Family physicians in the United States may hold either an M.D. or a D.O. degree. Physicians who specialize in family medicine must successfully complete an accredited three- or four-year family medicine residency in the United States in addition to their medical degree. They are then eligible to sit for a board certification examination, which is now required by most hospitals and health plans.^[4] American Board of Family Medicine requires its Diplomates to maintain certification through an ongoing process of continuing medical education, medical knowledge review, patient care oversight through chart audits, practice-based learning through quality improvement projects and retaking the board certification examination every 7 to 10 years. The American Osteopathic Board of Family Physicians requires its Diplomates to maintain certification and undergo the process of recertification every 8 years.^[5]

Physicians certified in family medicine in Canada are certified through the College of Family Physicians of Canada,^[6] after two years of additional education. Continuing education is also a requirement for continued certification.

The term "family medicine" is used in many European and Asian countries, instead of "general medicine" or "general practice". In Sweden, certification in family medicine requires five years working with a tutor, after the medical degree. In India, those who want to specialize in family medicine must complete a three-year family medicine residency, after their medical degree (MBBS). They are awarded either a D.N.B. or an M.D. in family medicine. Similar systems exist in other countries.

Family physicians deliver a range of acute, chronic and preventive medical care services. In addition to diagnosing and treating illness, they also provide preventive care, including routine checkups, health-risk assessments, immunization and screening tests, and personalized counseling on maintaining a healthy lifestyle. Family physicians also manage chronic illness, often coordinating care provided by other subspecialists.^[7] Many American family physicians deliver babies and provide prenatal care.^[8] In the U.S., family physicians treat more patients with back pain than any other physician subspecialist, and about as many as orthopedists and neurosurgeons combined.^[9]

Family medicine and family physicians play a very important role in the healthcare system of a country. In the U.S., for example, nearly one in four of all office visits are made to family physicians. That is 208 million office visits each year — nearly 83 million more than the next largest medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty.^[10]

Family Medicine (FM) came to be recognized as a medical specialty in India only in the late 1990s.^[30] According to the National Health Policy - 2002, there is an acute shortage of specialists in family medicine. As family physicians play very important role in providing affordable and universal health care to people, the Government of India is now promoting the practice of family medicine by introducing post graduate training through DNB (Diplomate National Board) programs.

There is a severe shortage of post graduate training seats, causing lot of struggle, hardship and a career bottle neck for newly qualified doctors, just passing out of medical school. The Family Medicine Training seats should ideally fill this gap and allow more doctors to pursue Family Medicine careers. However, the uptake, awareness and development of this specialty is slow.^[31]

Although family medicine is sometimes called general practice, they are not identical in India. A medical graduate who has successfully completed the Bachelor of Medicine, Bachelor of Surgery (MBBS) course and has been registered with Indian Medical Council or any state medical council is considered a general practitioner. A family physician, however, is a primary care physician who has completed specialist training in the discipline of family medicine.

The Medical Council of India requires three-year residency for family medicine specialty, leading to the award of Doctor of Medicine (MD) in Family Medicine or Diplomate of National Board (DNB) in Family Medicine.

The National Board of Examinations conducts family medicine residency programmes at the teaching hospitals that it accredits. On successful completion of a three-year residency, candidates are awarded Diplomate of National Board (Family Medicine).^[32] The curriculum of DNB (FM) comprises: (1) medicine and allied sciences; (2) surgery and allied sciences; (3) maternal and child health; (4) basic sciences and community health. During their three-year residency, candidates receive integrated inpatient and outpatient learning. They also receive field training at community health centres and clinics.^[33]

The Medical Council of India permits accredited medical colleges (medical schools) to conduct a similar residency programme in family medicine. On successful completion of three-year residency, candidates are awarded Doctor of Medicine (Family Medicine).^[34][35] Govt. medical college, Calicut had started this MD (FM) course in 2011. A few of the AIIMS institutes have also started a course called MD in community and family medicine in recent years. Even though there is an acute shortage of qualified family physicians in India, further progress has been slow

The Indian Medical Association’s College of General Practitioners, offers a one-year Diploma in Family Medicine (DFM), a distance education programme of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, for doctors with minimum five years of experience in general practice.^[36][37] Since the Medical Council of India requires three-year residency for family medicine specialty, these diplomas are not recognized qualifications in India.

