A PHYSICIAN, MEDICAL PRACTITIONER, MEDICAL DOCTOR, or simply DOCTOR
is a professional who practises medicine , which is concerned with
promoting, maintaining, or restoring health through the study,
diagnosis , and treatment of disease , injury , and other physical and
mental impairments. Physicians may focus their practice on certain
disease categories, types of patients and methods of treatment—known
as specialities —or they may assume responsibility for the provision
of continuing and comprehensive medical care to individuals, families,
and communities—known as general practice . Medical practice
properly requires both a detailed knowledge of the academic
disciplines (such as anatomy and physiology ) underlying diseases and
their treatment—the science of medicine—and also a decent
competence in its applied practice—the art or craft of medicine.
Both the role of the physician and the meaning of the word itself
vary around the world. Degrees and other qualifications vary widely,
but there are some common elements, such as medical ethics requiring
that physicians show consideration, compassion, and benevolence for
their patients .
* 1 Modern meanings
* 1.1 Specialist in internal medicine
Physician and surgeon
* 1.3 North America
* 1.4 American physicians
* 1.5 Podiatric physicians
* 2 Shortage
* 3 Social role and world view
* 3.3 Physicians\' own health
* 4 Education and training
* 4.1 All medical practitioners
* 4.2 Specialists in internal medicine
* 5 Regulation
* 5.1 All medical practitioners
* 5.2 Specialists in internal medicine
* 5.3 Performance and professionalism supervision
* 6 Related occupations and divisions of labor
* 6.2 Nurse practitioners
* 7 See also
* 8 References
* 9 External links
Francesco Redi , considered to be the founder of
experimental biology, he was the first to recognize and correctly
describe details of many important parasites .
SPECIALIST IN INTERNAL MEDICINE
Around the world the term physician refers to a specialist in
internal medicine or one of its many sub-specialties (especially as
opposed to a specialist in surgery ). This meaning of physician
conveys a sense of expertise in treatment by drugs or medications,
rather than by the procedures of surgeons .
This term is at least nine hundred years old in English: physicians
and surgeons were once members of separate professions, and
traditionally were rivals. The
Shorter Oxford English Dictionary ,
third edition, gives a Middle English quotation making this contrast,
from as early as 1400: "O Lord, whi is it so greet difference betwixe
a cirugian and a physician."
Henry VIII granted a charter to the London Royal College of
Physicians in 1518. It was not until 1540 that he granted the Company
of Barber-Surgeons (ancestor of the
Royal College of Surgeons ) its
separate charter. In the same year, the English monarch established
the Regius Professorship of Physic at the
University of Cambridge
University of Cambridge .
Newer universities would probably describe such an academic as a
professor of internal medicine . Hence, in the 16th century, physic
meant roughly what internal medicine does now.
Currently, a specialist physician in the
United States may be
described as an internist. Another term, hospitalist , was introduced
in 1996, to describe US specialists in internal medicine who work
largely or exclusively in hospitals. Such 'hospitalists' now make up
about 19% of all US general internists, who are often called general
physicians in Commonwealth countries.
This original use, as distinct from surgeon, is common in most of the
world including the
United Kingdom and other Commonwealth countries
New Zealand ,
South Africa ,
Sri Lanka ,
Zimbabwe ), as well as in places as diverse
Hong Kong ,
Ireland , and
Taiwan . In
such places, the more general English terms doctor or medical
practitioner are prevalent, describing any practitioner of medicine
(whom an American would likely call a physician, in the broad sense).
In Commonwealth countries, specialist pediatricians and geriatricians
are also described as specialist physicians who have sub-specialized
by age of patient rather than by organ system.
PHYSICIAN AND SURGEON
Around the world, the combined term "physician and surgeon" is used
to describe either a general practitioner or any medical practitioner
irrespective of specialty. This usage still shows the original
meaning of physician and preserves the old difference between a
physician, as a practitioner of physic, and a surgeon . The term may
be used by state medical boards in the
United States of America, and
by equivalent bodies in provinces of Canada, to describe any medical
Elizabeth Blackwell , the first female physician to receive a
medical degree in the
In modern English, the term physician is used in two main ways, with
relatively broad and narrow meanings respectively. This is the result
of history and is often confusing. These meanings and variations are
explained below. Further information:
Physician in the United States
Physician in the United States
United States and
Canada , the term physician describes all
medical practitioners holding a professional medical degree. The
American Medical Association
American Medical Association , established in 1847, as well as the
American Osteopathic Association , founded in 1897, both currently use
the term physician to describe members. However, the American College
of Physicians , established in 1915, does not: its title uses
physician in its original sense.
