General Practice
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Wikipedia-Article "General Practice"
A general practitioner (GP) or family physician (FP) is a physician/medical doctor 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 common in the United Kingdom, where the word "physician" is only used for certain specialists and not for GPs.
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United States
In the United States, a General Practitioner has completed the one-year internship required to obtain a medical license, after having received at least an undergraduate Baccalaureate Degree and a four year Doctor of Medicine (or in many states a Doctor of Osteopathy, or D.O.) Degree. A Family Medicine physician, however, has completed a 3-year family medicine residency in addition to the undergraduate and doctoral studies, and is eligible for the board certification now required by most hospitals and health plans.
Starting in the 1970's and 1980's, many board certified Family Physicians in the United States began to consider the terms "General Practitioner" and "GP" as somewhat demeaning and derogatory, discounting their additional years of training.
A Family Physician is board-certified in Family Medicine. Training is focused on treating an individual throughout all of his or her life stages. Family physicians will see anyone with any problem, but is an expert in common problems. Many family physicians deliver babies as well as taking care of all ages of patients. Family physicians complete undergraduate school, medical school and 3 more years of specialized medical residency training in Family Practice. Board Certified Family Physicians take a 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 the board certification process is being changed in Family Medicine 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 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.
Certificates of Added Qualifications (CAQs) in Adolescent Medicine, Geriatric Medicine, or Sports Medicine are available for those board certified family physicians who meet additional training and testing requirements.
UK
In the United Kingdom, doctors wishing to become GPs take at least 4 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 (MB ChB):
- 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.
At the end of the one year registrar post, the doctor must pass an examination in order to be allowed to practice independently as a GP (Summative Assessment). This consists of a video of two hours of consultations with patients, an audit cycle completed during their registrar year, a multiple choice questionnaire (MCQ), and a standardised assessment of competencies by their trainer.
Membership of the Royal College of General Practitioners is optional and can be awarded by examination, or by systematic assessment of an existing practitioner. After passing the exam or assessment, they are awarded the 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 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 contractural arrangements with the NHS which give them considerable predictability of income.
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.
Visits to GP surgeries are free in the United Kingdom, but most adults of working age who are not on benefits have to pay a standard prescription charge for any medicines they are prescribed that are not available over the counter.
Recent reforms to the NHS have included changing the GP contract. General Practitioners are now not 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. They are encouraged to prescribe medicines by their generic names. The system for assessing their income based on these criteria is called QMAS. A GP can expect to earn about 70,000 pounds a year without doing any overtime.
Spain
In Spain the médico de familia/médico general commonly called médico de cabecera, works in multidisciplinary teams (pediatrics, nurses, social workers and others) on primary care centers. They are in most cases salary-based healthcare workers.
After the graduation in Medicine (with a duration of 6 years), the medical doctors pass a National written exam called MIR (Internal Resident Doctor). The speciality devoted to primary care is "Family and Community Medicine Specialist".
To obtain it, the postgraduate doctors must complete a 4-years training period working in primary care centers (2 years) and hospitals (2 years) as residents.
Some of the specialist in Family Practice in Spain are forced to work in other countries (mainly UK, Portugal and France) due to lack of stable work offers in the public health system.
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 four 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]. 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 recognized but this is not standardized 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.
Netherlands
General practice in The Netherlands is considered fairly advanced. The huisarts (literally: "home doctor") administers all first-line care, and makes required referrals. Many have a specialist interest, e.g. in palliative care.
Training consists of three years of specialisation after completion of internships.
Australia
General Practice in Australia 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) and has traditionally been attained after completion of a six year course. Over the last few years, 4.5 year postgraduate courses have become more common. After graduating, a one or two year internship (dependent on state) is required for registration before specialised training begins. For General Practice training the young doctor enters into a 3 year Family Medicine Programme which is a combination of coursework and practical work leading to entry into the RACGP (Royal Australian College of General Practice). This qualification or its equivalent is needed to access the Medicare health system for remuneration as a General Practitioner. Medicare is Australia's Universal Health Care system and without access to this, a practioner cannot effectively work in Australia.
External links
- American Board of Family Medicine
- American Academy of Family Physicians
- GPs’ Qualification Royal College of General Practitioners RCGP UK
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