Internists

Career summary

Many internists are primary care physicians and often the first point of contact for people seeking health care. They see the same patients on a regular basis. When needed, they send patients to health care specialists for testing or treatment.

Internists treat common illnesses like infections and the flu. They also treat conditions and problems that affect internal organs, such as the:

• Stomach
• Kidneys
• Liver
• Digestive tract

Internists ask patients questions to learn about their medical history. They examine patients and, if necessary, order lab tests. Internists explain test results and review treatment options with patients and their families. If more than one treatment is available, they help patients decide which option to choose. Internists watch a patient's condition and make changes in the treatment plan if needed.

They talk to patients about good health practices, such as diet and exercise. They also talk to patients about managing their lifestyle, especially smoking cigarettes and drinking alcohol.

Internists share similar tasks with other types of physicians, they:

• Assign tasks to nurses and other health care workers
• Consult with other health care professionals
• Oversee the business aspects of running an office
• Keep detailed records about each patient
• Write reports for insurance companies and government agencies

Some internists teach at medical schools. They may also do research on procedures and treatments for disease. Advances in medicine require doctors to update their skills regularly.

Related careers

This career is part of the Health Science cluster of careers.

Related careers include:

• Allergists and Immunologists
• Anesthesiologists
• Dentists
• Dermatologists
• Family and General Practitioners
• Naturopathic Physicians
• Nurse Practitioners
• Obstetricians and Gynecologists
• Pediatricians
• Pharmacists
• Physician Assistants
• Podiatrists
• Psychiatrists
• Radiologists
• Surgeons
• University and College Teachers
• Veterinarians

Military careers

• Physicians and Surgeons

Job duties

Task list

The following list of tasks is specific to internists.

• Meet with patients to gather background information.
• Examine patients to find location of health problems.
• Order lab tests to help make diagnoses. Analyze data and make diagnoses.
• Counsel patients on preventive health measures, such as diet, hygiene, and exercise.
• Recommend treatment and discuss with patients.
• Monitor patients' health and re-evaluate treatment.
• Keep detailed records on patients' health.
• Counsel family members about patients' condition.
• Refer patients to health care specialists when needed.
• Treat internal disorders, such as high blood pressure and diabetes, as well as other common illnesses.
• Consult with other physicians.
• Write chart notes. Fill out paperwork for government agencies or insurance companies.
• Assign tasks to nurses and other health workers.
• Take classes to update skills.
• May administer hospital or community health programs.
• May do research and write articles for journals.
• May perform operations on patients to remove or repair diseased areas.

Common work activities

Internists perform the following tasks. These tasks are common to many careers.

• Document and record information
• Assist and care for others
• Make decisions and solve problems
• Update and use job-related knowledge
• Explain the meaning of information to others
• Communicate with supervisors, peers, or subordinates
• Analyze data or information
• Get information needed to do the job
• Perform for or work with the public
• Establish and maintain relationships
• Process information
• Schedule work and activities
• Monitor events, materials, and surroundings
• Organize, plan, and prioritize work
• Provide advice and consultation to others
• Use computers
• Evaluate information against standards
• Think creatively
• Identify objects, actions, and events
• Develop goals and strategies
• Judge the value of objects, services, or people
• Communicate with people outside the organization
• Resolve conflicts and negotiate with others
• Guide, direct, and motivate others
• Coordinate the work and activities of others
• Teach others
• Coach others
• Monitor and control resources

Work requirements

Working conditions

In a typical work setting, internists:

Interpersonal relationships

• Have a very high level of social interaction. They constantly talk with nurses, patients, and other doctors.
• Are responsible for outcomes and the results of other workers. However, patient health depends on many things outside an internist's control.
• Are substantially responsible for the health and safety of patients.
• May be placed in conflict situations where patients might become rude or angry.
• Communicate daily by phone, e-mail, and in person. They also write letters and memos.
• Usually work as part of a team of medical professionals.

Physical work conditions

• Always work indoors.
• Are exposed to diseases and infections on a daily basis. To protect themselves, they regularly wear gloves and surgical masks.
• Work very near others. They must come into close physical contact with patients during examinations.

Work performance

• Must be very exact and highly accurate in their work. Serious errors have a direct impact on patient health.
• Work in a moderately competitive, stressful atmosphere where they must meet daily deadlines.
• Make decisions on a daily basis that greatly impact patients and their families.
• Make nearly all their decisions and set their daily tasks and goals independently.
• Repeat the same physical and mental tasks.

Hours/travel

• Work full time, often in offices and clinics.
• Overtime and irregular work hours are common, especially in a hospital setting.
• Must meet strict daily and weekly deadlines.

Physical demands

Internists frequently:

• Stand for long periods of time.
• Use their hands to handle, control, or feel objects, tools, or controls.
• Walk or run for long periods of time.

It is important for internists to be able to:

• See details of objects that are less than a few feet away.
• Understand the speech of another person.
• Speak clearly so listeners can understand.