The vast majority of physicians trained in the
United States have a
Medicine degree, and use the initials
M.D. A smaller number
attend Osteopathic schools and have a Doctor of Osteopathic Medicine
degree and use the initials
D.O. After completion of medical school,
physicians complete a residency in the specialty in which they will
practice. Subspecialties require the completion of a fellowship after
All boards of certification now require that physicians demonstrate,
by examination, continuing mastery of the core knowledge and skills
for a chosen specialty. Recertification varies by particular specialty
between every seven and every ten years.
Also in the United States, the American Podiatric Medical Association
(APMA) defines podiatrists as physicians and surgeons that fall under
the department of surgery in hospitals. They undergo training with
the Doctor of Podiatric
Medicine (DPM) degree. This degree is also
available at one Canadian university, namely the Université du
Québec à Trois-Rivières . Students are typically required to
complete an internship in New York prior to the obtention of their
Many countries in the developing world have the problem of too few
physicians. A shortage of doctors can lead to diseases spreading out
of control as seen in the
Ebola virus epidemic in West Africa
Ebola virus epidemic in West Africa . In
2015, the Association of American Medical Colleges warned that the US
will face a doctor shortage of as many as 90,000 by 2025.
SOCIAL ROLE AND WORLD VIEW
Medical anthropology and
History of medicine
History of medicine
Western culture and over recent centuries, medicine has become
increasingly based on scientific reductionism and materialism . This
style of medicine is now dominant throughout the industrialized world,
and is often termed biomedicine by medical anthropologists .
Biomedicine "formulates the human body and disease in a culturally
distinctive pattern", and is a world view learnt by medical students.
Within this tradition, the medical model is a term for the complete
"set of procedures in which all doctors are trained" (R. D. Laing,
1972), including mental attitudes. A particularly clear expression of
this world view, currently dominant among conventional physicians, is
evidence-based medicine . Within conventional medicine, most
physicians still pay heed to their ancient traditions:
The critical sense and sceptical attitude of the citation of medicine
from the shackles of priestcraft and of caste; secondly, the
conception of medicine as an art based on accurate observation, and as
a science, an integral part of the science of man and of nature;
thirdly, the high moral ideals, expressed in that most "memorable of
human documents" (Gomperz), the
Hippocratic oath ; and fourthly, the
conception and realization of medicine as the profession of a
William Osler , Chauvanism in
In this Western tradition, physicians are considered to be members of
a learned profession , and enjoy high social status , often combined
with expectations of a high and stable income and job security .
However, medical practitioners often work long and inflexible hours,
with shifts at unsociable times. Their high status is partly from
their extensive training requirements, and also because of their
occupation's special ethical and legal duties. The term traditionally
used by physicians to describe a person seeking their help is the word
patient (although one who visits a physician for a routine check-up
may also be so described). This word patient is an ancient reminder of
medical duty, as it originally meant 'one who suffers'. The English
noun comes from the
Latin word patiens, the present participle of the
deponent verb , patior, meaning 'I am suffering,' and akin to the
Greek verb πάσχειν (= paskhein, to suffer) and its cognate noun
πάθος (= pathos).
Physicians in the original, narrow sense (specialist physicians or
internists, see above) are commonly members or fellows of professional
organizations, such as the
American College of Physicians
American College of Physicians or the Royal
College of Physicians in the United Kingdom, and such hard-won
membership is itself a mark of status.
