At UK Family & Community Medicine, medical residents work alongside the physicians. The residents are trained in pediatrics, including newborn care, breastfeeding support, well-child care and acute care, which may at times require a hospital stay or an emergency-department visit. Apr 26, 2019 - Study MFM in Family Medicine at the University of Edinburgh. Our online learning degree programme will equip students with the skills to.
Family medicine (FM), formerly family practice (FP), is a medical specialty devoted to comprehensive health care for people of all ages; the specialist is named a family physician or family doctor. In Europe, the discipline is often referred to as general practice and a practitioner as a general practice doctor or GP; this name emphasises the holistic nature of this speciality, as well as its roots in the family. Family practice is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body;[1] family physicians are often primary care physicians. It is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion.[2] According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community.[3] The issues of values underlying this practice are usually known as primary care ethics.
- 3Family medicine in the United States
Scope of practices[edit]
Family physicians in the United States may hold either a M.D. or a D.O. degree. Physicians who specialize in family medicine must successfully complete an accredited three- or four-year family medicine residency in the United States in addition to their medical degree. They are then eligible to sit for a board certification examination, which is now required by most hospitals and health plans.[4]American Board of Family Medicine requires its Diplomates to maintain certification through an ongoing process of continuing medical education, medical knowledge review, patient care oversight through chart audits, practice-based learning through quality improvement projects and retaking the board certification examination every 7 to 10 years. The American Osteopathic Board of Family Physicians requires its Diplomates to maintain certification and undergo the process of recertification every 8 years.[5]
Physicians certified in family medicine in Canada are certified through the College of Family Physicians of Canada,[6] after two years of additional education. Continuing education is also a requirement for continued certification.
The term 'family medicine' is used in many European and Asian countries, instead of 'general medicine' or 'general practice'. In Sweden, certification in family medicine requires five years working with a tutor, after the medical degree. In India, those who want to specialize in family medicine must complete a three-year family medicine residency, after their medical degree (MBBS). They are awarded either a D.N.B. or an M.D. in family medicine. Similar systems exist in other countries.
Family physicians deliver a range of acute, chronic and preventive medical care services. In addition to diagnosing and treating illness, they also provide preventive care, including routine checkups, health-risk assessments, immunization and screening tests, and personalized counseling on maintaining a healthy lifestyle. Family physicians also manage chronic illness, often coordinating care provided by other subspecialists.[7] Many American Family Physicians deliver babies and provide prenatal care.[8] In the U.S., family physicians treat more patients with back pain than any other physician subspecialist, and about as many as orthopedists and neurosurgeons combined.[9]
Family medicine and family physicians play a very important role in the healthcare system of a country. In the U.S., for example, nearly one in four of all office visits are made to family physicians. That is 208 million office visits each year — nearly 83 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty.[10]
Family medicine in Canada[edit]
In Canada, aspiring family physicians are expected to complete a residency in family medicine from an accredited university after obtaining their M.D. degree. Although the residency usually has a duration of two years, graduates may apply to complete a third year, leading to a certification from the College of Family Physicians Canada in disciplines such as emergency medicine, palliative care, and women's health, amongst many others. In some institutions, such as McGill University in Montreal, graduates from family medicine residency programs are eligible to complete a master's degree and a Doctor of Philosophy (Ph.D.) in Family Medicine, which predominantly consists of a research-oriented program.
Family medicine in the United States[edit]
History of medical family practice[edit]
Concern for family health and medicine in the United States existed as far back as the early 1930s and 40s. The American public health advocate Bailey Barton Burritt was labeled 'the father of the family health movement' by The New York Times in 1944.[11]
Following World War II, two main concerns shaped the advent of family medicine. First, medical specialties and subspecialties increased in popularity, having an adverse effect on the number of physicians in general practice. At the same time, many medical advances were being made and there was concern within the 'general practitioner' or 'GP' population that four years of medical school plus a one-year internship was no longer adequate preparation for the breadth of medical knowledge required of the profession.[12] Many of these doctors wanted to see a residency program added to their training; this would not only give them additional training, knowledge, and prestige, but would allow for board certification, which was increasingly required to gain hospital privileges.[12] In February 1969, family medicine (then known as family practice) was recognized as a distinct specialty in the U.S. It was the twentieth specialty to be recognized.[12]
Education and training[edit]
Family physicians complete an undergraduate degree, medical school, and three more years of specialized medical residency training in family medicine.[13] Their residency training includes rotations in internal medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, emergency medicine, and geriatrics. Residents also must provide care for a panel of continuity patients in an outpatient 'model practice' for the entire period of residency.[14] The specialty focuses on treating the whole person, acknowledging the effects of all outside influences, through all stages of life.[15] Family physicians will see anyone with any problem, but are experts in common problems. Many family physicians deliver babies in addition to taking care of patients of all ages.
