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The examples and perspective in this article deal primarily with the United States and do not represent a
of the subject. Please
and discuss the issue on the . (March 2011)
Family medicine ('FM), formerly family practice (FP), is a
devoted to comprehensive health care fo the specialist is named a family physician, family doctor, or formerly family practitioner. In Europe the discipline is often referred to as
and a practitioner as a General Practice Doctor or GP; this name emphasises the holistic nature of this speciality, as well as its roots in the family. It is a division of
that provides continuing and comprehensive health care for the individual and family across all ages, genders, , and parts of the body. It is based on knowledge of the patient in the context of the family and the community, emphasizing
and . According to the
(Wonca), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The issues of values underlying this practice are usually known as .
Family physicians in the United States may hold either an
degree. Physicians who specialize in family medicine must successfully complete an accredited three- or four-year family medicine
in the United States in addition to their medical degree. They are then eligible to sit for a
examination, which is now required by most hospitals and health plans.
requires its Diplomates to maintain certification through an ongoing process of , medical knowledge review, patient care oversight through chart audits, practice-based learning through quality improvement projects and retaking the board certification examination every 7 to 10 years. The
requires its Diplomates to maintain certification and undergo the process of recertification every 8 years.
Physicians certified in family medicine in
are certified through the College of Family Physicians of Canada, after two years of additional education. Continuing education is also a requirement for continued certification.
The term "family medicine" is used in many European and Asian countries, instead of "general medicine" or "". In , certification in family medicine requires five years working with a tutor, after the medical degree. In , those who want to specialize in family medicine must complete a three-year family medicine residency, after their medical degree (MBBS). They are awarded either a D.N.B. or an M.D. in family medicine. Similar systems exist in other countries.
Family physicians deliver a range of acute, chronic and preventive medical care services. In addition to diagnosing and treating illness, they also provide preventive care, including routine checkups, health-risk assessments, immunization and screening tests, and personalized counseling on maintaining a healthy lifestyle. Family physicians also manage chronic illness, often coordinating care provided by other subspecialists. Many American family physicians deliver babies and provide prenatal care. In the U.S., family physicians treat more patients with back pain than any other physician subspecialist, and about as many as
Family medicine and family physicians play a very important role in the healthcare system of a country. In the U.S., for example, nearly one in four of all office visits are made to family physicians. That is 208 million office visits each year — nearly 83 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty.
In Canada, aspiring family physicians are expected to complete a residency in family medicine from an accredited university after obtaining their
degree. Although the residency usually has a duration of two years, graduates may apply to complete a third year, leading to a certification from the
in disciplines such as , , and , amongst many others. In some institutions, such as
in , graduates from family medicine residency programs are eligible to complete a
in Family Medicine, which predominantly consists of a research-oriented program.
Following , two events shaped the advent of family medicine. First, medical specialties and subspecialties increased in popularity, having an adverse effect on the number of physicians in general practice. At the same time, many medical advances were being made and there was concern within the "" or "GP" population that four years of medical school plus a one-year internship was no longer adequate preparation for the breadth of medical knowledge required of the profession. Many of these doctors wanted to see a residency program add this would not only give them additional training, knowledge, and prestige, but would allow for board certification, which was increasingly required to gain hospital privileges. In 1969, family medicine (then known as family practice) was recognized as a distinct specialty in the U.S.
Family physicians complete an undergraduate degree, , and three more years of specialized
training in family medicine. Their residency training includes rotations in , , , , , , and . Residents also must provide care for a panel of continuity patients in an outpatient "model practice" for the entire period of residency. The specialty focuses on treating the whole person, acknowledging the effects of all outside influences, through all stages of life. Family physicians will see anyone with any problem, but are experts in common problems. Many family physicians deliver babies in addition to taking care of patients of all ages.
In order to become , family physicians must complete a residency in family medicine, possess a full and unrestricted medical license, and take a written cognitive examination. Between 2003 and 2009, the process for maintenance of board certification in family medicine is being changed (as well as all other ) to a series of yearly tests on differing areas. The , 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. Three hundred hours of
within the prior six years is also required to be eligible to sit for the exam.
Family physicians may pursue
in several fields, including
medicine, , , , and . The American Board of Family Medicine and the American Osteopathic Board of Family Medicine both offer
(CAQs) in each of these topics. Recently, new fellowships in
have emerged. These fellowships are designed to train family physicians working in resource poor environments.
