Tiago Villanueva: GPs are specialists too

Tiago_VillanuevaIn Portugal, general practitioners (GPs) are considered “specialists,” as general practice/family medicine is considered a specialty like any other hospital specialty. This is also the case in many other European Union/European Economic Area (EU/EEA) countries. If there’s a more satisfying moment than qualifying from medical school, it must be finishing specialist training. Becoming a “specialist” is a major milestone in the medical career ladder, and “generalism” is a specialty in its own right. GPs may not be as proficient in cardiology or vascular surgery as a cardiologist or a vascular surgeon, but they are specialists in “people,”—with a whole range of biological, psychological, social, and spiritual dimensions—and are ideally suited to approach patient’s problems in an integrated way.

However, the path to becoming a GP differs widely across Europe. In Italy or the Netherlands, for example, vocational training is three years long, whereas in Denmark it takes five years (http://www.gptraining.eu). In neighbouring Spain, even though there’s excellent training available, GP trainees do not undergo any sort of summative “exam type” assessment at the end of their vocational training. Here in Portugal, GP trainees as well as trainees from any hospital specialty are subject to a three day examination that covers assessment of your CV/portfolio, practical skills, and theoretical skills. The first day consists of a discussion and questions about the vocational training portfolio and writing a comprehensive report describing all our clinical and scientific activity in detail. On the second day, we take a history from an actual patient (previously selected by the exam panel) and discuss this with the panel. The final day entails an oral examination by the panel, which is pretty tricky since it can include almost any subject in the vast spectrum of general practice.

Many patients and even many colleagues from other specialties around here are not aware that GPs  are specialists in the same way as any hospital physician. Patients will often ask me “So, when are you going to specialise?” When I have my hair cut, my hairdresser always asks me what my specialty is. Status is important, and I am confident that general practice will become acknowledged as a specialty across Europe during my lifetime. But what is more important than status is to have competent and caring professionals who, even if carrying out vocational training programmes that may differ substantially in terms of their structure and content, may uphold similar technical and scientific standards. Standards of postgraduate training should not differ substantially, whether one works in Lisbon or in Helsinki.

Tiago Villanueva is a newly qualified general practitioner based in Lisbon, Portugal, and a former BMJ Clegg Scholar and editor, studentBMJ

  • Dylan

    Why does it matter? I'm also a GP but I'm proud of the fact that I DON'T consider myself a “specialist”. Because to me, to “specialise” means to develop a deep knowledge of a narrow field while being unconcerned about ones ignorance of other areas.
    I don't see “specialising” as in any way superior to “generalising” and I'm proud to be a generalist.

  • Tiago Villanueva

    I would just like to add that GP training final examinations I've mentioned in the blog are public, so anyone can come and watch the examinations. Usually, many GP trainees who will carry out the examination in the near future like to go and watch these examinations so as to understand better the kind of questions they will be asked. The fact that these examinations are public also enhances transparency.