General practitioner
Overview
A general practitioner is a medical practitioner
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 who treats acute
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....

 and chronic illnesses and provides preventive care and health education
Health education
Health education is the profession of educating people about health. Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health...

 for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities
Comorbidity
In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...

. 'The good GP will treat patients both as people and as a population'.

The term general practitioner or GP is common in the Republic of Ireland
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...

, the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 and several Commonwealth
Commonwealth of Nations
The Commonwealth of Nations, normally referred to as the Commonwealth and formerly known as the British Commonwealth, is an intergovernmental organisation of fifty-four independent member states...

 countries.
Encyclopedia
A general practitioner is a medical practitioner
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 who treats acute
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....

 and chronic illnesses and provides preventive care and health education
Health education
Health education is the profession of educating people about health. Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health...

 for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities
Comorbidity
In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...

. 'The good GP will treat patients both as people and as a population'.

The term general practitioner or GP is common in the Republic of Ireland
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...

, the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 and several Commonwealth
Commonwealth of Nations
The Commonwealth of Nations, normally referred to as the Commonwealth and formerly known as the British Commonwealth, is an intergovernmental organisation of fifty-four independent member states...

 countries. In these countries the word physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 is largely reserved for certain other types of medical specialists, notably in internal medicine
Internal medicine
Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists. They are especially skilled in the management of patients who have undifferentiated or multi-system disease processes...

. While in these countries, the term GP has a clearly defined meaning, in North America the term has become somewhat ambiguous, and is not necessarily synonymous with the term "family doctor"
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...

, as described below.

India

The basic medical degrees in India is MBBS. They are generally four and a half years course followed by a year of compulsory rotatory internship. The internship requires the candidate to work in all the departments for a stipulated period of time to undergo hands on training in managing patients.

The registration of doctors is managed usually by state medical councils. A permanent registration as a Registered Medical Practitioner is granted only after satisfactory completion of the compulsory internship. minimum training of 1 (one) year.

Pakistan

In Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...

, 5 years of MBBS is followed by one year of internship in different specialties. Pakistan Medical and Dental Council
Pakistan Medical and Dental Council
Pakistan Medical and Dental Council is the statutory regulatory authority for medical and dental education and practitioners in Pakistan. PMDC was established under Pakistan Medical and Dental Council Ordinance 1962 as a body corporate. It is part of International Community of Medical Regulatory...

 (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, Pakistan (CPSP) in 1992
and initiated in 1993 by the Family Medicine Division of the Department of Community Health
Sciences, Aga Khan University
Aga Khan University
The Aga Khan University is a coeducational research university spread over three continents. It was granted its charter in 1983 as Pakistan's first private, autonomous university. AKU was founded by His Highness the Aga Khan, and is part of the Aga Khan Development Network...

, Pakistan. In 1997, the Royal College of General Practitioners, UK, unconditionally approved the Programme for the MRCGP Examination and additionally declared it as amongst the top 10 programmes in UK.

Family Medicine residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 training programme of Ziauddin University is approved for Fellowship in Family Medicine.

The following centres are providing training for Diploma of College of Physicians and Surgeons, Pakistan (DCPSP):
  1. Ayub Medical College/Ayub Teaching Hospital, Abbottabad
  2. Dow University of Health Sciences, Karachi
  3. Khyber Medical university/Khyber Teaching Hospital, Peshawar
  4. PGMI / Lady Reading Hospital, Peshawar
  5. PGMI / Hayatabad Medical Complex, Peshawar

Sri Lanka

In Sri Lanka
Sri Lanka
Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka is a country off the southern coast of the Indian subcontinent. Known until 1972 as Ceylon , Sri Lanka is an island surrounded by the Indian Ocean, the Gulf of Mannar and the Palk Strait, and lies in the vicinity of India and the...

 to become a general physician, one must be registered at the Sri Lanka Medical Council (formally the Ceylon Medical Council). To do this one must gain a Bachelor of Medicine and Surgery
Bachelor of Medicine and Surgery
Bachelor of Medicine, Bachelor of Surgery, or in Latin Medicinae Baccalaureus, Baccalaureus Chirurgiae , are the two first professional degrees awarded upon graduation from medical school in medicine and surgery by universities in various countries...

