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Breaking The Barriers: Know All About Career as an Internal Medicine Specialist

Career as an Internal Medicine Specialist

Do you want to be a specialist doctor who treats multi-system disease complications? Would you like to take care of hospitalized patients who are critically ill? Do you yearn to be part of a team of highly skilled colleagues who are passionate about delivering best-in-class healthcare? You can also be among the highest paid doctors! Explore to find what Internist/ Internal Medicine Specialists do, how they do it and how to become one.

Internist/ Internal Medicine Specialists treat patients who have undifferentiated or multi-system disease processes that single-organ-disease specialists may not be trained to deal with such as dyspnea, weight loss, fatigue, chest pain, confusion or change in conscious state. They attend to ambulatory or hospitalized patients and may as well play a major role in teaching & research.

Why become an Internal Medicine Specialist?

Internist/ Internal Medicine Specialists treat patients who have undifferentiated or multi-system disease processes that single-organ-disease specialists may not be trained to deal with such as dyspnea, weight loss, fatigue, chest pain, confusion or change in conscious state. They attend to ambulatory or hospitalized patients and may as well play a major role in teaching & research.

They are dedicated to understanding and managing all aspects of the general health care of adults. They offer preventive care and disease prevention strategies to help patients maintain a healthy lifestyle.

They are specialists who are primarily associated with one or more healthcare establishments or a hospital or specialty clinics, and generally do not offer private independent care.

Internal Medicine Specialists do much of their work in hospitals since their patients are often seriously ill or require complex investigations and many of them specialize in the sub-specialty of Hospital Medicine. They may often have subspecialty interests concerning clinical conditions affecting particular organs or organ systems.

Some examples of clinical conditions Internists deal with are:

  • carotid artery disease (occurs when fatty deposits clog the blood vessels to your brain & head)
  • coronary artery disease (narrowing or blockage of the heart arteries)
  • hypertension
  • hyperlipidemia (acquired or genetic disorders that result in high levels of lipids)
  • peripheral vascular disease (causes the blood vessels outside of your heart & brain to narrow or spasm)
  • diabetes
  • thyroid & adrenal disorders
  • chronic kidney diseases
  • pulmonary or respiratory disease states like
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Chronic Bronchitis
    • Emphysema
    • Lung Cancer
    • Cystic Fibrosis/Bronchiectasis
    • Pneumonia
    • Pleural Effusion

General internal medicine professionals are primarily focused on:

  • Comprehensive care for patients with undefined symptoms — such as chest pain, shortness of breath, abdominal pain or back pain. Such patients need medical help in diagnosing their illness.

They conduct a general examination and orders tests and specialty consultations as needed. This includes preventive care, chronic disease management as well as care for acute medical conditions.

  • Collaboration, which means a patient may be referred to another doctor or a surgeon, including coordinating all tests and consultations
  • Preventive medicine care, such as Pap smears, mammograms, blood pressure screening and cholesterol screening
  • Communication with local doctors about successive therapies after a patient is discharged from hospital, which is especially important if she/he has one or more chronic medical illnesses, such as high blood pressure and diabetes.

1.1 Functional Fields of Work

Clinical / Diagnostic / Operative Care:

Work involves diagnoses, prognoses (how a disease progresses & assessing that progress) and treatment / therapy provided to patients suffering from clinical conditions affecting particular organs or organ systems including allergies, sinusitis, pharyngitis, arthritis, bone disorders and injuries, ulcers, high blood pressure, high cholesterol, coronary artery disease, congestive heart failure etc. Treatment could be done by surgery or through administration of internal medicine. 

Medical Research

You can pursue a career as a physician scientist. Work will be completely laboratory based sometimes involving field collections of biologic samples (human/animal). Depending on your interest, there are several different disciplines to choose from, including laboratory science, clinical research, and health services research.

Researchers often work at academic medical centers, for the pharmaceutical industry, or with the government. If you’re considering a career in research, it will be important to maximize your research experiences during medical school.

You can do this by participating in a research project, taking a gap year for a research scholars program or other structured research experience, or participating in summer research internships.

