Developing your career as a physician in general internal medicineBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6254 (Published 08 November 2019) Cite this as: BMJ 2019;367:l6254
A career in general internal medicine is varied, challenging, and rewarding. Doctors in the specialty manage a wide range of acute and long term medical conditions and symptoms. They are experts in diagnostic reasoning, dealing with uncertainty, and managing comorbidities. A career in general internal medicine also offers opportunities to subspecialise or to combine clinical work with academic research or a non-clinical role.
After completing the examinations for membership of the Royal College of Physicians, doctors move into specialty training which can take a further three to six years. Nearly all training in general internal medicine is done in parallel with another specialty, such as acute internal medicine, cardiology, clinical pharmacology and therapeutics, endocrinology and diabetes, gastroenterology, geriatric medicine, infectious diseases, renal medicine, respiratory medicine, or rheumatology.
To gain access to specialty training in general internal medicine it is necessary to apply for one of these specialties. Most will offer dual accreditation, with extra training time to fully specialise in both,1 although there are one or two training programmes that provide training solely in general internal medicine. Doctors can apply for consultant roles six months before achieving their certificate of completion of training.
A career in general internal medicine is flexible, with doctors having the choice of remaining a generalist or taking on a more specialist role according to their own interests, skills, and place of work. The ways in which general internal medicine is practised vary according to the size of the hospital, staffing, and the specialist services provided.
Smaller hospitals tend to rely on consultant physicians, regardless of their specialty, to participate routinely in the acute medical take, have duties on the acute medical unit, and provide ongoing care to general internal medicine patients. In larger hospitals and tertiary centres, general internal medicine physicians will commonly manage the acute medical unit and the care of unselected medical patients.
Consultants in general internal medicine have a unique perspective on whole systems care, safety, and the priorities for delivering quality improvement and improved patient outcomes. This means they are well placed to take on managerial roles. Opportunities include becoming a clinical lead (the lead consultant for the team), clinical director (the lead consultant for the department), or medical director (the lead consultant for the trust).
Education and training roles
Most NHS consultants will be involved with the clinical and educational supervision of junior doctors. There are also other opportunities including becoming the director of postgraduate medical education (the consultant responsible for the postgraduate medical training in a hospital) or the training programme director (overseeing the education of the cohort of trainee doctors within a local Health Education England office or deanery).
Doctors who have trained on an academic general internal medicine pathway or are interested in research may wish to consider an academic career. The usual route for an academic career is through an academic clinical fellowship (ACF) and then to a clinical lectureship. Applications for ACF posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre.2 There are also plenty of opportunities for trainees to undertake research as part of planned time out of their training programme.
SAS doctor roles
There are also opportunities to work at non-consultant level—for example, as a staff, associate specialist, and specialty (SAS) doctor. SAS posts are non-training roles where the doctor has at least four years of postgraduate training, two of those being in a relevant specialty.
Physicians who are motivated to make a difference to patient care or to improve conditions for healthcare workers may want to get involved in medical politics. Useful experience can be gained by working with the BMA, the Royal College of Physicians, or the General Medical Council.
Expedition medical officers support adventure travellers and overseas field researchers. The role involves pre-expedition planning as well as supporting people who become ill or injured during the trip. It may also involve arranging emergency transport. Doctors would need to take an expedition medicine course. Details of courses can be found on Health Education England’s Health Careers website,3 the World Extreme Medicine website,4 and the Adventure Medic website.5
There are opportunities for SAS doctors or consultants to work or volunteer abroad. Staff are often needed at short notice and work in challenging environments. Further information can be found on the BMA website.6 Opportunities can be found through Médecins Sans Frontières,7 MERLIN,8 and Voluntary Service Overseas.9