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Physician

A physician is a person who practices medicine. See that article for more information on what physicians do in their practices; this article focuses on physician training and regulation.

In the United States, the term physician is traditional and commonly used. In Britain, Australia, Pakistan and India, the term doctor is more common as physician refers to specialists in internal medicine.

Because of the extensive training requirements, physicians are traditionally considered to be members of a learned profession.

Training

United Kingdom

Medicine in the UK is an undergraduate subject. Students can begin training after leaving the school at 18 years of age. Medical school training lasts either five or six years, depending on the institution, and combines academic and practical training. Junior doctors then enter a vocational training phase. In the UK a doctor's training normally follows this path:

1. Degree level preclinical - Doctors must study medicine in university or medical school for two to three years "preclinical" (meaning little patient contact). However following recommendations by the British Medical Association (BMA) many universities are following a "Problem-based learning" approach, which stresses basing the studies around actual patient cases.
   
2. Clinical - This time is spent in a teaching hospital and typically lasts two or three years. After this is completed the student doctor is awarded a Bachelor of Medicine (BM or MB) and Bachelor of Surgery (BCh or BS). An honorary prefix of "Dr" is now entitled to be used, although it is not recognised in the academic sense of the word (see Doctorate). Doctors who graduated overseas have to pass the Professional and Linguistic Assessment Board test (PLAB) to be eligible for further postgraduate training and jobs in UK.
   
3. The Foundation Programme - Due to recent changes in the training of junior doctors, newly qualified doctors enter a two year Foundation Programme, where they train in a variety of different specialities. These must include training in General Medicine and General Surgery but can also include other fields such as Paediatrics or General Practice.

Following completion of the Foundation Programme a doctor can choose to specialise in one field. All routes involve further assessment and examinations. The majority in the UK work in the community as General Practitioners (GPs), who are the first port of call for patients. They diagnose illness and refer patients for further examination by specialists if necessary. The majority of patients are managed by their GP without the need for further referral.

Hospital doctors are promoted after sitting relevant postgraduate exams within their chosen specialty (e.g. Member of the Royal College of Physicians MRCP, Member of the Royal College of Surgeons [MRCS]) and a competitive interview selection process from SHO to Specialist Registrar and eventually Consultant on completion of the CCST (Certificate of Completion of Specialist Training), which is the highest level in a specialty team (with the exception of university-linked professors). The competition is great for those who wish to attain consultant level and many now complete higher degrees in research such as a Doctorate of Medicine (MD) which is a thesis-based award based on at least two years full-time research or PhD which involves at least three years of full-time research. The time taken to get from graduation from medical school to becoming a Consultant varies from speciality to speciality but can be anything from 7 to 10 years, or longer in some specialities.

United States

In the United States and countries following the U.S. method, the path to a medical degree is somewhat different.

Admissions: Admission into medical school requires either three years of undergraduate study or a four-year post-secondary bachelor's degree from an accredited college or university, depending on medical institution. Most require that the applicant have attained a bachelor's degree prior to matriculation. Admissions criteria include overall performance in the undergraduate years and performance in a group of courses specifically required by U.S. medical schools, the score on the Medical College Admissions Test (a national standardized test), application essays, letters of recommendation (number varies, but at least 1 from science faculty and 1 from non-science faculty), and interview(s). The list of courses required are as follows:

• biology (1 year)
• general chemistry (1 year)
• organic chemistry (1 year)
• physics (1 year)
• calculus or sometimes statistics (1 year)
• English composition (1 year)
• sometimes behavior science and/or biochemistry (1 semester)

