Internal Medicine Subspecialties: 7 Dark Horse Picks

These lesser-known internal medicine subspecialties can provide highly rewarding careers.

Amol Shrikhande, MD
Amol Shrikhande, MD
2nd Aug 2021 • 3m read

As an internal medicine resident, one of the biggest decisions you make is whether you want to specialize. Of course, if you choose to go down that route, you then need to pick a specialty. But don’t worry if you’re undecided. Not everyone has to be like your co-residents who have been doing research in cardiology and gastroenterology since childhood. You can take your time. And it’s good to know your options. While those around you might be focused on traditional pathways like oncology, endocrinology, and nephrology, it’s worth noting that the number of choices continues to increase. Here are seven lesser-known internal medicine subspecialties for your consideration.

Addiction medicine

This one-year training program is open to those who have completed a residency in one of multiple different specialties (including internal medicine). Trainees gain expertise in detoxification methods, the pharmacologic management of addiction, strategies to maintain abstinence, and the management of psychosocial factors associated with substance use disorders.

Adolescent medicine

This pathway typically involves a two- or three-year training and is open to those who have completed residency in internal medicine, pediatrics, or family medicine. Caring for adolescents and young adults involves an understanding of both the physical and psychological factors unique to the demographic. Among many other things, clinicians in this realm are comfortable handling learning disabilities, sexual health and gender identity concerns, eating disorders, substance use disorders, sports-related injuries, and acne. Adolescent medicine practitioners can also serve as a bridge between pediatric and adult care, making sure that chronic conditions such as diabetes and kidney disease are transitioned effectively.

Clinical informatics

This relatively new two-year training program accepts residents from a broad range of specialty areas. Like all industries, healthcare has seen an explosion of data in recent years, and expertise is needed to make sense of all that information. That’s where clinical informatics enters the picture. Trainees learn how to analyze healthcare data and apply the findings in novel ways that can improve individual patient outcomes, the health of targeted populations, and a host of other variables that are important for effective healthcare delivery.

Hospice and palliative medicine

This specialty focuses on the care of those with life-threatening illness. Residents from multiple specialty areas can pursue the training, typically lasting one year. Palliative medicine focuses on the relief of patient symptoms and suffering. Quality of life is the cornerstone of such care, and appropriate support is provided to both patients and their families. Hospice care is provided to those facing a terminal diagnosis and no longer wishing to undergo attempts at treatment. The principles of palliative medicine are then applied to the end-of-life setting.

Sleep medicine

As is true for other pathways on this list, residents from multiple specialties can choose this route, and training typically lasts one year. The discipline is focused on the diagnosis and management of sleep disorders such as sleep apnea, narcolepsy, insomnia, and sleep walking.

Sports medicine

In keeping with a common theme, this one-year training is open to residents from multiple clinical backgrounds. The non-surgical field revolves around physical fitness and encompasses injury prevention and treatment (including rehabilitation), the planning of appropriate training regimens, and the management of other medical conditions in athletes.

Women’s health

If not specifically incorporated into internal medicine residency training, one- or two-year programs are available to gain expertise in issues that are unique to or more common in women. Areas of focus include gynecologic care, family planning, and psychosocial concerns such as domestic violence.

When it comes to choosing among the internal medicine subspecialties, personal interest should be an important driving force. That said, always make sure to review other factors such as compensation, board certification requirements, lifestyle, and job opportunities (including the geographic location and healthcare setting of those opportunities).

As a final point, we know from personal experience that no decisions are final. Some who start in general medicine later opt to specialize. Others may complete training in one of the internal medicine subspecialties but prefer to practice general medicine. And, of course, many end up somewhere in between. So it’s okay to relax and enjoy the process, knowing that you’ll be a great doctor no matter what you choose.