Career Focus

Family practitioner in the United States

BMJ 1997; 315 doi: (Published 22 November 1997) Cite this as: BMJ 1997;315:S2-7119
  1. Roy L Bishop (, Family practitioner
  1. Chico,California,USA

    If the thought of working in the United States brings to mind Marcus Welby MD, ER, or Chicago Hope think again: the daily reality for this nation's 650 000 doctors is somewhat different.

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    Former president Calvin Coolidge said that “the business of America is business,” and medicine in the United States is a business, on which 15% of the gross domestic product of the world's largest economy is spent. Many American doctors disagree with this philosophy, but no change is foreseen after the Clinton plan to introduce national health care was thrown out by Congress in 1993. For British doctors willing to make the cultural adjustment, opportunities are good: market driven reform of health care is increasing the role of primary care and reducing costs. Making the move is fraught with bureaucratic obstacles but the golden door is still narrowly ajar.

    What is a family practice?

    In the United States a family practitioner is defined as a medical doctor who has graduated from a three year residency programme. The family practitioner is a generalist who treats patients of all ages in the office and hospital, but is expected to refer complex cases to specialists. A general practitioner is a doctor who has not graduated from a residency programme. Few such doctors remain in practice, mainly in remote areas, since group practices and employers recruiting new doctors will insist on a residency graduate.

    Family practitioners are only one group of doctors who may call themselves primary care providers (PCP) and receive payment from insurance companies. Internists, paediatricians, obstetrician/gynaecologists, and even doctors of osteopathy may also be a patient's PCP.

    Training for family practice

    Medicine is taught as a postgraduate course, so entrants to medical school must already have completed a college degree, which takes three to four years after graduating from high school at age 17-18.

    Applicants to medical schools …

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