View source for Physician

{{Short description|Professional who practices medicine}}
<!-- Moved redirect info to 'Medical Officer', now a disambiguation page -->   <!-- {{Redirect|Medical Officer|the title used in India|Medical Officer (AYUSH)|the senior government official of a health department|Medical Officer for Health}} -->
{{About|medical doctors in general|a first contact, primary or family doctor|General practitioner|the U.S.|Primary care physician}}
{{Distinguish|text=[[physicist]], a scientist who studies or researches physics}}
{{Use dmy dates|date=September 2020}}
{{Infobox Occupation
|name=Physician
|image=The Doctor Luke Fildes crop.jpg
|caption=''The Doctor'' by [[Luke Fildes]]<ref>In 1949, Fildes' painting ''The Doctor'' was used by the [[American Medical Association]] in a campaign against a proposal for nationalized medical care put forth by President [[Harry S. Truman]]. The image was used in posters and brochures along with the slogan, "Keep Politics Out of this Picture" implying that involvement of the government in medical care would negatively affect the quality of care. 65,000 Posters<!--The first letter of the first word of a sentence or title is capitalized.--> of ''The Doctor'' were displayed, which helped to raise public skepticism for the nationalized healthcare campaign.</ref>
| official_names= Physician, medical practitioner, medical doctor or simply ''doctor''
<!------------Details------------------->
|type=[[Professional]]
|activity_sector=[[Medicine]], [[health care]]
|competencies=The [[ethics]], [[art]] and science of [[medicine]], [[analytical skill]]s, and [[critical thinking]]
|formation=[[Bachelor of Medicine, Bachelor of Surgery|MBBS]], [[Doctor of Medicine|MD]], [[Doctor of Osteopathic Medicine|DO]], or [[Doctor of Medicine|MDCM]]
| employment_field   = [[Clinic]]s, [[hospital]]s
| related_occupation = [[General practitioner]]<br/>[[Family physician]]<br/>[[Surgeon]]<br/>[[Specialty (medicine)|Specialist physician]]
|average_salary=
}}

A '''physician''' ([[American English]]), '''medical practitioner''' ([[English in the Commonwealth of Nations|Commonwealth English]]), '''medical doctor''', or simply '''doctor''', is a [[health professional]] who practices [[medicine]], which is concerned with promoting, maintaining or restoring [[health]] through the [[Medical education|study]], [[Medical diagnosis|diagnosis]], [[prognosis]] and [[therapy|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 [[Specialty (medicine)|specialities]]—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as [[general practitioner|general practice]].<ref>[[World Health Organization]]: ''[https://www.who.int/hrh/statistics/Health_workers_classification.pdf?ua=1 Classifying health workers]''. Source: Adapted from [[International Labour Organization]], [[International Standard Classification of Occupations]]: ISCO-08 (www.ilo.org/public/english/bureau/stat/isco/isco08/index.htm).</ref> Medical practice properly requires both a detailed [[knowledge]] of the [[Discipline (academia)|academic disciplines]], such as [[anatomy]] and [[physiology]], [[pathophysiology|underlying diseases]] and their treatment—the ''[[science]]'' of medicine—and also a decent [[Competence (human resources)|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 [[patient]]s.

==Modern meanings==
[[File:Francesco Redi.jpg|right|thumb|upright=1|The [[Italians|Italian]] [[Francesco Redi]], considered to be the founder of experimental biology, was the first to recognize and correctly describe details of many important [[parasites]].<ref name=ami>{{cite journal|author= Roncalli Amici R|title= The history of Italian parasitology|url= http://his.library.nenu.edu.cn/upload/soft/haoli/114/367.pdf|journal= Veterinary Parasitology|volume= 98|issue= 1–3|pages= 3–10|year= 2001|pmid= 11516576|doi= 10.1016/S0304-4017(01)00420-4|url-status= dead|archive-url= https://web.archive.org/web/20131023060404/http://his.library.nenu.edu.cn/upload/soft/haoli/114/367.pdf|archive-date= 23 October 2013}}</ref>]]

