doctors for adults”. The specialty of internal medicine is comprised of physicians trained in adult medicine who provide the majority of health care to adults in the hospital and/or in the office. They provide comprehensive acute and chronic care (primary care) to adolescents, adults, and the elderly. This includes women’s healthcare, depression, and anxiety. The internist is not trained in maternity care, though he is trained in office gynecology. They also do not treat pediatric patients or neonates, though they may see older adolescents. Like the other generalist specialties, they may arrange consultations with other physicians and conduct preoperative evaluations for surgical colleagues.5

Specialists in internal medicine complete a 3-year residency and go on to treat patients with a variety of medical conditions. Subspecialists in internal medicine complete the 3-year residency and a 2-3 year fellowship in the area of interest. Subspecialties open to internal medicine residents include adolescent medicine, allergy and immunology, cardiology, sleep medicine, infectious disease, gastroenterology, and geriatrics, among many others. During residency, internists are trained in critical care and exposed to the internal medicine subspecialties and neurology, as well as given the opportunity to gain experiences in a breadth of fields that may benefit their practice. A short list of additional experiences includes psychiatry, dermatology, ophthalmology, office gynecology, palliative medicine and rehabilitation medicine.6 Like family medicine physicians, the internist may provide care to adults as broadly or narrowly as he likes. Currently, the majority of internal medicine trained physicians go on to complete subspecialty training, though recent years have seen a small increase in residency graduates electing to stay in general internal medicine. Additionally, the internal medicine graduate may practice in academic or private settings, engage in research, clinical or public health careers, work primarily in the office or in the hospital, or a combination of the two.

I hope this discussion has been useful to you in highlighting some of the differences between internal medicine and family medicine. Both fields serve a huge need and the demand for services is high. For more information about family medicine, see Responses to Medical Students' Frequently Asked Questions about Family Medicine" in American Family Physician, 7/1/07. For more information about internal medicine, see “Imagine the Possibilities: An Overview of Careers in Internal Medicine” (ACP, ).

Dana C. Mueller
Council of Student Members Representative, Central Atlantic Region
University of Virginia School of Medicine, 2011
E-mail: dcm4z@virginia.edu

1. AAFP. “Family Medicine, Definition of.” Accessed 11/26/2010. Available athttp://www.aafp.org/online/en/home/policy/policies/f/fammeddef.html. 
2. AAFP. “Family Medicine, Scope and Philosophical Statement.” Accessed 11/26/2010. Available athttp://www.aafp.org/online/en/home/policy/policies/f/scopephil.html. 
3. ACGME. “ACGME Program Requirements for Graduate Medical Education in Family Medicine.” Accessed 11/26/2010. Available athttp://www.acgme.org/acWebsite/downloads/RRC_progReq/120pr07012007.pdf.
4. Neale, Todd. “Family Physicians Doing Less Prenatal Care.” MedPage Today. Accessed 11/26/2010. Available athttp://www.medpagetoday.com/OBGYN/GeneralOBGYN/13140. 
5. ACP. “ACP: Fostering Excllence and Professionalism in the Practice of Internal Medicine”. Accessed 11/26/2010. Available athttp://www.acponline.org/medical_students/resources/interest_groups/ms_pp.htm.
6. ACGME. “ACGME Program Requirements for Graduate Medical Education in Internal Medicine.” Accessed 11/26/2010. Available athttps://www.acgme.org/acWebsite/downloads/RRC_progReq/140_internal_medicine_07012009.pdf.