In order to become board certified, family physicians must complete a residency in family medicine, possess a full and unrestricted medical license, and take a written cognitive examination.[16] Between 2003 and 2009, the process for maintenance of board certification in family medicine is being changed (as well as all other American Specialty Boards) to a series of yearly tests on differing areas. The American Board of Family Medicine, as well as other specialty boards, are requiring additional participation in continuous learning and self-assessment to enhance clinical knowledge, expertise and skills. The Board has created a program called the 'Maintenance of Certification Program for Family Physicians' (MC-FP) which will require family physicians to continuously demonstrate proficiency in four areas of clinical practice: professionalism, self-assessment/lifelong learning, cognitive expertise, and performance in practice. Three hundred hours of continuing medical education within the prior six years is also required to be eligible to sit for the exam.[17]
Family physicians may pursue fellowships in several fields, including adolescent medicine, geriatric medicine, sports medicine, sleep medicine, hospital medicine and hospice and palliative medicine.[18] The American Board of Family Medicine and the American Osteopathic Board of Family Medicine both offer Certificates of Added Qualifications (CAQs) in each of these topics.[19]
Shortage of family physicians[edit]
While many sources cite a shortage of family physicians (and also other primary care providers, i.e. internists, pediatricians, and general practitioners),[20] the per capita supply of primary care physicians has actually increased about 1 percent per year since 1998.[21] Additionally, a recent decrease in the number of M.D. graduates pursuing a residency in primary care has been offset by the number of D.O. graduates and graduates of international medical schools (IMGs) who enter primary care residencies.[21] Still, projections indicate that by 2020 the demand for family physicians will exceed their supply.[21]
The number of students entering family medicine residency training has fallen from a high of 3,293 in 1998 to 1,172 in 2008, according to National Residency Matching Program data. Fifty-five family medicine residency programs have closed since 2000, while only 28 programs have opened.[22]
In 2006, when the nation had 100,431 family physicians, a workforce report by the American Academy of Family Physicians indicated the United States would need 139,531 family physicians by 2020 to meet the need for primary medical care. To reach that figure 4,439 family physicians must complete their residencies each year, but currently the nation is attracting only half the number of future family physicians that will be needed.[23]
The waning interest in family medicine in the U.S. is likely due to several factors, including the lesser prestige associated with the specialty, the lesser pay, and the increasingly frustrating practice environment. Salaries for family physicians in the United States are respectable, but lower than average for physicians, with the average being $225,000.[24] However, when faced with debt from medical school, most medical students are opting for the higher paying specialties. Potential ways to increase the number of medical students entering family practice include providing relief from medical education debt through loan-repayment programs and restructuring fee-for-service reimbursement for health care services.[25] Family physicians are trained to manage acute and chronic health issues for an individual simultaneously, yet their appointment slots may average only ten minutes.[26]
Current practice[edit]
Most family physicians in the US practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. However, the specialty is broad and allows for a variety of career options including education, emergency medicine or urgent care, inpatient medicine, international or wilderness medicine, public health, sports medicine, and research.[27] Others choose to practice as consultants to various medical institutions, including insurance companies.[citation needed]
Family medicine in India[edit]
Family Medicine (FM) came to be recognized as a medical specialty in India only in the late 1990s.[28] According to the National Health Policy - 2002, there is an acute shortage of specialists in family medicine. As family physicians play very important role in providing affordable and universal health care to people, the Government of India is now promoting the practice of family medicine by introducing post graduate training through DNB (Diplomate National Board) programs.
There is a severe shortage of post graduate training seats, causing lot of struggle, hardship and a career bottle neck for newly qualified doctors, just passing out of medical school. The Family Medicine Training seats should ideally fill this gap and allow more doctors to pursue Family Medicine careers. However, the uptake, awareness and development of this specialty is slow.[29]
Although family medicine is sometimes called general practice, they are not identical in India. A medical graduate who has successfully completed the Bachelor of Medicine, Bachelor of Surgery (MBBS) course and has been registered with Indian Medical Council or any state medical council is considered a general practitioner. A family physician, however, is a primary care physician who has completed specialist training in the discipline of family medicine.
The Medical Council of India requires three-year residency for family medicine specialty, leading to the award of Doctor of Medicine (MD) in Family Medicine or Diplomate of National Board (DNB) in Family Medicine.
The National Board of Examinations conducts family medicine residency programmes at the teaching hospitals that it accredits. On successful completion of a three-year residency, candidates are awarded Diplomate of National Board (Family Medicine).[30] The curriculum of DNB (FM) comprises: (1) medicine and allied sciences; (2) surgery and allied sciences; (3) maternal and child health; (4) basic sciences and community health. During their three-year residency, candidates receive integrated inpatient and outpatient learning. They also receive field training at community health centres and clinics.[31]
The Medical Council of India permits accredited medical colleges (medical schools) to conduct a similar residency programme in family medicine. On successful completion of three-year residency, candidates are awarded Doctor of Medicine (Family Medicine).[32][33] Govt. medical college, Calicut had started this MD (FM) course in 2011. A few of the AIIMS institutes have also started a course called MD in community and family medicine in recent years. Even though there is an acute shortage of qualified family physicians in India, further progress has been slow.
The Indian Medical Association’s College of General Practitioners, offers a one-year Diploma in Family Medicine (DFM), a distance education programme of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, for doctors with minimum five years of experience in general practice.[34] Since the Medical Council of India requires three-year residency for family medicine specialty, these diplomas are not recognized qualifications in India.
As India’s need for primary and secondary levels of health care is enormous, medical educators have called for systemic changes to include family medicine in the undergraduate medical curriculum.[35]
Recently, the residency-trained family physicians have formed the Academy of Family Physicians of India (AFPI). AFPI is the academic association of family physicians with formal full-time residency training (DNB Family Medicine) in Family Medicine. Currently there are about two hundred family medicine residency training sites accredited by the National Board of Examination India, providing around 700 training posts annually. However, there are various issues like academic acceptance, accreditation, curriculum development, uniform training standards, faculty development, research in primary care, etc. in need of urgent attention for family medicine to flourish as an academic specialty in India. The government of India has declared Family Medicine as focus area of human resource development in health sector in the National Health Policy 2002[36] There is discussion ongoing to employ multi-skilled doctors with DNB family medicine qualification against specialist posts in NRHM (National Rural Health Mission).[37]
Three possible models of how family physicians will practise their specialty in India might evolve, namely (1) private practice, (2) practising at primary care clinics/hospitals, (3) practising as consultants at secondary/tertiary care hospitals.
