Hey, Doc! What kind of training do you need to be a family doctor?

Patients often ask about the differences between the specialties and practitioners involved in “primary care.”  To be quite honest, it can be confusing to sort out, so here’s a basic “Who’s Who” for adult primary care.

It used to be that a doctor graduating from medical school had two choices: go into general practice or specialize (surgery, neurology, cardiology, etc.).  A general practitioner did a 12-month rotating internship covering adult medicine, pediatrics, surgery and the other “basic” specialties.

At the end of that time, he/she could hang out a shingle and start seeing patients.  There are still a few of these doctors in practice today.  I had the pleasure of working with a general practitioner in medical school.  He worked in a rural community and I was amazed at his skills.  He could do everything from office medicine to obstetrics to basic surgeries.  In his community, the closest specialists were 70 miles away, so his diverse training was a real asset to his patients. 

As medical science has progressed, it has gotten harder for doctors to keep current with everything they need to know in all areas of care.  This is how family medicine evolved from general practice.  After four years of medical school, a family doctor does a three-year residency (instead of a 12-month internship).  A family medicine residency focuses on the basics of hospital medicine, clinic practice, pediatrics, emergency medicine, obstetrics and various subspecialties.

Family medicine usually includes special training on family systems and psychosocial aspects of health care. After completing residency training, family physicians take an exam to become board certified in family medicine.  Family doctors can see all ages and stages of life.

Internal medicine is another major specialty in primary care.  An internal medicine physician or internist also completes four years of medical school followed by a three-year residency.  Their residency training does not include obstetrics or pediatrics, so they are able to study subspecialties in more detail than a family doctor.  This makes them well suited for complicated or rare medical problems that may be beyond a family doctor’s scope of practice. 

Internists manage all aspects of adult health care.  They can do everything from coughs and colds to complex medical problems.  They also maintain board certification, which shows that they are up to date with the latest medical knowledge.  

Especially in smaller communities, nurse practitioners and physician assistants are a great asset to the primary care community.  Like doctors, they usually complete a four-year degree before entering their respective training programs.  Both programs are usually two to three years long.

A physician assistant may have an undergraduate degree in any area (although they must meet certain pre-medical requirements). A nurse practitioner is trained as a registered nurse.  Both practitioners have some type of physician supervision, depending on state regulations.  Their training has a greater focus in preventive and holistic care than most medical schools give their medical students.

Although the differences can be confusing, the variety of practice styles and training in primary care make it possible for you to find someone to fit your exact needs. Next time you’re waiting in an exam room, take a look at the diplomas on the wall.  See how your provider’s training has led him/her to where he/she is today. 

(Laura Archuleta, M.D., is a family physician at the St. Alexius Center for Family Medicine in Mandan. She lives in Bismarck with her husband and three children.)