| A general practitioner (GP) or family physician (FP) is a physician who provides primary care. A GP/FP treats acute
and chronic illnesses, provides preventive care and health education for all ages and both sexes. Some also care for hospitalized
patients, do minor surgery and/or obstetrics. The term family doctor is also common in the United Kingdom, since there the word "physician" has a more specialist meaning.
USA
In the United States, a General Practitioner has completed a one year
internship required to obtain a medical license, after having received at least an undergradulate Baccalaureate Degree and a four
year Doctor of Medicine (or in many US States a Doctor of Osteopathy) Degree. A Family Practice physician has completed a 3 year
medical residency in addition to the undergraduate and doctoral studies, and is eligible for board certification now required by
most hospitals in order to attend patients requiring admission.
In the modern era, American Family Physicians consider being referred to as a "General Practitioner" or a "GP" as a somewhat
demeaning and derogatory term, discounting their much more advanced training.
A Family Physician is board-certified in Family Practice. Training is focused on treating an individual throughout their life
stages. Family physicians complete undergraduate school, medical school
and 3 more years of specialized medical residency training in
Family Practice. Board Certified Family Physicians retake an 8 hour written examination every 6-7 years, as well as a case review
of 20 patients from their recent practice, to remain certified. Three hundred hours of continuing medical education within the
prior six years is also required to be eligible to sit for the exam.
Between 2003 and 2009 this process will be changed in Family Practice and all other American Specialty Boards to a continuous
series of yearly competency tests on differing areas within the given specialty.
The American Board of Family Practice, 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. Certificates of Added Qualifications (CAQs) in Adolescent Medicine, Geriatric Medicine, or Sports Medicine are available for those physicians who meet additional
training requirements.
UK
In the United Kingdom, doctors wishing to become GPs take at least 4
years training after medical school, which is an undergraduate course of four to six years, leading to the degrees "MBChB",
Bachelor of Medicine and Bachelor of Surgery:
- one year as a house officer (PRHO) (formerly called a houseman);
- two years as a senior house officer (SHO) - often on a General Practice Vocational Training Scheme (GP-VTS);
- one year as a general practice registrar.
After passing an exam they are awarded a specialist qualification of MRCGP – Member of the Royal College of General Practitioners. General practitioners are not required to
hold the MRCGP, but it is considered desirable. In addition, many hold qualifications such as the MRCP (Member of the Royal College
of Physicians) and/or the DRCOG (Diploma of the Royal College of Obstetricians and Gynaecologists).
There are many arrangements under which general practitioners can work in the UK. While the main career aim is becoming a
principal of a GP surgery, many become salaried or non-principal GPs, work in hospitals in GP-led acute care units, or perform
locum work.
The MBChB medical degree is generally considered equivalent to the North American MD medical degree. Doctors educated in the
United States, Canada, Ireland, and Great Britain have more ability to move between the countries than other national
systems.
France
In France, the médecin généraliste (commonly called docteur) is
responsible for the long term care in a population. 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).
The studies consist of six years in the university (common to all medical specialties), and two years and a half as a junior
practitioner (interne) :
- the first year (PCEM1, premier cycle d'études médicales, première année, often abbreviated to P1 by students)
is common with the dentists (and, in some universities, with students of other paramedical professions like midwifery); the rank at the final competitive examination determines in which branch the
student can go on;
- 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 (the general medicine is one of them) the student can make his
internat;
- the internat is two years and a half of initial professional experience under the responsibility of a senior;
the interne can prescribe, he can make replace physicians, and usually works in an hospital.
This ends with a doctorate, a research work which usually consist of a
statistical study of cases to propose a care strategy of a specific affection (in an epidemiological, diagnostical, or
therapeutical point of view).
Canada
In Canada, there are no newly qualifying General Practitioners: all medical students
go on to a specialty, Family Medicine being the most popular. Following three years in medical school, a resident will spend 2-3
years in an accredited Family Medicine program. At the end of this, residents are eligible to be examined for Certification in
the College of Family Physicians of Canada *[1] (http://www.cfpc.ca). Many hospitals and health
regions now require this Certification. To maintain their Certificate, doctors must document ongoing learning and upgrade
activities to accumulate MainPro credits. Some doctors add an extra year of training in Emergency Medicine and can thus be
additionally certified as CCFP(EM). Extra training in Anesthesia, Surgery and Obstetrics may also be recognised but this is not
standardised across the country.
There is very little private Family Medicine practice in Canada. Most FP's are remunerated via their Provincial government
health plans, via a variety of payment mechanisms, including fee-for-service, salaried positions, and alternate payment plans.
There is increasing interest in the latter as a means to promote best practices within a managed economic environment. As
standard office practice has become less financially viable in recent years, many FP's now pursue areas of special interest. In
rural areas, the majority of FP's still provide a broad, well-rounded scope of practice. Manpower inequities in rural areas are
now being addressed with some innovative training and inducement mechanisms.
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