How to Become a PA Specialized in Internal Medicine

Internal medicine encompasses the diagnosis, treatment, and care of adults across the spectrum, ranging from healthy individuals to those with complex illnesses. The broad scope of internal medicine makes this field an attractive option for physician assistants interested in working in a variety of settings and in a number of medical specialties.

Physician assistants in internal medicine solve both common and complex health issues. They provide long-term, comprehensive care in the office or the hospital, serving the needs of adolescents and adults in all areas of medicine, including:

  • Disease prevention
  • Mental health
  • Addiction
  • Treatment involving the cardiac, pulmonary, gastrointestinal, neurologic, nervous systems, etc.
  • Wellness and health promotion
  • Women’s health

Internists—physicians that practice internal medicine—may be generalists or subspecialists. Therefore, physician assistants working under the supervision of internists may also be generalists or subspecialists.

Physician Assistants in General Internal Medicine

General internists are physicians who choose not to subspecialize; therefore, they handle a comprehensive spectrum of illnesses affecting adults. They are experts in diagnosis, in the treatment of chronic illnesses, in health promotion, and in disease prevention.

Physician assistants working under the supervision of a general internist deal with patients suffering from acute and chronic medical conditions. It is common for physician assistants in general internal medicine to treat patients with multiple conditions or diseases and those taking multiple medications; therefore they possess a good, working knowledge of multiple disease processes and polypharmacology.

General internists often serve as primary care physicians. The main difference between internists and family practitioners is that internal medicine focuses on adults and the adult medicine subspecialties, while physicians in family medicine work with patients across the lifespan, including pediatric patients and newborns.

Physician Assistants in Internal Medicine Subspecialties

Physicians in internal medicine may also choose to subspecialize in areas such as:

  • Cardiology
  • Rheumatology
  • Endocrinology
  • Gastroenterology
  • Genetics
  • Infectious diseases
  • Pulmonary
  • Critical care
  • Nephrology
  • Immunology
  • Geriatrics
  • Hematology/oncology

Although physician assistants working as subspecialists concentrate on a specific area, their general internal medicine background allows them to focus on any number of issues affecting health and wellness, such as disease prevention and the promotion of health.

Core Competencies of Physician Assistants in Internal Medicine

Physician assistants in internal medicine possess knowledge, skills, and an understanding of numerous areas of adult healthcare; therefore, they have a working knowledge of many disease entities, such as:

  • Acute coronary syndrome
  • Chronic obstructive pulmonary disease
  • Acute renal failure
  • Care of the critically ill patient
  • Pain management
  • Tumor malignancies
  • Alcohol and drug withdrawal
  • Hematologic disorders and malignancies
  • Asthma
  • Heart failure
  • Cellulitis
  • Perioperative medicine
  • Pain management
  • Cardiac arrhythmia
  • Diabetes
  • Venous thromboembolism
  • Sepsis syndromes
  • Dementia
  • Stroke

They also possess the skills necessary to perform a wide array of procedures, such as:

  • Emergency procedures
  • Bedside ultrasound interpretation
  • Chest radiograph interpretation
  • Electrocardiogram interpretation
  • Problem-focused physical exams
  • Vascular access

These healthcare providers, who are educated and trained to provide medical care under the supervision of a physician, also possess an understanding of the care involved in treating elderly patients and vulnerable populations.

How to Become a Physician Assistant Specialized in Internal Medicine

The educational route to become a physician assistant is consistent among all PAs, regardless of the specialization. To become a physician assistant, individuals must first complete a physician assistant program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).  

All physician assistant programs culminate in a master’s degree and all require the completion of a bachelor’s degree (which must include specific biological and behavioral science undergraduate courses) before entering the program. In addition to classroom instruction and lab assignments, students of physician assistant programs must complete 2,000 hours of clinical rotations in a number of areas, including internal medicine.

Candidates may only apply for state licensure as a physician assistant upon completion of a recognized physician assistant program and upon passing the National Commission on Certification of Physician Assistants’ Physician Assistant National Certifying Examination (PANCE).

Post-graduate physician assistant programs provide new graduates with the opportunity to specialize their PA education. Physician assistant post-graduate fellowships, which are typically 12 months in duration, include a curriculum of diverse didactic instruction and direct clinical experiences. Most internal medicine fellowships allow students to choose a traditional/generalist track or a track focused on one or more areas of internal medicine.

Post-graduate fellowships offer physician assistants the opportunity to learn the essential elements of primary care internal medicine, providing them with an understanding of disease prevention, wellness, addiction, mental health, and the effective treatment of common problems involving the eyes, skins, ears, nervous system, and reproductive system.

The Association of Postgraduate Physician Assistant Programs maintains a list of physician assistant post-graduate programs throughout the U.S.

Professional Certification Options for Physician Assistants in Internal Medicine

One of the ways physician assistants build their credibility in the industry is by earning a specialty certification through the National Commission on Certification of Physician Assistants (NCCPA).

The NCPAA offers the certificate of added qualifications (CAQ) program, which allows physician assistants to earn a specialty credential in a specific area of medicine. Although the NCCPA does not offer a CAQ in internal medicine specifically, physician assistants practicing in internal medicine may choose to pursue the hospital medicine CAQ.

To qualify for the hospital medicine CAQ,, candidates must be licensed physician assistants, pass a specialty examination in hospital medicine, and possess at least 3,000 hours of experience, which must involve the management of hospitalized adult patients.

Candidates must also receive an attestation from a supervising physician working in internal medicine that details they have performed patient management services relevant to the practice setting and/or they understand how and when to apply techniques and methods.

Resources for Physician Assistants in Internal Medicine

By becoming a member of a professional association and engaging in education and networking activities, physician assistants can broaden their knowledge, stay current on advances in the profession, and make valuable professional contacts.

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