===Specialist in internal medicine===
{{Main|Internal medicine}}
Around the world the term physician refers to a [[Medical specialist|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 [[surgeon]]s.<ref name="Fowler">{{cite book |author=H.W. Fowler |title=A Dictionary of Modern English Usage (Wordsworth Collection) |publisher=NTC/Contemporary Publishing Company |year=1994 |isbn=1-85326-318-4 |url=https://archive.org/details/dictionaryofmo00fowl }}</ref>

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."<ref name="newSOED"/>

[[Henry VIII of England|Henry&nbsp;VIII]] granted a charter to the London [[Royal College of Physicians]] in 1518. It was not until 1540 that he granted the [[Barber surgeon|Company of Barber-Surgeons]] (ancestor of the [[Royal College of Surgeons]]) its separate charter. In the same year, the English monarch established the [[Regius Professor of Physic (Cambridge)|Regius Professorship of Physic]] at the [[University of Cambridge]].<ref>{{cite web | url = http://www.medschl.cam.ac.uk/about/history.html | title = University of Cambridge: History of the School of Clinical Medicine | publisher = [[University of Cambridge]] | access-date =  5 February 2008 | url-status = dead | archive-url = https://web.archive.org/web/20121209023135/http://www.medschl.cam.ac.uk/about/history.html | archive-date = 9 December 2012}}</ref> 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,<ref>{{cite journal |author=Wachter R|author2=Goldman L |title=The emerging role of "hospitalists" in the American health care system |journal=N Engl J Med |volume=335 |issue=7 |pages=514–7 |year=1996 |pmid=8672160 |doi=10.1056/NEJM199608153350713}}</ref> 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'',<ref>{{cite journal |title=Growth in the care of older patients by hospitalists in the United States|journal=N Engl J Med |volume=360 |issue=11 |pages=1102–1112 |year=2009|quote=See also editorial by Hamel M. B. ''et al''. on pp1141–1143 of same issue |doi=10.1056/NEJMsa0802381 |pmc=2977939 |pmid=19279342 |last1=Kuo |first1=YF |last2=Sharma |first2=G |last3=Freeman |first3=JL |last4=Goodwin |first4=JS}}</ref> who are often called ''general physicians'' in [[Commonwealth of nations|Commonwealth]] countries.

This original use, as distinct from surgeon, is common in most of the world including the [[United Kingdom]] and other Commonwealth countries (such as [[Australia]], [[Bangladesh]], [[India]], [[New Zealand]], [[Pakistan]], [[South Africa]], [[Sri Lanka]], and [[Zimbabwe]]), as well as in places as diverse as [[Brazil]], [[Hong Kong]], [[Indonesia]], [[Japan]], [[Republic of Ireland|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).<ref>{{cite web
|url=http://www.racp.edu.au/index.cfm?objectid=49EF1EB5-2A57-5487-D74DBAFBAE9143A3
|title=The Royal Australasian College of Physicians: What are Physicians?
|access-date=5 February 2008
|publisher=[[Royal Australasian College of Physicians]]
|archive-url=https://web.archive.org/web/20080306053048/http://www.racp.edu.au/index.cfm?objectid=49EF1EB5-2A57-5487-D74DBAFBAE9143A3
|archive-date=6 March 2008
|url-status=dead}}</ref> In Commonwealth countries, specialist [[pediatrics|pediatricians]] and [[geriatrics|geriatricians]] are also described as specialist physicians who have sub-specialized by age of patient rather than by [[Organ (anatomy)|organ]] system.

===Physician and surgeon===
{{Further|Bachelor of Medicine, Bachelor of Surgery|Doctor of Medicine}}
Around the world, the combined term "physician and surgeon" is used to describe either a general practitioner or any medical practitioner irrespective of specialty.<ref name="Fowler"/><ref name="newSOED">{{cite book |author=Brown, Lesley |title=The New shorter Oxford English dictionary on historical principles |publisher=Clarendon |location=Oxford [Eng.] |year=2002 |isbn=0-19-861271-0 |url=https://archive.org/details/newshorteroxford00lesl }}</ref> 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===
{{Further|Physicians in the United States|Physicians in Canada}}
[[File: Elizabeth Blackwell.jpg|thumb|upright|[[Elizabeth Blackwell]], the first female physician in the United States graduated from [[State University of New York Upstate Medical University|SUNY Upstate]]. ]]

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]], 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.

