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Can the family physicians work in hospital?


cgzca

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Probably family doctors visit patients at patients' home, or family doctors set up their own offices. Doctors who can work in hospital are internal physician?

I am wondering, can family doctors work in hospital? what is the difference between family physician and internal physician?

Thank you:)

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Family physicians do work in hospitals in addition to their clinics. I've run into my family doctor many times at various local hospitals. Usually she is there checking on her patients that needed to be admitted or attending their surgeries, but she's also there doing rounds since she has to contribute a certain amount of hours a month to the hospital. She said this is why it is so difficult to get an appointment with her, and why she always seems to be looking for another physician to join her practice.

 

Family doctors are more likely to assess the situation, then determine the treatment whether it be writing a prescription or referring them to a specialist. ER or walk-in clinic docs are somewhat similar in that regard, however they usually have not treated the patient previously - unless of course you live in a city like me where there is a huge shortage on family physicians (which is more or less the country); in that case people sometimes end up being treatment several times by the same ER or walk-in clinic doc.

 

I'm not sure if you mean internal physicians in the sense of any type of doctor who works primarily in a hospital, or an internist who also provides primary care with diagnosis and treatment for only adults with internal organ issues. But I don't know any family doctors who treat patients at home anymore - not that they don't want to I'm sure, they just do not have the time.

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Family doctors do all sorts of stuff, especially in small towns - this includes staffing the emergency room, the walk-in-clinics, admitting and treating in-patients, obstetrics, etc. Family doctors have 2 years of training. They MAY choose to do an extra year in an area of interest (Emerg, Obstetrics, Palliative Care, etc) but this extra training is not required in order to treat patients in these areas...again, this especially holds true in small towns. Some family doctors do still do home calls in my experience, but the renumeration (minimal) and the time required (lots) have resulted in this being a much less common practice than in the past.

 

In some smaller towns, the hospital will hire a family medicine-trained physician to do only in-patient work. The term most commonly used to describe such doctors is a "hospitalist" or "GP/Hospitalist."

 

Internal medicine doctors are specialists who treat more complex issues in adult patients by medical (as opposed to surgical) means. They are not restricted just to the "internal organs" as one might think from the name. For example, a Rheumatologist is a specialist who is internal-medicine trained, but who often ends up dealing with the joints (not an internal organ imo). Internists train for 3-4 years if they wish to remain as general internal medicine specialists, and longer if they sub-specialize (Eg. Cardiologists, Rheumatologists, Oncologists). Thus, they have significantly more training in dealing with medical issues of adults than do family physicians - since family physicians train for only two years and train in many areas - adult medicine, pediatric medicine, obstetrics, psychiatry, etc - instead of specializing as internists do. Internists can work in either clinic or hospitals settings - most, in my experience, do both.

 

Often, family physicians refer to internists. For example, a patient with hypertension - the family physician will work with the patient to control the hypertension using lifestyle and pharmacologic therapies. If, however, the patient's blood pressure is difficult to control and/or the patient has multiple co-morbidities (eg. diabetes, angina, obesity), the family doctor may choose to refer the patient to the internist to get a specialist's advice and help in caring for such a complicated medical patient.

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One of the issues in academic centres is that only a few family doctors have admitting privileges at the hospitals; patients that are otherwise "theirs" come under the care of a team of specialists in a black box; the FPs become dependent on the transfer notes/discharge summary/medication changes to understand what happened to their patients while in hospital.

 

On one hand that is a help to the family doc; a very sick person can chew up a lot of time sorting out their medical issues, and that could be very disruptive to an office practice. On the other hand, rarely do they have any input, their years of interaction with this patient can never be brought to bear (residents and clerks, think about it; how many times have YOU phoned a family doc about an admitted patient?), and any suggestions they might have are just that: suggestions without the weight of an order unless they have admitting privileges.

 

In the community, family docs do the whole she-bang; they might see a patient in the office, admit them to the hospital if they have chest pain or a bad pneumonia, order the tests, round, discharge them, and see them in follow-up. Some acaedmic centres have family docs manage the care of chronic, stable patients waiting for long-term care because it doesn't chew up too much of their day, and lifts the weight off the admitting teams.

 

Family docs do 2 years of training to meet licensing requirements (my classmates in family med just wrote their CCFP exams) and many do an additional year of training before practicing. Internists do 4 years (3 core, at least 1 year if general, 2-3 years in other subspecialties) to meet their FRCP licensing requirements, and write any subspecialty exams after a total of five or six years of residency. While the family doc has the breadth (paeds, psych, OB, surgical assist, etc), internists and subspecialists have the depth; that is likely why in larger centres, the predominant number of hospital-based physicians are specialists.

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