General internal medicine
Doctors in general internal medicine (GIM) diagnose, treat and manage the care of inpatients and outpatients with acute and long term medical conditions.
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 in general internal medicine diagnose and treat 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.
They provide advice and care for patients admitted to hospital under other specialties (e.g. surgery, obstetrics & gynaecology) who have or develop medical problems.
Doctors working in GIM also diagnose and treat the wide spectrum of medical conditions that are referred to medical outpatient clinics.
The work also involves managing patients with co-morbidities (ie complex medical problems involving multiple symptoms and conditions), 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. GIM may be practised on its own, but it is more usual to combine GIM with one of these specialties.
- safe prescribing
- airway management
- insertion of lines and drains
- diagnostic procedures such as echocardiography and ultrasound
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 Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.
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 Expand / Collapse
Read about consultant and non-consultant roles in general internal medicine, flexible working and about wider opportunities.
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 medical education - the NHS consultant appointed to the hospital board who is 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 NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery
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
A significant proportion of UK acute internal medicine trainees are undergoing flexible training; arrangements are made between the trainee and their local education and training board (LETB).
If you have trained on an academic general internal medicine 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-ST4.
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.
There are good opportunities for research and teaching.
- Job market and vacancies Expand / Collapse
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.
The competition ratio for Core Medical Training (CT1), the first stage in the training (post-foundation), in 2015 was 1.7 (NHS Specialty Training, 2015). Note you cannot apply directly to general internal medicine (GIM) at ST3 level. Nearly all training in GIM will be done in parallel with another medical specialty (JRCPTB).
In 2012-13, the consultant workforce contracted by eight in England, Wales and Northern Ireland. However, the Centre for Workforce Intelligence expects the acute medical workforce to grow as a result of population growth and ageing but most of this increase may be in acute internal medicine.
Although there is a debate about increasing the supply of generalists in hospitals, it is not fully clear whether employers will prefer to employ single or dual CCT holders in future which does not help doctors-in-training to decide between choosing acute medical care as a career or as part of a portfolio career.
On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.
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.
Local education and training boards (LETBs)/deaneries will have details of training vacancies. Not all LETBs/deaneries will offer new training posts in all specialties in all years.
All jobs will be advertised on the NHS Jobs website.
The BMJ Careers website also advertises vacancies.
- Further information Expand / Collapse