====American physicians====
The vast majority of [[physician in the United States|physicians trained in the United States]] have a [[Doctor of Medicine]] degree, and use the initials [[M.D.]] A smaller number attend [[Osteopathic medicine in the United States|osteopathic]] [[Medical school in the United States|medical schools]] and have a [[Doctor of Osteopathic Medicine]] degree and use the initials [[D.O.]]<ref>{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/002020.htm |title=Doctor of Osteopathic Medicine |author=Medline Plus |year=2012 |publisher=U.S. National Library of Medicine of National Institutes of Health |access-date=22 December 2012}}</ref> The [[World Directory of Medical Schools]] lists both MD and DO granting schools as ''medical schools'' located in the United States. After completion of [[Medical school in the United States|medical school]], physicians complete a [[Residency (medicine)|residency]] in the specialty in which they will practice. Subspecialties require the completion of a [[Fellowship (medicine)|fellowship]] after residency. Both MD and DO physicians participate in the [[National Resident Matching Program]] (NRMP) and attend [[Accreditation Council for Graduate Medical Education|ACGME]]-accredited residencies and fellowships across all medical [[American Board of Medical Specialties|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]]s guide patients in preventing disease and detecting health problems early while they are still treatable.<ref>{{cite web |title=Choosing Between a Family Medicine Doctor and an Internal Medicine Doctor |url=https://www.beaumont.org/health-wellness/blogs/choosing-between-a-family-medicine-doctor-and-an-internal-medicine-doctor |website=beaumont.org |publisher=[[Beaumont Health]] |access-date=14 January 2020}}</ref> They are divided into two types: [[family medicine]] doctors and [[internal medicine]] doctors.<ref>{{cite web |title=The difference between family medicine and internal medicine |url=https://www.piedmont.org/living-better/the-difference-between-family-medicine-and-internal-medicine |website=piedmont.org |publisher=[[Piedmont Hospital]] |access-date=14 January 2020}}</ref> Family doctors, or family physicians, are trained to care for patients of any age, while internists are trained to care for adults.<ref>{{cite news |last1=Bernat |first1=Karl |last2=Caplea |first2=Andrea |title=Family Medicine or Internal Medicine Doctor? |url=https://www.dukehealth.org/blog/family-medicine-or-internal-medicine-doctor |newspaper=Duke Health |publisher=[[Duke University Health System]] |access-date=14 January 2020}}</ref> Family doctors receive training in a variety of care and are therefore also referred to as [[general practitioner]]s.<ref>{{cite news |last1=Decker |first1=Fred |title=Difference Between Internist & General Practitioner |url=https://work.chron.com/difference-between-internist-general-practitioner-6745.html |access-date=14 January 2020 |work=[[Houston Chronicle]] |publisher=Hearst Newspapers, LLC |date=9 August 2018}}</ref> 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.<ref>{{cite web |title=Internal Medicine vs. Family Medicine |url=https://www.acponline.org/about-acp/about-internal-medicine/career-paths/medical-student-career-path/internal-medicine-vs-family-medicine |website=acponline.org |publisher=[[American College of Physicians]] |access-date=14 January 2020}}</ref>