For an example, you may be board certified in Internal Medicine (for a practice license) and an Associate Professor of Medicine as well, simultaneously you may also be a recipient of research grants from different sources and pursue scientific research on say, hand sanitizers (their formulation aspects, adverse effects, & regulations) or suppose colorectal cancer treatment if you are researching on the development of novel screening and therapeutic strategies or new therapies.

Education and Training:

Typically, in medical colleges and universities, all educators are involved in training and educating aspiring doctors. This includes operative techniques & experiences as well as theoretical lectures to develop a deep understanding of clinical and basic sciences surrounding Cardiac Sciences and its various sub-specialties including the principles of disease investigation, interpretation of diagnostic test results and employed technologies.

  • Internist (Community Internal Medicine): Community Internal Medicine specialists play a significant role in providing local communities with the expertise, knowledge and strength.
  • Internist (Adolescent medicine): Adolescent medicine Specialists focus on patients in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, and when adulthood begins.
  • Internist (Hospital medicine): Hospital medicine is a medical subspecialty which deals with the care of acutely ill hospitalized patients.
  • Internist (Allergy, Asthma and Immunology): Some Internists can specialize in clinical conditions like allergies, asthma and immunological modalities of treatments of various infections.
  • Internist (Clinical cardiac electrophysiology): Doctors specializing in this sub-specialty focus on the study and treatment of rhythm disorders of the heart. They assess your heart’s electrical system or activity and diagnose abnormal heartbeats or arrhythmia.
  • Internist (Gastroenterology): This subspecialty is concerned with the field of digestive system disorders.
  • Internist (Geriatric Medicine): This branch focuses on healthcare of the elderly people. There is no stipulated age when a patient needs the care of a specialist geriatrician.
  • Internist (Interventional cardiology): This subspecialty specifically deals with catheter-based treatment of structural heart diseases. For example, the interventional cardiology procedure of primary angioplasty is now the gold standard of care for an acute myocardial infarction (commonly known as heart attack).
  • Internist (Hematology): This is the branch concerned with blood, the blood-forming organs and its disorders.
  • Internist (Sleep medicine): Doctors specializing in this discipline are devoted to the diagnosis and therapy of sleep disturbances and disorders.
  • Internist (Sports medicine): This branch of medicine deals with physical fitness and the treatment and prevention of injuries related to sports and exercise.
  • Internist (Transplant hepatology): Transplant Hepatologists receive advanced training in gastroenterology and focus on the management of advanced liver disease.
  • Internist (Infectious disease): This subspecialty is concerned with disease caused by a biological agent such as by a virus, bacterium, parasite or other etiological agents like prions etc.
  • Internist (Medical oncology): Medical Oncologists deal the immunotherapeutic (immunological) and/or chemotherapeutic (chemical) treatment modalities of cancer.
  • Internist (Nephrology): Nephrologists deal with the study of the function and diseases of the human kidney.
  • Internist (Pulmonology): Pulmonologists deal with diseases of the lungs and the respiratory tract
  • Internist (Rheumatology): Rheumatologists primarily deal with immunity related disorders of the musculoskeletal system, soft tissues, autoimmune diseases, and/or inherited connective tissue disorders.

What does an Internal Medicine Specialist do?

As an Internist/ Internal Medicine Specialist, depending on your functional field of work, you will be engaged with one or moreof the following roles and responsibilities: –

Clinical / Diagnostic / Operative Care:

  1. You will be examining a patient (physical examination and primary screening) for diagnosis of and obtaining information on medical / physical conditions, history, and tendencies to ascertain necessary medical attention or required surgical procedures.
  2. You will be diagnosing bodily disorders and clinical conditions and suggest therapeutic treatments, such as prescribing medicines or necessary surgeries, in hospital wards, clinics, or operating rooms.
  3. You will be determining the nature of treatment, conferring with other medical professionals if required for or to obtain historical data to construct a patient’s medical portfolio and plan further treatment – advising throughout the prognosis (progression) of a disease.
  4. You will be involved in recording patient’s condition or progress throughout the tenure of your treatment sessions, writing reports and maintaining proper registers containing patient information (case histories).