While many sources cite a shortage of family physicians (and also other primary care providers, i.e. internists, pediatricians, and general practitioners), the per capita supply of primary care physicians has actually increased about 1 percent per year since 1998. Additionally, a recent decrease in the number of M.D. graduates pursuing a residency in primary care, has been offset by the number of
who enter primary care residencies. Still, projections indicate that by 2020 the demand for family physicians will exceed their supply.
The number of students entering family medicine residency training has fallen from a high of 3,293 in 1998 to 1,172 in 2008, according to National Residency Matching Program data. Fifty-five family medicine residency programs have closed since 2000, while only 28 programs have opened.
In 2006, when the nation had 100,431 family physicians, a workforce report by the
indicated the United States would need 139,531 family physicians by 2020 to meet the need for primary medical care. To reach that figure 4,439 family physicians must complete their residencies each year, but currently the nation is attracting only half the number of future family physicians that we will need.
The waning interest in family medicine is likely due to several factors, including the lesser prestige associated with the specialty, the lesser pay, and the increasingly frustrating practice environment in the U.S. Salaries for family physicians in the United States are respectable, but lower than average for physicians, with the average being $159,564 and ranging from $102,358 to $212,421, but when faced with debt from medical school, most medical students are opting for the higher paying specialties. Potential ways to increase the number of medical students entering family practice include providing relief from medical education debt through loan-repayment programs and restructuring fee-for-service reimbursement for health care services. Family physicians are trained to manage acute and chronic health issues for an individual simultaneously, yet their appointment slots may average only ten minutes. Physicians are increasingly forced to do more administrative work, and to shoulder higher malpractice 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 in order to focus more on patient care as they are originally trained to do.[]
Most family physicians in the US practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. However, the specialty is broad and allows for a variety of career options including education, emergency medicine or urgent care, inpatient medicine, international or wilderness medicine, public health, sports medicine, and research. Others choose to practice as consultants to various medical institutions, including insurance companies.[]
Family Medicine (FM) came to be recognized as a
in India only in the late 1990s. According to the National Health Policy - 2002, there is an acute shortage of specialists in family medicine. As family physicians play very important role in providing affordable and universal health care to people, the Government of India is now promoting the practice of family medicine by introducing post graduate training through DNB (Diplomate National Board) programs.
There is a severe shortage of post graduate training seats, causing lot of struggle, hardship and a career bottle neck for newly qualified doctors, just passing out of medical school. The Family Medicine Training seats should ideally fill this gap and allow more doctors to pursue Family Medicine careers. However, the uptake, awareness and development of this specialty is slow.
Although family medicine is sometimes called , they are not identical in India. A medical graduate who has successfully completed the
(MBBS) course and has been registered with Indian Medical Council or any state medical council is considered a . A family physician, however, is a
who has completed specialist training in the discipline of family medicine.
requires three-year residency for family medicine specialty, leading to the award of
(MD) in Family Medicine or
(DNB) in Family Medicine.
conducts family medicine residency programmes at the teaching hospitals that it accredits. On successful completion of a three-year residency, candidates are awarded Diplomate of National Board (Family Medicine). The curriculum of DNB (FM) comprises: (1) medicine (2) surgery (3) mater (4) basic sciences and community health. During their three-year residency, candidates receive integrated inpatient and outpatient learning. They also receive field training at community health centres and clinics.
The Medical Council of India permits accredited medical colleges (medical schools) to conduct a similar residency programme in family medicine. On successful completion of three-year residency, candidates are awarded Doctor of Medicine (Family Medicine). Govt. medical college, Calicut had started this MD (FM) course in 2011. A few of the AIIMS institutes have also started a course called MD in community and family medicine in recent years. Even though there is an acute shortage of qualified family physicians in India, further progress has been slow
The ’s College of General Practitioners, offers a one-year Diploma in Family Medicine (DFM), a distance education programme of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, for doctors with minimum five years of experience in . Since the Medical Council of India requires three-year residency for family medicine specialty, these diplomas are not recognized qualifications in India.
As India’s need for primary and secondary levels of health care is enormous, medical educators have called for systemic changes to include family medicine in the undergraduate medical curriculum.