====Podiatrists====
In the United States, the [[American Podiatric Medical Association]] (APMA) defines [[podiatrists]] as physicians and surgeons who treat the foot, ankle, and associated structures of the leg.<ref>{{cite web|url=http://www.apma.org/MainMenu/AboutPodiatry.aspx |title=About Podiatry |publisher=Apma.org |access-date=19 September 2011}}</ref> Podiatrists undergo training with the [[Doctor of Podiatric Medicine]] (DPM) degree.<ref>{{cite web|title=Podiatrist|url=http://science.education.nih.gov/lifeworks.nsf/alphabetical+list/Podiatrist?OpenDocument&ShowTab=All&|url-status=dead|archive-url=https://web.archive.org/web/20130429231921/http://science.education.nih.gov/lifeworks.nsf/alphabetical+list/Podiatrist?OpenDocument&ShowTab=All&|archive-date=29 April 2013|access-date=22 December 2012|publisher=Office of Science Education}}</ref> The [[American Medical Association]] (AMA), however, advocates for the definition of a ''physician'' as "an individual possessing degree of either a [[Doctor of Medicine]] or [[Doctor of Osteopathic Medicine]]."<ref>{{Cite web|title=Policy Finder {{!}} AMA|url=https://policysearch.ama-assn.org/policyfinder/detail/D-405.989?uri=/AMADoc/directives.xml-0-1397.xml|access-date=2021-12-27|website=policysearch.ama-assn.org}}</ref> 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.<ref>{{cite web |url=https://www.acfas.org/Fellowship-Center/Recognized-Fellowship-Intiative/List-of-Available-Fellowships/ |title=List of Available Fellowships |publisher=American College of Foot and Ankle Surgeons |access-date=9 July 2021}}</ref>

Podiatry residencies and/ or fellowships are not accredited by the [[Accreditation Council for Graduate Medical Education|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.<ref>{{Cite web|title=Scope of Practice Support|url=https://www.acfas.org/Health-Policy-and-Advocacy/Scope-of-Practice/Scope-of-Practice-Support/|access-date=2021-08-29|website=ACFAS}}</ref> DPM 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 professional degree. The [[World Directory of Medical Schools]] 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==
{{Main|Physician supply}}
[[File:Medical doctors per 1,000 people, OWID.svg|thumb|upright=1.8|Medical doctors per 1,000 people in 2018.<ref>{{cite web |title=Medical doctors per 1,000 people |url=https://ourworldindata.org/grapher/physicians-per-1000-people |website=Our World in Data |access-date=5 March 2020}}</ref>]]
Many countries in the developing world have the problem of too few physicians. 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.<ref>{{cite web|last=Bernstein |first=Lenny |url=https://www.washingtonpost.com/news/to-your-health/wp/2015/03/03/u-s-faces-90000-doctor-shortage-by-2025-medical-school-association-warns/ |title=U.S. faces 90,000 doctor shortage by 2025, medical school association warns |newspaper=The Washington Post |date=3 March 2015 |access-date=27 October 2016}}</ref>

==Social role and world view==
{{Main|Medical anthropology|History of medicine}}

===Biomedicine===
Within [[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 anthropology|medical anthropologists]].<ref name="hahn1">{{cite book |editor1-first= R.A. Hahn|editor1-last= A. Gaines|title= Physicians of western medicine  |year= 1985|publisher=  D. Reidel|location=   Dordrecht (Netherlands)|isbn= 90-277-1790-7|pages= 3–22| chapter= Chapter 1: Introduction (by editors)}}</ref> Biomedicine "formulates the human body and disease in a culturally distinctive pattern",<ref name="Good94">{{cite book |author=Good, Byron J |title=Medicine, rationality, and experience: an anthropological perspective (based on the Lewis Henry Morgan Lectures, at the University of Rochester, NY, in March 1990)|publisher=Cambridge University Press |location=Cambridge, UK |year=1994 |pages= 65, 65–87 |chapter=Chapter (pbk)3 |isbn=0-521-42576-X}}</ref> 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",<ref name="Laing71">{{cite book |author=Laing, R.D. |title=The politics of the family and other essays |publisher=Tavistock Publications |location=London |year=1971 }}</ref> 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:

{{blockquote|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 cultivated gentleman.

