General practice, internal medicine, family medicine and pediatrics are concerned with wide variety of human medical issues and circumstances which blurs the public’s understanding and differentiation of each specialty.
General Practioner, Family Physician, Family Practitioner
A general practitioner (GP), family physician or family practitioner (FP) is a medical doctor who provides primary care. A GP or FP treats acute and chronic illnesses, provides preventive care and health education for all ages and both sexes. The synomyms family practitioner or family physician have become widespread in Canada and the USA. The term general practitioner is common in the United Kingdom and some other Commonwealth countries, where the word physician is largely reserved for certain other types of medical specialists, notably in internal medicine.
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 M.D. Doctor of Medicine or a D.O. Doctor of Osteopathic Medicine degree. A physician who specializes in family medicine (also known as a family physician), however, has completed a three-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.
Most family physicians practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. Still, many choose to teach medicine at medical schools or family medicine residency programs, though usually for much less pay. Others choose to practice as consultants to various medical institutions, including insurance companies.
Starting in the 1970s and 1980s, 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. It was not until 1969 that Family Medicine (formerly known as Family Practice) was recognized as a distinct specialty in the U.S.
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 are experts in common problems. Many family physicians deliver babies as well as taking care of patients of all ages. Family physicians complete undergraduate school, medical school, and three more years of specialized medical residency training in Family Medicine. Board-certified family physicians take a written examination every six, seven, nine, or ten years to remain board certified, depending on what track they choose regarding the maintenance of their certification. 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. Additionally, fellowships are available for family physicians in adolescent medicine, geriatrics, sports medicine, rural medicine, faculty development, obstetrics, research, and preventative medicine.
The family medicine (FM) paradigm is bolstered by primary care physicians trained in internal medicine (IM); although these physicians are trained in internal medicine only, adult patients provide the majority of the patient base of many family medicine practices. In the United States, there is a rising contingent of physicians dually trained in internal medicine and pediatrics (“peds”, pronounced “peeds”), which can be completed in four years, instead of the three years each for IM and pediatrics. A significant number of family medicine practices (especially in suburban and urban areas) do not provide obstetric services anymore (due to litigation issues and provider preference), and as such, this blurs the line between the FM and IM/Peds difference. One suggested difference is that the IM/Peds-trained physicians are more geared towards subspecialty training or hospital-based practice. Even so, there are many groups with FM-trained and IM/Peds-trained physicians working in seamless harmony.
There is currently a shortage of family 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 United States. Physicians are increasingly forced to do more administrative work, shoulder higher malpractice premiums due to highly profitable insurance monopolies that charge excessive premiums, thus forcing doctors to spend less and less time with patient care due to the current payor model stressing patient volume vs. quality of care. Things are starting to change as more insurance carriers consolidate. They are not stressing performance but more and more volume, thus increasing insurance company profit margins. Physicians are starting to shun insurance carriers to lessen the paperwork and focus more on patient care as they are originally trained to do. The average starting salary in the United States for family physicians is $100,000 to 120,000 a year.
Traditionally, GPs may care for hospitalized patients; where they have hospital privileges, they may perform minor surgery and/or obstetrics. Many GPs do some minor procedures, such as removal of skin lesions, in their offices (their rooms in UK and Commonwealth usage).
The American Academy of Family Physicians (AAFP) was founded in 1947 to promote the science and art of family medicine. It is one of the largest medical organizations in the world with more than 94,000 members. The Academy was instrumental in establishing family medicine as a recognized medical specialty; a certifying board was approved by the American Board of Medical Specialties in 1969.
American Board of Family Medicine (originally called the American Board of Family Practice was recognized as the 20th medical specialty in February, 1969. The board was formed out of a need to encourage medical school graduates to enter “general practice.” In 2005, the board’s name was changed to the American Board of Family Medicine.
Pediatrician
The American Academy of Pediatrics (AAP) is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: “Dedicated to the Health of All Children.” Most American pediatricians are members of this physician-focused organization.
In 1930, 60 physicians who specialized in child health founded the American Academy of Pediatrics (AAP). The name of the non-profit organization reflected the physician’s commitment to children and the specialty of pediatrics. It also formally acknowledged the difference between adult and child health care. In 1948, the first issue of their journal Pediatrics was published.
