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A physician (
American English American English, sometimes called United States English or U.S. English, is the set of varieties of the English language native to the United States. English is the most widely spoken language in the United States and in most circumstances ...
), medical practitioner (
Commonwealth English The use of the English language in current and former member countries of the Commonwealth of Nations was largely inherited from British colonisation, with some exceptions. English serves as the medium of inter-Commonwealth relations. Many ...
), medical doctor, or simply doctor, is a
health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...
who practices
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
, which is concerned with promoting, maintaining or restoring
health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
through the
study Study or studies may refer to: General * Education ** Higher education * Clinical trial * Experiment * Observational study * Research * Study skills, abilities and approaches applied to learning Other * Study (art), a drawing or series of ...
,
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engin ...
,
prognosis Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the likely or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) or remain sta ...
and treatment of
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
,
injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...
, 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 Knowledge can be defined as awareness of facts or as practical skills, and may also refer to familiarity with objects or situations. Knowledge of facts, also called propositional knowledge, is often defined as true belief that is distin ...
of the
academic disciplines An academy (Attic Greek: Ἀκαδήμεια; Koine Greek Ἀκαδημία) is an institution of secondary or tertiary higher learning (and generally also research or honorary membership). The name traces back to Plato's school of philosophy, f ...
, such as
anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having i ...
and
physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemic ...
, underlying diseases and their treatment—the ''
science Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe. Science may be as old as the human species, and some of the earliest archeological evidence ...
'' of medicine—and also a decent competence in its applied practice—the art or ''
craft A craft or trade is a pastime or an occupation that requires particular skills and knowledge of skilled work. In a historical sense, particularly the Middle Ages and earlier, the term is usually applied to people occupied in small scale pr ...
'' 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 Medical ethics is an applied branch of ethics which analyzes the practice of clinical medicine and related scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. T ...
requiring that physicians show consideration, compassion, and benevolence for their
patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other heal ...
s.


Modern meanings


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 Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...
). This meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of
surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...
s. 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 The ''Shorter Oxford English Dictionary'' (''SOED'') is an English language dictionary published by the Oxford University Press. The SOED is a two-volume abridgement of the twenty-volume ''Oxford English Dictionary'' (''OED''). Print editions ...
'', third edition, gives a
Middle English Middle English (abbreviated to ME) is a form of the English language that was spoken after the Norman conquest of 1066, until the late 15th century. The English language underwent distinct variations and developments following the Old Englis ...
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 The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
in 1518. It was not until 1540 that he granted the
Company of Barber-Surgeons The Royal College of Surgeons of England (RCS England) is an independent professional body and registered charity that promotes and advances standards of surgical care for patients, and regulates surgery and dentistry in England and Wales. The ...
(ancestor of the
Royal College of Surgeons The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations ...
) its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the
University of Cambridge , mottoeng = Literal: From here, light and sacred draughts. Non literal: From this place, we gain enlightenment and precious knowledge. , established = , other_name = The Chancellor, Masters and Schola ...
. 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 Physicians in the United States are doctors who practice medicine for the human body. They are an important part of health care in the United States. The vast majority of physicians in the US have a Doctor of Medicine (MD) degree, though some have ...
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 A commonwealth is a traditional English term for a political community founded for the common good. Historically, it has been synonymous with "republic". The noun "commonwealth", meaning "public welfare, general good or advantage", dates from the ...
countries. This original use, as distinct from surgeon, is common in most of the world including the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...
and other Commonwealth countries (such as
Australia Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...
,
Bangladesh Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mo ...
,
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area, the List of countries and dependencies by population, second-most populous ...
,
New Zealand New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island coun ...
,
Pakistan Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...
,
South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring coun ...
,
Sri Lanka Sri Lanka (, ; si, ශ්‍රී ලංකා, Śrī Laṅkā, translit-std=ISO (); ta, இலங்கை, Ilaṅkai, translit-std=ISO ()), formerly known as Ceylon and officially the Democratic Socialist Republic of Sri Lanka, is an ...
, and
Zimbabwe Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and ...
), as well as in places as diverse as
Brazil Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
,
Hong Kong Hong Kong ( (US) or (UK); , ), officially the Hong Kong Special Administrative Region of the People's Republic of China (abbr. Hong Kong SAR or HKSAR), is a List of cities in China, city and Special administrative regions of China, special ...
,
Indonesia Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Gui ...
,
Japan Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the n ...
,
Ireland Ireland ( ; ga, Éire ; Ulster-Scots: ) is an island in the North Atlantic Ocean, in north-western Europe. It is separated from Great Britain to its east by the North Channel, the Irish Sea, and St George's Channel. Ireland is the s ...
, and
Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the no ...
. 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 Organ may refer to: Biology * Organ (biology), a part of an organism Musical instruments * Organ (music), a family of keyboard musical instruments characterized by sustained tone ** Electronic organ, an electronic keyboard instrument ** Hammond ...
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, and by equivalent bodies in Canadian provinces, to describe any medical practitioner.