:— [[William Osler|Sir William Osler]], ''Chauvanism in Medicine'' (1902)<ref name="osler1">{{cite journal |author=Osler, Sir William|title=Chauvanism in medicine: address to the Canadian Medical Association, Montreal (17 September 1902)|journal=The Montreal Medical Journal |volume=XXXI |year=1902}}</ref>}}

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 [[Medical ethics|ethical]] and [[Medical jurisprudence|legal]] duties. The term traditionally used by physicians to describe a person seeking their help is the word ''patient'' (although one who [[Doctor's visit|visits]] a physician for a routine [[check-up]] may also be so described). This word [[wikt:patient|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]], [[wikt:patior|patior]], meaning 'I am suffering', and akin to the [[Ancient Greek|Greek]] verb {{Lang-grc|πάσχειν|label=none}} (<small>[[Romanization of Ancient Greek|romanized]]:</small> ''paschein'', <small>[[Literal translation|lit.]]</small> to suffer) and its cognate noun [[wikt:πάθος|πάθος]] ([[wikt:pathos|''pathos'']], suffering).<ref name="newSOED"/><ref name="Partridge">{{cite book |author=Partridge, Eric |title=Origins: a short etymological dictionary of modern English |publisher=Macmillan |location=New York |year=1966 |isbn=0-02-594840-7 }}</ref>

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]] or the [[Royal College of Physicians]] in the United Kingdom, and such hard-won membership is itself a mark of status. {{Citation needed|date=July 2015}}

===Alternative medicine===
While contemporary biomedicine has distanced itself from its ancient roots in religion and magic, many forms of [[traditional medicine]]<ref name="galdston63tradmed">{{cite book |editor1-first= Iago|editor1-last= Galdston|title= Man's image in medicine and anthropology: Monograph&nbsp;IV, Institute of social and historical medicine, New York Academy of Medicine|url= https://archive.org/details/mansimageinmedic00arde|url-access= registration|year= 1963 |publisher=International Universities Press |location=New York |pages=[https://archive.org/details/mansimageinmedic00arde/page/43 43–334] |chapter=Part 1: Medicine and primitive man (five chapters); Part 2: Medical man and medicine man in three North American Indian societies (three chapters) }}</ref> 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".<ref>{{cite book |author=Grossinger, Richard |title=Planet medicine: from stone age shamanism to post-industrial healing |pages=116–131 |orig-year=1980 |year=1982 |edition=Revised |publisher= North Atlantic Books|location=Berkeley, CA, US |isbn= 978-1-55643-369-6}}</ref> The US [[National Center for Complementary and Integrative Health|National Center for Complementary and Alternative Medicine]] (NCCAM) classifies [[complementary and alternative medicine]] therapies into five categories or domains, including:<ref name="titleComplementary and Alternative Medicine - U.S. National Library of Medicine Collection Development Manual">{{cite web |url=https://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html |title=Complementary and Alternative Medicine&nbsp;– U.S. National Library of Medicine Collection Development Manual |access-date=31 March 2008 }}</ref> alternative medical systems, or complete systems of therapy and practice; [[bodymind|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 therapy.

In considering these alternate traditions that differ from biomedicine (see above), [[medical anthropology|medical anthropologists]] emphasize that all ways of thinking about health and disease have a significant cultural content, including conventional western medicine.<ref name="hahn1" /><ref name="Good94" /><ref name="galdston63biomed">{{cite book |editor1-first= Iago|editor1-last= Galdston|title= Man's image in medicine and anthropology: Monograph&nbsp;IV, Institute of social and historical medicine, New York Academy of Medicine|url= https://archive.org/details/mansimageinmedic00arde|url-access= registration|year= 1963 |publisher=International Universities Press |location=New York |pages=[https://archive.org/details/mansimageinmedic00arde/page/477 477–520] |chapter=Part V: Culture and the practice of modern medicine (two chapters)}}</ref><ref name="Joralemon99">{{cite book |author=Joralemon, DonaldJ |title=Exploring medical anthropology|publisher=Allyn and Bacon |location=Needham Heights, MA, US |year=1999 |pages= 1–15 |chapter= chapter 1: What's so cultural about disease? (pbk) |isbn=0-205-27006-9}}</ref>