Family medicine in Japan[edit]
Family medicine was first recognized as specialty in 2015 and currently has approximately 500 certified family doctors.[38] The Japanese government has made a commitment to increase the number of family doctors in an effort to improve the cost-effectiveness and quality of primary care in light of increasing health care costs.[39] The Japan Primary Care Association (JPCA) is currently the largest academic association of family doctors in Japan.[40] The JPCA family medicine training scheme consists of a three-year programme following the two-year internship.[41] The Japanese Medical Specialty Board define the standard of the specialty training programme for board-certified family doctors. Japan has a free access healthcare system meaning patients can bypass primary care services. In addition to family medicine specialists Japan also has ~100,000 organ-specialist primary care clinics.[39] The doctors working in these clinics do not typically have formal training in family medicine. In 2012 the mean consultation length in a family medicine clinic was 10.2 minutes.[42]
See also[edit]
- ATC codes - Anatomical Therapeutic Chemical Classification System
- ICD-10 - International Classification of Diseases
- International Classification of Primary Care ICPC-2
References[edit]
- ^'Definitions and Policies'. American Board of Family Medicine. Retrieved 30 June 2009.
- ^'Definitions, What is Family Medicine?'. American Academy of Family Physicians. Archived from the original on 22 November 2008. Retrieved 17 July 2009.
- ^'Global Family Doctor'. Wonca Online. Archived from the original on 20 March 2012.
- ^'Choosing a Primary Care Provider'. Medline Plus Medical Encyclopedia. Retrieved 30 June 2009.
- ^'Certificates/Longevity'. AOBFP. Archived from the original on 30 December 2010. Retrieved 25 August 2012.
- ^'Principles | About CFPC | The College of Family Physicians Canada'. Cfpc.ca. Retrieved 2012-10-28.
- ^'Family Medicine, Scope and Philosophical Statement'. American Academy of Family Physicians. Retrieved 17 July 2009.
- ^Nesbitt TS (Jan–Feb 2002). 'Obstetrics in family medicine: can it survive?'(PDF). The Journal of the American Board of Family Practice. 15 (1): 77–9. PMID11841145.[permanent dead link]
- ^Kinkade S (April 2007). 'Evaluation and treatment of acute low back pain'. American Family Physician. 75 (8): 1181–8. PMID17477101.
- ^'Facts About Family Medicine'. American Academy of Family Physicians. Retrieved 17 July 2009.
- ^'B. B. Burritt Honored as Health Advocate'. The New York Times. October 25, 1944. Retrieved 2017-05-16.
Bailey B. Burritt, known as 'the father of the family health movement'...
- ^ abcPisacano NJ. 'History of the Specialty'. American Board of Family Medicine. Retrieved 2009-06-30.
- ^Adams B (March 17, 1995). 'Primary Care: Will more family doctors improve health care?'. CQ Researcher. 5 (10).
- ^'Patient Brochure'. American Board of Family Medicine. Retrieved 30 June 2009.
- ^Martin JC, Avant RF, Bowman MA, Bucholtz JR, Dickinson JR, Evans KL, et al. (Future of Family Medicine Project Leadership Committee) (Mar–Apr 2004). 'The Future of Family Medicine: a collaborative project of the family medicine community'. Annals of Family Medicine. 2 Suppl 1: S3–32. doi:10.1370/afm.130. PMC1466763. PMID15080220.
- ^'Certification Policies'. American Board of Family Medicine. Archived from the original on 10 January 2016. Retrieved 30 June 2009.
- ^'Maintenance of Certification for Family Physicians (MC-FP)'. American Board of Family Medicine. Archived from the original on 3 January 2011. Retrieved 30 June 2009.
- ^'Fellowship Directory for Family Physicians'. American Academy of Family Physicians. Retrieved 30 June 2009.
- ^'Certificates of Added Qualifications'. American Board of Family Medicine. Retrieved 30 June 2009.
- ^Halsey A (June 20, 2009). 'Primary-Care Doctor Shortage May Undermine Health Reform Efforts'. The Washington Post. Retrieved 12 November 2012.
- ^ abc'Recent Supply Trends, Projections, and Valuation of Services'(PDF). Testimony Before the Committee on Health, Education, Labor, and Pensions, U.S. Senate. United States Government Accountability Office. Retrieved 12 November 2012.
- ^'2009 Match Summary and Analysis'. American Academy of Family Physicians. Retrieved 17 July 2009.
- ^'Family Physician Workforce Reform'. American Academy of Family Physicians. Retrieved 17 July 2009.
- ^'Family Physician Salaries Continue to Rise at Rapid Clip'. AAFP. Retrieved 2016-06-17.
- ^Bodenheimer T, Grumbach K, Berenson RA (June 2009). 'A lifeline for primary care'. The New England Journal of Medicine. 360 (26): 2693–6. doi:10.1056/NEJMp0902909. PMID19553643.
