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A general practitioner, or GP is a medical practitioner who provides primary care and specializes in family medicine. A general practitioner treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities.

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.
The Americas

Brazil

General practice in Brazil is called clínica geral or clínica médica. Any physician is legally allowed to practice without any training after graduation in the medical school, but recent efforts by the government, the Brazilian Medical Association and the specialized Sociedade Brasileira de Clínica Médica are trying to demand also a specialist title for its practice, just like for others such as cardiology, endocrinology, etc. The majority of general practitioners in Brazil are located in the public health sector and consists mostly of young, recently graduated physicians[citation needed]. The reason is that general practice is not very profitable and about 40% of Brazilian medical practitioners prefer to do specialized practice, instead[citation needed]. To do this, they are required to do medical residence of variable duration and submit to a board of medical examiners in order to get the title of specialist. Each medical society is in charge of organizing the examinations (which usually are carried out once a year) and granting the titles to those physicians who passed the requirements. The title is recognized by the Federal Council of Medicine (the Federal professional regulatory body), the Ministry of Education and the Ministry of Health.

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[citation needed], 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[citation needed]). 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.

Canada

In Canada, just like in the United States there have become two meanings for the term general practitioner. The Canadian specialty that is equivalent to the English general practioner training program is family medicine 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.

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.

United States

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.[1]

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.

Asia and Oceania

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 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) is required for registration before specialist training begins. For general practice training, the physician then applies to enter the three-year "Australasian General Practice Training Program", a combination of coursework and apprenticeship type training leading to the awarding of the FRACGP (Fellowship of the Royal Australian College of General Practitioners) 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 rebates as a general practitioner. Medicare is Australia's universal health insurance system, and without access to it, a practitioner cannot effectively work in private practice in Australia. The Royal Australian College of General Practitioners also has a reciprocal agreement with the American Board of Family Medicine as the Australasian general practitioner training program is recognised as equalivalant to the US family medicine residency programs in the United States. Most GPs work under a fee-for-service arrangement although 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 (OTDs).

India

India has the highest number of medical schools in the world, with approximately 262. In India to become a GP or a Family Physician, one has to enroll in a Medical Council Of India (MCI) recognised medical college and complete a four and a half year course for the twin Bachelor of Medicine, Bachelor of Surgery (MB,BS) degree, after which one is provisionally registered with the Medical Council of India. After one further year of compulsory rotatory internship, the Medical Council of India (or any of the State Medical Councils) confer permanent registration which licences the holder to practise as a GP. A person may qualify to attend a medical course at the age of 17 after completing a two-year pre-university course in which one of the core subjects would be Biology.

Medical education

An MBBS medical practitioner can appear for pre-post-graduate examinations (Pre-PG) at national, state or institute levels and gain entry to a MD (Doctor of Medicine), MS (Master of Surgery) or a Diploma course in a number of specialisations including Internal Medicine (or General Medicine).

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.

Pakistan

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):

Ayub Medical College/Ayub Teaching Hospital, Abbottabad
Dow University of Health Sciences, Karachi
Khyber Medical College/Khyber Teaching Hospital, Peshawar
PGMI / Lady Reading Hospital, Peshawar
PGMI / Hayatabad Medical Complex, Peshawar