Internal Medicine vs. Family Medicine

This is perhaps one of the most confusing questions for many students (and patients alike), particularly when referring to internists who practice general internal medicine. However, there are fundamental differences in the focus, training, and patient care activities of these two specialties.

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. 

Much of the confusion likely arises because the majority of patients seen by family physicians are adults, thus overlapping with the patient population focused on by internists. A general estimate is that a typical family medicine practice might see 10% to 15% children, meaning that 85% to 90% of patients will be adults, the same population seen by internists. Additionally, an increasing number of family physicians do not include obstetrics, neonatology, or significant surgery as part of their practices, which makes the care provided to adults appear similar to that provided by internists. These factors make it is easy to see that the differences between general internal medicine and family medicine may not be easily understood.

However, there are significant differences in the training and clinical approach of internists and family physicians1,2. Although the length of basic training for both is three years, internal medicine focuses only on adults (internists who wish to include the care of children in their practice may choose dual training in internal medicine and pediatrics, frequently referred to as “med-peds”; you can find out more about this career path). 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. All trainees are required to have a longitudinal outpatient continuity clinic experience in which residents develop continuous, long-term therapeutic relationships with a panel of general medicine patients. In addition to this continuity clinic experience, trainees also see outpatients during the course of their subspecialty clinical rotations. At least one year of internal medicine training must involve caring for hospitalized patients, with at least three months of work in intensive/critical care settings. Most training programs require more than one year of hospital-based work with additional training on inpatient subspecialty services such as cardiology, hematology-oncology, or gastroenterology.  

Family medicine training is typically based in dedicated outpatient training centers in which residents work throughout the course of their training. Trainees are required to provide acute, chronic, and wellness care for a panel of continuity patients, with a minimum number of encounters being with children and older adults. Family medicine trainees are also required to have at least 6 months of inpatient hospital experience and 1 month of adult critical care, and up to 2 months of care for children in the hospital or emergency settings. Additional requirements include 2 months of obstetrics, a minimum number of newborn encounters, 1 month of gynecology, 1 month of surgery, 1 month of geriatric care, and 2 months of training in musculoskeletal medicine. Family medicine trainees must also have experiences in behavioral health issues, common skin diseases, population health, and health system management, and there is a particular emphasis on wellness and disease prevention.

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. Internists are well prepared to provide primary care to adults through their outpatient continuity experience during training, particularly for medically complicated patients. Their training also enables them to effectively interact with their internal medicine subspecialty colleagues in co-managing complex patients (such as those with transplants, cancer, or autoimmune disease) and easily managing the transitions from outpatient to inpatient settings (and vice versa) for their patients who require hospitalization. Additionally, the extensive hospital experience during training uniquely prepares internists who choose to focus their clinical work in inpatient settings (learn more about hospital medicine).

Family medicine education is broader in nature than internal medicine since it involves training in the care of children and procedures and services often provided by other specialties. This breadth of education equips family physicians to deal with a wide range of medical issues, and this broad skill set may be particularly valuable in communities or geographical areas where certain specialists and subspecialists may not be available. Because of their broad skill set, family physicians typically adapt the nature of their practices to meet the specific medical needs of their community. Although the depth of training in adult medical issues may be less than in internal medicine, the emphasis on outpatient medicine, continuity of care, health maintenance, and disease prevention allows family physicians to function as primary care providers for adults as part of a family unit depending on individual medical need. And family physicians are trained to coordinate care among different specialists and subspecialists when these services are needed by their patients. 

Thus, it can be seen that there are important differences between internal medicine and family medicine.  Both have unique skill sets and important roles in the care of adult patients and providing primary care depending on the practice setting and the specific needs of the patient.

Cervical Health Awareness

January is Cervical Health Awareness Month, and Internal Medicine Associates of Oklahoma City wants you to know that there’s a lot you can do to prevent cervical cancer.

HPV (human papillomavirus) is a very common infection that spreads through sexual activity. About 79 million Americans currently have HPV, but many people with HPV don’t know they are infected.

HPV is also a major cause of cervical cancer. Each year, more than 11,000 women in the United States get cervical cancer.

The good news?

  • The HPV vaccine (shot) can prevent HPV.
  • Cervical cancer can often be prevented with regular screening tests (called Pap tests) and follow-up care.

