PA Internal Medicine Rotation: What to Expect
PA Internal Medicine Rotation: What to Expect
By: Savanna Perry, PA-C
Internal medicine is a core PA rotation, but your experience depends heavily on the site you land. You can learn a ton about chronic disease management and clinical reasoning even at a tough site, and you should always speak up if you are asked to do something outside your comfort level as a student.
Last Updated: June 12, 2026
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What does a PA internal medicine rotation actually look like?
Internal medicine is one of the core rotations during your PA clinical year, and the setup varies a lot from site to site. Mine was an outpatient clinic that also covered multiple nursing homes and did home visits, so I split my time between the office and those settings. There was an MD and a PA in the office, plus a PA who only handled nursing homes and home visits.
The day to day was a mix of check ups, chronic disease follow ups, and managing patients across different locations. You get a real sense of how internal medicine ties together everything you studied in didactic year, from diabetes to blood pressure to medication management. Even when a site is not your favorite, the volume and variety teach you how to think through a patient and build a plan.
Why does your rotation site matter so much?
Here is the honest part. This was one of my least favorite rotations, and it had nothing to do with internal medicine itself. It came down to where I was placed. Over time my site had drifted toward pain management, which is questionable territory for an IM practice. There were a lot of patients on chronic high dose opioids, and the practice regularly prescribed for ADD and weight loss too. There were fewer routine IM patients than I expected.
So if you have a rough experience at one site, it does not mean the specialty is wrong for you. It might just mean that one office was not a good fit. If you can, consider doing one of your electives in that same area at a different practice so you get a fair second look before you write off a field entirely.
In our experience coaching future PA students, the rotation site can completely color how you feel about an entire specialty. I tell students all the time that one bad placement is not a verdict on the field. Speak up early, loop in your clinical director, and keep an open mind for an elective in that same area somewhere new.
What should you do if a rotation site makes you uncomfortable?
I learned to stand my ground on this rotation, and I want you to feel empowered to do the same. There were times I was encouraged to move forward with a treatment plan and send a patient home without my preceptor ever laying eyes on them. That is not appropriate, and I was a student. So I let them know I was not comfortable with it, and I told my clinical director at my program what was being encouraged.
You are there to learn, not to practice independently before you are licensed. Never do anything you are not comfortable with, and always tell your program if a site feels like it would not be good to use in the future. For what it is worth, that physician later lost his DEA license, which tells you a little about what was going on.
Every Pre-PA Should Know...
Most PA programs build in 4-6 weeks of internal medicine, and it is one of the highest yield rotations for boards because IM touches nearly every organ system.
Free Resume Download → https://www.thepaplatform.com/services/free-resume-download/
Listen: Day in the Life of an Infectious Disease PA, Part 1: Ngan and Josh
Two PAs with the same job title and completely different days.
Two PAs with the same job title and completely different days.
This one is a blast from the past. Ngan and Josh put together a full presentation on life as an infectious disease PA for one of our virtual shadowing sessions during ID Week, and it ran about an hour and a half. I split it into two episodes so you're not stuck listening all at once. This is part one.
Ngan is one of our mock interview coaches at The PA Platform. She graduated from FIU at the end of 2017, started out in ENT, and moved into inpatient ID at a VA hospital in Orlando. She also has an MPH with an infection control track and worked as an epidemiologist at two health departments before PA school, including a CDC-funded hepatitis C project and the tail end of Ebola.
Josh is in Dallas and has been doing HIV and ID care since 2017, mostly outpatient. His day looks nothing like Ngan's, and that is the entire point of this episode.
There's a really useful piece in here about hours, too. Ngan's epidemiology work counted as healthcare experience, not patient care experience, so she worked as an MA in an HIV clinic to get her PCE. That distinction trips up a lot of applicants.