As India’s need for primary and secondary levels of health care is enormous, medical educators have called for systemic changes to include family medicine in the undergraduate medical curriculum.^[38]

Recently, the residency-trained family physicians have formed the Academy of Family Physicians of India (AFPI). AFPI is the academic association of family physicians with formal full-time residency training (DNB Family Medicine) in Family Medicine. Currently there are about two hundred family medicine residency training sites accredited by the National Board of Examination India, providing around 700 training posts annually. However, there are various issues like academic acceptance, accreditation, curriculum development, uniform training standards, faculty development, research in primary care, etc. in need of urgent attention for family medicine to flourish as an academic specialty in India. The government of India has declared Family Medicine as focus area of human resource development in health sector in the National Health Policy 2002 <http://mohfw.nic.in/np2002.htm>. There is discussion ongoing to employ multi-skilled doctors with DNB family medicine qualification against specialist posts in NRHM (National Rural Health Mission).^[39]

Three possible models of how family physicians will practise their specialty in India might evolve, namely (1) private practice, (2) practising at primary care clinics/hospitals, (3) practising as consultants at secondary/tertiary care hospitals.

Reference and source : https://en.wikipedia.org/wiki/Family_medicine

Dr Chaand Nagpaul

Dr Nagpaul, the BMA GP Committee Chair, and his practice have recently started using mobile technology that has achieved a reduced workload, and has made a tangible and positive difference to the way in which they care for housebound patients.

Until recently, like most GPs, he used to print out a brief two-page summary of patients’ records to take with him on home visits. These visits are for patients who by definition are mostly elderly, frail, and have multiple or complex morbidity.

“This limited summary of the patient’s record significantly compromised my clinical management – I was unable to refer to previous consultations or results, or answer questions from patients regarding a hospital admission or test results, and for those patients with memory impairment I could not rely on direct questioning.

I would scribble handwritten notes and then return to the surgery and duplicate effort by typing the entry into the patient records. If the visit took place after evening surgery, there would be a delay in the information being entered until the next morning.

For many patients, I had to defer making a clinical decision and go back to the surgery to look at the full clinical records, phone the patient back, and in some cases even revisit them. Multiply this rigmarole by a number of visits, and the workload generated and time potentially wasted were significant.”

He now uses EMIS mobile. This is a software program that is loaded on to a tablet (iPad or Android device) and wirelessly downloads the patient’s clinical data from the EMIS clinical system. 

Other clinical suppliers offer similar products, but only a minority of practices use this nationally. Systems such as this provide a scaled-down but comprehensive version of patients' medical records on the tablet during a home visit, including data on consultations spanning the past year, investigation results, medication, details of referrals, major alerts, quality and outcomes framework reminders, and even hospital letters.

He records consultations on the tablet while seeing the patient, and with a keystroke this is synchronised wirelessly into the practice clinical records in real-time. No more going back to the surgery to type up the consultation or calling the patient back because  vital information wasn’t available during the visit. The scenario is all the more advantageous when visiting multiple patients in care homes.

Not only has this significantly saved on time and work, but has the added clinical-governance benefit of managing patients more effectively and safely with access to their medical records. It has information-governance advantages of no longer carrying around pages of confidential patient data, and allows contemporaneous remote recording of my clinical entry into the patient's records while visiting a patient.

His CCG funded the software and subsidised the costs of tablets. Dr Nagpaul said “This is a facility I believe should be fully resourced by all CCGs and equivalent bodies in the devolved nations, and I strongly recommend that you ask your CCG to provide this. At a time when Government emphasis is on managing patients out of hospital, this is an inexpensive investment that can optimise our ability to care for our most vulnerable patients at home, while saving ourselves work and time.”

source : http://www.rcgp.org.uk/clinical-and-research/bright-ideas/technology-to-ease-your-workload.aspx

The Concept of Family MedicineFamily medicine is an independent academic discipline and speciality of medical science. Family medicine developed as a counterculture in response to rapid fragmentation of medical care during post second world war period into speciality and sub speciality care in the much of the developed world. The concept evolved as a concept of medical care to cater to the growing demand of the people for personalized, continued and comprehensive care.   

Thus Family medicine (FM) is a medical speciality devoted to comprehensive health care for people of all ages and provides continuing and comprehensive health care for the individual and family across all ages, genders, disease and parts of the body. It is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion.  