North America

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. In the United States and Canada, the term ''physician'' describes all medical practitioners holding a professional medical degree. The
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's sta ...
, established in 1847, as well as the
American Osteopathic Association The American Osteopathic Association (AOA) is the representative member organization for the more than 176,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinoi ...
, founded in 1897, both currently use the term ''physician'' to describe members. However, the
American College of Physicians The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults.Sokanu "What is an Internist?" Retrieved October 20, 2014 With 161,000 members, ACP is the largest ...
, established in 1915, does not: its title uses ''physician'' in its original sense.


American physicians

The vast majority of physicians trained in the United States have a
Doctor of Medicine Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. ...
degree, and use the initials M.D. A smaller number attend
osteopathic Osteopathy () is a type of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. Practitioners of osteopathy are referred to as osteopaths. Osteopathic manipulation is the core set of techniques ...
medical schools A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, ...
and have a
Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
degree and use the initials
D.O. Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...
The
World Directory of Medical Schools The World Directory of Medical Schools is a public database of institutions that provide medical education. There are over 3,600 medical schools listed in the directory. The directory is published as a collaboration of the World Federation for Med ...
lists both MD and DO granting schools as ''medical schools'' located in the United States. After completion of
medical school A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, ...
, physicians complete a
residency Residency may refer to: * Domicile (law), the act of establishing or maintaining a residence in a given place ** Permanent residency, indefinite residence within a country despite not having citizenship * Residency (medicine), a stage of postgrad ...
in the specialty in which they will practice. Subspecialties require the completion of a
fellowship A fellow is a concept whose exact meaning depends on context. In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements. Within the context of higher educatio ...
after residency. Both MD and DO physicians participate in the
National Resident Matching Program The National Resident Matching Program (NRMP), also called The Match, is a United States-based private non-profit non-governmental organization created in 1952 to place U.S. medical school students into residency training programs located in U ...
(NRMP) and attend ACGME-accredited residencies and fellowships across all medical specialties to obtain licensure. 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.


= Primary care

=
Primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The ter ...
s guide patients in preventing disease and detecting health problems early while they are still treatable. They are divided into two types:
family medicine Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primar ...
doctors and internal medicine doctors. Family doctors, or family physicians, are trained to care for patients of any age, while internists are trained to care for adults. Family doctors receive training in a variety of care and are therefore also referred to as general practitioners. Family medicine grew out of the general practitioner movement of the 1960s in response to the growing specialization in medicine that was seen as threatening to the doctor-patient relationship and continuity of care.


