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Clinician

Blog articles for clinicians and other medical professionals.

Internal Medicine vs. Family Medicine 

April 28th, 2025

While these fields share similarities, they differ significantly in scope of practice, patient population, and required certifications.

This article will provide an in-depth analysis of each discipline, including their roles, specialties, certification requirements, and steps to establishing a practice.

Definitions and scope of practice

Internal medicine

Internal medicine is dedicated to the prevention, diagnosis, and treatment of diseases affecting adults. Clinicians in this area are known as internists and are trained to manage complex and chronic illnesses, making them specialists in adult healthcare.

  • Patient population: Adults (18+ years)
  • Scope of practice:
    • Management of chronic illnesses (e.g., hypertension, diabetes, COPD)
    • Acute care management
    • Preventive care and health maintenance
    • Coordination of specialist referrals
    • Hospital-based and outpatient care
  • Subspecialties:
    • Cardiology
    • Gastroenterology
    • Infectious disease
    • Nephrology
    • Rheumatology
    • Oncology
    • Pulmonology

Internists often serve as primary care providers (PCPs) for adults, but they may also focus on subspecialty care. Those who complete additional fellowship training pursue specialized practices within internal medicine.

Family medicine

Family medicine consists of providing comprehensive medical care across all age groups, from pediatrics to geriatrics. Family physicians are trained to handle a broad spectrum of health concerns, including preventive care, acute conditions, and chronic disease management.

  • Patient population: All ages (infants, children, adults, and older adults)
  • Scope of practice:
    • Pediatric and adult primary care
    • Obstetrics and gynecological care (for some practitioners)
    • Management of chronic diseases (e.g., diabetes, asthma, heart disease)
    • Minor surgical procedures
    • Behavioral and mental health care
    • Emergency and urgent care

Family medicine practitioners emphasize holistic and continuity-based care. They manage entire families, often treating multiple generations within the same practice.

Primary care practices

Primary care is an umbrella term referring to healthcare services that provide first-contact and continuous care. Both family physicians and general internists can function as PCPs, along with pediatricians, nurse practitioners (NPs), and physician assistants (PAs).

  • Patient population: Varies based on specialty
  • Scope of practice:
    • First point of contact for medical concerns
    • Preventive healthcare and screenings
    • Chronic disease management
    • Coordination of specialist referrals
    • Vaccination and wellness visits

Primary care providers serve as the entry point to the healthcare system, addressing a wide range of medical needs and coordinating care across specialties.

Key differences between internal and family medicine

Factor

Internal medicine

Family medicine

Patient population

Adults (18+ years)

All ages (newborns to older adults)

Training focus

Adult disease management, hospital-based care, chronic disease treatment

Comprehensive care across all ages, including pediatrics, gynecology, and geriatrics

Subspecialty options

Multiple (e.g., cardiology, endocrinology)

Few, but some integrate areas like sports medicine and obstetrics

Practice setting

Hospital, outpatient clinics, specialized practices

Outpatient clinics, community health centers, private practice

Procedures performed

Diagnostic and therapeutic procedures related to adult medicine

Minor surgical procedures, dermatologic procedures, gynecologic procedures

Certifications and training requirements

Internal medicine training pathway

  1. Medical school (MD or DO): Four years
  2. Residency in internal medicine: Three years
  3. Optional fellowship (for sub-specialization): One to three additional years
  4. Board certification:
    1. American Board of Internal Medicine (ABIM) or
    2. American Osteopathic Board of Internal Medicine (AOBIM)

Family medicine training pathway

  1. Medical school (MD or DO): Four years
  2. Residency in family medicine: Three years
  3. Optional fellowship (for areas like sports medicine, geriatrics, or obstetrics): One additional year
  4. Board certification:
    1. American Board of Family Medicine (ABFM) or
    2. American Osteopathic Board of Family Physicians (AOBFP)

Establishing an independent practice

Clinicians considering opening their own internal medicine or family medicine practice must take several key steps, including:

1. Developing a business plan

  • Define the target patient population and scope of services.
  • Choose between solo or group practice.
  • Identify potential locations and market analysis.
  • Use resources such as the Small Business Administration (SBA) business planning tools, and the Medical Group Management Association (MGMA) for financial and operational insights,