While family medicine evolved since 1950s and 1960s in USA and UK to its present form today.  It has been gaining momentum in Middle east, Africa, Latin America and South Asia during last couple of decades. In India there is a growing recognition and value for family medicine. It has been realized that competent primary care physicians can form the back bone of health care delivery system and can play a vital role in fulfilling the Human Resource Requirment of National Rural Health Mission which is gradually evolving into the National Health Mission (NHM).

Definitions

Definition of Family Medicine Speciality: 
Family medicine is the academic discipline that both serves and leads the specialty of family practice. It organizes curiosity, systematizes observation, advances understanding, communicates knowledge, and challenges convention. The form of family practice follows the function of family physicians.

Definition of Family Practice
Family practice is the professional discipline that trains and sustains the doctors who practice the evolving arts and sciences of family medicine. Family practice is patient centered, evidence based, family focused, and problem oriented. It shares historical roots and a worldwide movement with general practice.

European Definition of Family Doctors
Family doctors are specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness. They care for individuals in the context of their family, their community, and their culture, always respecting the autonomy of their patients. They recognise they will also have a professional responsibility to their community. In negotiating management plans with their patients they integrate physical, psychological, social, cultural and existential factors, utilising the knowledge and trust engendered by repeated contacts. General practitioners/family physicians exercise their professional role by promoting health, preventing disease providing cure, care, or palliation and promoting patient empowerment and self-management. This is done either directly or through the services of others according to health needs and the resources available within the community they serve, assisting patients where necessary in accessing these services. They must take the responsibility for developing and maintaining their skills, personal balance and values as a basis for effective and safe patient care. Like other medical professionals, they must take responsibility for 8 continuously monitoring, maintaining and if necessary improving clinical aspects, services and organisation, patient safety and patient satisfaction of the care they provide.

AAFP definition of family physician:
Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity. (1986) (2010 COD).

A physician who is educated and trained in family practice - a broadly encompassing medical specialty. Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance, and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources.

National Board of Examination (NBE) India definition of Family Medicine 

Family Medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral and social sciences. As an academic discipline, it includes comprehensive health care services, education and research. A family doctor provides primary and continuing care to the entire family within the communities; addresses physical, psychological and social problems; and coordinates comprehensive health care services with other specialists, as needed.

History of Family Medicine Specialty 
Historically doctors used to be generalist practitioners. However during the past fifty years, technological and scientific advances have brought exciting prospects in medicine. The fragmentation of medicine into subspecialties has produced advances in our understanding of diseases. Generalist mode of practice languished, while spectacular advances were made by subspecialists who were concentrated in hospitals, with expertise in single organs, systems or diseases, in the performance of specific procedures or in the use of expensive and advanced equipment.

It is precisely the development of these subspecialists and their concentration in hospitals that gave rise to a demand in the community for a physician, who was caring and accessible and who was also more expert and better trained than the general practitioner of those days, but who could act as the patient’s guide, protector, philosopher and friend. This led to the emergence of family practice as the natural inheritor of the ancient traditions of general medicine.

In USA, the American Academy of General Practice (AAGP) was established in 1947 to give voice to the decreasing number of generalists. A series of events after that paved the way for family medicine to become an accredited, board-certified, professional specialty. In 1966, three landmark reports were released by commissions that had been appointed to study the problem of declining generalists. These include:

The Folsom Report 

concluded that “every American should have a personal physician to ensure the integration and continuity of all medical services.” It also stressed the importance of preventive medicine, the use of community resources and the importance of caring for the patient as a whole.

              

The Millis Report

 Focused on graduate medical education and determined that family     medicine needed to be a board-certified specialty.

The Willard Report 

Recommended residency training programs for family medicine and   specified the establishment of a board to oversee certification. The American Board of Family Practice was established three years later in 1969.

In 1952, the British College of General Practitioners was formed. Then in 1958, The Royal  Australian College of General Practitioners was established. The family medicine counterculture was particularly strong in America and the general practitioner community worked towards a new general practice and even changed the name of the discipline from “general practice” to “family medicine” to reflect a renaissance in its culture.

Since then the counterculture movement has become worldwide. In India, though the General practice associations have existed in form of IMA College of General Practitioners (IMA CGP) and Federation of Family Physicians of India (FFPAI) represented by traditional old GPs. The forum for development of academic family medicine was only formed in 2010 in the name of Academy of Family Physicians of India (AFPI).