[[Ayurveda]], [[Unani medicine]], and [[homeopathy]] 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.<ref>{{cite journal |author=Appel JM |title=Smoke and mirrors: one case for ethical obligations of the physician as public role model |journal=Camb Q Healthc Ethics |volume=18 |issue=1 |pages=95–100 |year=2009 |pmid=19149049 |doi=10.1017/S0963180108090142|s2cid=42678745 }}</ref> 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,<ref name=frank>{{cite journal |author=Frank E|author2=Biola H|author3=Burnett CA |title=Mortality rates and causes among U.S. physicians |journal=Am J Prev Med |volume=19 |issue=3 |pages=155–9 |date=October 2000 |pmid=11020591 |doi=10.1016/S0749-3797(00)00201-4}}</ref> [[life expectancy]] 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]], [[pneumoconioses]], [[Chronic obstructive pulmonary disease|COPD]], but excluding [[emphysema]] and other [[chronic airway obstruction]]), alcohol-related deaths, [[Rectosigmoid neoplasm|rectosigmoid]] and [[anal cancer]]s, and bacterial diseases.<ref name=frank/>

Physicians do experience exposure to [[occupational hazard]]s, and there is a well-known aphorism that "doctors make the worst patients".<ref name=schneck>{{cite journal |author=Schneck SA |title='Doctoring' doctors and their families |journal=JAMA |volume=280 |issue=23 |pages=2039–42 |date=December 1998 |pmid=9863860 |doi=10.1001/jama.280.23.2039|doi-access=free }}</ref> Causes of death that are shown to be higher in the physician population include [[suicide among doctors]] and [[Self inflicted injury|self-inflicted injury]], drug-related causes, traffic accidents, and cerebrovascular and ischaemic heart disease.<ref name=frank/> Physicians are also prone to [[occupational burnout]]. 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]] reported that time pressure was the greatest cause of burnout; a survey from the [[American Medical Association]] reported that more than half of all respondents chose "too many bureaucratic tasks" as the leading cause of burnout.<ref>{{cite web |title=Physician Burnout |url=https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html |website=[[Agency for Healthcare Research and Quality]] |access-date=31 July 2020 |date=July 2017}}</ref><ref>{{cite web |last1=Berg |first1=Sara |title=Physician burnout: It's not you, it's your medical specialty |url=https://www.ama-assn.org/residents-students/specialty-profiles/physician-burnout-it-s-not-you-it-s-your-medical-specialty |website=[[American Medical Association]] |access-date=31 July 2020 |date=3 August 2018}}</ref>

==Education and training==
{{Main|Medical education}}
[[File:Aerial-Picture-of-Jackson-e1445995779731.jpg|thumb|250px|[[Jackson Memorial Hospital]] in [[Miami]], the primary teaching hospital for the [[Leonard M. Miller School of Medicine]] at the [[University of Miami]], July 2010]]

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 education|tertiary]]-level [[Course (education)|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 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 "[[medical intern|internship]]", 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 [[medical license|licensed]] 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]], 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]], 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.{{Dubious|date=November 2019}}<ref>{{cite web|url=http://www.sueddeutsche.de/bildung/qualitaet-medizinischer-promotionen-kommt-ein-doktor-zum-arzt--1.2673150|title=Kommt ein Doktor zum Arzt ...|first=Sarah|last=Schmidt|date=30 September 2017|access-date=30 September 2017|website=Sueddeutsche.de}}</ref><ref>{{cite web|url=http://www.spiegel.de/lebenundlernen/uni/von-der-leyen-in-der-kritik-schlechte-promotionen-sind-in-der-medizin-ueblich-a-1055039.html|title=Medizin-Promotionen: Akademische Ramschware|first=Bernd|last=Kramer|date=28 September 2015|access-date=30 September 2017|website=Spiegel.de}}</ref>