Medical Research:

  1. You will plan, organize, coordinate & participate in scientific research projects, in collaborative work on study/experiment design, data analysis, & manuscript preparation for various scientific projects.
  2. You will identify & implement strategies to enhance collaboration between investigators and clinical or research scientists.
  3. You will recruit healthy & affected individuals for a period of close monitoring of their personal clinical response to disease stimulants or to obtain biologic samples from these participants for extensive analysis.
  4. You will determine specific goals or objectives to be obtained; evaluate research data and develop & revise techniques or approaches to work problems.
  5. You will function in a separate & independent manner in the design and initiation of research experiments.
  6. You will design, develop or adapt equipment used in experiments or research to obtain desired results. You will be responsible for laboratory equipment and implementing safety procedures.
  7. You will independently compose abstracts, technical reports, slide presentations, posters, spreadsheets, and manuscripts for submission to corporate and federal sponsors, conferences, and scientific journals.
  8. You will produce medical illustrations, scientific posters, publication graphics, and slide presentations for national & international meetings.

Education and Training:

  1. You will be involved in instructing / teaching to a class of students pursuing post graduate or higher levels or study in the fields of Internal Medicine or related disciplines.
  2. You may demonstrate techniques or handling of instruments / tools to your students inside an operation theatre and counsel / guide students in performance of operative experiments.
  3. You will participate in seminars, medical congresses, conferences across the world.

How to become an Internal Medicine Specialist – Educational Requirement

  1. After Class 11-12 & NEET (compulsory), you have to go for your Bachelor of Medicine and Bachelor of Surgery course (MBBS). Various forms of this qualification’s name are MB ChB, MB BChir, BM BCh, BMBS and MB BCh around the globe.
  2. After your graduation, you have to go for a Master / post graduation PG level program like MD, DNB and complete senior residencies to specialize in various branches of Oncology.

DNB is considered equivalent to MD. The only difference is for MD you will be trained in medical colleges with hundreds of patients and for DNB you will be trained in big private hospitals with much lesser number of patients.

After post graduation, you can further proceed with FNB, DM or PDCC if you want to higher qualifications or obtain PhD if you want to be a physician scientist.

The MD specialties approved by the Medical Council of India are:

  • Anaesthesiology        
  • Aviation Medicine     
  • Aviation Medicine/Aerospace Medicine       
  • Bio-Chemistry
  • Bio-Physics    
  • Blood Banking & Immuno. Haem./Imm. Haem. & Blood Trans.       
  • CCM (Cerebral Cavernous Malformation)
  • Community Health Administration   
  • Community Medicine
  • Dermatology 
  • Dermatology , Venereology & Leprosy         
  • Emergency Medicine 
  • Family Medicine        
  • Forensic Medicine/Forensic Medicine & Toxicology
  • General Medicine      
  • Geriatrics        
  • Health Administration
  • Hospital Administration        
  • Immuno Haematology & Blood Transfusion
  • Lab Medicine 
  • Marine Medicine       
  • Maternity & Child Health      
  • Medical Genetics       
  • Medical Toxicology   
  • Medicine        
  • Microbiology 
  • Nuclear Medicine      
  • Obstetrics & Gynaecology    
  • Ophthalmology         
  • PSM (Preventive & Social Medicine) 
  • Paediatrics     
  • Palliative Medicine    
  • Pathology      
  • Pathology & Microbiology    
  • Pharmacology
  • Pharmacology and Therapeutics       
  • Physical Medicine & Rehabilitation  
  • Physiology     
  • Psychiatry       
  • Pulmonary Medicine 
  • Radio Diagnosis        
  • Radio Diagnosis/Radiology   
  • Radiology      
  • Rheumatology
  • Skin & VD      
  • Skin & VD & Lepxsy   
  • Social & Preventive Medicine / Community Medicine         
  • Sports Medicine        
  • TB & Chest     
  • Thoracic Medicine     
  • Transfusion Medicine
  • Trauma and Critical Care Medicine   
  • Tropical Medicine      
  • Tuberculosis & Respiratory Diseases / Pulmonary Medicine
  • Tuberculosis & Respiratory Diseases/Medicine        
  • Venereology  
  • Anaesthesiology & Critical Care Med.
  1. In the UK, MRCP / MRCS / FRCS is mandatory to practice as a Internist/ Internal Medicine Specialist.