What we cover
What infectious disease PAs actually treat, from HIV to TB to travel medicine
Ngan's inpatient day: consults, rounding with the attending, chasing down cultures
Josh's outpatient day: HIV primary care, telemedicine, and the insurance side nobody warns you about
How each of them landed in ID, and why one rotation changed Josh's whole plan
HCE versus PCE and why the difference matters on your application
Why being nice to people pays off later, since one of Ngan's old contacts is now her attending
Heads up that this was recorded during the pandemic, and Ngan has since moved to a different specialty. Part two picks up right where this leaves off.
Resources
Follow The Pre-PA Club: Apple Podcasts · Spotify · All episodes
Listen: Day in the Life of an Infectious Disease PA, Part 2: Ngan and Josh
Part two with Ngan and Josh, and this is where it gets into the honest stuff.
Part two with Ngan and Josh, and this is where it gets into the honest stuff.
In part one we covered what infectious disease PAs do. Here we go deeper into what the job costs and what it gives back. The rewarding cases, the frustrating ones, the patients who stick with you.
ID is one of those specialties where you never stop studying, and both of them are clear-eyed about that. New pathogens, new resistance patterns, new guidelines. If continuous learning sounds exhausting to you, that's useful information. If it sounds great, that's also useful information.
This is the value of day-in-the-life episodes. You get to try on a career before you commit years to getting there.
What we cover
The most rewarding parts of infectious disease work
The hardest parts, said plainly
How much continuing education the specialty requires
What patient care looks like on a consult service
How the field has changed and where it's headed
Their advice for pre-PAs choosing a direction
Start with Part 1 if you haven't heard it.
Resources
Follow The Pre-PA Club: Apple Podcasts · Spotify · All episodes
Listen: Infectious Disease and HIV Care: An Interview with Josh
Josh works in infectious disease in Texas, mostly HIV care, and it's a specialty almost nobody thinks about when they're applying.
Josh works in infectious disease in Texas, mostly HIV care, and it's a specialty almost nobody thinks about when they're applying.
He went to George Mason for biology, then Drexel for PA school, and graduated in December 2017. We spend a good chunk of this talking about the application - how he built up patient contact hours and what he thinks actually made him stand out.
His point about interviews stuck with me. Be specific. Not "I want to help people," but the actual patient, the actual moment, the actual thing you did. Generic answers blend together. Specific ones get remembered.
What we talk about
His path from biology at George Mason to Drexel
Getting patient contact hours that mattered
What set his application apart
Being specific instead of generic in interviews
What infectious disease and HIV care look like day to day
Why he'd recommend the specialty to students
Resources
Follow The Pre-PA Club: Apple Podcasts · Spotify · All episodes
Need to Know:
Internal medicine is a required core rotation in nearly every PA program
Your specific site shapes your experience far more than the specialty itself
Expect a heavy mix of chronic disease management and routine follow ups
Speak up if you are asked to do anything outside your comfort or scope as a student
Tell your clinical director about any site concerns so future students are protected
Consider an elective in the same field elsewhere if your first experience was rough
FAQ
Yes, internal medicine is a core required rotation in essentially every accredited PA program, usually lasting 4-6 weeks.
You will manage chronic conditions like diabetes, hypertension, and heart disease, refine your physical exam and history skills, and practice building treatment plans across many organ systems.
Often the difficulty comes from the specific site rather than the specialty. A practice that has drifted into a narrow focus or an awkward dynamic can make even a great field feel frustrating.
Politely decline anything you are not comfortable with, and report the situation to your clinical director. You are a student, and patient safety and your training come first.
Absolutely. Internal medicine overlaps with a huge portion of the PANCE blueprint, so a strong IM rotation builds a foundation across many exam topics.
Many programs let you use an elective to revisit a field at a different practice, which is a great way to get a fairer look before deciding it is not for you.
CLOSING
Internal medicine will stretch your clinical reasoning and prepare you well for boards, even when the rotation is not your favorite. Trust your judgment, protect your learning, and remember that one site is not the whole story. If you want help mapping out your clinical year and making the most of every rotation, we are here to support you.
New Graduate Coaching → https://www.thepaplatform.com/new-graduate-coaching/
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