1. Medical School: Once admitted to medical school, it takes four years to earn a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree. The course of study is divided into two roughly equal parts. Preclinical study generally comprises the first two years and consists of classroom and laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, microbiology, pathology, and neurosciences. Once the student successfully completes preclinical training, he or she moves on to the clinical portion. This usually occupies the final two years of medical school and takes place almost exclusively on the wards of a teaching hospital or, occasionally, with community physicians. The students observe and take part in the care of actual patients under the supervision of residents and attending physicians. Rotations on clinical services such as internal medicine, surgery, pediatrics, obstetrics/gynecology, and psychiatry are the foundation of this curriculum, but many specialty electives may be chosen as well. Upon completion of medical school, the student earns the title of doctor, but cannot practice independently until completing further training. Also, several universities across the U.S. admit high school students to both their undergraduate colleges and the medical schools simultaneously; students attend a single seven-year or eight-year integrated program consisting of three or four years of an undergraduate curriculum and four years of medical school curriculum, culminating in both a bachelor's and M.D. degree.
2. Internship: During the last year of medical school, students apply for postgraduate residencies in their chosen field of specialization. These are more or less competitive depending upon the desirability of the specialty, prestige of the program, and the number of applicants relative to the number of available positions. All but a few positions are granted via a national computer match which pairs an applicant's preference with the programs' preference for applicants. The first year of any residency is known as "internship". Completion of this year is the minimum training requirement for obtaining a license to practice medicine in the U.S.
3. Residency: Each of the specialties in medicine has established its own curriculum, which defines the length and content of residency training necessary to practice in that specialty. Programs range from three years after medical school for internal medicine to five years for surgery to eight or nine for neurosurgery. This does not include research years that may last from 1 year up to a completion of a Ph.D. Each specialty incorporates an internship year to satisfy the requirements of licensure. All specialties hold a board exam (either written or written and oral) at the completion of training in order to confer "Board Certification" in that specialty.
4. Fellowship: Certain highly specialized fields require formal training beyond residency. Examples of these are cardiology, endocrinology, oncology after internal medicine; cardiothoracic surgery, pediatric surgery, surgical oncology after general surgery to name just a few. There are many others for each field of study. The training programs for these fields are known as fellowships and their participants are "Fellows" to denote that they already have completed a residency and are "Board Eligible" or "Board Certified" in their basic specialty. Fellowships range in length from one to three years and are granted by application to the individual program or sub-specialty organizing board.
5. Attendings and Consultants: The physician or surgeon who has completed his or her residency and possibly fellowship training and is in the practice of their specialty is known as an Attending or Consultant. These are the physicians who may independently care for patients and are the final arbiters of care. They are responsible for all care decisions and may bill for their services.

However, medicine is an extremely diverse profession with many options available. Some doctors work in pharmaceutical research, occupational medicine (within a company), public health medicine (working for the general health of a population in an area), or join the armed forces.

France

In France, a doctor's training is performed in public university hospital, called Centre hospitalier universitaire or CHU; it consists in:

• First cycle
  • the first year is common with the dentists and the midwives; the rank at the final examination determines in which branch the student can go on; it is called "PCEM1" (premier cycle des études médicales, first cycle of medical studies) or "P1";
  • the second year is called "PCEM2" and is dedicated to the fundamental sciences (or propédeutique, propaedeutics): anatomy, human physiology, biochemistry, bacteriology, statistics...
• Second cycle
  • The first year is called "DCEM1" (deuxième cycle des études médicales, second cycle of medical studies), and is also dédicated to the study of propaedeutics
  • The second, third and fourth years (DCEM2-4) are called externat, and are dedicated to the study of clinical medicine; they end with a classifying examination, the rank determines in which speciality (the general medicine is one of them) the student can make an internat: the first graduate can choose speciality, and at the rank n, the graduate must choose amongst the places left; the graduate also gets a Certificat de synthèse clinique et thérapeutique (certificate of clinical and therapeutical synthesis).
• The internat is two years and a half (general medicine) or four years (specialist) of initial professional experience under the responsibility of a senior; the interne can prescribe, replacements of liberal phsicians can be made, and usually the student works in an hospital.

This ends with a doctorate, a research work which most of times consist in a statistical study of cases to propose a care strategy of a specific affection (in an epidemiological, diagnostical, or therapeutical point of view). A specialist also gets a DES (diplôme d'études spécialisées, diploma for specialised studies). The initial training thus consist in eight years and a half for a general practitioner, and ten years for a specialist (including a surgeon).

Regulation

In most jurisdictions, physicians need government permission to practise. This is known as licensing in the United States, as colegiation in Spain, as ishi menkyo in Japan, as approbation in Germany, and as registration in Australia and the United Kingdom. In France, civilian physicians must be a member of the Order of physicians to practice medicine. In some countries, including the United Kingdom, the profession regulates itself, with the government affirming the regulating body's authority (in the UK the General Medical Council [GMC]).

Regulating authorities will revoke permission to practice in cases of malpractice or serious misconduct.

Graduates of Foreign Medical Schools, who enter USA have to pass USMLE step 1 and 2 ECFMG old nameand do a residency program to qualify for a state license. After graduating from medical school, American physicians usually take a standardized exam which enables them to obtain a certificate to practice from the appropriate state agency. All American states have an agency which 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," etc. Australian states usually have a "Medical Board," while Canadian provinces usually have a "College of Physicians and Surgeons."

In the United States, as a result of the war on drugs, pharmaceuticals are strictly regulated at the federal level by the Food and Drug Administration and the Drug Enforcement Administration. All practicing American physicians who intend to prescribe controlled substances must obtain a number from the DEA, and that DEA number must appear on all their prescriptions. Use of the DEA number enables dispensing pharmacists or the DEA to ensure that a physician is not dispensing potentially addictive or harmful drugs, such as opiates or stimulants, in contravention to accepted standards of care.