- ^Stange KC, Zyzanski SJ, Jaén CR, Callahan EJ, Kelly RB, Gillanders WR, et al. (May 1998). 'Illuminating the 'black box'. A description of 4454 patient visits to 138 family physicians'(PDF). The Journal of Family Practice. 46 (5): 377–89. PMID9597995.
- ^'Practice Options'. Family Medicine Interest Group. Archived from the original on 15 September 2010. Retrieved 30 June 2009.
- ^Abraham S. 'Practicing and Teaching Family Medicine in India'(PDF). Society of Teachers of Family Medicine. Retrieved 12 November 2012.
- ^Beswal G (July 2013). 'Family Medicine: A Solution for Career Inequalities among Doctors in India'. Journal of Family Medicine and Primary Care. 2 (3): 215–7. PMC3902674. PMID24479085.
- ^'Welcome To National Board Of Examination'. Natboard.edu.in. 2012-10-17. Retrieved 2012-10-28.
- ^Bulletin of Information for Diplomate of National Board in Family Medicine (New Rules)
- ^Minimum Qualifications for Teachers in Medical Institutions Regulations - 1998, table 1.
- ^Postgraduate Medical Education Regulations 2000, schedule A.
- ^'News Letter'(PDF). Indian Medical Association. 6 February 2009. Archived from the original(PDF) on February 17, 2010.
- ^Zachariah P (September 9, 2009). 'Rethinking medical education in India'. The Hindu. Retrieved 12 November 2012.
- ^'National Health Policy 2002'. Ministry of Health & Family Welfare, Government of India. Archived from the original on 4 November 2010.
- ^'Academy of Family Physicians of India'.
- ^Takamura A (September 2016). 'The new era of postgraduate certified general practice training in Japan'. Education for Primary Care. 27 (5): 409–412. doi:10.1080/14739879.2016.1220235. PMID27658321.
- ^ abTakemura Y (2003). 'Family medicine: What does it mean in Japan?'. Asia Pacific Family Medicine. 2 (4): 188–192. doi:10.1111/j.1444-1683.2003.00094.x.
- ^'About Us'. Japan Primary Care Association.
- ^Takamura A (September 2016). 'The new era of postgraduate certified general practice training in Japan'. Education for Primary Care. 27 (5): 409–412. doi:10.1080/14739879.2016.1220235. PMID27658321.
- ^Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, Holden J (November 2017). 'International variations in primary care physician consultation time: a systematic review of 67 countries'. BMJ Open. 7 (10): e017902. doi:10.1136/bmjopen-2017-017902. PMC5695512. PMID29118053.
Retrieved from 'https://en.wikipedia.org/w/index.php?title=Family_medicine&oldid=901457093'
Consultation with a mobile health team doctor in Madagascar
In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.
A general practitioner manages types of illness that present in an undifferentiated way at an early stage of development, which may require urgent intervention.[1] The holistic approach of general practice aims to take into consideration the biological, psychological, and social factors relevant to the care of each patient's illness. Their duties are not confined to specific organs of the body, and they have particular skills in treating people with multiple health issues. They are trained to treat patients of any age and sex to levels of complexity that vary between countries.
The role of a GP can vary greatly between (or even within) countries. In urban areas of developed countries, their roles tend to be narrower and focused on the care of chronic health problems; the treatment of acute non-life-threatening diseases; the early detection and referral to specialised care of patients with serious diseases; and preventive care including health education and immunisation. Meanwhile, in rural areas of developed countries or in developing countries, a GP may be routinely involved in pre-hospital emergency care, the delivery of babies, community hospital care and performing low-complexity surgical procedures.[2][3] In some healthcare systems GPs work in primary care centers where they play a central role in the healthcare team, while in other models of care GPs can work as single-handed practitioners.
The term general practitioner or GP is common in the UK, Republic of Ireland, and several Commonwealth countries. In these countries the word 'physician' is largely reserved for certain other types of medical specialists, notably in internal medicine. While in these countries, the term GP has a clearly defined meaning, in North America the term has become somewhat ambiguous, and is not synonymous with the terms family doctor or primary care physician, as described below.
Historically, the role of a GP was once performed by any doctor qualified in a medical school working in the community. However, since the 1950s, general practice has become a specialty in its own right, with specific training requirements tailored to each country.[4][5][6] The Alma Ata Declaration in 1978 set the intellectual foundation of what primary care and general practice is nowadays.
- 1Asia
- 2Europe
- 3North America
- 4Oceania
Asia[edit]
India and Bangladesh[edit]
The basic medical degrees in India and Bangladesh are MBBS (Bachelor of Medicine, Bachelor of Surgery), BAMS (Bachelor of Ayurveda, Medicine and Surgery), BHMS (Bachelor of Homoeopathic Medicine and Surgery) and BUMS (Bachelor of Unani Medicine and Surgery). These generally consist of a four-and-a-half-year course followed by a year of compulsory rotatory internship in India. In Bangladesh it is five years course followed by a year of compulsory rotatory internship. The internship requires the candidate to work in all departments for a stipulated period of time, to undergo hands-on training in treating patients.
The registration of doctors is usually managed by state medical councils. A permanent registration as a Registered Medical Practitioner is granted only after satisfactory completion of the compulsory internship.
The Federation of Family Physicians' Associations of India (FFPAI) is an organization which has a connection with more than 8000 general practitioners through having affiliated membership.[7]
Pakistan[edit]
In Pakistan, 5 years of MBBS is followed by one year of internship in different specialties. Pakistan Medical and Dental Council (PMDC) then confers permanent registration, after which the candidate may choose to practice as a GP or opt for specialty training.