 (MBBS) degree after 5½ years of study at a local state university and undergo one year of internship. For physicians who gained their medical qualifications out side Sri Lanka must sit for a special exam conducted by the medical council known as the act 16. The Sri Lanka Medical Council confers permanent registration, after which the candidate may choose to practice as a GP, opt for specialty training, have a career in government or private health care institutions.

There are also assistant medical practitioners (AMP) who later on become registered medical practitioners (RMP) due to seniority. They follow a course of three years in a govt institution and gain Sri Lanka Medical Council registration. These doctors also work in Sri Lanka as general practitioners, mainly in rural areas.

France

In France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

, the médecin généraliste (commonly called docteur) is responsible for the long term care in a population. This implies prevention, education, care of the disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

s and trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

s 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
Sport
A Sport is all forms of physical activity which, through casual or organised participation, aim to use, maintain or improve physical fitness and provide entertainment to participants. Sport may be competitive, where a winner or winners can be identified by objective means, and may require a degree...

, death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

 certificate, certificate for hospitalisation without consent in case of mental incapacity), and a role in the emergency care
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

 (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 three years 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 midwifery
    Midwifery
    Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....

    ; 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
    Anatomy
    Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...

    , human physiology
    Physiology
    Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

    , biochemistry
    Biochemistry
    Biochemistry, sometimes called biological chemistry, is the study of chemical processes in living organisms, including, but not limited to, living matter. Biochemistry governs all living organisms and living processes...

    , bacteriology
    Bacteriology
    Bacteriology is the study of bacteria. This subdivision of microbiology involves the identification, classification, and characterization of bacterial species...

    , statistics
    Statistics
    Statistics is the study of the collection, organization, analysis, and interpretation of data. It deals with all aspects of this, including the planning of data collection in terms of the design of surveys and experiments....

    ...
  • the three following years are called externat and are dedicated to the study of clinical medicine
    Clinical Medicine
    Clinical Medicine is a peer-reviewed medical journal published bimonthly by the Royal College of Physicians. It was established in 1966 as the Journal of the Royal College of Physicians of London. It was doubly named between 1998 and 2000, and since 2001 it has appeared as Clinical Medicine. Its...

    ; they end with a classifying examination, the rank determines in which specialty (general medicine is one of them) the student can make his internat;
  • the internat is three years of initial professional experience under the responsibility of a senior; the interne can prescribe, he can replace physicians, and usually works in a hospital.

This ends with a doctorate
Doctorate
A doctorate is an academic degree or professional degree that in most countries refers to a class of degrees which qualify the holder to teach in a specific field, A doctorate is an academic degree or professional degree that in most countries refers to a class of degrees which qualify the holder...

, a research work which usually consist of a statistical study of cases to propose a care strategy of a specific affection (in an epidemiological, diagnostic, or therapeutic point of view).

Denmark

In Denmark to become a general practitioner 6 years of training are required after medical school: 1 year of basic training and 5 years of specialist training. Of the 6 years approximately half will take place in general practice and the other half is hospital training. Having finished the program the doctor will receive the title "Speciallæge i Almen Medicin" - this translates into "specialist in general medicine", which can be considered a contradiction in terms. Every Danish citizen has his own general practitioner. The patient has to be able to contact his doctor Monday to Friday from 8 am to 4 pm. After 4 pm the patients can use the on-call doctor service which all general practitioners under the age of 60 are obligated to participate in. Treatment at hospitals require a referral from a general practitioner, as do treatment by specialists in private practice, e.g., gynecologists and dermatologists. Patients can freely consult ophthalmologists and otologists though.

Ireland

General Practice in Ireland
Republic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...

 largely follows the British model, with some exceptions. GP training in Ireland requires the completion of a primary medical degree. In Ireland the title of MB BCh BAO (Bachelor of Medicine, Bachelor of Surgery, Bachelor of the Obstetric Art) or BM BS (Bachelor of Medicine, Bachelor of Surgery) is awarded upon successful completion of a 4 year graduate or 5 to 6 year undergraduate degree programme in one of the country's 6 medical schools.

Following this a further year is spent as an Intern, rotating through medical and surgical specialties. In most, but not all instances, 6 months are spent in medicine and 6 months in surgery. Some interns can gain experience in general practice, psychiatry and other specialties. The successful completion of intern training leads to full registration with the Irish Medical Council.