Podiatrists

In the United States, the
American Podiatric Medical Association The American Podiatric Medical Association (APMA) is a professional medical organization representing Doctors of Podiatric Medicine (podiatrists) within the United States. The organization was founded in 1912 and is headquartered in Bethesda, ...
(APMA) defines podiatrists as physicians and surgeons who treat the foot, ankle, and associated structures of the leg. Podiatrists undergo training with the
Doctor of Podiatric Medicine A podiatrist ( ) is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for ...
(DPM) degree. The
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's sta ...
(AMA), however, advocates for the definition of a ''physician'' as "an individual possessing degree of either a
Doctor of Medicine Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. ...
or
Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
." In the US, podiatrists are required to complete three to four years of podiatry residency upon graduating with a DPM degree. After residency, one to two years of fellowship programs are available in plastic surgery, foot and ankle reconstructive surgery, sports medicine, and wound care. Podiatry residencies and/ or fellowships are not accredited by the ACGME. The overall scope of podiatric practice varies from state to state and is not similar to that of physicians holding an MD or DO degree. DPM is also available at one Canadian university, namely the
Université du Québec à Trois-Rivières The Université du Québec à Trois-Rivières (UQTR) (''English: University of Quebec in Trois-Rivières''), also known as "l'université du peuple", established in 1969 and mainly located in Trois-Rivières, Quebec, Canada, is a public unive ...
; students are typically required to complete an internship in New York prior to the obtention of their professional degree. The
World Directory of Medical Schools The World Directory of Medical Schools is a public database of institutions that provide medical education. There are over 3,600 medical schools listed in the directory. The directory is published as a collaboration of the World Federation for Med ...
does not list US or Canadian schools of podiatric medicine as ''medical schools'' and only lists US-granted MD, DO, and Canadian MD programs as medical schools for the respective regions.


Shortage

Many countries in the developing world have the problem of too few physicians. In 2015, the
Association of American Medical Colleges The Association of American Medical Colleges (AAMC) is a nonprofit organization based in Washington, D.C. that was established in 1876. It represents medical school A medical school is a tertiary educational institution, or part of such an i ...
warned that the US will face a doctor shortage of as many as 90,000 by 2025.


Social role and world view


Biomedicine

Within
Western culture Leonardo da Vinci's ''Vitruvian Man''. Based on the correlations of ideal Body proportions">human proportions with geometry described by the ancient Roman architect Vitruvius in Book III of his treatise ''De architectura''. image:Plato Pio-Cle ...
and over recent centuries, medicine has become increasingly based on scientific
reductionism Reductionism is any of several related philosophical ideas regarding the associations between phenomena which can be described in terms of other simpler or more fundamental phenomena. It is also described as an intellectual and philosophical po ...
and
materialism Materialism is a form of philosophical monism which holds matter to be the fundamental substance in nature, and all things, including mental states and consciousness, are results of material interactions. According to philosophical materialis ...
. This style of medicine is now dominant throughout the industrialized world, and is often termed ''
biomedicine Biomedicine (also referred to as Western medicine, mainstream medicine or conventional medicine)
'' by medical anthropologists. Biomedicine "formulates the human body and disease in a culturally distinctive pattern", and is a
world view A worldview or world-view or ''Weltanschauung'' is the fundamental cognitive orientation of an individual or society encompassing the whole of the individual's or society's knowledge, culture, and point of view. A worldview can include natural ...
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", including mental attitudes. A particularly clear expression of this world view, currently dominant among conventional physicians, is
evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
. Within conventional medicine, most physicians still pay heed to their ancient traditions: In this Western tradition, physicians are considered to be members of a learned
profession A profession is a field of work that has been successfully '' professionalized''. It can be defined as a disciplined group of individuals, '' professionals'', who adhere to ethical standards and who hold themselves out as, and are accepted b ...
, and enjoy high
social status Social status is the level of social value a person is considered to possess. More specifically, it refers to the relative level of respect, honour, assumed competence, and deference accorded to people, groups, and organizations in a society. St ...
, often combined with expectations of a high and stable income and
job security Job security is the probability that an individual will keep their job; a job with a high level of security is such that a person with the job would have a small chance of losing it. Many factors threaten job security: globalization, outsourcing ...
. 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 Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concerns ma ...
and
legal Law is a set of rules that are created and are law enforcement, enforceable by social or governmental institutions to regulate behavior,Robertson, ''Crimes against humanity'', 90. with its precise definition a matter of longstanding debate. ...
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 In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient ...
may also be so described). This word
patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other heal ...
is an ancient reminder of medical duty, as it originally meant 'one who suffers'. The English noun comes from the
Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through ...
word ''patiens'', the
present participle In linguistics, a participle () (from Latin ' a "sharing, partaking") is a nonfinite verb form that has some of the characteristics and functions of both verbs and adjectives. More narrowly, ''participle'' has been defined as "a word derived fro ...
of the
deponent verb In linguistics, a deponent verb is a verb that is active in meaning but takes its form from a different voice, most commonly the middle or passive. A deponent verb has no active forms. Languages with deponent verbs ''This list may not be ex ...
, patior, meaning 'I am suffering', and akin to the
Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...
verb (
romanized Romanization or romanisation, in linguistics, is the conversion of text from a different writing system to the Roman (Latin) script, or a system for doing so. Methods of romanization include transliteration, for representing written text, and ...
:
''paschein'', lit. to suffer) and its cognate noun πάθος ( ''pathos'', suffering). 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 The American College of Physicians (ACP) is a national organization of internists, who specialize in the diagnosis, treatment, and care of adults.Sokanu "What is an Internist?" Retrieved October 20, 2014 With 161,000 members, ACP is the largest ...
or the
Royal College of Physicians The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
in the United Kingdom, and such hard-won membership is itself a mark of status.


