Internist Overview

Physicians and surgeons diagnose and treat injuries or illnesses. Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They often counsel patients on diet, hygiene, and preventive healthcare. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.

There are two types of physicians, with corresponding degrees: M.D. (Medical Doctor) and D.O. (Doctor of Osteopathic Medicine). Both use the same methods of treatment, including drugs and surgery, but D.O.s place additional emphasis on the body's musculoskeletal system, preventive medicine, and holistic (whole-person) patient care. D.O.s are most likely to be primary care physicians, although they can be found in all specialties.

Physicians and surgeons typically do the following:

• Take a patient’s medical history
• Update charts and patient information to show current findings and treatments
• Order tests for nurses or other healthcare staff to perform
• Review test results to identify any abnormal findings
• Recommend and design a plan of treatment
• Address concerns or answer questions that patients have about their health and well-being
• Help patients take care of their health by discussing topics such as proper nutrition and hygiene

Physicians and surgeons work in one or more specialties. The following are examples of types of physicians and surgeons:

Anesthesiologists focus on the care of surgical patients and on pain relief. They administer drugs (anesthetics) that reduce or eliminate the sensation of pain during an operation or another medical procedure. During surgery, they are responsible for adjusting the amount of anesthetic as needed and monitoring the patient's heart rate, body temperature, blood pressure, and breathing. They also work outside of the operating room, providing pain relief in the intensive care unit, during labor and delivery of babies, and for patients who suffer from chronic pain. Anesthesiologists work with other physicians and surgeons to decide on treatments and procedures before, during, and after surgery. 

Family and general physicians assess and treat a range of conditions that occur in everyday life. These conditions include anything from sinus and respiratory infections to broken bones. Family and general physicians typically have regular, long-term patients.

General internists diagnose and provide nonsurgical treatment for a range of problems that affect internal organ systems such as the stomach, kidneys, liver, and digestive tract. Internists use a variety of diagnostic techniques to treat patients through medication or hospitalization. They work mostly with adult patients.

General pediatricians provide care for infants, children, teenagers, and young adults. They specialize in diagnosing and treating problems specific to younger people. Most pediatricians treat common illnesses, minor injuries, and infectious diseases, and administer vaccinations. Some pediatricians specialize in pediatric surgery or serious medical conditions that commonly affect younger patients, such as autoimmune disorders or chronic ailments.

Obstetricians and gynecologists (OB/GYNs) provide care related to pregnancy, childbirth, and the female reproductive system. They treat and counsel women throughout their pregnancy and deliver babies. They also diagnose and treat health issues specific to women, such as breast cancer, cervical cancer, hormonal disorders, and symptoms related to menopause.

Psychiatrists are primary mental health physicians. They diagnose and treat mental illnesses through a combination of personal counseling (psychotherapy), psychoanalysis, hospitalization, and medication. Psychotherapy involves regular discussions with patients about their problems. The psychiatrist helps them find solutions through changes in their behavioral patterns, explorations of their past experiences, or group and family therapy sessions. Psychoanalysis involves long-term psychotherapy and counseling for patients. Psychiatrists may prescribe medications to correct chemical imbalances that cause some mental illnesses.

Surgeons treat injuries, diseases, and deformities through operations. Using a variety of instruments, a surgeon corrects physical deformities, repairs bone and tissue after injuries, or performs preventive or elective surgeries on patients. Although a large number perform general surgery, many surgeons choose to specialize in a specific area. Specialties include orthopedic surgery (the treatment of the musculoskeletal system), neurological surgery (treatment of the brain and nervous system), cardiovascular surgery, and plastic or reconstructive surgery. Like other physicians, surgeons examine patients, perform and interpret diagnostic tests, and counsel patients on preventive healthcare. Some specialist physicians also perform surgery.

