The term general practitioner is common in Ireland, the United Kingdom, some other Commonwealth countries, and Bulgaria. In the English-speaking countries the word medical practitioner is largely reserved for certain other types of medical specialists, notably in internal medicine.
Family medicine, on the other hand, has evolved only recently in Brazil as a separate specialization of general practice. It is a concept which was adapted from several community health models in Europe, such as in Italy, but particularly the one which was created successfully in Cuba, and which was felt to be the most adequate to Brazilian reality. Around 10 years ago, the government recognized that primary health care in Brazil was poorly organized and fraught with many problems, including a lack of attractiveness to young physicians, so a different approach, the Family Health Program (Programa de Saúde da Família or PSF) was tried, initially with some failures, but later with increasing strength and coverage. By spending a great deal of money in order to move the program forward, the Ministry of Health expanded and reinforced the public health care system, called Unified Health System (Sistema Único de Saúde or SUS) by decentralizing its management to the states and municipalities, by demanding in the Federal Constitution that a minimum percentage of the municipal budget should be spent in free health care to the population, and by setting up a new, multidisciplinary, family health-based system, the PSF. It is essentially based on teams composed by one to four physicians (usually a GP, a gynecologist/obstetrician and a pediatrician), one to two dentists, several nurses and a number of so called Community Health Agents (Agentes Comunitários de Saúde or ACS), who are trained lay persons who visit and have close contact with the families covered in a specific geographical location by the PSF team, in order to carry out preventative, educational and epidemiological work. Specific intensive training programs and recruiting efforts were set up in the country in order to form the PSF teams, which currently involve about 3,000 municipalities, with more than 45,000 teams already in operation; so that it can be considered one of the largest family health programs in the world.
Family medical practitioners per se are still a rare specialty in Brazil, as the profession is generally shunning it (although economical incentive is no longer a valid reason, since medical practitioners who work in the PSF units are generally well paid in comparison to primary health care physicians in the public sector). A few years ago a Brazilian Society of Family and Community Medicine was founded and has lobbied to have its own specialty title and board of examiners, but it has so far remained relatively small.
There is very little private family medicine practice in Canada. Most FPs 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 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.
All medical practitioners must hold a license to practice medicine in the US. The only requirement is that the physician be enrolled or have completed a year of training, more commonly called a rotating internship. The few licensed medical practitioners who do not complete 3 to 10 year residency, are legally allowed to practice medicine in the state where they are licensed.
The population of this type of medical practitioner is dwindling, however. Currently the United States Navy has many of these general practitioners, formally known as General Medical Officers, in active practice.
The US now holds a different definition for the term "general practitioner". The two terms “general practitioner” and “family medicine” doctor were synonymous prior to 1970. At that time both terms (if used within the US) referred to someone who completed medical school and the 1 year required internship and then worked as a general family doctor or as a hospitalist. Completion of a postgraduate specialty training program or residency in family medicine was at that time not a requirement.
A medical practitioner who specializes in “family medicine” must now complete a residency in family medicine, and must be eligible for board certification now required by most 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 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. A family practitioner is licensed to practice strictly family medicine. Family medical practitioners after completing medical school must then complete three to four additional years of 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.
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, is 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 practitioners 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, sports medicine, sleep medicine, and hospice and palliative medicine are available for those board-certified family physicians with additional residency training requirements.
There is currently 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 lesser pay, and the increasingly frustrating practice environment. In the US Physicians are increasingly forced to do more administrative work, shoulder higher malpractice premiums due to highly profitable insurance monopolies that charge excessive premiums, thus spending less and less time with patient care due to the current payor model stressing patient volume vs. quality of care.
One can also opt to join the National Board of Examinations (NBE)'s fellowship for Family Medicine at any of the NBE designated and recognised Health care center or hospital and appear for qualifying exams for fellowship to the National Board on successful completion of which, one is awarded the "Diplomate of National Board" degree and title. Other than the practitioners discussed above, graduates of homeopathy, ayurveda, and unani courses from recognised medical colleges and institutions, duly registered with the respective state or national boards of these medical systems, can also practice as family practitioners.
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, Pakistan (CPSP) in 1992 and initiated in 1993 by the Family Medicine Division of the Department of Community Health Sciences, Aga Khan University, 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 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):
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) :
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, diagnostic, or therapeutic point of view).
In The Netherlands, training consists of three years of specialization after completion of internships. In Belgium, one year of lectures and two years of residency are required.
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.
Up until the year 2005, those wanting to become a General Practitioner of medicine had to do a minimum of the following postgraduate training:
At the end of the one year registrar post, the medical practitioner must pass an examination in order to be allowed to practice independently as a GP. This summative assessment 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. These changes have led to accusations of "dumbing down" from the British Medical Association.
Membership of the Royal College of General Practitioners 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) and/or the DRCOG (Diploma of the Royal College of Obstetricians and Gynaecologists) and/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.
The (MB ChB/BS) medical degree is entirely equivalent to the North American MD medical degree. Medical practitioners educated in the United States, Canada, Australia, New Zealand, Ireland, and Great Britain have more ability to move between the countries than other national systems.
Visits to GP surgeries are free in all countries of the United Kingdom, but charges for prescription only medicine vary. Wales has already abolished all charges, and Scotland has embarked on a phased reduction in charges to be completed by 2011. In England, however, most adults of working age who are not on benefits have to pay a standard charge for prescription only medicine of £7.10 per item from April 2008.
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, through the Quality and Outcomes Framework. 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. These potential earnings have been the subject of much criticism in the press for being excessive. However, a full time GP can now expect to earn around £110,000 before tax.
The NHS was criticised in the July 1997 Shipman inquiry for a lack of accountability. The report commented on "an NHS complaints system failing to detect issues of professional misconduct or criminal activity. However, as of 2008 public satisfaction with GPs is still extremely high in the UK.
The possible advent of polyclinics, as detailed in Professor Lord Darzi's report into the future of the NHS, led to growing fears in the medical profession that the government and the Department of Health were attempting to privatise GP services.
Following this a further year is spent as an Intern, rotating through medical and surgical specialities. 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 specialities. The successful completion of intern training leads to full registration with the Irish Medical Council.
Those medical practitioners 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 specialities (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 mush 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.