2. Securing licensing and credentialing

  • Obtain state medical licensure:
    • Apply through the relevant State Medical Board, meeting educational and training requirements.
    • Complete background checks and provide proof of postgraduate training.
    • Pass the USMLE (for MDs) or COMLEX (for DOs), as required by the state.
    • Fulfill continuing medical education (CME) requirements for renewal.
  • Complete DEA registration for prescribing medications:
    • Apply for a DEA number through the Drug Enforcement Administration (DEA) online.
    • Pay the required registration fee and specify the schedules of controlled substances to be prescribed.
    • Renew DEA registration every three years.
  • Apply for board certification:
    • Pass the board certification exam offered by ABIM (for internists) or ABFM (for family physicians).
    • Maintain certification through periodic recertification exams and CME credits.
  • Enroll in Medicare and Medicaid (if applicable):
    • Apply through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).
    • Obtain a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES).
    • Complete site visits and background checks as required.
    • Regularly update provider information and adhere to compliance audits.

3. Obtaining financing

  • Secure a business loan or investment.
  • Explore healthcare-specific loans such as SBA 7(a) and SBA 504 loans, which offer favorable terms for medical practices.
  • Consider physician-focused financial institutions like Bank of America’s Practice Solutions or Wells Fargo’s Healthcare Practice Finance.
  • Look into private medical practice loans from lenders specializing in healthcare, such as Live Oak Bank or Provide.
  • Seek out venture capital or angel investors if pursuing an innovative care model.
  • Budget for equipment, office space, and staff salaries.

4. Setting up legal and administrative structures

  • Register as a legal entity:
    • Most clinicians setting up their own practice choose between a Limited liability company (LLC), an S corporation (S corp), or a professional corporation (PC).
    • An LLC provides flexibility and protects personal assets, making it a popular choice for solo and small group practices.
    • An S corp allows for tax advantages, particularly for higher-earning physicians, but requires compliance with more regulations.
    • A PC is often mandated in some states for licensed professionals and provides liability protection while allowing for corporate taxation options.
    • Consult a healthcare attorney and an accountant to determine the best entity for tax and liability purposes.
  • Acquire malpractice insurance:
    • Malpractice insurance is essential for protecting against legal claims and must be obtained before seeing patients.
    • Options include occurrence-based and claims-made policies. Occurrence-based covers any claim from an incident during the policy period, while claims-made covers only claims filed while the policy is active.
    • Consider insurers that specialize in medical malpractice, such as The Doctors Company, MedPro Group, and Coverys.
    • Some states and hospital affiliations may have minimum coverage requirements.
  • Establish electronic health record (EHR) systems:
    • Choose an EHR system that complies with HIPAA regulations and meets the specific needs of your practice.
    • Popular EHR providers include Epic, Cerner, eClinicalWorks, and Athenahealth.
    • Evaluate EHR options based on interoperability, ease of use, cost, and integration with billing systems.
    • Ensure staff receive adequate training to optimize workflow efficiency and maintain compliance with healthcare regulations.

5. Building a referral network and marketing strategy

  • Connect with local specialists and hospitals.
  • Develop an online presence (website, social media, digital marketing), including:
    • Create a professional website with patient education resources, online appointment scheduling, and telemedicine capabilities. Examples of high-traffic clinician websites include Dr. Peter Attia’s longevity-focused site and Dr. Kevin Pho’s KevinMD, a widely read medical blog.
    • Use social media platforms like Instagram, Twitter, and LinkedIn to engage with patients and share medical insights.
    • Implement digital marketing strategies, including SEO optimization, Google Ads, and content marketing, to increase visibility and attract new patients.
  • Engage in community outreach and professional networking.

6. Hiring staff and finalize operations

  • Recruit medical assistants, nurses, and administrative staff with these approaches:
    • Use healthcare-specific job boards such as Health eCareers, PracticeLink, and MedJobNetwork.
    • Partner with local nursing schools, medical assistant training programs, and universities for internship and recruitment opportunities.
    • Leverage professional networks such as the American Association of Medical Assistants (AAMA) and the American Nurses Association (ANA) to find qualified candidates.
    • Consider using recruitment agencies specializing in healthcare staffing, such as AMN Healthcare and CompHealth.
    • Optimize job postings on LinkedIn and Indeed with clear role expectations and competitive benefits to attract top talent.
  • Implement billing and coding systems.
  • Establish quality assurance and compliance programs.

Internal medicine and family medicine are both important components of primary care but serve different patient populations and clinical needs. While internists specialize in adult medicine, family physicians provide comprehensive care across all ages.

Clinicians looking to establish a practice must navigate licensure, financing, and operational logistics to build a successful, sustainable healthcare business. Understanding these distinctions can help physicians make informed career choices and improve healthcare delivery in their communities.