While contemporary biomedicine has distanced itself from its ancient
roots in religion and magic, many forms of traditional medicine and
alternative medicine continue to espouse vitalism in various guises:
'As long as life had its own secret properties, it was possible to
have sciences and medicines based on those properties' (Grossinger
1980). The US National Center for Complementary and Alternative
Medicine (NCCAM) classifies CAM therapies into five categories or
domains, including: alternative medical systems , or complete systems
of therapy and practice; mind-body interventions, or techniques
designed to facilitate the mind's effect on bodily functions and
symptoms; biologically based systems including herbalism ; and
manipulative and body-based methods such as chiropractic and massage
In considering these alternate traditions that differ from
biomedicine (see above), medical anthropologists emphasize that all
ways of thinking about health and disease have a significant cultural
content, including conventional western medicine.
Unani medicine and homeopathy are popular types of
alternative medicine. They are included in national system of
medicines in countries such as India. In general, the practitioners of
these medicine in these countries are referred to as Ved, Hakim and
homeopathic doctor/homeopath/homeopathic physician, respectively.
PHYSICIANS\' OWN HEALTH
Some commentators have argued that physicians have duties to serve as
role models for the general public in matters of health, for example
by not smoking cigarettes. Indeed, in most western nations relatively
few physicians smoke, and their professional knowledge does appear to
have a beneficial effect on their health and lifestyle. According to a
study of male physicians, life expectancy is slightly higher for
physicians (73.0 years for white and 68.7 for black) than lawyers or
many other highly educated professionals. Causes of death less likely
in physicians than the general population include respiratory disease
(including pneumonia , pneumoconioses , COPD , but excluding emphysema
and other chronic airway obstruction ), alcohol-related deaths,
rectosigmoidal and anal cancers, and bacterial diseases.
Physicians do experience exposure to occupational hazards, and there
is a well-known aphorism that "doctors make the worst patients".
Causes of death that are shown to be higher in the physician
population include suicide among doctors and self-inflicted injury,
drug-related causes, traffic accidents, and cerebrovascular and
ischaemic heart disease.
EDUCATION AND TRAINING
Medical education and career pathways for doctors vary considerably
across the world.
ALL MEDICAL PRACTITIONERS
In all developed countries, entry-level medical education programs
are tertiary -level courses , undertaken at a medical school attached
to a university . Depending on jurisdiction and university, entry may
follow directly from secondary school or require pre-requisite
undergraduate education . The former commonly takes five or six years
to complete. Programs that require previous undergraduate education
(typically a three- or four-year degree, often in Science) are usually
four or five years in length. Hence, gaining a basic medical degree
may typically take from five to eight years, depending on jurisdiction
Following completion of entry-level training, newly graduated medical
practitioners are often required to undertake a period of supervised
practice before full registration is granted, typically one or two
years. This may be referred to as an "internship ", as the
"foundation" years in the UK, or as "conditional registration". Some
jurisdictions, including the United States, require residencies for
Medical practitioners hold a medical degree specific to the
university from which they graduated. This degree qualifies the
medical practitioner to become licensed or registered under the laws
of that particular country, and sometimes of several countries,
subject to requirements for internship or conditional registration.
SPECIALISTS IN INTERNAL MEDICINE
Specialty training is begun immediately following completion of
entry-level training, or even before. In other jurisdictions, junior
medical doctors must undertake generalist (un-streamed) training for
one or more years before commencing specialization. Hence, depending
on jurisdiction, a specialist physician (internist) often does not
achieve recognition as a specialist until twelve or more years after
commencing basic medical training—five to eight years at university
to obtain a basic medical qualification, and up to another nine years
to become a specialist.
In most jurisdictions, physicians (in either sense of the word) need
government permission to practice. Such permission is intended to
promote public safety, and often to protect the public purse, as
medical care is commonly subsidized by national governments.
In some jurisdictions (e.g.,
Singapore ), it is common for physicians
to inflate their qualifications with the title "Dr" in correspondence
or namecards, even if their qualifications are limited to a basic
(e.g., bachelor level) degree. In other countries (e.g.,
only physicians holding an academic doctorate may call themselves
doctor – on the other hand, the
European Research Council has
decided that the German medical doctorate does not meet the
international standards of a PhD research degree.
