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General Practitioners

Learn about how the role of general practitioner has evolved into the designation "family practitioner."

General practicioners are also known as family doctors. [©Shutterstock, 2010]
©Shutterstock, 2010
General practicioners are also known as family doctors.

The Bureau of Labor Statistics describes general practitioners as doctors who provide the initial health care for regular and long-standing patients. General practitioners represent approximately 12.3 percent of active doctors in the United States. In 2005, the average salary for a general practitioner with more than one year of experience was $156,010. The role of general practitioner has evolved into a family practitioner specialty over the years, which requires additional training strictly in family medicine. They are both qualified to treat a range of conditions, and play an important role in referring patients to specialists.

History of General Practitioners

The term general practitioner is an older term, used before the development of new standards for primary care training that has lead to the designation of "family practitioner." A general practitioner is someone who practices as a primary care physician, but has not completed the family practice residency. Family practitioners have completed a three-year family practice residency and, consequently, have advanced training when compared to a general practitioner Lately, the term "general practitioner" is gradually being replaced by the term family practitioner..

The term family practitioner emerged during the1960s, when it became evident that there was a shift towards specialization in medicine. At that time the number of general practitioners was dwindling, so the American Board of Family Medicine created a specialty in general practice medicine, known as family medicine. Today, general practitioners represent older doctors who were trained prior to the development of family practitioner standards. While the medical field views family practitioners as specialists, the duties of a general practitioner and family practitioner are the same.

Duties of a General Practitioner

The general/family practitioner treats the entire family, ranging from infants to the elderly. They may treat minor injuries, such as cuts that require simple stitches. They can also treat colds resulting from bacterial or viral infections, or upset stomachs. In addition to temporary conditions, the general practitioner helps patients manage more long-term conditions, such as diabetes, cholesterol and high blood pressure.

The general or family practitioner is skilled at identifying the interaction between ailments and other issues, such as diet, stress and psychosocial issues. Consequently, even if a patient sees a specialist for more complex issues, the family practitioner should remain informed about treatment plans and progress so that they can monitor the effects of treatment on the entire body.

General Practitioner's Interaction with Patients

Active listening and other communication skills are key components of general/family practice medicine. Most family practice residency training programs have a licensed psychologist on staff that facilitates the development of positive communication skills between the doctors and patients. Doctors are typically instructed in the patient-centered model of doctor-patient interaction. Under this model, the doctor is encouraged to actively seek the patient's point of view. The doctor behaves in a manner which encourages the patient to talk openly and freely.

The patient-centered interview is a key component to the patient-centered model used by most general/family practitioners. A typical patient-centered interview commences with greetings and introduction. The doctor identifies the major concern and sets a brief agenda for the interview. Next, the doctor interviews the patient using open-ended questions, such as, "Tell me about your stomach pain." Once the doctor has an understanding of the overall situation, the doctor attempts to elicit information about specific symptoms and the effect of the symptoms on the patient's overall health and mental well-being. Finally, the doctor moves to the doctor-centered phase of the interview, during which the patient answers specific questions.

Referral to Specialists

While the general practitioner is trained to treat a variety of ailments, more serious and complex conditions typically require a referral to a specialist. Referrals to specialists may occur after a period of unsuccessful treatment or when the doctor feels that the nature of the illness is beyond his or her scope of training. For example, a general/family practitioner may attempt to treat a skin condition; however, if that condition does not improve with treatment, the doctor refers the patient to a dermatologist.

General and Family Practitioner Training

Since family practitioners are now replacing general practitioners, there are limited training opportunities for general practitioners. Doctors seeking advanced training to become a primary care physician typically enter into a family practitioner residency program. Advanced training to become a family practitioner includes first point of contact care, family care, comprehensive care, personal care, continuous care and competence in scientific general medicine. The Harbor-UCLA Medical Center offers a typical family residency program, which includes three years of hands-on practice and education. Rotations during this time allow the resident to experience various components of family medicine, such as medical ICU, pediatric inpatient, nursery, obstetrics, community medicine, surgery, adult emergency medicine, pediatric development, neurology, pediatric emergency, psychiatry, orthopedics, geriatrics, sports medicine, women's health and dermatology.

Following residency, some doctors opt to complete a fellowship to hone specific skills. For example, the University of Alabama School of Medicine  has a one-year fellowship in the area of obstetrics at its Huntsville Campus. While fellows learn specific skills in the area of obstetrics and gynecology, they also teach medical students and residents.

General Practitioner Board Certification

Currently, there is no way to become certified as a general practitioner. Instead, doctors may obtain board certification through the American Board of Family Medicine (ABFM). In order to apply for the certification, an applicant must have completed three full years of training in a family residency program that is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Residency must be subsequent to graduation with an M.D. or O.D. from a school accredited by the Liaison Committee on Medical Education or the Committee for Accreditation of Canadian Schools. Candidates from foreign schools may also be eligible if they obtain a certificate from the Educational Commission for Foreign Medical Graduates (ECFMG), or comply with other ACGME requirements. Once all training and credentials have been verified, applicants must take and pass the ABFM exam.

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