Internal Medicine Residency Length, Requirements, and More

November 13, 2023
Are you a medical student who’s curious about internal medicine and considering it as a career path? If so, I was once in your shoes, and I can tell you an internal medicine residency is a challenging yet rewarding journey that can open doors to a wide range of career opportunities.
But the question is, is it the right journey for you? In this post, we’ll explore the essential aspects of internal medicine residency, from its length and requirements to what you can expect in terms of your training and future career prospects.

What Drew Me to Internal Medicine

Let’s begin by examining a question that’s fundamental to understanding why we select a particular specialty: what drew us to medicine in the first place? Here’s my story.

Before medical school, what did being a doctor look like to you? Maybe it was like being JD from Scrubs or Dr. House, or maybe it was being a character on Grey’s Anatomy. 

Having multiple family members who were already working in IM, I had a first-hand view of what being a doctor was like, and to me that meant being an internal medicine physician.

When you think about it, an internist is what most people imagine when they think of a physician: someone with expansive medical knowledge, who is compassionate, and able to care for a wide range of health problems. 

So for me, going into internal medicine was a way to realize my vision of what a doctor is supposed to be. And it was the right move.

I love IM because I can forge close relationships with patients and I have flexibility in what I do, whether that’s being able to work in a clinic, a rehab, a hospital, doing research, or something else. IM allows you to stay general or specialize really at any time, so you can pivot during your career as you see fit!

Should You Pursue an Internal Medicine Residency?

So, what makes for a good internist? And is it a career path you’d enjoy? Internal medicine might be a good fit for you if…

1. You have a passion for problem solving.

Internal medicine is a specialty that focuses on the diagnosis, management, and treatment of adult patients with a wide array of medical conditions. If you have a strong passion for problem solving, enjoy diagnosing complex cases, and appreciate a holistic approach to patient care, IM might be the right choice for you.

2. You thrive in a versatile environment with a broad knowledge base.

Internal medicine provides you with a versatile foundation that can lead to a diverse array of career opportunities. If you’re interested in subspecialties like cardiology, gastroenterology, or infectious diseases, IM is an excellent launching pad. Not to mention, you can help more people than you could if you went into any other specialty, since there is so much need in the field!

3. You care about holistic and preventative medicine.

Internal medicine focuses on every aspect of a disease: why someone is at risk, why they became ill, what can be done to prevent it, how do you treat it, etc. You can care for patients at every level during residency, including clinic, hospital floors, and even intensive care units.

How Long is IM Residency and What’s it Like?

An internal medicine residency takes three years to complete. During this time, you’ll work in hospital and clinic settings under the guidance of experienced attending physicians.

Your daily routine will involve rounds, patient care, charting, and various educational activities. You’ll learn how to be a primary care physician and a hospital medicine physician—think of it like you’re the “quarterback” for your patients’ care in either setting.

Rotations and Learning

Each year varies by program, but the total weeks in each field are about the same: a mix of clinic and hospital rotations, both specialty and primary care.

Residency includes 40 weeks of inpatient medicine and about 30 weeks of outpatient medicine. The rest of your time is split into rotations through cardiology, pulmonology, GI, endocrinology, nephrology, ICU, night float, rheumatology, and electives.

This can be demanding, with long hours, overnight shifts, and a steep learning curve. However, the experience you gain is invaluable, and it prepares you to become a competent and confident physician.

My Schedule as an IM Resident

For example, my program uses a “4&1 schedule,” which means I complete four weeks of inpatient/specialty rotation followed by one week of clinic. This is a nice schedule for breaking up long periods of challenging rotations and gives you a guaranteed weekend off after your clinic week.

Some programs have continuity clinic on certain days of the week, and it can be challenging to go from the hospital to clinic and back to the hospital, but this also gives you more regular experience in the clinic. IM residency definitely focuses more on speciality education and hospital management than outpatient education, which is more a focus of family medicine.

What are Your Options After Internal Medicine Residency?

1. General Internist

Upon completing IM residency, you can choose to become a general internist, providing comprehensive care to adult patients as inpatients, outpatients, or both. You can work in a private practice, community hospital, or academic setting, and interact with a diverse patient population.

2. Subspecialty Fellowships

Many internists choose to pursue subspecialty fellowships in areas such as cardiology, gastroenterology, or pulmonary/critical care. Fellowships typically last two to three years and provide in-depth knowledge in a specific field, making you an expert in the subject. These are great for those who have a passion for a particular field.

3. Academic Medicine

If you have a passion for teaching and research, you can explore opportunities in academic medicine. These positions allow you to teach medical students and residents while conducting valuable research. Research is not a critical part of getting into an IM residency, but for those interested in pursuing a research career, there are ample opportunities as an attending.

How Do I Apply for an IM Residency?

The Match Process

Applying for residency programs in the United States involves the National Resident Matching Program (NRMP), commonly known as “the Match.” This is the system that pairs applicants with programs through a computer algorithm based on their preferences and the preferences of the programs. There are only a few residencies that do not use the NRMP.

Preparing Your Application

Preparing your application for IM residency is more straightforward compared to smaller fields like dermatology or any specialty surgery. How well you do on your clerkships is critical to getting good recommendations from attendings. Having great scores is important but IM is not as competitive as other fields.

Research is not a common part of one’s application, so place more focus on your scores, letters of recommendation, and interviews. If you have connections, they can certainly help you get into a program, but for the most part they’re not needed, since class sizes are often very large and there are many programs to apply to.

Make sure your application includes: 

  • Your medical school transcripts
  • Letters of recommendation
  • A personal statement
  • Your USMLE scores

Looking for help preparing your residency application? Consider working with a residency counselor to help you brainstorm your personal statement, review your application, prep for interviews, and more!

Make sure to research programs carefully and apply to those that align with your career goals and interests. With so many programs that are often very large (as many as 40 per class), it can be easy to get lost among the herd. That might be something you prefer, or you may want to have more individualized attention with your training.

When choosing programs to apply to, be certain to consider your future goals. For example, if you want a fellowship, look for a program with that fellowship so you can build connections and maybe stay there for your training.

Further Reading

Internal medicine residency is a challenging but rewarding path if you’re interested in adult patient care but still want a diverse range of career options. The training is rigorous, but the knowledge and experience you gain will lay a strong foundation for your future in medicine. Good luck with your medical school journey and finding the residency that’s right for you!

Looking for more (free!) content to help you choose a specialty and apply for residency programs? Check out these other posts on the Rosh Review blog!

Rosh Review is a Blueprint Test Prep company helping you pass your exams through every stage of your medical journey. You can find more resources for medical students (including tutoring, Qbanks, study planners, and more) over at Blueprint Med School!

By Dr. Navin Prasad

Comments (0)