Modern meanings

Specialist in internal medicine

Around the world the term physician refers to a specialist in internal medicine or one of its many sub-specialties (especially as opposed to a specialist in surgery). This meaning of physician conveys a sense of expertise in treatment by drugs or medications, rather than by the procedures of surgeons.

This term is at least nine hundred years old in English: physicians and surgeons were once members of separate professions, and traditionally were rivals. The Shorter Oxford English Dictionary, third edition, gives a Middle English quotation making this contrast, from as early as 1400: "O Lord, whi is it so greet difference betwixe a cirugian and a physician."

Henry VIII granted a charter to the London Royal College of Physicians in 1518. It was not until 1540 that he granted the Company of Barber-Surgeons (ancestor of the Royal College of Surgeons) its separate charter. In the same year, the English monarch established the Regius Professorship of Physic at the University of Cambridge. Newer universities would probably describe such an academic as a professor of internal medicine. Hence, in the 16th century, physic meant roughly what internal medicine does now.

Currently, a specialist physician in the United States may be described as an internist. Another term, hospitalist, was introduced in 1996, to describe US specialists in internal medicine who work largely or exclusively in hospitals. Such 'hospitalists' now make up about 19% of all US general internists, who are often called general physicians in Commonwealth countries.

This original use, as distinct from surgeon, is common in most of the world including the United Kingdom and other Commonwealth countries (such as Australia, Bangladesh, India, New Zealand, Pakistan, South Africa, Sri Lanka, and Zimbabwe), as well as in places as diverse as Brazil, Hong Kong, Indonesia, Japan, Ireland, and Taiwan. In such places, the more general English terms doctor or medical practitioner are prevalent, describing any practitioner of medicine (whom an American would likely call a physician, in the broad sense). In Commonwealth countries, specialist pediatricians and geriatricians are also described as specialist physicians who have sub-specialized by age of patient rather than by organ system.

Physician and surgeon

Around the world, the combined term "physician and surgeon" is used to describe either a general practitioner or any medical practitioner irrespective of specialty. This usage still shows the original meaning of physician and preserves the old difference between a physician, as a practitioner of physic, and a surgeon. The term may be used by state medical boards in the United States, and by equivalent bodies in Canadian provinces, to describe any medical practitioner.

North America

In modern English, the term physician is used in two main ways, with relatively broad and narrow meanings respectively. This is the result of history and is often confusing. These meanings and variations are explained below.

In the United States and Canada, the term physician describes all medical practitioners holding a professional medical degree. The American Medical Association, established in 1847, as well as the American Osteopathic Association, founded in 1897, both currently use the term physician to describe members. However, the American College of Physicians, established in 1915, does not: its title uses physician in its original sense.

American physicians

The vast majority of physicians trained in the United States have a Doctor of Medicine degree, and use the initials M.D. A smaller number attend Osteopathic schools and have a Doctor of Osteopathic Medicine degree and use the initials D.O. After completion of medical school, physicians complete a residency in the specialty in which they will practice. Subspecialties require the completion of a fellowship after residency.

All boards of certification now require that physicians demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every seven and every ten years.

Primary care

Primary care physicians guide patients in preventing disease and detecting health problems early while they're still treatable. They are divided into two types: family medicine doctors and internal medicine doctors. Family doctors, or family physicians, are trained to care for patients of any age, while internists are trained to care for adults. Family doctors receive training in a variety of care and are therefore also referred to as general practitioners. Family medicine grew out of the general practitioner movement of the 1960s in response to the growing specialization in medicine that was seen as threatening to the doctor-patient relationship and continuity of care.

Podiatric physicians

Also in the United States, the American Podiatric Medical Association (APMA) defines podiatrists as physicians and surgeons that fall under the department of surgery in hospitals. They undergo training with the Doctor of Podiatric Medicine (DPM) degree. In the US, podiatrist are required to complete three to four years surgical residency upon graduating from DPM degree. After residency, one to two years of fellowship programs are available in plastic surgery, foot and ankle reconstructive surgery, sports medicine, and wound care. This degree is also available at one Canadian university, namely the Université du Québec à Trois-Rivières. Students are typically required to complete an internship in New York prior to the obtention of their professional degree.