Recently, the residency-trained family physicians have formed the
(AFPI). AFPI is the academic association of family physicians with formal full-time residency training (DNB Family Medicine) in Family Medicine. Currently there are about two hundred family medicine residency training sites accredited by the National Board of Examination India, providing around 700 training posts annually. However, there are various issues like academic acceptance, accreditation, curriculum development, uniform training standards, faculty development, research in primary care, etc. in need of urgent attention for family medicine to flourish as an academic specialty in India. The government of India has declared Family Medicine as focus area of human resource development in health sector in the National Health Policy 2002 &&. There is discussion ongoing to employ multi-skilled doctors with DNB family medicine qualification against specialist posts in NRHM (National Rural Health Mission).
Three possible models of how family physicians will practise their specialty in India might evolve, namely (1) private practice, (2) practising at primary care clinics/hospitals, (3) practising as consultants at secondary/tertiary care hospitals.
Anatomical Therapeutic Chemical Classification System
International Classification of Diseases
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: Hidden categories:practise medicine in order to help the people
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practice 名词 practise 动词practice
也作动词vt., vi. [美]=practise
vt. 实践, 实行, 实施
实习, 练习; 使...练习; 训练
惯做, 常做,开业从事 习惯用语 practise on [upon] 利用(别人的弱点); 欺骗(某人) 以...作为实习[实验]对象 Practise what you preach. 躬行己说, 身体力行。
practice 词性及解释
n. 实践, 练习, 实行, 惯例, 习惯, 开业 vt. 实践, 实行, 练习, 实习, 业务 vi. 实践, 实行, 练习, 实习, ...
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出门在外也不愁Deakin's medicine course provides you with a comprehensive understanding of the practice of medicine. There is an emphasis on the early development of clinical, communication and procedural skills, diagnosis and management of chronic diseases, and multidisciplinary teamwork, as well as an emphasis on
rural and regional medicine. Honours and PhD courses in medicine are available. For graduates of medicine and allied health we offer a Graduate Certificate of Agricultural Health and Medicine and a Master of Clinical Leadership.
What can I study?
The Bachelor of Medicine Bachelor of Surgery (BMBS) is a four-year, graduate-entry program and is accredited by the Australian Medical Council (AMC).
Four themes are visible throughout the course:Knowledge of Health and IllnessDoctor and PatientPublic Health MedicineEthics, Law and Professional Development.
Graduates who satisfactorily complete an accredited intern year following successful completion of this course will qualify as registered medical practitioners in Australia and New Zealand.
Why study at Deakin?
Problem-based and multidisciplinary learningIn the first two years, you'll mainly learn via problem-based learning. You'll analyse real cases in small groups to learn the basic sciences required to practise medicine. There is a strong emphasis on information technology, which has become an essential part of clinical practice, and on early clinical experience including simulation-based teaching. You'll also work with students and practitioners from a range of other health disciplines including nursing, psychology, social work, occupational therapy and dietetics. This experience introduces you to working in multidisciplinary teams and develops your understanding of the expertise and role of different health professionals.
Practical work experience and clinical based learningThe first two years of the medicine course are based at the Geelong Waurn Pond's Campus. During this time, you'll attend clinical sites such as hospitals, general practices and community health centres in the Geelong region.For the third and fourth years of the course, you'll choose one of four clinical schools in Geelong, Ballarat, Warrnambool or Box Hill. Some third year students will have the opportunity to spend the year attached to a general practice in one of a number of rural centres in Western Victoria as part of the Integrated Model of Medical Education in Rural Settings (IMMERSe) program.
Teaching and research excellenceStudents are taught and supervised by dedicated and experienced academic staff and clinicians.The School of Medicine houses a vibrant program of research, including more than 30 research staff, as well as a growing cohort of research students. The school has already established a reputation for research excellence, underpinned by success in National Health and Medical Research Council and other competitive funding schemes, and research publications in high-impact journals. In the 2012 Excellence in Research for Australia (ERA) assessment Deakin received the highest possible ranking (5/5 – well above world standard) for research in Medical and Health Sciences. Only seven of Australia's 39 universities were ranked at this level.
Research that mattersMedical research spans from basic biology through to development and testing of new therapeutics, to epidemiological and health outcome studies. There is a strong emphasis on investigating the causes, prevention and management of common chronic diseases. Our medical research is underpinned by strong strategic partnerships.
Study overseasThere is an elective term in the fourth year of the course where students can arrange clinical placements interstate or overseas.
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