In times past, the internist used to be THE consultant, called by GPs, surgeons and other specialists to give their opinion on management of complex medical issues.
How times have changed.
IM residency is 3 years. There are IM residencies with a primary care focus -- a categorical primary care residency where you can still specialize afterwards, but geared for those who know they want to be in primary care, with rotations where you spend more rotation time in outpatient settings and in ambulatory rotations in other fields like gyn, ortho, ent, ophtho, gu, learning about what they commonly see so that when you see it in your practice you'll know what you can take care of and what to refer on. Then there are your bread and butter IM residencies where you divide your time between Units, wards, and subspecialty consult months like Cards, GI, ID, Renal, etc. These are geared for those who want to go into primary care as well as for those who might want to specialize. The programs with primary care tracts have you spend time on these services as well, but a little less compared to the basic, regular tract.
The private general internist in his/her office sees x number of adult patients a day diagnosing and managing medical conditions (hypertension, diabetes, endocrine, ID, renal and cardiac stuff, as well as heme-onc issues), and managing what they feel comfortable managing, and referring onto specialists for particular care/procedures/evaluation.
They can also have busy inpatient services where they pretty much manage acute exacerbations of medical conditions. This is a good field for those who enjoy having a broad based expertise, enjoy the cognitive side of medicine, patient contact/variety and a wide variety of disease conditions. Almost all general internists do paps/pelvics. IM residency is supposed to train you in performing flexible signmoidoscopies, and many gen. IMs do them in their practice. Tapping joints is another common procedure. Good IM residencies (in my opinion) make their residents competent in placing central lines, placing chest tubes, intubation, floating swans and other ICU type procedures as well as paracenteses, thoracenteses and lumbar punctures -- but the degree to which a general internist will do any or all of these procedures is going to vary with comfort level and practicality (the ICU stuff goes without saying, and you need to consider that time can be better spent in the office seeing patients than putting in a central line).
IM is a great field for patient contact. If you like procedures, you should consider procedure intensive sub-specialties like Pulmonary/Critical Care, GI or Cardiology. These fields require an additional 3-5 years (Cards can be 5) after IM residency, and all have a wide scope and variety of diagnostic and therapeutic procedures requiring a high degree of training and skill if you like to work with your hands but also like to think <img src="graemlins/laughy.gif" border="0" alt="[Laughy]" /> and have patient contact. Cardiology is often referred to as the most "surgical" IM subspecialty (I'll excuse the derision
)and I've heard GI docs referred to as endoscopic surgeons (much to the chagrin of their surgical colleagues, I'm sure).
Hope this helps a little.