Those medical practitioners
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 wishing to pursue a career in General Practice must complete an approved training scheme. Previously completion of a training scheme was not mandatory to sit the MICGP exam (Member of the Irish College of General Practictioner) and practice as a GP in Ireland. Many doctors took up stand-alone SHO posts in the required specialities and then sat the exam without any vocational training. This route has now been abolished and vocational training is mandatory. Completion of vocational GP training in other jurisdictions (e.g. the UK) and completion of the MICGP or equivalent (e.g. MRCGP) is still possible, but anecdotal evidence would suggest Irish trained GPs are at a significant advantage when applying for Irish GP posts.

Entry to a General Practice Training Scheme is based on competitive interview. Most are of 4 years duration (one is 5 years). Generally the first 2 years are spent rotating through relevant specialties (medicine, paediatrics, obstetrics & gynaecology, psychiatry, accident & emergency, ENT etc.). Two years are then spent as a GP registrar in designated Training Practice. After successfully completing the MICGP exams, the new general practitioner is free to practice.

General practice in Ireland is a desirable career for many and competition for places on training schemes is intense. There has been much criticism of the perceived under-supply of training places and efforts are made to increase places annually. Currently there are 12 schemes - Donegal, Sligo, Western (Galway, Mayo and Roscommon), Mid-Western (Limerick, Clare and Tipperary North Riding), Southern (Cork & Kerry), South-East (Waterford, Wexford, Kilkenny and Tipperary South Riding), Midlands (Offaly, Westmeath, Laois, Kildare), North-East (Louth, Meath, Monaghan, Cavan), Ballinasloe and 3 schemes based in Dublin.

Typically Irish GPs work exclusively with private (i.e. fee-for-service paying) patients or have a mix of public and private. So-called "public" patients are those who qualify for a medical card under the General Medical Services (or GMS) system. This is free health care, provided by the government and is means tested. Other groups such as those with specified chronic illnesses and the elderly are also entitled to a medical card. A medical card entitles the holder to free GP consultations, free medications and free hospital treatment.
In order to treat medical card holders a GP must apply for and be granted a GMS list. Applications for such lists are competitive as they can be very lucurative for the GP and vacancies do not often arise.

GPs deal with the entire spectrum of medical ailments. They are well placed to implement preventative measures and to manage chronic illness. They also act as "gate-keepers" for the tertiary care system, providing referrals to specialist services when appropriate. Some GPs are employed by private agencies.

Netherlands and Belgium

General practice in the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

 and Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...

 is considered fairly advanced. The huisarts (literally: "home doctor") administers first line, primary care 24 hours a day, 7 days a week. Patients cannot consult a hospital specialist without a required referral. Most GP's work in private practice although more medical centers with employed GP's are seen. Many GP's have a specialist interest, e.g. in palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...

.

In Belgium, one year of lectures and two years of residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 are required. In the Netherlands, training consists of three years (full time) of specialization after completion of internships. 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 of a general hospital, three months of training at a psychiatric hospital and three months at a nursing home (verpleeghuis). 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).
All residents must also take the national GP knowledge test (landelijke huisarts kennistoets) twice a year. In this test of about 160 multiple choice questions, medical, ethical, scientific and legal matters of GP work are addressed.

Spain

In Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...

 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.

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.

United Kingdom

In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

, doctors wishing to become GPs take at least 5 years training after medical school
Medical school (United Kingdom)
In the United Kingdom, medical school generally refers to a department within a university which is involved in the education of future medical practitioners...

, 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/BS).

Up until the year 2005, those wanting 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
    Pre-registration house officer
    Pre-registration house officer , often known as a houseman or house officer, was until 2005 the only job open to medical graduates in the United Kingdom who had just passed their final examinations at medical school and had received their medical degrees.Newly-qualified doctors are only allowed...

     (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
    Senior house officer
    A senior house officer is a junior doctor undergoing training within a certain speciality in the British National Health Service or in the Republic of Ireland. SHOs are supervised by consultants and registrars, who oversee their training and are their designated clinical supervisors...

     (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 has changed under the programme Modernising Medical Careers
Modernising Medical Careers
Modernising Medical Careers is a programme for postgraduate medical training introduced in the UK from 2005 onwards. The programme replaced the traditional grades of medical career before the level of Consultant. The different stages of the programme contribute towards a "Certificate of...

. Medical practitioners
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 graduating from 2005 onward have to do a minimum of 5 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 Specialty Training Program containing (GPSTP): 18 months as a Specialty Registrar in which time the trainee completes a mixture of jobs in hospital specialties such as obstetrics
    Obstetrics
    Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...

     and gynaecology
    Gynaecology
    Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive system . Literally, outside medicine, it means "the science of women"...