You have to qualify graduation from any medical school (in UK or any other country including India), complete MD (if you are studying in India) and obtain your MRCP qualification from any of the Royal Colleges (Edinburgh, Glasgow, London).

For Medicine, there are 3 Royal Colleges that grant membership certifications: in Edinburgh, Glasgow and London.

MRCP exams are conducted by each college separately. So there are 3 different MRCP exams by 3 different colleges. Each exam has its own format that can be referred to from respective portals of conducting bodies.

You can appear for any MRCP exams from India. Exam centers in India include many cities such as New Delhi, Hyderabad, Chennai etc. The fee for New Delhi is the lowest usually. The Indian locations are detailed on the individual websites of the 3 colleges (the dates are subject to change but the specialties and locations are not)

  1. Aiming the UK, it will be most profitable of you also earn registrations with established bodies such as AHCS (The Academy for Healthcare Science), RCCP (The Registration Council for Clinical Physiologists), or HCPC (Health and Care Professions Council).
  2. If you are targeting US or Canada, remember, you will have to clear USMLE after you complete an MBBS program in India to be able to directly practice in the US. To study in medical schools in USA or Canada for an MD degree before practicing there, you will have to clear MCAT. Medical College Admission Test (MCAT) is a compulsory test for anyone who plans to get admission in medical schools of USA and Canada. MD degrees are followed by 3 to 7 years of residency. Graduates can practice any specialty. Physicians are fully certified after passing board exams. 152 MD-granting schools in the United States and 17 in Canada.

MCAT consists for 4 distinct sections which are individually scored. Each section is allotted either 90 or 95 minutes and tests between 50 and 60 questions. Including breaks, the full examination lasts approximately 7.5 hours.

Most MBBS graduates go for further study by passing MCAT, completing 4- year MD in US or Canada and then appearing for USMLE because this way is easier. However, some MBBS graduates avoid this path and directly aim at USMLE from India but cannot succeed as they lack US-based education which is extremely essential in order to pass USMLE.

MCAT is administered 25 times in a year. With a pass in MCAT, they will need to complete a medical degree (MD) in the US or Canada which is for 4 years. Then they can appear for USMLE and get a practice license.

Remember: after passing USMLE once, you cannot repeat it for attempting a better score. Programs usually eliminate candidates with multiple attempts. For this reason it is essential to do extremely well in the first attempt. Further, youranswers will not be evaluated on a population curve basis; you will be marked on the level of difficulty of the items you have attempted during the examination.

Graduates from any other streamin India (other than MBBS) are also eligible to practice as a Medical Professional in the US but they have to appear for MCAT with a ‘special permission’from Association of American Medical Colleges (AAMC) (before registering for the exam, mail to [email protected] stating the reasons why you wish to take the exam). If you are specially permitted by AAMC, which is rare, you can then attempt & clear MCAT, then pass 4-year MD, then clear USMLE and then practice in US / Canada.

So, in short

MBBS in India > MCAT > Basic Medical Degree in US / Canada (MD) > USMLE >Practice

Alternatively, a tougher router is,

MBBS in India > USMLE >Practice

For non-medical graduates from India,

Bachelor degree (duration is not a factor) > MCAT with special permission> Basic Medical Degree in US / Canada (MD) > USMLE >Practice

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Job Opportunities

In India, after a DM you can get a job as a Consultant in any of the following healthcare establishments:

•           Multi-Specialist Government and private hospitals such as All India Institute of Medical Sciences (AIIMS), Christian Medical College, Apollo, Fortis, Narayana, Kasturba, Tata, Lilavati, Medanta, Kokilaben, King Edward Memorial, Max, Wockhardt, Sterling, Shalby, Medica, King George, Assam Medical College, Columbia Asia, Jaslok, AMRI, and so on.