The first Family Medicine Training programme was approved by the College of Physicians and Surgeons of Pakistan (CPSP) in 1992 and initiated in 1993 by the Family Medicine Division of the Department of Community HealthSciences, Aga Khan University, Pakistan.[8]
Family Medicine residency training programme of Ziauddin University is approved for Fellowship in Family Medicine.[9]
Europe[edit]
France[edit]
In France, the médecin généraliste (commonly called docteur) is responsible for the long term care in a population.[10] This implies prevention, education, care of the diseases and traumas that do not require a specialist, and orientation towards a specialist when necessary. They also follow the severe diseases day-to-day (between the acute crises that require the intervention of a specialist).
They have a role in the survey of epidemics, a legal role (constatation of traumas that can bring compensation, certificates for the practice of a sport, death certificate, certificate for hospitalisation without consent in case of mental incapacity), and a role in the emergency care (they can be called by the samu, the French EMS). They often go to a patient's home when the patient cannot come to the consulting room (especially in case of children or old people), and have to contribute to a night and week-end duty (although this was contested in a strike in 2002).[citation needed]
The studies consist of six years in the university (common to all medical specialties), and three years as a junior practitioner (interne) :
- the first year (PACES, première année commune aux études de santé, often abbreviated to P1 by students) is common with the dentists, pharmacists and midwifery. The rank at the final competitive examination[11] determines in which branch the student can choose to study.
- the following two years, called propédeutique, are dedicated to the fundamental sciences: anatomy, human physiology, biochemistry, bacteriology, statistics...
- the three following years are called externat and are dedicated to the study of clinical medicine; they end with a classifying examination, the rank determines in which specialty (general medicine is one of them) the student can make her or his internat;
- the internat is three years -or more depending on the specialty- of initial professional experience under the responsibility of a senior; the interne can prescribe, s/he can replace physicians,[12] and usually works in a hospital.
This ends with a doctorate, a research work which usually consist of a statistical study of cases to propose a care strategy for a specific affliction (in an epidemiological, diagnostic, or therapeutic point of view).
Greece[edit]
General Practice was established as a medical specialty in Greece in 1986. To qualify as a General Practitioner (γενικός ιατρός, genikos iatros) doctors in Greece are required to complete four years of vocational training after medical school, including three years and two months in a hospital setting.[13] General Practitioners in Greece may either work as private specialists or for the National Healthcare Service, ESY (Εθνικό Σύστημα Υγείας, ΕΣΥ).
Netherlands and Belgium[edit]
General practice in the Netherlands and Belgium is considered advanced. The huisarts (literally: 'home doctor') administers first line, primary care. In the Netherlands, patients usually cannot consult a hospital specialist without a required referral. Most GPs work in private practice although more medical centers with employed GPs are seen. Many GPs have a specialist interest, e.g. in palliative care.
In Belgium, one year of lectures and two years of residency are required. In the Netherlands, training consists of three years (full-time) of specialization after completion of internships of 3 years.[14] First and third year of training takes place at a GP practice. The second year of training consists of six months training at an emergency room, or internal medicine, paediatrics or gynaecology, or a combination of a general or academic hospital, three months of training at a psychiatric hospital or outpatient clinic and three months at a nursing home (verpleeghuis) or clinical geriatrics ward/policlinic. During all three years, residents get one day of training at university while working in practice the other days. The first year, a lot of emphasis is placed on communications skills with video training. Furthermore, all aspects of working as a GP gets addressed including working with the medical standards from the Dutch GP association NHG (Nederlands Huisartsen Genootschap).[15]All residents must also take the national GP knowledge test (Landelijke Huisartsgeneeskundige Kennistoets (LHK-toets)) twice a year.[16] In this test of 120 multiple choice questions, medical, ethical, scientific and legal matters of GP work are addressed.[16][17]
Russia[edit]
![Family Family](http://smartelearning.co.uk/elearning/pluginfile.php/12816/course/overviewfiles/Diploma%20in%20Family%20Medicine.jpg)
In the Soviet Union specialty 'general practitioner' did not exist, similar functions were performed by the Therapist (Russian: терапевт). In the Russian Federation, the General Practitioner's Regulation was put into effect in 1992, after which medical schools started training in the relevant specialty.The right to practice as a general practitioner gives a certificate of appropriate qualifications. General medical practice can be carried out both individually and in a group, including with the participation of narrow specialists. The work of general practitioners is allowed, both in the medical institution and in private.The general practitioner has broad legal rights. He can lead junior medical personnel, provide services under medical insurance contracts, conclude additional contracts to the main contract, and conduct an examination of the quality of medical services. For independent decisions, the general practitioner is responsible in accordance with the law.
The main tasks of a general practitioner are:
- Prevention, diagnosis and treatment of the most common diseases;
- Emergency and emergency medical care;
- Performance of medical manipulations.
Spain[edit]
Francisco Vallés (Divino Vallés)
In Spain GPs are officially especialistas en medicina familiar y comunitaria but are commonly called 'médico de cabecera' or 'médico de familia'.[18] Was established as a medical specialty in Spain in 1978.
Most Spanish GPs work for the state funded health authority through the regional government (comunidad autónoma). They are in most cases salary-based healthcare workers.