    , paediatrics, geriatric medicine, accident and emergency
    Emergency department
    An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...

     or psychiatry
    Psychiatry
    Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

    ; 18 months as a GP Specialty Registrar in General Practice.

During the GP specialty training program, 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 13 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 in the specially designed centre at Croydon. 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".

Membership of the Royal College of General Practitioners
Royal College of General Practitioners
The Royal College of General Practitioners is the professional body for general practitioners in the United Kingdom. The RCGP represents and supports GPs on key issues including licensing, education, training, research and clinical standards. It is the largest of the medical royal colleges, with...

 was previously optional. However, new trainee GP's from 2008 are now compulsorily required to complete the nMRCGP. They will not be allowed to practice without this postgraduate qualification. After passing the exam or assessment, they are awarded the specialist qualification of MRCGP – Member of the Royal College of General Practitioners. Previously qualified general practitioners (prior to 2008) are not required to hold the MRCGP, but it is considered desirable. In addition, many hold qualifications such as the DCH (Diploma in Child Health of the Royal College of Paediatrics and Child Health
Royal College of Paediatrics and Child Health
Royal College of Paediatrics and Child Health in London is responsible for the training of postgraduate doctors in paediatrics and conducting the MRCPCH membership exams. They also conduct the Diploma in Child Health exam, which is taken by many doctors who plan a career in General Practice...

) and/or the DRCOG (Diploma of the Royal College of Obstetricians and Gynaecologists
Royal College of Obstetricians and Gynaecologists
The Royal College of Obstetricians and Gynaecologists is a professional association based in the UK. Its members, including people with and without medical degrees, work in the field of obstetrics and gynaecology, that is, pregnancy, childbirth, and female sexual and reproductive health...

) and/or the DGH (Diploma in Geriatric Medicine of the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...

). Some General Practitioners also hold the MRCP (Member of the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...

) 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
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 (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.

Visits to GP surgeries are free in all countries of the United Kingdom, but charges for prescription only medicine vary. Wales, Scotland and Northern Ireland have already abolished all charges. In England, however, most adults of working age who are not on benefits have to pay a standard charge for prescription only medicine of £7.40 per item from April 2011.

Recent reforms to the NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 have included changing the GP contract
General medical services
General medical services is the name used in the United Kingdom to describe the medical services provided by General Practitioners who, in effect, run private businesses independently contracting with the National Health Service...

. 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, through the Quality and Outcomes Framework
Quality and Outcomes Framework
The Quality and Outcomes Framework is a system for the performance management and payment of general practitioners in the National Health Service in England, Wales, Scotland and Northern Ireland...

. They are encouraged to prescribe medicines by their generic names. The IT system used for assessing their income based on these criteria is called QMAS. A GP can expect to earn about £70,000 a year without doing any overtime, although this figure is extremely variable. A 2006 report noted that some GPs were earning £250k per year, with the highest-paid on £300k for working alone across five islands in the Outer Hebrides
Outer Hebrides
The Outer Hebrides also known as the Western Isles and the Long Island, is an island chain off the west coast of Scotland. The islands are geographically contiguous with Comhairle nan Eilean Siar, one of the 32 unitary council areas of Scotland...

. However, a full time GMS or PMS practice partner can now expect to earn around £95,900 before tax, while a salaried GP earns on average £57,300.. This equates to an hourly rate of around £40 an hour for a GP partner.

A survey by Ipsos Mori released in 2011 reports that 88% of adults in the UK "trust doctors to tell the truth".

Canada

In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

, the term general practitioner often has two meanings. The Canadian specialty that is equivalent to the British general practitioner training program is family medicine
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...

 which accounts for almost 40% of the residency positions for graduating students. 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. Many hospitals and health regions now require this certification. To maintain their certificate, medical practitioners must document ongoing learning and upgrade activities to accumulate "MainPro" credits. Some practitioners 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.

General practitioners in Canada do operate in private practice, in that they are not employees of the government. They either own their own practice or work for a privately owned practice. However, the majority of GPs are remunerated via their provincial governments' publicly funded health insurance 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 FPs now pursue areas of special interest. In rural areas, the majority of FPs 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. An imbalance between physician manpower and a growing patient load has resulted in orphan patients who find it difficult to access primary care, but this is not unique to Canada. Family Medicine is recently recognized as a Medical Specialty in Canada. Family Physicians who pass the Certification exam, CCFP, become Specialist in Family Medicine.