•           You may also consult patients at various health clinics.

Most jobs for Specialist Consultant Physicians are contractual. Many of the Consultants work in more than one hospital.

•           If you want to pursue a career in teaching along with practice (practice means you will be involved in treating patients), you may join a teaching hospital as an Associate Professor, generally referred to as Medical College and Hospital such as the AIIMS, St. John, Kasturba Medical College, Maulana Azad Medical College, King George’s Medical College, Christian Medical College Vellore, Grant Medical College, Calcutta Medical College, Lady Hardinge Medical College, etc. In India, generally an alumnus of a medical college is absorbed into the faculty of the college after their Senior Residency in that college itself.

If you want to pursue a career in Medical Research along with practice (practice means you will be involved in treating patients), then you may join any of the medical colleges which are involved in research such as the AIIMS, JIPMER Pondicherry, Institute of Medical Sciences, BHU, University College of Medical Science, Delhi University, Sri Ramachandra Medical College & Research Institute, Regional Medical Research Centre at Bhubaneswar and Dibrugarh, PGIMER, Chandigarh, IPGMER, Kolkata, etc.

Salary of an Internal Medicine Specialist

After your DM, as a specialist Consultant Internist, you will be getting about Rs. 1,00,000-1,30,000 a month to begin with at a Government hospital. At private hospital, you may get about Rs. 1,50,000-2,00,000 or even more a month depending upon your experience.

Remember that by the time you complete a DM, you will have at least 8 years of practice experience, first as a junior resident (3 years during MD), then as a senior resident (3 years during DM) and considering 1 year gaps between MBBS and MD and then another 1 year gap between MD and DM). In most cases, however, it takes at least 10 years to complete a DM.

With about 2-5 years post qualification experience (after DM), you will be making about Rs. 1,20,000 – 3,00,000 or more per month.

With about 6-12 years post qualification experience (after DM), you will be making about Rs. 1,80,000 – 5,00,000 or more per month.

Senior Specialist Consultants with about 15-20+ years post qualification experience (after DM), you will be making about Rs. 2,50,000 – 12,00,000 or more per month.

Career Progression in Internal Medicine Specialist Profession

In hospitals, if you are engaged as a practicing Consultant, there is no growth as such in terms of job positions, except being called a Senior Consultant. However, in teaching hospitals, if you are engaged in teaching along with practice, you may grow from an Associate Professor’s role to a Professor and then to a Senior Professor.

If you are engaged at a medical research institution, you may grow from the position of a Senior Scientist to that of a Principal Scientist, then to a Deputy Director and Director.

What does industry trends say – Future Prospects

The future of this pathway seems bright as the industry statistics are encouraging.TheHealthcare Market in India has a potential to increase 3 fold to 133.44 billion US Dollars by 2022. Indian Government is willing to expand public health spending to 2.5% of GDP by 2025. Pradhan Mantri Jan Arogya Yojana (PMJAY) launched in 2018 provides 7,124.54 US Dollars each to over 100 million families every year.

TheentireHealthcare Industry in India is one of the fastest growing sectors and it is expected to reach $280 billion by 2020. The major focus is on quality of service and hence skilled labor is much required to sustain growth of this industry.

The Services Sector (including community, social and personal services) is the key economic growth driver in India. It is the dominant sector in India’s GDP, has also attracted significant FDI (Foreign Direct Investment) in 2018 itself and generated large scale employment opportunities.

By 2025, medical spending in India is expected to grow byalmost 9 to 12% making India one of the world’s top ten in this zone. India’s earnings from medical tourism could exceed US$ 9 billion by 2020.

The Indian Life Sciences industry will sustain its growth trajectory of 11 to 12% and grow 7 to 8 times to a size of USD 190 billion to 200 billion by 2030. The industry will also create nearly 4 million new jobs for the country over the next 15 years starting from 2019.

Overall, R&D spend from pharma and biotech companies is expected to be USD 177 billion in 2019, compared to about USD 171 billion in 2018. Biotechnology products are expected to contribute steadily to sales, rising to 52% the top 100 product sales by 2024.

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