![Uk family practice turfland Uk family practice turfland](/uploads/1/2/4/7/124787312/272610639.jpg)
For the provision of primary care, Spain is currently divided geographically in basic health care areas (áreas básicas de salud), each one containing a primary health care team (Equipo de atención primaria). Each team is multidisciplinary and typically includes GPs, community pediatricians, nurses, physiotherapists and social workers, together with ancillary staff. In urban areas all the services are concentrated in a single large building (Centro de salud) while in rural areas the main center is supported by smaller branches (consultorios), typically single-handled.[19]
Becoming a GP in Spain involves studying medicine for 6 years, passing a competitive national exam called MIR (Medico Interno Residente) and undergoing a 4 years training program. The training program includes core specialties as general medicine and general practice (around 12 months each), pediatrics, gynecology, orthopedics and psychiatry. Shorter and optional placements in ENT, ophthalmology, ED, infectious diseases, rheumathology or others add up to the 4 years curriculum. The assessment is work based and involves completing a logbook that ensures all the expected skills, abilities and aptitudes have been acquired by the end of the training period.[20][21]
United Kingdom[edit]
In the United Kingdom, physicians wishing to become GPs take at least 5 years training after medical school, which is usually an undergraduate course of five to six years (or a graduate course of four to six years) leading to the degrees of Bachelor of Medicine and Bachelor of Surgery.
Until 2005, those wishing to become a General Practitioner of medicine had to do a minimum of the following postgraduate training:
- One year as a pre-registration house officer (PRHO) (formerly called a house officer), in which the trainee would usually spend 6 months on a general surgical ward and 6 months on a general medical ward in a hospital;
- Two years as a senior house officer (SHO) - often on a General Practice Vocational Training Scheme (GP-VTS) in which the trainee would normally complete four 6-month jobs in hospital specialties such as obstetrics and gynaecology, paediatrics, geriatric medicine, accident and emergency or psychiatry;
- One year as a general practice registrar on a GP-VTS.
This process changed under the programme Modernising Medical Careers. Medical practitioners graduating from 2005 onwards have to do a minimum of five years postgraduate training:
- Two years of Foundation Training, in which the trainee will do a rotation around either six 4-month jobs or eight 3-month jobs - these include at least 3-months in general medicine and 3-months in general surgery, but will also include jobs in other areas;
- A three-year 'run-through' GP Speciality Training Programme containing (GPSTP): eighteen months as a Specialty Registrar in which time the trainee completes a mixture of jobs in hospital specialties such as obstetrics and gynaecology, paediatrics, geriatric medicine, accident and emergency or psychiatry; eighteen months as a GP Specialty Registrar in General Practice.
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The postgraduate qualification Membership of the Royal College of General Practitioners (MRCGP) was previously optional. In 2008, a requirement was introduced for doctors to succeed in the MRCGP assessments in order to be issued with a certificate of completion of their specialty training (CCT) in general practice. After passing the assessments, they are eligible to use the post-nominal letters MRCGP. During the GP specialty training programme, the medical practitioner must complete a variety of assessments in order to be allowed to practice independently as a GP. There is a knowledge-based exam with multiple choice questions called the Applied Knowledge Test (AKT). The practical examination takes the form of a 'simulated surgery' in which the doctor is presented with thirteen clinical cases and assessment is made of data gathering, interpersonal skills and clinical management. This Clinical Skills Assessment (CSA) is held on three or four occasions throughout the year and takes place at the renovated headquarters of the Royal College of General Practitioners (RCGP), at 30 Euston Square, London. Finally throughout the year, the doctor must complete an electronic portfolio which is made up of case-based discussions, critique of videoed consultations and reflective entries into a 'learning log'.
In addition, many hold qualifications such as the DCH (Diploma in Child Health of the Royal College of Paediatrics and Child Health) or the DRCOG (Diploma of the Royal College of Obstetricians and Gynaecologists) or the DGH (Diploma in Geriatric Medicine of the Royal College of Physicians). Some General Practitioners also hold the MRCP (Member of the Royal College of Physicians) or other specialist qualifications, but generally only if they had a hospital career, or a career in another speciality, before training in General Practice.
There are many arrangements under which general practitioners can work in the UK. While the main career aim is becoming a principal or partner in a GP surgery, many become salaried or non-principal GPs, work in hospitals in GP-led acute care units, or perform locum work. Whichever of these roles they fill, the vast majority of GPs receive most of their income from the National Health Service (NHS). Principals and partners in GP surgeries are self-employed, but they have contractual arrangements with the NHS which give them considerable predictability of income.
GPs in the United Kingdom may operate in community health centres.
