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 | Physicians
By Michael Spilane, MD
An internist is a specialist and a more specialized internist is a subspecialist. But none of them are interns. A family medicine physician is not the same as a general practitioner. A geriatrician can be either an internist or a family medicine physician. Confused? Help is ahead.
It was all a lot easier when there were just general doctors and surgeons. But medicine has changed, and so have its physicians. The tremendous advances in medical knowledge and technology have created the imperative for specialization, even special specialization. Anyone seeking a physician or being referred to a physician needs to understand who-is-who.
Let's begin with the training. All physicians start with four years of college and four years of medical school. With a doctor degree in-hand, they then decide which specialty to pursue and enter as a resident in that field. All physicians must complete a minimum of three years of resident training (the first year of this education traditionally has been called an internship). So far it involves eleven years of training after high school, but for many it is not over. Advanced training as a fellow is required for many highly specialized fields and demands two to four additional years.
With so much training, it is fair that all physicians consider themselves specialists. An important distinction is between those who are primary care specialists and those who are consultant specialists. Primary care specialists are first-line personal physicians who provide continuing care for their patients. Their broad interest and training allow them to effectively serve at the entry point to the medical care system and to control patient forays through its maze. Consultant specialists narrow their interest but bring in-depth knowledge and expertise in their chosen field. An ophthalmologist knows the eye but will not treat psoriasis. A dermatologist will treat the psoriasis but not an eye problem. There are a couple of dozen different consultant specialties (just look in the Yellow Pages) and some of these fields even have specialties within their own specialty. For instance, an ophthalmologist might specialize in diseases of the retina.
For an older person, the selection of a primary care physician is a very important decision. The first advice is to not choose a pediatrician. The next advice is to be sure to have a primary care physician.
You will need to choose between a general internal medicine specialist and a family medicine specialist. A general practitioner is seldom an option, since this type of physician has not been produced since added residency training was required for all physicians many years ago. The differences between general internists and family medicine specialists relate to training and interests, and not to whether they are better or worse doctors.
The largest numbers of physicians in the United States are internists, or specialists in internal medicine. Internists are basically non-surgical specialists in adult medicine. They are trained to be highly expert diagnosticians, and to be especially thorough and scientific in their approach. About half of the internists practice in general internal medicine. The other half take advanced training to practice as subspecialists in areas such as cardiology (heart), pulmonary (lung), gastroenterology (stomach, intestinal tract and liver), and rheumatology (muscles and joints). General internal medicine specialists are primary care physicians. They limit their practice to adults, do not treat pregnant women, and do not perform major surgery.
The training of a family medicine (or family practice) physician is usually as intense as that of a general internist, but is broader in scope. The training of a family medicine physician includes pediatrics, obstetrics, surgery, orthopedics and other areas needed to assure a broad expertise. A family medicine physician is prepared to diagnose and treat a wide variety of ailments across the entire life span. By definition, all family medicine specialists are primary care physicians.
The training and focus of general internal medicine specialists make them ideal physicians for the older population. But some family medicine physicians possess interests and skills that enable them to provide excellent care for the complex medical problems presented by older adults.
A geriatrician is a physician who has taken advanced training in caring for medical problems of the elderly. This training presently demands one or two years of fellowship after completion of a three-year residency program in either internal medicine or family medicine.
There are not enough geriatricians to care for all of the elderly, but most older persons do not need one. General internists and family medicine physicians provide excellent care to this age group. The geriatrician is most needed by frail and multi-impaired home-living older persons and by those who reside in nursing facilities.
If it is still confusing, remember just one thing. Be sure to have a personal physician. Whether it is a general internal medicine specialist or a family medicine specialist is less important than the trust placed in the knowledge, skill and attitude of the physician.
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