ALL MEDICAL PRACTITIONERS
Among the English-speaking countries, this process is known either as
licensure as in the United States, or as registration in the United
Kingdom , other Commonwealth countries, and
Ireland . Synonyms in use
elsewhere include colegiación in
Spain , ishi menkyo in
Norway , Approbation in
Germany , and "άδεια
εργασίας" in Greece. In
Portugal , civilian
physicians must be members of the Order of Physicians to practice
In some countries, including the
United Kingdom and Ireland, the
profession largely regulates itself, with the government affirming the
regulating body's authority. The best known example of this is
General Medical Council of Britain. In all countries, the
regulating authorities will revoke permission to practice in cases of
malpractice or serious misconduct.
In the large English-speaking federations (
United States ,
Australia ), the licensing or registration of medical practitioners is
done at a state or provincial level or nationally as in New Zealand.
Australian states usually have a "Medical Board," which has now been
replaced by the Australian
Health Practitioner Regulatory Authority
(AHPRA) in most states, while Canadian provinces usually have a
"College of Physicians and Surgeons." All American states have an
agency that is usually called the "Medical Board", although there are
alternate names such as "Board of Medicine," "Board of Medical
Examiners", "Board of Medical Licensure", "Board of Healing Arts" or
some other variation. After graduating from a first-professional
school, physicians who wish to practice in the U.S. usually take
standardized exams, such as the USMLE for MDs ).
SPECIALISTS IN INTERNAL MEDICINE
Most countries have some method of officially recognizing specialist
qualifications in all branches of medicine, including internal
medicine. Sometimes, this aims to promote public safety by restricting
the use of hazardous treatments. Other reasons for regulating
specialists may include standardization of recognition for hospital
employment and restriction on which practitioners are entitled to
receive higher insurance payments for specialist services.
PERFORMANCE AND PROFESSIONALISM SUPERVISION
The issue of medical errors, drug abuse, and other issues in
physician professional behavior received significant attention across
the world, in particular following a critical 2000 report which
"arguably launched" the patient-safety movement. In the U.S., as of
2006 there were few organizations that systematically monitored
performance. In the U.S. only the Department of Veterans Affairs
randomly drug tests, in contrast to drug testing practices for other
professions that have a major impact on public welfare. Licensing
boards at the U.S. state level depend upon continuing education to
maintain competence. Through the utilization of the National
Practitioner Data Bank , Federation of State Medical Boards
Disciplinary Report, and
American Medical Association
American Medical Association Physician
Profile Service, the 67 State Medical Boards (MD/DO) continually
self-report any Adverse/Disciplinary Actions taken against a licensed
Physician in order that the other Medical Boards in which the
Physician holds or is applying for a medical license will be properly
notified so that corrective, reciprocal action can be taken against
the offending physician. In Europe, as of 2009 the health systems are
governed according to various national laws, and can also vary
according to regional differences similar to the United States.
RELATED OCCUPATIONS AND DIVISIONS OF LABOR
Chiropractors use the physician title in some countries. In the
United States, practitioners with a
Doctor of Chiropractic (DC) have
been added to the list of recognized physicians by the Joint
Commission on Accreditation of Healthcare Organizations. This change
does not affect or alter any health care practitioner’s license or
scope of practice. Some medical organizations have criticized the
addition of chiropractic to the definition of physician.
In Switzerland, students since 2008 have the option of studying in
University of Zurich medical school earning a Bachelor of Medicine
(with a focus on chiropractic) and a Masters in Chiropractic Medicine.
By attending medical school, they become "physicians" in the more
traditional sense. Swiss chiropractors have been found to treat
conditions in a similar way to their international counterparts while
enjoying a greater number of medical specialist referrals.
Nurse practitioners (NPs) in the
United States are advanced practice
registered nurses holding a post-graduate degree such as a Doctor of
Nursing Practice . In Canada, nurse practitioners typically have a
Master of nursing degree as well as substantial experience they have
accumulated throughout the years. Nurse practitioners are not
physicians but may practice alongside physicians in a variety of
fields. Nurse practitioners are educated in nursing theory and nursing
practice . The scope of practice for a nurse practitioner in the
United States is defined by regulatory boards of nursing, as opposed
to boards of medicine that regulate physicians.
Occupations of physicians and surgeons
International medical graduate
List of medical schools
List of physicians
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