United States

Medical practitioner
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s must hold a license to practice medicine in the United States. The requirement is to be enrolled in or have completed a year of training, more commonly called a rotating internship. There are generally four years of undergraduate college and four years of medical school prior to the internship. All licensed medical practitioners who complete a two-to-ten-year residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 are legally allowed to practice medicine in the state within which they are licensed.

The population of this type of medical practitioner is declining, however. Currently the United States Navy
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...

 has many of these general practitioners, formally known as General Medical Officers or GMO
GMO
A GMO is a genetically modified organism.GMO may also refer to:* Gell-Mann–Okubo mass formula in particle physics* General Medical Officer, a designation for United States Army soldiers* Generalised molecular orbital theory, in chemistry...

s, 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
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...

 was, at that time, not a requirement.
A medical practitioner
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 who specializes in “family medicine” must now complete a residency in family medicine, and must be eligible for board certification
Board certification
Board certification is the process by which a physician , dentist , or podiatrist in the United States demonstrates through either written, practical, and/or simulator based testing, a mastery of the basic knowledge and skills that define an area of medical specialization...

, which is required by many hospitals and health plans. It was not until the 1970s that family medicine (formerly known as family practice) was recognized as a specialty in the US.

Many licensed family medical practitioners
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 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
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

. Family medical practitioners (after completing medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...

) 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; 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. As well, the American Academy of General Practice changed its name to the American Academy of Family Physicians. The prior system of graduating from medical school and completing one year of post-graduate training (rotating internship) was abolished. If one wanted to become a "house-call-making" type of physician, one needed to stay in the academic setting two or three more years.

Since many general practitioners were grandfathered into this specialty, the number of family practitioners initially grew significantly. However, the number of medical students graduating into Family Practice drastically declined. Logically, students felt that they could complete similar residencies in higher-paying specialties in the same amount of time. This produced more of the lower-cost and less-trained "medical extenders" such as physician assistants, nurse practitioners, etc.

Between 2003 and 2009 the board certification process changed in family medicine and all other American Specialty Boards
American Board of Medical Specialties
The American Board of Medical Specialties is a non-profit physician-led umbrella organization for 24 of the 26 approved medical specialty boards in the United States...

 to a continuous series of yearly competency tests on differing areas within the given specialty. The American Board of Family Medicine
American Board of Family Medicine
The American Board of Family Medicine is a non-profit, independent medical association of American physicians who practice in family medicine and its sub-specialties...

, as well as other specialty boards, now requires additional participation in continuous learning and self-assessment activities that enhance clinical knowledge, expertise and skills. The Board has created a program called the "Maintenance of Certification Program for Family Physicians" (MC-FP) which requires family physicians to continuously demonstrate proficiency in four areas of clinical practice: professionalism, self assessment/lifelong learning, cognitive expertise, and performance in practice.

The American Academy of General Physicians, the only such organization representing general practitioners, it is also the only organization that provides a path for Board Certification in this specialty. Through the American Board of General Practice, there is a specialty of "General Practice with Board Certification". These organizations also actively train physicians and educate physicians with a prescribed body of knowledge through the American College of General Medicine.

The American Academy of General Physicians is actively involved in providing a pathway to “Board Certification” for a large number of General Practitioners produced by the medical colleges. These physicians have no other path to board certification save going back into a residency program, which is not feasible in most cases due to a variety of reasons.

The new system of academically trained “specialist” family practitioners has indeed produced well-trained physicians. However, many feel that these physicians are less likely to go to smaller towns and rural communities due to socio-economic conditions or circumstances as well as access to nascent technology. Statistics in 2009 show that medical students graduate with debt in excess of $200,000 for their education. This system has most likely created physicians who are more likely to work in a profit-driven, third-party-payer model as they provide a more assured income and ability to repay debt.

When the American Academy of Family Practice was created, the American Academy of General Practice was abolished. Several members of the AMA were in opposition to this and predicted that another General Practice organization would inevitably result, including Dr. Susan Black, MD. She predicted a “second coming” of a “General Practice Movement”. Several physicians nationwide created the American Academy of General Physicians. They prescribed a body of knowledge that defined a “General Practitioner”. Along with the College of William and Mary they created a system of study and practice-oriented residency in order to board-certify the ten to fifteen percent of doctors in the United States who are not board certified, but who are “General Practitioners”.