Visits to GP surgeries are free in all countries of the United Kingdom, but charges for prescriptions are applied in England. Wales, Scotland and Northern Ireland have abolished all charges.[citation needed]
Recent reforms to the NHS have included changes to the GP contract. General practitioners are no longer required to work unsociable hours, and get paid to some extent according to their performance, (e.g. numbers of patients treated, what treatments were administered, and the health of their catchment area, through the Quality and Outcomes Framework). The IT system used for assessing their income based on these criteria is called QMAS. The amount that a GP can expect to earn does vary according to the location of their work and the health needs of the population that they serve. Within a couple of years of the new contract being introduced, it became apparent that there were a few examples where the arrangements were out step with what had been expected.[22] A full-time self-employed GP, such as a GMS or PMS practice partner, might currently expect to earn a profit share of around £95,900 before tax[23] while a GP employed by a CCG could expect to earn a salary in the range of £54,863 to £82,789.[24] This can equate to an hourly rate of around £40 an hour for a GP partner.[25]
A survey by Ipsos MORI released in 2011 reports that 88% of adults in the UK 'trust doctors to tell the truth'.[26]
In May 2017, there was said to be a crisis in the UK with practices having difficulties recruiting GPs they need. Prof. Helen Stokes-Lampard of the Royal College of General Practitioners said, “At present, UK general practice does not have sufficient resources to deliver the care and services necessary to meet our patients’ changing needs, meaning that GPs and our teams are working under intense pressures, which are simply unsustainable. Workload in general practice is escalating – it has increased 16% over the last seven years, according to the latest research – yet investment in our service has steadily declined over the last decade and the number of GPs has not risen in step with patient demand … This must be addressed as a matter of urgency.”[27]
In 2018 the average GP worked less than three and a half days a week because of the “intensity of working day”.[28]
There is an NHS England initiative to situate GPs in or near hospital emergency departments to divert minor cases away from A&E and reduce pressure on emergency services. 97 hospital trusts have been allocated money, mostly for premises alterations or development.[29]
North America[edit]
United States[edit]
A medical practitioner is a type of doctor.
The population of this type of medical practitioner is declining, however. Currently, the United States Navy has many of these general practitioners, known as General Medical Officers or GMOs, in active practice. The GMO is an inherent concept to all military medical branches. GMOs are the gatekeepers of medicine in that they hold the purse strings and decide upon the merit of specialist consultation. The US now holds a different definition for the term 'general practitioner'. The two terms 'general practitioner' and 'family practice' were synonymous prior to 1970. At that time both terms (if used within the US) referred to someone who completed medical school and the one-year required internship, and then worked as a general family doctor. Completion of a post-graduate specialty training program or residency in family medicine was, at that time, not a requirement. A physician who specializes in 'family medicine' must now complete a residency in family medicine, and must be eligible for board certification, which is required by many hospitals and health plans for hospital privileges and remuneration, respectively. It was not until the 1970s that family medicine was recognized as a specialty in the US.[30]
Many licensed family medical practitioners in the United States after this change began to use the term 'general practitioner' to refer to those practitioners who previously did not complete a family medicine residency. Family physicians (after completing medical school) must then complete three to four years of additional residency in family medicine. Three hundred hours of medical education within the prior six years is also required to be eligible to sit for the board certification exam[citation needed]; these hours are largely acquired during residency training.
The existing general practitioners in the 1970s were given the choice to be grandfathered into the newly created specialty of Family Practice. In 1971 the American Academy of General Practice changed its name to the American Academy of Family Physicians.[31] The prior system of graduating from medical school and completing one year of post-graduate training (rotating internship) was not abolished as 47 of the 50 states allow a physician to obtain a medical license without completion of residency.[32] If one wanted to become a 'house-call-making' type of physician, one still needs to only complete one or two years of a residency in either pediatrics, family medicine or internal medicine. This would make a physician a non-board eligible general practitioner able to qualify and obtain a license to practice medicine in 47 of the 50 United States of America.[32] Since the establishment of the Board of Family Medicine, a family medicine physician is no longer the same as a general practitioner. What makes a Family Medicine Physician different than a General Practitioner/Physician is two-fold. First off a Family Medicine Physician has completed the three years of Family Medicine residency and is board eligible or board certified in Family Medicine; while a General Practitioner does not have any board certification and cannot sit for any board exam. Secondly, a Family Medicine Physician is able to practice obstetrics, the care of the pregnant woman from conception to delivery, while a general practitioner is not adequately trained in obstetrics.
Prior to recent history most postgraduate education in the United States was accomplished using the mentor system.[citation needed] A physician would finish a rotating internship and move to some town and be taught by the local physicians the skills needed for that particular town. This allowed each community's needs to be met by the teaching of the new general practitioner the skills needed in that community. This also allowed the new physician to start making a living and raising a family, etc. General practitioners would be the surgeons, the obstetricians, and the internists for their given communities. Changes in demographics and the growing complexities of the developing bodies of knowledge made it necessary to produce more highly trained surgeons and other specialists. For many physicians it was a natural desire to want to be considered 'specialists'.[citation needed]
What was not anticipated by many physicians is that an option to be a generalist would lose its prestige and be further degraded by a growing bureaucracy of insurance and hospitals requiring board certification and the financial corruption of the board certification agencies.[33] It has been shown that there is no statistically significant correlation between board certification and patient safety or quality of care[34][35][33] which is why 47 states do not require board certification to practice medicine. Board certification agencies have been increasing their fees exponentially since establishment and the board examinations are known to not be clinically relevant and are at least 5 years out of date.[33] Yet, there is still a misbelief that board certification is necessary to practice medicine and therefore it has made a non-board eligible general physician a rare breed of physician due to the lack of available job opportunities for them.[33]
Certificates of Added Qualifications (CAQs) in adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine are available for those board-certified family physicians with additional residency training requirements. Recently,[when?] new fellowships in International Family Medicine have emerged. These fellowships are designed to train family physicians working in resource-poor environments.[36]
There is currently[when?] a shortage of primary care physicians (and also other primary care providers) due to several factors, notably the lesser prestige associated with the young specialty, the lower pay, and the increasingly frustrating practice environment. In the US physicians are increasingly forced to do more administrative work,[37] and shoulder higher malpractice premiums.