Alternative medicine

While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms of
traditional medicine Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
and
alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and al ...
continue to espouse
vitalism Vitalism is a belief that starts from the premise that "living organisms are fundamentally different from non-living entities because they contain some non-physical element or are governed by different principles than are inanimate things." Wher ...
in various guises: "As long as life had its own secret properties, it was possible to have sciences and medicines based on those properties". The US National Center for Complementary and Alternative Medicine (NCCAM) classifies
complementary and alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and al ...
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 Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern reme ...
; and manipulative and body-based methods such as
chiropractic Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudosci ...
and massage therapy. 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.
Ayurveda Ayurveda () is an alternative medicine system with historical roots in the Indian subcontinent. The theory and practice of Ayurveda is pseudoscientific. Ayurveda is heavily practiced in India and Nepal, where around 80% of the population rep ...
,
Unani medicine Unani or Yunani medicine (Urdu: ''tibb yūnānī'') is Perso-Arabic traditional medicine as practiced in Muslim culture in South Asia and modern day Central Asia. Unani medicine is pseudoscientific. The Indian Medical Association describes Un ...
, and
homeopathy Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths, believe that a substance that causes symptoms of a d ...
are popular types of alternative medicine.


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 Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, current age, and other demographic factors like sex. The most commonly used measure is life expectancy at birth ...
is slightly higher for physicians (73 years for white and 69 years for black) than lawyers or many other highly educated professionals. Causes of death which are less likely to occur in physicians than the general population include respiratory disease (including
pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...
,
pneumoconioses Pneumoconiosis is the general term for a class of interstitial lung disease where inhalation of dust ( for example, ash dust, lead particles, pollen grains etc) has caused interstitial fibrosis. The three most common types are asbestosis, silico ...
,
COPD Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...
, but excluding
emphysema Emphysema, or pulmonary emphysema, is a lower respiratory tract disease, characterised by air-filled spaces ( pneumatoses) in the lungs, that can vary in size and may be very large. The spaces are caused by the breakdown of the walls of the alv ...
and other
chronic airway obstruction Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce mu ...
), alcohol-related deaths, rectosigmoid 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 Suicide among doctors refers to physicians or medical trainees dying by suicide. Studies report that physicians are more likely to die by suicide than the general population and even people with similar academic training who are not physicians. T ...
and self-inflicted injury, drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease. Physicians are also prone to
occupational burnout According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s ...
. This manifests as a long-term stress reaction characterized by poorer quality of care towards patients, emotional exhaustion, a feeling of decreased personal achievement, and others. A study by the
Agency for Healthcare Research and Quality The Agency for Healthcare Research and Quality (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered i ...
reported that time pressure was the greatest cause of burnout; a survey from the
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's sta ...
reported that more than half of all respondents chose "too many bureaucratic tasks" as the leading cause of burnout.