General practitioners have in the past, and currently are being created by the present system of producing doctors, with no way to codify or “board certify” their competency for numerous reasons. The American Board of General Physicians has been in existence for over 10 years. It is charged with certifying the quality of the physicians who have completed a prescribed course of study and practice and has no relation to the American Board of Specialties. Presently doctors Board Certified by the American Board of General Practice are accepted readily in large and small hospitals and medical centers as well as smaller community-based hospitals. The American Board of General Practice also has the support of the American Medical Legal Law center, which has written an extensive brief detailing the history of general practitioners, and the legal validity of their existence.

Board certification of general practitioners is different from the board certification of family physicians. Testing for the American Board of Family Practice involves a written exam. Testing for the American Board of General Practice involves a written exam as well as an oral exam as well as a practical exam with a clinical skills evaluation. Re-certification by the American Board of Family Practice is by written exam. It is the only physician-certifying board that does not use oral exams for initial certification or re-certification. The American Board of General Practice uses oral examination for re-certification as well as requiring 50 hours of continuing education per year for seven years to be re-certified.

Prior to recent history most postgraduate education in the United States was accomplished using the mentor system. 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”. What was not anticipated by many physicians is that an option to be a generalist would be abolished.

The general practice concept has historically been based on creating a physician who can "do anything" that may be necessary for the patient’s life and welfare, as well as for the community. Sadly, the same physician that visits your home, takes out your tonsils or appendix, delivers your babies and cares for you from cradle to grave is long gone. As well, the general practice movement promotes the continuing education of its doctors using the Internet-based information systems, community-based educational resources as well as academic center based resources.

Certificates of Added Qualifications (CAQs) in adolescent medicine
Adolescent medicine
Adolescent medicine is a medical subspecialty that focuses on care of patients who are in the adolescent period of development, generally ranging from the last years of elementary school until graduation from high school...

, geriatric medicine
Geriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...

, sports medicine
Sports medicine
Sports medicine is a branch of medicine that deals with physical fitness, treatment and prevention of injuries related to sports and exercise...

, sleep medicine
Sleep medicine
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge and answered many questions about sleep-wake functioning. The rapidly evolving field has...

, and hospice and palliative medicine are available for those board-certified family physicians with additional residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 training requirements. Recently, new fellowships in International Family Medicine
International Family Medicine
International Family Medicine physicians are Family Physicians that specialize in working with under served populations in resource poor environments, often in developing nations. These physicians must face the challenge of diagnosing patients without advanced laboratory or imaging techniques...

 have emerged. These fellowships are designed to train family physicians working in resource poor environments.

There is currently a shortage of primary care physician
Primary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....

s (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, and shoulder higher malpractice premiums.

Australia and New Zealand

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, and New Zealand the MBChB degree (Bachelor of Medicine, Bachelor of Surgery), which has traditionally been attained after completion of a five or six-year course. Over the last few years, an ever increasing number of four-year medical programs that require a previous bachelors degree have become more common and now account for up to half of all Australian medical graduates. After graduating, a one- or two-year internship (dependent on state) in the public hospital system is required for 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 the three- or four-year "Australasian General Practice Training Program" (four-year for additional Fellowship in Advanced Rural General Practice), a combination of coursework and apprenticeship type training leading to the awarding of the FRACGP (Fellowship of the Royal Australian College of General Practitioners
Royal Australian College of General Practitioners
The Royal Australian College Of General Practitioners is the professional body for General Practitioners in Australia.The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian...

) or FRNZCGP (Fellowship of the Royal New Zealand College of General Practitioners), if successful. Since 1996 this qualification or its equivalent has been required in order for the GP to access Medicare
Medicare (Australia)
Medicare is Australia's publicly funded universal health care system, operated by the government authority Medicare Australia. Medicare is intended to provide affordable treatment by doctors and in public hospitals for all resident citizens and permanent residents except for those on Norfolk Island...

 rebates as a general practitioner. Medicare is Australia's universal health insurance
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...

 system, and without access to it, a practitioner cannot effectively work in private practice in Australia. The Royal Australian College of General Practitioners
Royal Australian College of General Practitioners
The Royal Australian College Of General Practitioners is the professional body for General Practitioners in Australia.The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian...

 also has a reciprocal agreement with the American Board of Family Medicine
American Board of Family Medicine
The American Board of Family Medicine is a non-profit, independent medical association of American physicians who practice in family medicine and its sub-specialties...

 as the Australasian general practitioner training program is recognised as equivalent to the US family medicine residency programs in the United States.

