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Career Progression General Discussion and Questions

chinaski

Regular Member
Certain specialties are extremely hard to get in. Some junior doctors have tried for years still unable to get an accredited training position. Maybe they don't want to switch to something else less competitive, I don't know. But it's like another round of med admission later in life - if you can't get into med go for physio, if you can't get neurosurgery go for palliative care for example.

Making a life choice to follow a certain discipline is usually done with more maturity and insight than most school leavers possess when they pick a uni course. As such, it's not a matter of just picking a random "other" specialty if you can't get onto the programme of your first choice. To pick another programme, you must have an abiding-enough interest and adequate ability to sustain a life-long career in that area. For many, that does not exist outside of their primary area of interest.

Hopefully chinaski will help answer this.

You are not a GP without a fellowship. It is not possible to complete internship and then call yourself a GP and practise as one, as was the case some decades ago.
 

Tomato

Regular Member
Making a life choice to follow a certain discipline is usually done with more maturity and insight than most school leavers possess when they pick a uni course. As such, it's not a matter of just picking a random "other" specialty if you can't get onto the programme of your first choice. To pick another programme, you must have an abiding-enough interest and adequate ability to sustain a life-long career in that area. For many, that does not exist outside of their primary area of interest.



You are not a GP without a fellowship. It is not possible to complete internship and then call yourself a GP and practise as one, as was the case some decades ago.

What is the major difference between a GP and a general physician? I know a GP is a specialist but the name sounds more like a generalist.
 

chinaski

Regular Member
A general physician is a fellow of the College of Physicians, and is a specialist in general medicine. A general practitioner is a fellow of the College of General Practitioners, and is a specialist in general practice. General practitioner = GP.
 

Tomato

Regular Member
A general physician is a fellow of the College of Physicians, and is a specialist in general medicine. A general practitioner is a fellow of the College of General Practitioners, and is a specialist in general practice. General practitioner = GP.

So what is the major difference of the scope of practice between a physician and a GP? To me a physician is a all-round specialist in general/internal medicine, and a GP is more like a generalist who knows a bit everything but not in depth. Is there any further explanation? Thank you.
 

Cathay

🚂Train Driver🚆
Emeritus Staff
So what is the major difference of the scope of practice between a physician and a GP? To me a physician is a all-round specialist in general/internal medicine, and a GP is more like a generalist who knows a bit everything but not in depth. Is there any further explanation? Thank you.
Generally speaking (no pun intended), and in the urban context at least, a GP is a primary care doctor, your "family doctor" kind of role, working in the community (i.e. in a GP clinic and the like). GPs are generally the first point of contact for patients (unless they went straight to the Emergency Department).

A physician, on the other hand, would generally be a hospital doctor specialising in a medical (as opposed to surgical) specialty. So we're talking about the likes of cardiologists, respiratory physicians, gastroenterologist, nephrologists, endocrinologists, neurologists, paediatricians, geriatricians, haematologists*, infectious diseases specialists*, rheumatologists, medical oncologists, etc. (*: some require dual training, e.g. haematologists and infectious diseases often have dual training between physician college and pathology college.)

A General Medicine physician is a physician who has training in General & Acute Care Medicine; and Gen Med (in my limited experience and understanding as a former med student) tends to handle acute medical^ hospitalisations that don't go straight to a particular medical^ specialty; undifferentiated presentations (cases that are hard to figure out); or cases requiring input from multiple specialties. This is as opposed to "heart attacks" (acute MI) going straight to cardiology, or strokes going to neurology or dedicated stroke unit. Notably, at least in NZ, many physicians dual-train between Gen Med and another medical^ specialty - e.g. GM+cardio, GM+resp, GM+neuro, GM+endocrine, GM+InfectiousDiseases, GM+ClinPharm, etc.

(^: "medical" meaning internal medicine, as opposed to surgical / obgyn / psych.)