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 Tertiary ( ) is a widely used but obsolete term for the geologic period from 66 million to 2.6 million years ago. The period began with the demise of the non-avian dinosaurs in the Cretaceous–Paleogene extinction event, at the start ...
-level
courses Course may refer to: Directions or navigation * Course (navigation), the path of travel * Course (orienteering), a series of control points visited by orienteers during a competition, marked with red/white flags in the terrain, and corresponding ...
, undertaken at a
medical school A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, ...
attached to a
university A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United Stat ...
. Depending on jurisdiction and university, entry may follow directly from
secondary school A secondary school describes an institution that provides secondary education and also usually includes the building where this takes place. Some secondary schools provide both '' lower secondary education'' (ages 11 to 14) and ''upper seconda ...
or require pre-requisite
undergraduate education Undergraduate education is education conducted after secondary education and before postgraduate education. It typically includes all postsecondary programs up to the level of a bachelor's degree. For example, in the United States, an entry-le ...
. 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 and university. Following the 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 An internship is a period of work experience offered by an organization for a limited period of time. Once confined to medical graduates, internship is used practice for a wide range of placements in businesses, non-profit organizations and gover ...
", as the "foundation" years in the UK, or as "conditional registration". Some jurisdictions, including the United States, require residencies for practice. Medical practitioners hold a medical degree specific to the university from which they graduated. This degree qualifies the medical practitioner to become
licensed A license (or licence) is an official permission or permit to do, use, or own something (as well as the document of that permission or permit). A license is granted by a party (licensor) to another party (licensee) as an element of an agreeme ...
or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for an 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 the 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.


Regulation

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 government spending, as medical care is commonly subsidized by national governments. In some jurisdictions such as in
Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...
, 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 such as
Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwee ...
, only physicians holding an academic doctorate may call themselves doctor – on the other hand, the
European Research Council The European Research Council (ERC) is a public body for funding of scientific and technological research conducted within the European Union (EU). Established by the European Commission in 2007, the ERC is composed of an independent Scientific ...
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 Licensure means a restricted practice or a restriction on the use of an occupational title, requiring a license. A license created under a "practice act" requires a license before performing a certain activity, such as driving a car on public roa ...
as in the United States, or as
registration Register or registration may refer to: Arts entertainment, and media Music * Register (music), the relative "height" or range of a note, melody, part, instrument, etc. * ''Register'', a 2017 album by Travis Miller * Registration (organ), th ...
in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...
, other
Commonwealth A commonwealth is a traditional English term for a political community founded for the common good. Historically, it has been synonymous with "republic". The noun "commonwealth", meaning "public welfare, general good or advantage", dates from the ...
countries, and
Ireland Ireland ( ; ga, Éire ; Ulster-Scots: ) is an island in the North Atlantic Ocean, in north-western Europe. It is separated from Great Britain to its east by the North Channel, the Irish Sea, and St George's Channel. Ireland is the s ...
. Synonyms in use elsewhere include ''colegiación'' in
Spain , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg , national_motto = '' Plus ultra'' (Latin)(English: "Further Beyond") , national_anthem = (English: "Royal March") , ...
, ''ishi menkyo'' in
Japan Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the n ...
, ''autorisasjon'' in
Norway Norway, officially the Kingdom of Norway, is a Nordic countries, Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of ...
, ''Approbation'' in
Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwee ...
, and in Greece. In
France France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
,
Italy Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical ...
and
Portugal Portugal, officially the Portuguese Republic ( pt, República Portuguesa, links=yes ), is a country whose mainland is located on the Iberian Peninsula of Southwestern Europe, and whose territory also includes the Atlantic archipelagos of th ...
, civilian physicians must be members of the Order of Physicians to practice medicine. 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 probably the
General Medical Council The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by ...
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 The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...
,
Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by to ...
,
Australia Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...
), 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 Regulation Agency The Australian Health Practitioner Regulation Agency (AHPRA), infrequently spelt as the Australian Health Practitioners Regulation Agency is a statutory authority founded in 2010 which is responsible, in collaboration with the ''Medical Board of ...
(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 US usually take standardized exams, such as the
USMLE The United States Medical Licensing Examination (USMLE) is a three-step examination program for medical licensure in the United States sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). ...
for a Doctor in Medicine.