===All medical practitioners===
Among the English-speaking countries, this process is known either as [[licensure]] as in the United States, or as [[Registration (occupational)|registration]] in the [[United Kingdom]], other [[Commonwealth of Nations|Commonwealth]] countries, and [[Republic of Ireland|Ireland]]. Synonyms in use elsewhere include ''colegiación'' in [[Spain]], ''ishi menkyo'' in [[Japan]], ''autorisasjon'' in [[Norway]], ''Approbation'' in [[Germany]], and {{Script|Greek|άδεια εργασίας}} in Greece. In [[France]], [[Italy]] and [[Portugal]], 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]] 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]], [[Canada]], [[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 Regulation Agency]] (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.<ref>{{cite web|url=http://www.ama-assn.org/ama/pub/category/2645.html|title=AMA Links to state medical boards|access-date=1 March 2008}}</ref> After graduating from a first-professional school, physicians who wish to practice in the US usually take standardized exams, such as the [[United States Medical Licensing Examination|USMLE]] 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]]s, drug abuse, and other issues in physician professional behavior received significant attention across the world,<ref>{{cite journal |author=Lim MK |title=Quest for quality care and patient safety: the case of Singapore |journal=Qual Saf Health Care |volume=13 |issue=1 |pages=71–5 |date=February 2004 |pmid=14757804 |pmc=1758053 |doi=10.1136/qshc.2002.004994  }}</ref> in particular following a critical 2000 report<ref>Committee on Quality of Health Care in America, Institute of Medicine. (2000). To Err is Human: Building A Safer Health System. ''National Academies Press''. [http://www.nap.edu/catalog.php?record_id=9728#toc Free full-text].</ref> which "arguably launched" the patient-safety movement.<ref>{{cite journal |author=Wachter RM |title=Patient safety at ten: unmistakable progress, troubling gaps |journal=Health Aff (Millwood) |volume=29 |issue=1 |pages=165–73 |year=2010 |pmid=19952010 |doi=10.1377/hlthaff.2009.0785 }}</ref> In the US, as of 2006 there were few organizations that systematically monitored performance. In the US, only the [[Department of Veterans Affairs]] 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.<ref>{{cite journal |author=Leape LL|author2=Fromson JA |title=Problem doctors: is there a system-level solution? |journal=Ann. Intern. Med. |volume=144 |issue=2 |pages=107–15 |date=January 2006 |pmid=16418410 |doi= 10.7326/0003-4819-144-2-200601170-00008|doi-access=free }}</ref> Through the utilization of the [[National Practitioner Data Bank]], [[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.<ref>{{cite web|url=http://www.medlicense.com |title=Medical Board Licensing Service for Physicians seeking an Expedited Medical License with any of the 50 State Medical Boards |publisher=MedLicense.com |access-date=19 September 2011}}</ref> 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.<ref>{{cite journal |author=Suñol R|author2=Garel P|author3=Jacquerye A |title=Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project |journal=Qual Saf Health Care |volume=18 Suppl 1 |pages=i3–7 |date=February 2009 |issue=Suppl_1 |pmid=19188459 |pmc=2629851 |doi=10.1136/qshc.2008.029678 }}</ref>

==See also==
{{portal|Medicine}}
{{col div|colwidth=30em}}
* [[AI doctor]]
* [[Doctor's office]]
* [[Doctor–patient relationship]]
* [[Occupations of physicians and surgeons]]
* [[International medical graduate]]
* [[List of countries and dependencies by number of physicians]]
* [[List of medical schools]]
* [[List of physicians]]
* [[Medic]]
* [[Physician-scientist]]
* [[Physicians in Canada]]
{{colend}}

==References==
{{reflist}}

==Further reading==
* Bell, Whitfield J. "Medical practice in colonial America". ''Bulletin of the History of Medicine'' 31.5 (1957): 442–453. {{Jstor|44449174}}.
* Hamilton, Bernice. "The Medical Professions in the Eighteenth Century". ''Economic History Review'' 4#2 1951, pp.&nbsp;141–169. {{Jstor|2599120}}. In Britain
* Holloway, Sydney WF. "Medical education in England, 1830–1858: A sociological analysis". ''History'' 49.167 (1964): 299–324. {{Jstor|24404427}}.
* 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==
{{Wikiquote}}
* {{Commons category-inline|Physicians}}
* {{Wiktionary-inline|physician}}

{{Medicine|state=collapsed}}
{{Glossaries of science and engineering}}
{{Authority control}}
{{二次利用|date=2 December 2022}}
[[Category:Physicians| ]]
[[Category:Health care occupations]]
[[Category:Hospital staff]]