Canada[edit]
The College of General Practice of Canada was founded in 1954 but in 1967 changed its name to College of Family Physicians of Canada (CFPC).[38]
Oceania[edit]
Australia[edit]
General Practice in Australia and New Zealand has undergone many changes in training requirements over the past decade. The basic medical degree in Australia is the MBBS (Bachelor of Medicine, Bachelor of Surgery), which has traditionally been attained after completion of an undergraduate five or six-year course. Over the last few years, an ever-increasing number of post-graduate four-year medical programs (previous bachelor's degree required) have become more common and now account more than half of all Australian medical graduates. After graduating, a one-year internship is completed in a public and private hospitals prior to obtaining full registration. Many newly registered medical practitioners undergo one year or more of pre-vocational position as Resident Medical Officers (different titles depending on jurisdictions) before specialist training begins. For general practice training, the medical practitioner then applies to enter a three- or four-year program either through the 'Australian General Practice Training Program', 'Remote Vocational Training Scheme' or 'Independent Pathway'.[39] The Australian Government has announced an expansion of the number of GP training places through the AGPT program- 1,500 places per year will be available by 2015.[40]
A combination of coursework and apprenticeship type training leading to the awarding of the FRACGP (Fellowship of the Royal Australian College of General Practitioners) or FACRRM (Fellowship of Australian College of Rural and Remote Medicine), if successful. Since 1996 this qualification or its equivalent has been required in order for new GPs to access Medicare rebates as a specialist general practitioner. Doctors who graduated prior to 1992 and who had worked in general practice for a specified period of time were recognized as 'Vocationally Registered' or 'VR' GPs, and given automatic and continuing eligibility for general practice Medicare rebates.[41] There is a sizable group of doctors who have identical qualifications and experience, but who have been denied access to VR recognition. They are termed 'Non-Vocationally Registered' or so-called 'non-VR' GPs.[42] The federal government of Australia recognizes the experience and competence of these doctors, by allowing them access to the 'specialist' GP Medicare rebates for working in areas of government policy priority, such as areas of workforce shortage, and metropolitan after hours service.[43] Some programs awarded permanent and unrestricted eligibility for VR rebate levels after 5 years of practice under the program.[44] There is a community-based campaign in support of these so-called Non-VR doctors being granted full and permanent recognition of their experience and expertise, as fully identical with the previous generation of pre-1996 'grandfathered' GPs.[45] This campaign is supported by the official policy of the Australian Medical Association (AMA).[42]
Medicare is Australia's universal health insurance system, and without access to it, a practitioner cannot effectively work in private practice in Australia.[citation needed]
Procedural General Practice training in combination with General Practice Fellowship was first established by the 'Australian College of Rural and Remote Medicine' in 2004. This new fellowship was developed in aid to recognise the specialised skills required to work within a rural and remote context. In addition it was hoped to recognise the impending urgency of training Rural Procedural Practitioners to sustain Obstetric and Surgical services within rural Australia. Each training registrar select a speciality that can be used in a rural area from the Advanced Skills Training list and spends a minimum of 12 months completing this specialty, the most common of which are Surgery, Obstetrics/Gynaecology and Anaesthetics. Further choices of specialty include Aboriginal and Torres Strait Islander Health, Adult Internal Medicine, Emergency Medicine, Mental Health, Paediatrics, Population health and Remote Medicine. Shortly after the establishment of the FACRRM, the Royal Australian College of General Practitioners introduced an additional training year (from the basic 3 years) to offer the 'Fellowship in Advanced Rural General Practice'. The additional year, or Advanced Rural Skills Training (ARST)[46] can be conducted in various locations from Tertiary Hospitals to Small General Practice.
The Competent authority pathway is a work-based place assessment process to support International Medical Graduates (IMGs) wishing to work in General Practice. Approval for the ACRRM to undertake these assessments was granted by the Australian Medical Council In August 2010 and the process is to be streamlined in July 2014.[47]
New Zealand[edit]
In New Zealand, most GPs work in clinics and health centres[48] usually as part of a Primary Health Organisation (PHO). These are funded at a population level, based on the characteristics of a practice's enrolled population (referred to as capitation-based funding). Fee-for-service arrangements still exist with other funders such as Accident Compensation Corporation (ACC) and Ministry of Social Development (MSD), as well as receiving co-payments from patients to top-up the capitation-based funding.
The basic medical degree in New Zealand is the MBChB degree (Bachelor of Medicine, Bachelor of Surgery), which has traditionally been attained after completion of an undergraduate five or six-year course. In NZ new graduates must complete the GPEP (General Practice Education Program) Stages I and II in order to be granted the title Fellowship of the Royal New Zealand College of General Practitioners (FRNZCGP), which includes the PRIMEX assessment and further CME and Peer group learning sessions as directed by the RNZCGP.[49] Holders of the award of FRNZCGP may apply for specialist recognition with the New Zealand Medical Council (MCNZ), after which they are considered specialists in General Practice by the council and the community.[50] In 2009 the NZ Government increased the number of places available on the state-funded programme for GP training.[51]
There is a shortage of GPs in rural areas and increasingly outer metropolitan areas of large cities, which has led to the use of overseas trained doctors (international medical graduates (IMGs)).[citation needed]
See also[edit]
- ATC codes Anatomical Therapeutic Chemical Classification System
- Classification of Pharmaco-Therapeutic ReferralsCPR
- Dental General Practitioner (GDP)
- ICD-10 International Classification of Diseases
- International Classification of Primary CareICPC-2
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