A GP never really knows what the next patient will come in with, and need to know "a bit of everything" - medicine, surgery, Obs & Gynae, psych, paeds, dermatology, etc; they need to do screening (cardiovascular risk, blood pressure, prostate exams etc etc), they need to be good at managing things that don't need a hospital specialist (most commonly hypertension, diabetes, asthma, etc), know and recognize red flags for serious concern (symptoms and signs indicative of malignancy), and know when to refer patients to specialists, which specialty to refer to, and how urgently - should you send the patient straight to ED by ambulance, should you phone the hospital and send patient there in a couple of hours with a letter, or is it just a matter of posting a referral letter for a potential outpatient consult in a few months? Some GPs perform minor surgery too (skin lesion excision etc).
 

Tomato

Regular Member
Generally speaking (no pun intended), and in the urban context at least, a GP is a primary care doctor, your "family doctor" kind of role, working in the community (i.e. in a GP clinic and the like). GPs are generally the first point of contact for patients (unless they went straight to the Emergency Department).

A physician, on the other hand, would generally be a hospital doctor specialising in a medical (as opposed to surgical) specialty. So we're talking about the likes of cardiologists, respiratory physicians, gastroenterologist, nephrologists, endocrinologists, neurologists, paediatricians, geriatricians, haematologists*, infectious diseases specialists*, rheumatologists, medical oncologists, etc. (*: some require dual training, e.g. haematologists and infectious diseases often have dual training between physician college and pathology college.)

A General Medicine physician is a physician who has training in General & Acute Care Medicine; and Gen Med (in my limited experience and understanding as a former med student) tends to handle acute medical^ hospitalisations that don't go straight to a particular medical^ specialty; undifferentiated presentations (cases that are hard to figure out); or cases requiring input from multiple specialties. This is as opposed to "heart attacks" (acute MI) going straight to cardiology, or strokes going to neurology or dedicated stroke unit. Notably, at least in NZ, many physicians dual-train between Gen Med and another medical^ specialty - e.g. GM+cardio, GM+resp, GM+neuro, GM+endocrine, GM+InfectiousDiseases, GM+ClinPharm, etc.

(^: "medical" meaning internal medicine, as opposed to surgical / obgyn / psych.)

A GP never really knows what the next patient will come in with, and need to know "a bit of everything" - medicine, surgery, Obs & Gynae, psych, paeds, dermatology, etc; they need to do screening (cardiovascular risk, blood pressure, prostate exams etc etc), they need to be good at managing things that don't need a hospital specialist (most commonly hypertension, diabetes, asthma, etc), know and recognize red flags for serious concern (symptoms and signs indicative of malignancy), and know when to refer patients to specialists, which specialty to refer to, and how urgently - should you send the patient straight to ED by ambulance, should you phone the hospital and send patient there in a couple of hours with a letter, or is it just a matter of posting a referral letter for a potential outpatient consult in a few months? Some GPs perform minor surgery too (skin lesion excision etc).
Thank you for the detailed explanation.
 

chinaski

Regular Member
From the General and Acute Care Medicine advanced training curriculum (link to the pdf here: General and Acute Care Medicine):

"General physicians are also able to provide the necessary support to primary care providers in general practice and other ambulatory settings following discharge and over the longer term. A major differentiating feature between general physicians and general practitioners is the specialised diagnostic and management expertise of the general physician. Put simply, general practitioners may refer patients to consultant general physicians when there are diagnostic issues, or acute or complex management needs, beyond the capability of the general practitioner to provide."

Aside from the very different training pathways, other salient points:

1. General medicine either involves purely adult medicine, or purely paediatric medicine, but not both. General practice covers all stages of life and expects a broad competency in the same.

2. The public can't self-refer to a general physician and be eligible for Medicare rebates. Obviously they can to a general practitioner.

3. The role and scope of referrals and practice of general medicine is different in rural areas compared to that of the city. Generalists are involved quite a bit more in rural areas in the provision of services that would otherwise be covered by other medical specialists in an urban setting.
 

ProfessorPond

Yahallo!
Is there a valid pathway for medical research instead of a clinical career for MBChB graduates? I would love to have the opportunity to research as a job but I haven't really seen any career pathways for that.
 

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A1

Rookie Doc
Moderator
Is there a valid pathway for medical research instead of a clinical career for MBChB graduates? I would love to have the opportunity to research as a job but I haven't really seen any career pathways for that.

I think if you manage to get a full-time job with a med school that would involve teaching + research.
 

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