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General internal medicine

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

Doctors working in general internal medicine (GIM) have particular expertise in diagnostic reasoning, managing uncertainty, dealing with co-morbidities (complex medical problems involving multiple symptoms and conditions) and recognising when specialty opinion or care is required.

The work involves:

• diagnosing and treating the wide spectrum of medical disorders that present acutely to hospital emergency departments and acute medical units, referring for specialist opinion and care as appropriate.
• providing advice and care for patients admitted to hospital under other specialties (e.g. surgery, obstetrics & gynaecology) who have or develop medical problems.
• diagnosing and treating the wide spectrum of medical conditions that are referred to medical outpatient clinics. 
• managing inpatients and outpatients with co-morbidities, including elderly patients with frailty and dementia.

Doctors specialising in GIM are part of the acute medical care workforce, which includes those who practise acute medicine, geriatrics and other ‘physicianly specialties’ such as gastroenterology, diabetes and endocrinology, respiratory medicine, cardiology, renal medicine and rheumatology.

Most doctors who practise GIM are also trained in another physicianly specialty or sub-specialty. Some physicians may also combine GIM with academic research or a non-clinical role.

Common procedures/interventions

These include:

• advanced cardiopulmonary resuscitation
• direct current (DC) cardioversion (a procedure to convert an abnormal heart rhythm to a normal heart rhythm)
• temporary cardiac pacing
• insertion of venous lines (peripheral and central)
• aspiration of fluid from chest and abdomen
• insertion of drainage catheters into chest and abdomen
• lumbar puncture
• prescribing of drugs for acute and long term conditions

Want to learn more?

Find out more about:

• the working life of someone in general internal medicine
• the entry requirements and training and development

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.

  Find out more about the current pay scales for doctors, there's more information on the BMA website.

  NHS Employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in general internal medicine, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training (CCT). You will receive your CCT at the end of general internal medicine.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of postgraduate medical education - the consultant responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards
  • training programme director - the consultant overseeing the education of the cohort of trainee doctors within a HEE local office/deanery, eg foundation training programme director, specialty training programme director
  • head of school - the consultant responsible for management of the entirety of a training programme within the HEE local office/deanery, e.g. head of school of medicine.
  • various roles in clinical schools responsible for education of medical students

  SAS doctor roles

  There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor. SAS doctors are non-training roles where the doctor has at least four years of postgraduate training, two of those being in a relevant specialty. Find out more about SAS doctors roles.

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Flexible working

  A significant proportion of UK acute internal medicine trainees are undergoing flexible training; arrangements are made between the trainee and their HEE local office/deanery.

  Academic pathways

  If you have trained on an academic GIM pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in general internal medicine. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST3/4.

  Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.

  The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  There are good opportunities for research and teaching.

• Job market and vacancies

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  This page provides useful information about the availability of jobs, finding vacancies and where to find out more.

  Job market information

  General internal medicine had 818 consultants and 1,077 medical registrars in England (NHS Digital 2016). These figures do not include those practising general internal medicine together with another specialty.

  In 2016, the competition ratio CT1/ST1 for Core Medical Training was1.53 (NHS specialty training 2016).

  Women make up 21% of the consultant workforce, and 48% of higher specialty trainees in the UK (2014/15 RCP census, 2016).

  Although there is a debate about increasing the supply of generalists in hospitals, it is not clear whether employers will prefer to employ single or dual CCT holders in future. For this reason (nearly) all trainees training in General Internal Medicine continue to do so in combination with training with another medical specialty (commonly known as dual training).

  Find out more about the Centre for Workforce Intelligence’s profile of the General Internal Medicine and Acute Internal Medicine workforce in England.

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data

  NHS Wales medical and dental workforce data

  Department of Health, Social Services and Public Safety workforce information for Northern Ireland

  Where to look for vacancies

  All trainees apply through the online application system Oriel. You will be able to register for training, view all vacancies, apply, book interviews and assessment centres, and manage offers made to you.

  All jobs will be advertised on the NHS Jobs website.

  The BMJ Careers website also advertises vacancies.

• Further information

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  Organisations

  Royal College of Physicians

  Royal College of Physicians of Edinburgh

  Royal College of Physicians and Surgeons of Glasgow

  Society for Acute Medicine

  European Federation of Internal Medicine

  Real-life stories

  Working in general internal medicine (BMJ)