In New Zealand, most GPs work within a practice that is part of a Primary Health Organisation
Primary Health Organisation
Primary Health Organisations , in New Zealand, are health care providers that are funded on a capitation basis by the New Zealand Government via District Health Boards...

 (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. In NZ new graduates must complete the RNZCGP GPEP (Gneral Practice Education Program) Stages I and II in order to be granted the title FRNZCGP, which includes the PRIMEX assessment and further CME and Peer group learning sessions as directed by the RNZCGP. 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.

Increasingly a portion of income is derived from government payments for participation in chronic disease management programs.

There is a shortage of GPs in rural areas and increasingly outer metropolitan areas of large cities, which has led to the utilisation of overseas trained doctors (international medical graduates (IMGs)).

Pay

Pay of medical practitioners varies widely in different countries throughout the world. In the UK, for example, full time GPs can currently expect to earn a salary of £100,000 per annum and hospital consultants can earn between £74,504 and £100,446.

Notable general practitioners

  • Alex Tudor-Hart
  • Francisco Vallés
    Francisco Vallés
    Francisco Vallés also known as Divino Vallés was a Spanish physician, the best example of the medical Renaissance in Spain....

  • Juan Gérvas
    Juan Gérvas
    Juan Javier Gérvas Camacho born in Lorca in 1948, is a general practitioner, teacher and researcher in primary care and public health.- Personal :...

  • Julian Tudor Hart
    Julian Tudor Hart
    Julian Tudor Hart is a British physician.- Biography :He studied medicine at Cambridge University and in London....


See also

  • American Board of Family Medicine
    American Board of Family Medicine
    The American Board of Family Medicine is a non-profit, independent medical association of American physicians who practice in family medicine and its sub-specialties...

  • ATC codes Anatomical Therapeutic Chemical Classification System
  • Classification of Pharmaco-Therapeutic Referrals
    Classification of Pharmaco-Therapeutic Referrals
    The Classification of Pharmaco-Therapeutic Referrals is a taxonomy focused to define and group together situations requiring a referral from pharmacists to physicians regarding the pharmacotherapy used by the patients. It has been published in 2008...

     CPR
  • Dental General Practitioner (GDP)
  • Family medicine
    Family medicine
    Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...

  • Family practice
  • ICD-10
    ICD-10
    The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

     International Classification of Diseases
  • ICPC-2 PLUS
    ICPC-2 PLUS
    ICPC-2 PLUS is an extended terminology classified to ICPC-2 International Classification of Primary Care, which aids data entry, retrieval and analysis. ICPC-2 PLUS takes into account the frequency distribution of problems seen in primary health care...

  • International Classification of Primary Care
    International Classification of Primary Care
    The International Classification of Primary Care is a classification method for primary care encounters. It allows for the classification of the patient’s reason for encounter , the problems/diagnosis managed, primary or general health care interventions, and the ordering of the data of the...

     ICPC-2
  • National Integrated Medical Association
    National Integrated Medical Association
    The National Integrated Medical Association is an Indian non-governmental organization of general practitioners educated in integrated system of medicine which includes modern scientific medicine and traditional wisdom from ayurveda and unani in India established in 1947.- All India Conference...

  • Primary care
    Primary care
    Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...

  • Primary Health Organisation
    Primary Health Organisation
    Primary Health Organisations , in New Zealand, are health care providers that are funded on a capitation basis by the New Zealand Government via District Health Boards...

  • Quaternary prevention
    Quaternary prevention
    The quaternary prevention, concept coined by the Belgian general practitioner , are the action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable...

  • Referral (medicine)
    Referral (medicine)
    In medicine, referral is the transfer of care for a patient from one clinician to another.Tertiary care is usually done by referral from primary or secondary medical care personnel....

  • Royal College of General Practitioners
    Royal College of General Practitioners
    The Royal College of General Practitioners is the professional body for general practitioners in the United Kingdom. The RCGP represents and supports GPs on key issues including licensing, education, training, research and clinical standards. It is the largest of the medical royal colleges, with...

  • Royal Australian College of General Practitioners
    Royal Australian College of General Practitioners
    The Royal Australian College Of General Practitioners is the professional body for General Practitioners in Australia.The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian...

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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