Physicians and surgeons may work in a number of other medical and surgical specialties and subspecialties. The following specialists are some of the most common examples:

• Allergists (specialists in diagnosing and treating hay fever or other allergies)
• Cardiologists (heart specialists)
• Dermatologists (skin specialists)
• Gastroenterologists (digestive system specialists)
• Ophthalmologists (eye specialists)
• Pathologists (specialists who study body tissue to see if it is normal or abnormal)
• Radiologists (specialists who review and interpret x rays and other images and deliver radiation treatments for cancer and other illnesses)

Physicians work daily with other healthcare staff, such as registered nurses, other physicians, medical assistants, and medical records and health information technicians.

Physicians and surgeons have demanding education and training requirements. Almost all physicians complete at least 4 years of undergraduate school, 4 years of medical school, and, depending on their specialty, 3 to 7 years in internship and residency programs.

Most applicants to medical school have at least a bachelor's degree, and many have advanced degrees. Although no specific major is required, all students must complete undergraduate work in biology, chemistry, physics, math, and English. Students also take courses in the humanities and social sciences. In addition, some students volunteer at local hospitals or clinics to gain experience in a healthcare setting.

Medical schools are highly competitive. Most applicants must submit transcripts, scores from the Medical College Admission Test (MCAT), and letters of recommendation. Schools also consider an applicant’s personality, leadership qualities, and participation in extracurricular activities. Most schools require applicants to interview with members of the admissions committee.

A few medical schools offer combined undergraduate and medical school programs that last 6 or 7 years.

Students spend most of the first 2 years of medical school in laboratories and classrooms, taking courses such as anatomy, biochemistry, pharmacology, psychology, medical ethics, and the laws governing medicine. They also gain practical skills, learning to take medical histories, examine patients, and diagnose illnesses.

During their last 2 years, medical students work with patients under the supervision of experienced physicians in hospitals and clinics. Through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery, they gain experience in diagnosing and treating illnesses in a variety of areas.

Communication skills. Physicians and surgeons need to be excellent communicators. They must be able to communicate effectively with their patients and other healthcare support staff.

Compassion. Physicians and surgeons deal with patients who are sick or injured and may be in extreme pain or distress. Physicians and surgeons must be able to treat patients and their families with compassion and understanding.

Detail oriented. Physicians and surgeons must ensure that patients are receiving appropriate treatment and medications. They must also monitor and record various pieces of information related to patient care.

Dexterity. Physicians and surgeons must be good at working with their hands. They may work with very precise and sometimes sharp tools, and mistakes can have serious consequences.

Leadership skills. Physicians who work in their own practice need to be effective leaders. They must be able to manage a staff of other professionals to run their practice.

Organizational skills. Some physicians own their own practice. Strong organizational skills, including good recordkeeping, are critical in both medical and business settings.

Patience. Physicians and surgeons may work for long periods with patients who need special attention. Persons who fear medical treatment may require more patience.

Physical stamina. Physicians and surgeons should be comfortable performing physical tasks, such as lifting or turning disabled patients. Surgeons may spend a great deal of time bending over patients during surgery.

Problem-solving skills. Physicians and surgeons need to evaluate patients’ symptoms and administer the appropriate treatments. They need to do this quickly if a patient’s life is threatened.

After medical school, almost all graduates enter a residency program in their specialty of interest. A residency usually takes place in a hospital and varies in duration, generally lasting from 3 to 7 years, depending on the specialty.

All states require physicians and surgeons to be licensed; requirements vary by state. To qualify for a license, candidates must graduate from an accredited medical school and complete residency training in their specialty.

All physicians and surgeons also must pass a standardized national licensure exam. M.D.s take the U.S. Medical Licensing Examination (USMLE). D.O.s take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). For specific state information about licensing, contact your state’s medical board. 

Certification is not required for physicians and surgeons; however, it may increase their employment opportunities. M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years in residency training; the length of time varies with the specialty. To become board certified, candidates must complete a residency program and pass a specialty certification exam from the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), or the American Board of Physician Specialties (ABPS).