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=== United States === {{unfocused|date=June 2014}} [[File:DoctorsDavisOfficeTransylvania.jpg|thumb|A general practitioner's office in 1940]] The population of this type of medical practitioner is declining, however. Currently, the Medical Departments of the US Air Force, Army and Navy have many of these general practitioners, known as General Medical Officers or GMOs, in active practice. The GMO is an inherent concept to all military medical branches. GMOs are the gatekeepers of medicine in that they hold the purse strings and decide upon the merit of specialist consultation. The US now holds a different definition for the term "general practitioner". The two terms "general practitioner" and "family practice" were synonymous prior to 1970. At that time both terms (if used within the US) referred to someone who completed medical school and the one-year required [[Internship (medicine)|internship]], and then worked as a general family doctor. Completion of a post-graduate specialty training program or residency in family medicine was, at that time, not a requirement. A physician who specializes in "family medicine" must now complete a residency in family medicine and must be eligible for [[board certification]], which is required by many hospitals and health plans for hospital privileges and remuneration, respectively. It was not until the 1970s that family medicine was recognized as a specialty in the US.<ref>{{cite web |url=https://www.theabfm.org/about/history.aspx |title=History of the Specialty |publisher=[[American Board of Family Medicine]] |author=Pisacano, Nicholas J. |access-date=2007-08-08 |url-status=live |archive-url=https://web.archive.org/web/20070808002921/https://www.theabfm.org/about/history.aspx |archive-date=2007-08-08 }}</ref> Many licensed family medical practitioners in the United States after this change began to use the term "general practitioner" to refer to those practitioners who previously did not complete a family medicine residency. Family physicians (after completing [[medical school]]) must then complete three to four years of additional residency in family medicine. Three hundred hours of medical education within the prior six years is also required to be eligible to sit for the board certification exam;{{citation needed|date=August 2013}} these hours are largely acquired during residency training. The existing general practitioners in the 1970s were given the choice to be grandfathered into the newly created specialty of Family Practice. In 1971 the American Academy of General Practice changed its name to the American Academy of Family Physicians.<ref>{{cite web | url=http://www.aafp.org/about/the-aafp/history.htm | title=The History of the AAFP |publisher=American Academy of Family Physicians | access-date=31 May 2014}}</ref> The prior system of graduating from medical school and completing one year of post-graduate training (rotating internship) was not abolished as 47 of the 50 states allow a physician to obtain a medical license without completion of residency.<ref name=medlicense>{{Cite web | url=https://medlicense.com/licensure-information/state-licensure-requirements | title=State Licensure Requirements}}</ref> If one wanted to become a "house-call-making" type of physician, one still needs to only complete one or two years of a residency in either pediatrics, family medicine or internal medicine. This would make a physician a non-board eligible general practitioner able to qualify and obtain a license to practice medicine in 47 of the 50 United States of America.<ref name=medlicense/> Since the establishment of the Board of Family Medicine, a family medicine physician is no longer the same as a general practitioner. What makes a Family Medicine Physician different from a General Practitioner/Physician is two-fold. First off, a Family Medicine Physician has completed the three years of Family Medicine residency and is board eligible or board certified in Family Medicine, under the auspices of the [[American Board of Family Medicine]] or the American Osteopathic Board of Family Physicians; a General Practitioner may complete board certification through the American Academy of General Physicians. Secondly, a Family Medicine Physician is able to practice obstetrics, the care of the pregnant woman from conception to delivery, while a general practitioner typically are not trained in obstetrics.<ref name="Larkin1999">{{cite web |last1=Larkin |first1=Howard |title=General practice gets a second wind |url=https://www.medicaleconomics.com/view/general-practice-gets-second-wind |publisher=Medical Economics |access-date=4 April 2025 |language=en |date=20 September 1999}}</ref> Prior to recent history most postgraduate education in the United States was accomplished using the [mentor system, a form of [[apprenticeship]].{{Citation needed|date=April 2009}} A physician would finish a rotating internship and move to some town and be taught by the local physicians the skills needed for that particular town. This allowed each community's needs to be met by the teaching of the new general practitioner the skills needed in that community. This also allowed the new physician to start making a living and raising a family, etc. General practitioners would be the surgeons, the obstetricians, and the internists for their given communities. Changes in demographics and the growing complexities of the developing bodies of knowledge made it necessary to produce more highly trained surgeons and other specialists. For many physicians it was a natural desire to want to be considered "specialists".{{Citation needed|date=September 2010}} In the latter part of the 20th century, there has been a growing bureaucracy of insurance and hospitals requiring board certification.<ref name=roswellpark>{{Cite web | url=https://www.roswellpark.org/partners-practice/white-papers/board-certification | title=Is Board Certification Overrated?}}</ref> It has been shown that there is no statistically significant correlation between board certification and patient safety or quality of care,<ref>{{cite journal |pmid=12063199 |year=2002 |last1=Sharp |first1=L. K. |title=Specialty board certification and clinical outcomes: The missing link |journal=Academic Medicine |volume=77 |issue=6 |pages=534β42 |last2=Bashook |first2=P. G. |last3=Lipsky |first3=M. S. |last4=Horowitz |first4=S. D. |last5=Miller |first5=S. H. |doi=10.1097/00001888-200206000-00011|doi-access=free }}</ref><ref>{{cite journal |doi=10.1111/j.1365-2753.2006.00556.x |pmid=16987109 |title=Does specialty board certification influence clinical outcomes? |journal=Journal of Evaluation in Clinical Practice |volume=12 |issue=5 |pages=473β481 |year=2006 |last1=Grosch |first1=Eric N. }}</ref><ref name=roswellpark/> which is why 47 states do not require board certification to practice medicine. Board certification agencies have been increasing their fees exponentially since establishment and the board examinations are known to not be clinically relevant and are at least 5 years out of date.<ref name=roswellpark/> Yet, there is still a misbelief that board certification is necessary to practice medicine and therefore it has made a non-board eligible general physician a rare breed of physician due to the lack of available job opportunities for them.<ref name=roswellpark/> [[Certificate of added qualifications|Certificates of Added Qualifications]] (CAQs) in [[adolescent medicine]], [[geriatrics|geriatric medicine]], [[sports medicine]], [[sleep medicine]], and hospice and palliative medicine are available for those board-certified family physicians with additional [[residency (medicine)|residency]] training requirements. Recently,{{When|date=December 2010}} new fellowships in [[International Family Medicine]] have emerged. These fellowships are designed to train family physicians working in resource-poor environments.<ref>[http://www.vcfm.net/fellowships/international-medicine-fellowship/ "International Family Medicine Fellowship"] {{webarchive|url=https://web.archive.org/web/20100627030223/http://www.vcfm.net/fellowships/international-medicine-fellowship/ |date=2010-06-27 }}, Via Christi Retrieved 4/14/2010.</ref> In 2009 an ongoing shortage of [[primary care physician]]s (and also other primary care providers) was reported. It was due to several factors, notably the lesser prestige associated with the young specialty, the lower pay, and the increasingly frustrating practice environment. In the US physicians are increasingly forced to do more administrative work,<ref>{{cite web |last=Kavilanz |first=Parija B. |date=July 18, 2009 |title=Why primary care doctors are shrinking in the U.S. |url=https://money.cnn.com/2009/07/16/news/economy/healthcare_doctors_shortage/ |publisher=[[CNN Money]] |url-status=live |archive-url=https://web.archive.org/web/20090731150401/http://money.cnn.com/2009/07/16/news/economy/healthcare_doctors_shortage/ |archive-date=2009-07-31 |access-date=12 February 2020}}</ref> and pay higher malpractice insurance premiums.
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