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 error A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavio ...
s, 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 US, as of 2006 there were few organizations that systematically monitored performance. In the US, only the
Department of Veterans Affairs The United States Department of Veterans Affairs (VA) is a Cabinet-level executive branch department of the federal government charged with providing life-long healthcare services to eligible military veterans at the 170 VA medical centers an ...
randomly drug tests physicians, in contrast to drug testing practices for other professions that have a major impact on public welfare. Licensing boards at the US state-level depend upon continuing education to maintain competence. Through the utilization of the
National Practitioner Data Bank The National Practitioner Data Bank ("the NPDB") is a database operated by the U.S. Department of Health and Human Services that contains medical malpractice payment and adverse action reports on health care professionals. Hospitals and state licen ...
, Federation of State Medical Boards' disciplinary report, and American Medical Association Physician Profile Service, the 67 State Medical Boards 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.


See also

* AI doctor *
Doctor's office A doctor's office in American English, a doctor's surgery in British English, or a doctor's practice, is a medical facility in which one or more medical doctors, usually general practitioners (GP), receive and treat patients. Description Do ...
* Doctor–patient relationship * Occupations of physicians and surgeons *
International medical graduate An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. The term non-local medical graduate may be ...
* List of countries and dependencies by number of physicians *
List of medical schools Medical schools are developed, monitored and credentialed by national organizations in each country. The agency responsible for this recognition in most countries is the Ministry of Health. Medical schools that are recognized by the appropriate a ...
*
List of physicians This is a list of famous physicians in history. Chronological lists Ancient physicians 30th century BCE to 4th century CE * List of ancient physicians Post-classical physicians 5th century CE to 15th century CE * List of post-classical ph ...
*
Medic A medic is a person involved in medicine such as a medical doctor, medical student, paramedic or an emergency medical responder. Among physicians in the UK, the term "medic" indicates someone who has followed a "medical" career path in postgra ...
*
Physician-scientist A physician-scientist is traditionally a holder of a medical degree and a doctor of philosophy also known as an MD-PhD. Compared to other clinicians, physician-scientists invest significant time and professional effort in scientific research an ...
*
Physicians in Canada Physicians and surgeons play an important role in the provision of health care in Canada. They are responsible for the promotion, maintenance, and restoration of health through the study, diagnosis, prognosis, and treatment of disease, injury, a ...


References


Further reading

* Bell, Whitfield J. "Medical practice in colonial America". ''Bulletin of the History of Medicine'' 31.5 (1957): 442–453. . * Hamilton, Bernice. "The Medical Professions in the Eighteenth Century". ''Economic History Review'' 4#2 1951, pp. 141–169. . In Britain * Holloway, Sydney WF. "Medical education in England, 1830–1858: A sociological analysis". ''History'' 49.167 (1964): 299–324. . * Keevil, John Joyce. ''Medicine and the Navy, 1200-1900'' (4 vol.; E. & S. Livingstone, 1957) on Royal Navy * Porter, Roy. ''Disease, Medicine and Society in England, 1550–1860'' (Cambridge University Press, 1995).


External links

* * {{Authority control Health care occupations Hospital staff