In honor of National Cervical Health Awareness Month, Internal Medicine Associates of Oklahoma City encourages:

  • Women to start getting regular Pap tests at age 21
  • Parents to make sure pre-teens get the HPV vaccine at age 11 or 12

Teens and young adults also need to get the HPV vaccine if they didn’t get it as pre-teens. Women up to age 26 and men up to age 21 can still get the vaccine.

Thanks to the health care reform law, you and your family members may be able to get these services at no cost to you. Check with your insurance company to learn more.

Taking small steps can help keep you safe and healthy. Call our office today to schedule an appointment.

Hot off the Press! IMA-OKC earns UnitedHealthcare PATH Excellence in Patient Service Awards

 

Contact:

 

Emily Deffner

Internal Medicine Associates of Oklahoma City

405-604-0688

emily@internalmedicineassociatesokc.com

 

For Immediate Release

 

Internal Medicine Associates of Oklahoma City Earns Recognition for Improving Health Outcomes, Addressing Care Opportunities for UnitedHealthcare Medicare Advantage Members

 

Internal Medicine Associates of Oklahoma City among more than 1,900 care providers nationwide recognized with UnitedHealthcare PATH Excellence in Patient Service Awards for hitting key quality measures in treatment of Medicare Advantage members

 

Oklahoma City, OK August 25, 2016) – Internal Medicine Associates of Oklahoma City was recently recognized with the 2015 UnitedHealthcare PATH Excellence in Patient Service Award for its commitment to improving health outcomes for people enrolled in UnitedHealthcare’s Medicare Advantage plans. 

 

Drs. Rakesh and Sujata Prasad earned the award by achieving performance metrics in the UnitedHealthcare PATH Program and successfully addressing care opportunities when treating UnitedHealthcare’s Medicare Advantage members. 

 

UnitedHealthcare created the PATH program to help people enrolled in its Medicare Advantage plans be as healthy as possible by encouraging greater use of preventive health care services and proactive monitoring of chronic conditions. 

 

The program annually rewards physicians who meet certain performance-based criteria, including achieving or exceeding targets established by the Centers for Medicare & Medicaid Services (CMS) for specific Healthcare Effectiveness Data and Information Set (HEDIS) measures. Health plans and CMS use HEDIS as a tool to measure performance on important dimensions of health care and service. 

 

Examples of the quality measures used to evaluate care providers’ performance in the 2015 PATH program include:

  • the percentages of eligible UnitedHealthcare Medicare Advantage members who received a breast cancer screening or colorectal cancer screening; 
  • the percentage of members with diabetes who received an eye exam; and,
  • the percentage of members who received advice from their doctor to maintain or enhance their level of physical activity.

 

By achieving the PATH program’s performance metrics, Internal Medicine Associates of Oklahoma City also proactively addressed care opportunities for UnitedHealthcare’s Medicare Advantage members. A care opportunity exists when an individual hasn’t received a health care service or medication recommended based on his or her age or health status. In 2015, care providers nationwide participating in the PATH program addressed nearly 1.8 million care opportunities for UnitedHealthcare’s Medicare Advantage members.

 

“Our team works very hard to provide quality care to all of our patients, with the goal of helping them achieve optimal health. It’s gratifying to be recognized for our efforts,” said Dr. Rakesh Prasad. “We appreciate UnitedHealthcare’s support and look forward to continuing to work together to help improve their Medicare Advantage members’ health and well-being.”>

 

“We are grateful for Internal Medicine Associates of Oklahoma City’s efforts to ensure our Medicare Advantage members receive the preventive health care services they need,” said Efrem Castillo, M.D., chief medical officer of UnitedHealthcare Medicare & Retirement. “These awards are one of the ways we are supporting the transition to a value-based health care system that rewards physicians for the quality of care they deliver to the people we serve.” 

 

Internal Medicine Associates of Oklahoma City is an Internal Medicine office dedicated to providing primary care for adults, including the diagnosis and treatment of diseases and illnesses, routine care, and preventative medicine.

 

Serving one in five Medicare beneficiaries, UnitedHealthcare is the largest business dedicated to the health and well-being needs of seniors and other Medicare beneficiaries.