It is not as important, but still necessary, for internists to be able to:

• Use fingers to grasp, move, or assemble very small objects.
• See details of objects that are more than a few feet away.
• Hear sounds and recognize the difference between them.
• See differences between colors, shades, and brightness.
• Hold the arm and hand in one position or hold the hand steady while moving the arm.
• Use one or two hands to grasp, move, or assemble objects.
• Use stomach and lower back muscles to support the body for long periods without getting tired.
• Make quick, precise adjustments to machine controls.
• Focus on one source of sound and ignore others.

Skills and abilities

Internists need to:

Communicate

• Speak clearly so listeners can understand.
• Understand spoken information.
• Understand written information.
• Listen to others and ask questions.
• Read and understand work-related materials.
• Write clearly so other people can understand.

Reason and problem solve

• Combine several pieces of information and draw conclusions.
• Notice when something is wrong or is likely to go wrong.
• Recognize the nature of a problem.
• Judge the costs and benefits of a possible action.
• Analyze ideas and use logic to determine their strengths and weaknesses.
• Use reasoning to discover answers to problems.
• Understand new information or materials by studying and working with them.
• Develop rules that group items in various ways.
• Follow guidelines to arrange objects or actions in a certain order.
• Identify what must be changed to reach goals.
• Recognize when important changes happen or are likely to happen in a system.
• Concentrate and not be distracted while performing a task.
• Think of new ideas about a topic.
• Think of original, unusual, or creative ways to solve problems.

Use math and science

• Use scientific methods to solve problems.

Manage oneself, people, time, and things

• Check how well one is learning or doing something.
• Go back and forth between two or more activities or sources of information without becoming confused.
• Manage the time of self and others.

Work with people

• Be aware of others' reactions and understand the possible causes.
• Look for ways to help people.
• Change behavior in relation to others' actions.
• Persuade others to approach things differently.
• Teach others how to do something.
• Use several methods to learn or teach new things.

Perceive and visualize

• Identify a pattern (a figure, object, word, or sound) that is hidden in distracting material.
• Quickly and accurately compare letters, numbers, objects, pictures, or patterns.

Education and training

Educational programs

The programs of study listed below will help you prepare for the occupation or career cluster you are exploring.

Programs of study directly related to this occupation

• Medicine
• Osteopathic Medicine

Other programs of study to consider

• Pre-Medicine

Training

To work as an internist, you typically need to:

• have a high school diploma or equivalent;
• have a bachelor's degree;
• graduate from medical school;
• complete an internship;
• pass a state licensing exam;
• complete a residency program in internal medicine; and
• pass additional exams to become board certified.

Education after high school

To become a doctor, you must complete medical school. Medical schools grant a Doctor of Medicine (MD) degree or a Doctor of Osteopathic Medicine (DOM) degree. You spend the first two years of medical school in classrooms and labs. You study anatomy, biochemistry, and medicines. You also learn how to take a medical history, examine patients, and make a diagnosis. During the next two years, you work in hospitals and clinics under the supervision of physicians.

You usually need a bachelor's degree to get into medical school. While you do not need to be a pre-medicine or science major, these programs are good preparation. If you earn a liberal arts degree, be sure to take courses in physics, biology, and chemistry.

On-the-job training

While in medical school, you spend two years working as an intern in a hospital or clinic. As an intern, you rotate through internal medicine, family medicine, obstetrics, oncology, and other hospital departments.

After medical school, you complete a residency program in internal medicine. Residency usually lasts three years. Residents usually work in hospitals. After your residency, you take additional exams to become board certified.

Military training

The military provides advanced training for internists. However, it does not provide the training to become a doctor. Scholarships for advanced medical training are available in return for a required period of military service.

Helpful high school courses

In high school, take classes that prepare you for college. A college preparatory curriculum  may be different from your state's graduation requirements . You need a very strong background in math and science to become a doctor. Take as many math and science courses as you can.

You should also consider taking some advanced courses in high school. This includes Advanced Placement (AP) and International Baccalaureate (IB) courses if they are available in your school. If you do well in these courses, you may receive college credit for them. Advanced courses can also strengthen your college application.

Helpful electives to take in high school that prepare you for this career include:

• Anatomy and Physiology
• Computer Applications
• Food and Nutrition
• Foreign Language
• Introduction to Health Care
• Nursing
• Safety and First Aid

The courses listed above are meant to help you create your high school plan. If you have not already done so, talk to a school counselor or parent about the courses you are considering taking.

You should also check with a teacher or counselor to see if work-based learning opportunities are available in your school and community. These might include field trips, job shadowing, internships, and actual work experience. The goal of these activities is to help you connect your school experiences with real-life work.

Join some groups, try some hobbies, or volunteer with an organization that interests you. By participating in activities you can have fun, make new friends, and learn about yourself. Maybe one of them will help direct you to a future career. Here are examples of activities and groups  that may be available in your high school or community.

Things to know

Many internists begin work in a group practice or clinic. Some internists go to work for the hospital where they complete their residency.

