[acrosome]

Sorry, yes:

FP = family practice. By definition an FP is sort of a generalist who learned a little pediatrics, a little internal medicine, and a little obstetrics.

Internist = IM = internal medicine, or sometimes called "adult general medicine", i.e. the guy who takes over once the pediatrician has timed out. Internists don't learn pediatrics or obstetrics- they concentrate on adults ages 18 to whenever they die. Yet technically in most states pediatricians are licensed to care to people up to the age of 21, believe it or not.

OTOH, yes, an "intern" is someone who has graduated medical school and is now in the first year of a residency. After the first year you are called a "resident."

Anyway, most of you are mis-using the term GP or "general practitioner." You're using GP as a synonym for "primary care", and it is not. At least in U.S. vernacular a GP is a doctor who graduated from medical school and then went into practice- full-stop. Most significantly, he has not completed a residency (though most have done a 1-year internship somewhere). They are not board-certified, nor even board-eligible. (Or they could be someone who flunked out of residency and didn't wan to start another, or who couldn't find a residency to accept them after their internship.) This is very uncommon nowadays. Most practicing GPs are dinosaurs who are nearing retirement, if you could even find one. Perhaps in a small rural town somewhere? These old guys are sort of grandfathered in. It is otherwise nowadays (quite literally) impossible to get admitting privileges at a hospital without a residency. There really aren't that many left. It's also dangerous to just hang up your shingle and start your own clinic.

Lawyer: So, Dr. Smith, where did you do your residency?
Smith: Well, er, um, I didn't really do a residency-
Lawyer: Ka-ching! It's like a license to print money!

FWIW, GS = general surgery (e.g. me). General surgeons do all of the surgery for which you can't think of a subspecialist. So, no orthopedics, no cardiothoracic, no ENT, no GYN, no vascular, no neurosurgery, etc. Everything else is GS, which amounts to abdominal organs, hernias, skin excisions (i.e. tumors), and general trauma. Yes, there is some overlap. For instance there are specialist trauma surgeons, but they aren't common and are basically intensive care specialists. All GS surgeons learn a lot of trauma. Plus, trauma fellowships are disappearing and being replaced with "acute care surgery" fellowships, and the medical intensivists (a subspecialty of internal medicine) are starting to take over the trauma ICUs. Likewise, dermatologists excise skin cancers and just call me when it is very large. Most GS surgeons will excise varicose veins even though it's technically a vascular procedure. (And can do all sorts of cardiac and vascular repairs for trauma.) Most GS surgeons can remove a thyroid or parathyroid, even though the ENTs are the real experts. Any GS surgeons will do a VATS (sticking a scope in the chest cavity) if he has to- for instance for a lung decortication or pleurodesis- even though that's thoracic surgery. Etc.

Originally Posted by Refplace

This could make a decent Pyramid article or even fit into a few of the E23 wish list items.

This has been brought up before, in the thread that I linked. Unfortunately I don't really have the time to do it myself. Others have expressed an interest, and I offered to consult and answer questions, but I simply can't commit to more than that.

Originally Posted by DangerousThing

No, the fictitious Dr. House is a diagnostician, which is the specialty of diagnosis.

There is no such specialty as a "diagnostician." Every physician is a diagnostician, with few possible exceptions. (Radiation oncologists?) Trust me, Dr. House is an internist- albeit one who has carved himself a very specific niche in his institution. And you'll note that he also treats his patients- or at least the ones that are treatable. That's Physician skill.

Originally Posted by Rasputin

Add the extra prep time spent looking over the patient's chart. That's time a field medic doesn't and can't spend.

I was counting prep time. Primary care is freakin out of hand in the U.S. Luckily I'm a specialist, and I work for the government to boot, so I get 30 minute clinic slots. I'm not uncommonly double-booked, but it's the thought that counts, right? :)

FYI- "Primary care" means any doctor who you might see first for a problem that isn't an emergency. They are "your doc", i.e. non-specialists. So, in general: pediatricians, FPs, internists. If they can't figure it out (or if they can but you need special care) they send you to a specialist.

Originally Posted by DouglasCole

I started seeing an internal medicine specialist in my 30's. They mean adults as distinct from pediatric medicine. Geriatric medicine is the specialty for older adults.

Correct. Geriatrics is something else (usually a subspecialty of internal medicine). I don't know if there is a formal fellowship for it- I think in general if you want to do that you just take some courses, then start selecting for old patients.

FYI- pediatricians get really pissy if you try to tell them that kids are just little adults... :P