In the la
st 75 years, the AAP has grown to a membership of 60,000 board-certified primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists. Through advocacy efforts, physician education, research, and the continual creation of pediatric care and practice policies, AAP members and staff work tirelessly to affect broad social and medical changes benefiting all children and the future of pediatrics.
Internist/Internal Medicine
Internal medicine is the branch and specialty of medicine concerning the diagnosis and nonsurgical treatment of diseases in adults, especially of internal organs. Doctors of internal medicine, also called “internists”, are required to have included in their medical schooling and postgraduate training at least three years dedicated to learning how to prevent, diagnose, and treat diseases that affect adults. Internists are sometimes referred to as the “doctor’s doctor,” because they are often called upon to act as consultants to other physicians to help solve puzzling diagnostic problems. While the name “internal medicine” may lead one to believe that internists only treat “internal” problems, this is not the case. Doctors of internal medicine treat the whole person, not just internal organs.
Internists hold either an allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree. Internists should not be confused with “Medical Interns,” who are either physicians in their first year of residency training (in countries like the USA), or last-year medical students (in countries like Colombia). Although Internists may act as primary care physicians, they are not “family physicians,” “family practitioners,” or “general practitioners” (whose training in certain countries includes the medical care of children, and may include surgery, obstetrics and pediatrics). General Internists practice medicine from a primary care perspective but they can treat and manage many ailments and are usually the most adept at treating a broad range of diseases affecting adults.
Internal Medicine sub-specialists may also practice general internal medicine, but can focus their practice on their particular subspecialty like cardiology or pulmonology after completing a fellowship. (Additional training of 2-3 years).
In the USA, adult primary care is usually provided by either family practice or general internal medicine physicians (Internists). The primary care of adolescents is provided by family practice, internists and pediatricians. The primary care of children and infants is provided by Family Practice or Pediatricians.
Internists are trained to solve puzzling diagnostic problems and handle severe chronic illnesses and situations where several different illnesses may strike at the same time. They also bring to patients an understanding of preventative medicine, men’s and women’s health, substance abuse, mental health, as well as effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. Most older adults in the United States see an internist as their primary physician.
Subspecialties of internal medicine
Internists can choose to focus their practice on general internal medicine, or may take additional training to “subspecialize” in one of 13 areas of internal medicine, generally organized by organ system. Cardiologists, for example, are doctors of internal medicine who subspecialize in diseases of the heart. The training an internist receives to subspecialize in a particular medical area is both broad and deep. Subspecialty training (often called a “fellowship”) usually requires an additional one to three years beyond the standard three year general internal medicine residency. (Residencies come after a student has graduated from medical school.)
In the United States, there are two organizations responsible for certification of subspecialists within the field, the American Board of Internal Medicine, and the American Osteopathic Board of Internal Medicine.
The American Board of Internal Medicine (ABIM) recognizes the following subspecialties of Internal Medicine:
Cardiology, medical management of disorders of the heart and blood vessels
Endocrinology, medical management of disorders of the endocrine system and its specific secretions called hormones
Gastroenterology, medical management of of digestive system diseases
Hematology, concerned with blood, the blood-forming organs and its disorders
Infectious disease, medical management of diseases caused by a biological agent such as by a virus, bacterium or parasite
Medical oncology, medical management of diagnosis and treatment of cancer
Nephrology, medical management of of the function and diseases of the kidney
Pulmonology, medical management of diseases of the lungs and the respiratory tract
Rheumatology, medical management of diagnosis and therapy of rheumatic diseases.
The ABIM also recognizes additional qualifications in the following areas of Internal Medicine:
Adolescent medicine
Clinical cardiac electrophysiology
Critical care medicine
Geriatric medicine
Interventional cardiology
Sports medicine
Transplant hepatology
Internists may also specialize in allergy and immunology. The American Board of Allergy, Asthma, and Immunology is a conjoint board between internal medicine and pediatrics.
The American College of Osteopathic Internists recognizes the following subspecialties.
Allergy/Immunology
Cardiology
Critical care medicine
Endocrinology
Gastroenterology
Geriatric medicine
Hematology/Oncology
Infectious diseases
Nuclear medicine
Nephrology
Pulmonology
Rheumatology