Costs to workers

Internists must pay licensing costs to the State of Washington as either medical or osteopathic physicians. Internist practitioners who have borrowed money to pay school expenses have large debt payments for the first few years after graduation. The average educational debt for medical students who graduated in 2018 was $196,520 with 83% percent owing at least $100,000. Malpractice insurance is expensive. To enter private practice, physicians must invest in equipment, office space, and staffing costs. Estimated costs range from $75,000 to $100,000 or more.

#Updated to mean 2013 graduate debt info from https://www.aamc.org/download/152968/data/debtfactcard.pdf   2/4/14 cj. updated from 10/14 debtfactcard 1/28/15 lh. Updated from aamc.org/FIRST debtfactcard for Oct. 2015 on 5/2/16 cj. Updated link for source of debt data & updated info 1/31/18, cj. https://members.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf, same but 2018 data 1/30/19 lh

Licensing/certification

Internists must be licensed by the State of Washington as either medical or osteopathic doctors. Licensing requirements include:

• a good moral character;
• physical and mental capability to safely perform the duties of a physician;
• completion of a four-year doctor of medicine or doctor of osteopathic medicine program at an approved medical school;
• one year (osteopathic physician) or two years (medical physician) approved post-graduate training;
• completion of four- (medical physician) or seven- (osteopathic physician) clock hours AIDS education; and
• passing a national written exam.

For more information on the US Medical Licensing Exam, call 215.590.9500 or go to the National Board of Medical Examiners  website.

Osteopathic doctors must complete 150 hours of continuing education every three years and medical doctors must complete 200 hours of continuing education every four years.

Licensing fees vary ranging from $491 (medical physicians) to $391 (osteopathic physicians) for the application. The annual renewal fee for osteopathic physicians is $441 and the biannual renewal fee for medical physicians is $657. The combined fee for an application and state exam for osteopathic practitioners is $516. The licensing and the renewal fees generally include an access fee for health-related online library journals and publications and a Washington physician health program surcharge.

For more information on medical doctors, contact:

Washington Medical Commission 
PO Box 47866
Olympia, WA 98504-7866
360.236.2750

For information on osteopathic doctors, contact:

Washington State Board of Osteopathic Medicine and Surgery 
PO Box 47877
Olympia, WA 98504-7865
360.236.4700

# No changes to licensing info 5/2/16, 4/12/18 cj. 2019 lh

Job listings

Listed below are links to job categories from the National Labor Exchange that relate to this career. Once you get a list of jobs, you can view information about individual jobs and find out how to apply. If your job search finds too many openings, or if you wish to search for jobs outside of Washington, you will need to refine your search.

• Internists, General 

To get a listing of current jobs from the WorkSource system, go to the WorkSource website .

Wages

Wages vary by years of experience, area of the country, and hours worked. The doctor's skill, personality, and professional reputation also affect wages. Self-employed internists generally earn more than those who are not self-employed.

Internists usually receive benefits. Typical benefits include sick leave, paid vacation, health insurance, and a retirement plan. 

Employment and outlook

Washington outlook

The table below provides information about the number of workers in this career in various regions. It also provides information about the expected growth rate and future job openings.

National employment

Major employers:

• Doctors' offices
• Hospitals
• Federal, state, and local government agencies

National outlook

Demand for this occupation will be driven by the increase in population and especially due to the increase in elderly patients. Factors that will limit growth are advances in technology that allow more patients to be seen each day. Also more people see nurse practitioners and physician assistants.

Internists who are willing to move to rural and low-income areas should have little trouble finding a job.

Other resources

American Association of Colleges of Osteopathic Medicine 
5550 Friendship Boulevard, Suite 310
Chevy Chase, MD 20815
301.968.4100

American Board of Internal Medicine 
510 Walnut Street, Suite 1700
Philadelphia, PA 19106
800.441.2246
215.446.3590

American College of Physicians 
190 North Independence Mall West
Philadelphia, PA 19106
800.523.1546
215.351.2600

American Medical Association 

American Medical Association - Medical Student Section 

American Osteopathic Association 
142 East Ontario Street
Chicago, IL 60611
800.621.1773
312.202.8000

Aspiring Docs Website from the American Association of Medical Colleges 

The Student Doctor Network 

Washington Osteopathic Medical Association 
PO Box 1187
Gig Harbor, WA 98335
425.677.3930

Washington State Medical Association 
2001 Sixth Avenue, Suite 2700
Seattle, WA 98121
800.552.0612
206.441.9762

References

Career cluster

• Health Science

Career path

• Investigative (Science)

O*Net  occupation

• Internists, General (29-1063.00) 

O*Net job zone 

• Job Zone 5 - Extensive preparation needed. Extensive skill, knowledge, and experience are needed for these occupations. Many require more than five years of experience.

DOT occupation

• Internist (070.101-042) 

Strong Interest Inventory

• Physician

Holland occupational cluster

• Investigative/Social/Realistic

COPSystem

• Science Professional
• Service Professional