Changing Nomenclature 
New disciplines need new terminologies, especially when the older terminology implied lower levels of specialised training and competence as well as lower status. The different historical backgrounds to medical practice in each country have produced different terminologies for family physicians and family medicine. The term ‘family physician’ originated in USA, where it was deemed necessary to distinguish between family medicine and traditional general practice

Three alternatives to the term ‘general practitioner’ have been proposed (a) Personal physician (b) Primary physician and (c) family physician. The term ‘Primary Physician’ was used in the report of the Citizen’s Commission on Graduate Medical Education (1966) chaired by Dr. John Millis. The adoption of the term ‘family physician’, by the American Academy and the Canadian College, promoted the universal use of this term to describe the new specialist. The health policies of several developing countries including that of India are were profoundly influenced by WHO’s concept of primary health care (Health For All – HFA) movement for basic and minimal health care services.

For a country like India term ‘Primary physician’ or ‘primary care physician’ are also more suitable and appropriate terms where family practice takes on a strong community orientation in the context of a national primary healthcare programme. This term covers wide range of primary care providers including urban GPs, rural physicians, medical officers, emergency physicians, occupational physicians, doctors employed in military and public sectors enterprises etc. These doctors often provide undifferentiated clinical and preventive services to the communities they serve. 

In the UK, the term ‘general practice’ continues to exist by custom and statute but with a much higher level of acceptance and prestige. In Australia, the term ‘general practitioner’ is still in use, but the state-funded training programme is called the ‘family medicine programme’. In Europe the term ‘medicine generale’ is in use.

Practitioners of Family Medicine 
By convention the term ‘family doctor’ should be understood as referring to the following: (a) family physician, (b) general practitioner, or (c) medical officer. A family physician has postgraduate training in Family Medicine. A medical officer is a generalist in the public sector, without postgraduate training.A medical officer is a generalist in the public sector, without postgraduate training.A general practitioner is qualified private practitioner without postgraduate training.

Family medicine in India
Family medicine is a recognized speciality since 1983 by an amendment in Medical Council of India Act. Since 2005 The NBE (National Board of Examination) has been promoting family medicine as a special human resource need for National Rural Health Mission (NRHM). The National Board of Examinations is an autonomous organization functioning under the Ministry of Health & Family Welfare, Govt. of India. The prime objective of the Board is to conduct post-graduate examinations of high and uniform standard throughout the country in 42 specialties including DNB is Family medicine. National Board of Examinations is keen to encourage family medicine as a specialty programme since it serves the needs of the society by providing comprehensive and continuing care of the patients in their own settings.

As per National Board of Examination, after qualifying the final examinations the candidate should be able to function as a junior consultant (specialist) in Family Medicine. He/she should be able to render health services to the community by providing health care to all members irrespective of age, sex, culture and socio-economic background. He/she should be able to decide for appropriate referral in order to provide secondary/tertiary health services when necessary. He/she should be clinically competent and should be able to take personal responsibility for rendering comprehensive and continuing care of his patients in their own family settings.

Various policy deliberation and discussions have supported the concept of family medicine in India. These include (a) Bhore committee report (b) Bajaj Commission (c) Reorientation of Medical Education (ROME) (d) Mehta Committee Report (e) Prime Minister’s National Knowledge commission (f) National Health Policy 2002 (g) Task force for development of human resource for National Rural Health Mission (h) Planning Commission’s Steering Committee on Health in 12th Plan (i) Pradhan Mantrai Swastha Surakhas Yojana (PMSSY) by establishing department of Community and Family Medicine at new AIIMS like institutions. (j) Medical Council of India’s Vision 2015.

Family Medicine in India: Recent developments:

Calicut Medical College Kerala has become first institute to start the MD family medicine program in India. Earlier only DNB family medicine training was available at National Board of Examination affiliated institutions. Under PMSSY, all recently established AIIMS like institutions have started department of Community and Family Medicine which is a welcome change. AIIMS Bhopal has declared developing family medicine as one of its primary priorities.

Family medicine seats availability in the DNB system for Jan 2013 Session (there are two session, other one starts in July). 

www.cet.natboard.edu.in/pdoofs/Seatsfordnbcet.pdf

Leading academies and colleges of family medicine in world 
www.globalfamilydoctor.com/AboutWonca/Regions.aspx