Primary care around the world

[Lumbago90]

Hi fellow students and physicians. I was thinking it could be interesting to get some insight on how primary care work in different countries. Im studying for specialisation GP for adults in Slovakia. As you can see here the primary care is divided to GP for kids and adults up to 28 yo and GP strictly for adults for patients 18 yo and more. By wanting to care for both you'll have to do two specialisations.
They are strictly outpatient specialties with no chance working in hospital settings. Also no chance of subspecialize.
We get to treat common colds and other non complex infections, hypertension and DM 2 type, back pain syndromes. Almost all other problems get reffered to specialists.
Im frankly quite fascinated how much work can FP in US do.

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[MedicineZ0Z]

In the US and Canada, family doctors can do a lot and make a lot of money too. I believe Australia is quite similar.

I don't want to generalize all of Europe as I'm sure there may be a couple exceptions, but in Europe (from what I know) it's more similar to what you describe.
GPs in many (?most/all) European countries do not even order CT scans. If they suspect something that warrants a CT, they have to refer to a specialist first.

I think our system is the most logical and you could even argue family doctors don't do enough in many cases (in north america). This is of course based off the level of training, 4 years of medical school where in ms3-ms4 you are actively engaged in patient care. Then 3 years of residency with long hours.
I understand medical school is very hands off overseas (Europe, Australia, Asia, etc.) and mostly just shadowing. Even residency is not as hands-on as north america (right away).

 

[Splenda88]

Residency is the best part of US medical education. The way our residency system is built, it makes it difficult to be an incompetent physician (at least for primary care IM/FM/peds)

@Lumbago90 Take the USMLE and come over here so you can practice medicine the way you like...

 

[theKingLT]

I'll add in a bit on Mexico for anyone interested (although fair warning I'm not an expert and have not been through the process myself, just passing on info from a good friend who's been through it). Their medical school clinical training is more "hands-on" than even here in the U.S. but not always in a good way. Students are treated like techs much of the time. Spending lots of time taking EKG's and such while being less involved in the diagnosis/treatment plan development and ultimately not learning as quickly. Then they are "thrown to the wolves" during 6th year where they are sent to a tiny little clinic in the middle of nowhere to practice as a GP before residency and often without any oversight. I suppose it teaches independence but I'm not sure how they're supposed to learn anything that way with no one telling them what they did wrong. I think it's mostly just a way to fill the need for physicians out in towns that no one wants to live in. Finally, after year 6 they take their residency exam and try to get accepted into residency (I don't think they have a match). Oh and statistically speaking they have a higher chance of matching into residency here in the U.S. than in their own country due to the ridiculous number of graduates and lack of residency spots.

 

[Bascombe]

I live in a country in Central america, and here physicians don't have to do a residency or any kind of specialization to practice primary care, what we have is a compulsory 2 year internship after graduating med school, which is a requirement for getting licensed. The degree to which physicians get adequately prepared to do primary care from internship alone is very program dependent; national internship rules put a required minimum of outpatient rotations in 2nd year internship, but many programs that are more hospital based won't comply all that well to the 'requirement'.

Physicians out of internship can also apply for almost the same variety of jobs family medicine physicians can in the US, including urgent care, ED in many settings, and inpatient jobs not exactly to the degree of what I understand an hospitalist in the US does, but in many aspects is the same kind of job.

We do have one family medicine residency program, but it doesn't attract more than a few applicants each year. The main difference between a family physician and a general practitioner without residency here, besides the higher level of training, is that the former will actually be kinda restricted to outpatient practice; in the public system at least those are the only positions available for family doctors, and I still don't know of any family doctor doing ED or hospitalist jobs in private practice. On the other hand, in the public system it's actually easier for a doctor right out of internship to get a position in an ED or inpatient service than one in an outpatient primary care clinic, as these positions are usually given to general practitioners with many years of service. So the sure way to land a primary care outpatient job in our public system for a physician right out of training would be doing the family medicine residency.

I think our system is the most logical and you could even argue family doctors don't do enough in many cases (in north america).

So many end up practicing almost the same way general practitioners without residency do in other countries...Ok no, in all seriousness I think that the average family medicine physician here is better prepared to do primary care than the average physician without a residency.