To the Editor:
In the latest issue, Nikolaos Nikitidis1 presented WONCA Europe’s 2023 definition for General Practice/Family Medicine.2 It builds on WONCA’s founding name (World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians), previous definitions of the field, and considers emerging needs and contents (eg, Health and Sustainability).3–6 However, by framing our discipline as General Practice/Family Medicine, all definitions fail to recognize that in most parts of the world, physicians graduating from medical schools practice medicine as general physicians without additional postgraduate training.7–9 This is the case in most countries in Asia, Latin America, some European countries, India, South Africa, etc. In these countries, general physicians provide the bulk of primary care services and could pursue Family Medicine training if they desire to advance their professional skills, but is not required to provide clinical services in primary care. This lack of distinction between general practice without postgraduate training and the practice of family medicine, which includes residency or additional training and certification after medical school graduation, creates confusion and is troublesome to our field. In these contexts, patients, researchers, decision-makers, and other health care professionals, including physician colleagues, frequently fail to recognize the added value of family medicine training, despite evidence that patients receiving care at health care centers with a greater number of family physicians achieve better health (eg, improved chronic disease indicators, higher immunization rates, and enhanced maternal and child health indicators) and have greater satisfaction compared with patients seen at health care centers with only general practitioners.10,11
Research in this area is limited because the countries producing most published primary care research (United States, United Kingdom, Australia, and Canada)12,13 require additional training to practice medicine and, therefore, do not have general and family physicians coexisting in their primary care workforce.6,7 Physicians without additional postgraduate training should not have the same knowledge and skills as family physicians who complete a postgraduate residency or a supervised internship, and therefore, should be treated as a different type of primary care clinician. Even though family physicians are generalists,14 not all generalists are family physicians. Clarifying the difference in knowledge, skills, roles, and outcomes between general and family physicians is essential to the future of our discipline, and a future professional definition of our discipline should clarify them.
