In English, there have been many synonyms for physician, both old and new, with some semantic variation. The noun phrase medical practitioner is perhaps the most widely understood and neutral synonym. Medical practitioner is lengthy but inclusive: it covers both medical specialists and general practitioners (family physician, family practitioner), and historically would include physicians (in the narrow sense), surgeons or apothecaries. In England, apothecaries historically included those who now would be called general practitioners and pharmacists.

In some jurisdictions, specialty training is begun immediately following completion of entry-level training, or even before. In other jurisdictions, junior medical doctors must undertake generalist (un-streamed) training for one or more years before commencing specialization. Hence, depending on jurisdiction, a specialist physician (internist) often does not achieve recognition as a specialist until twelve or more years after commencing basic medical training — five to eight years at university to obtain a basic medical qualification, and up to another six years to become a specialist.

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ISLAMABAD – A decision by Taliban militants to withdraw from a peace deal in a tribal region close to the Afghan border threatens to open a new front for the Pakistan army as it battles the insurgents in two other areas.
Militants close to the border are behind a spate of bombings that are destabilizing nuclear-armed Pakistan. They are also blamed for attacks on Western troops in Afghanistan, where violence is running at record levels eight years after the U.S.-led invasion.
The disintegration of the truce in North Waziristan was the latest failure of a government pact with local Taliban leaders. The agreements have been criticized abroad because they effectively cede space to the insurgents.
The current government offensive in the Swat Valley — which began after a peace deal there fell apart — and an artillery and air campaign in South Waziristan have been praised by the United States, which has been trying since the Sept. 11, 2001, attacks to get Islamabad to take military action against Taliban and al-Qaida fighters in the border region.
Militants in North Waziristan announced Monday that they had pulled out of a peace deal with the government dating back to early 2008, citing attacks by the army and missile strikes by the United States. The move followed a weekend ambush by insurgents on an army convoy in the region that killed at least 16 soldiers, among them three officers.
Army spokesman Maj. Gen. Athar Abbas vowed Tuesday to avenge the attack.
"There is now a new situation in North Waziristan," he said. "Lets see how we are going to handle this," he said, declining to elaborate.
The border region is a lawless, mountainous region where the central government has little control.
Pakistan began its offensive in the Swat Valley region in late May after militants there advanced on the capital, violating the terms of the peace deal. The military claims to have killed more than 1,000 fighters and has retaken much of the district, but most of the some 2 million people who fled the fighting have yet to return.
This month, the army began bombing targets in South Waziristan, saying it was softening up the region for an offensive targeting Baitullah Mehsud, the leader of Pakistan's major Taliban faction who has been blamed for many of the county's most deadly suicide attacks in recent years.
The scrapping of the accord to the north adds to the difficulties facing the army.
"The group they are trying to neutralize has become bigger, as has the area they will need to contain them," said Shahzad Chaudhry, the former deputy head of the Pakistani air force and a security analyst. "The attempt was to try and reduce the size of the opposing forces, but now it seems the army have a bigger problem at hand. It will have to be a long-haul fight now."
Details of the peace deal had not been made public, but it had appeared to cause a reduction in attacks on Pakistani military targets in North Waziristan compared to other parts of the border region. But U.S. and NATO commanders in Afghanistan said the region was being used by fighters there as a safe haven.
Since August, the United States has fired more than 40 missiles at suspected militant targets in the tribal regions in a sign of its frustration with Islamabad. The strikes have killed many militants but have also served as a rallying cry for the insurgents.
A spokesman for North Waziristan Taliban leader Hafiz Gul Bahadur cited those attacks when pulling out of the deal.
"This accord is being scrapped because of Pakistan's failure to stop the American drone attacks in North and South Waziristan," Ahmadullah Ahmadi told The Associated Press. "Since the army is attacking us in North and South Waziristan, we will also attack them."
The offensives against the militants have been broadly welcomed by most Pakistanis, but this support could waver as the campaign drags on. Pakistan has more than 100,000 troops in the region, but most are poorly trained for counterinsurgency.
The army offensive in the tribal region suffered another blow last week when gunmen assassinated Qari Zainuddin, a militant leader in South Waziristan who opposed Mehsud and was seen as close to the government. A Mehsud aide allegedly carried out the slaying.

The News, a leading English-language newspaper, said in an editorial that Sunday's ambush and the scrapping of the accord showed the tough fight ahead in the Waziristans, where the militants have had years to dig in and prepare their defenses.

"This is going to be no sweeping up of a few raggle-taggle remnants," it said. "This is going to be a hard-fought bitter battle against a force no less able, and perhaps better equipped, than our own."

Also Tuesday, a car bomb struck trucks taking supplies to Western troops in Afghanistan, killing four people in Pakistan's southwest, police said. No one claimed responsibility for the explosion in Baluchistan province, but militants have frequently targeted supply trucks for U.S. and NATO troops that travel through Pakistani territory.

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Associated Press Writer Abdul Sattar contributed to this report from Quetta.

PITTSBURGH – The Pittsburgh Pirates, swapping outfielders at a rapid rate for the second successive season, sent starting left fielder Njyer Morgan to the Washington Nationals in a four-player deal involving outfielder Lastings Milledge and also shipped backup Eric Hinske to the Yankees on Tuesday.
The Pirates, who have pushed to restock a thin farm system by making numerous trades over the last year, get Milledge and reliever Joel Hanrahan from the Nationals for the fleet Morgan and left-hander Sean Burnett, a former first-round draft pick.
Earlier, they sent 2002 AL Rookie of the Year Hinske to the Yankees for minor-league right-hander Casey Erickson and outfielder Eric Fryer. The Yankees also get some cash to help pay Hinske's $1.5 million salary.
Just as they did last season by dealing Jason Bay and Xavier Nady, the Pirates have traded two of their three starting outfielders before Aug. 1. They sent former NL All-Star center fielder Nate McLouth to the Braves on June 4 for pitcher Charlie Morton and two other prospects.
Though rumored for several days, the Nationals trade is somewhat surprising because the Pirates dealt Morgan — who turns 28 on Thursday — less than halfway through a promising first season as a starter. He is hitting .277 with 2 homers and 27 RBIs, only four fewer than No. 3 hitter Freddy Sanchez, and has 18 steals, although he has been thrown out 10 times.
Milledge, a former top Mets prospect, has played in only seven games with Washington while part of the season rehabilitating a broken right ring finger that required surgery in May. He is expected to join Triple-A Indianapolis before being called up by Pittsburgh later this month.
Milledge, 23, has more power than Morgan — he has 25 homers in 897 career at-bats — but has bothered frequently by injury problems that include a broken right hand, sore foot and groin strain. He hit .268 with 14 homers, 61 RBIs and 24 doubles in 138 games last season, earning him a spot on the cover of the Nationals' media guide this season.
Still, Milledge was a major disappointment to the Nationals, who dealt two starters — catcher Brian Schneider and outfielder Ryan Church — to acquire Milledge from the Mets in November 2007.
The right-handed Hanrahan, 27, is 0-3 with a 7.71 ERA in 34 games — he was demoted from the closer's job — and has a 5.30 ERA in 115 career games. Burnett, the Pirates' top pick in 2000, is 1-2 with a 3.06 ERA in 38 games and has pitched in 96 games the last two seasons.
The 31-year-old Hinske hit .255 in 106 at-bats this season with nine doubles, one homer and 11 RBIs, playing right field, first base and third base. He was 8 for 24 as a pinch hitter and has been disappointed by a lack of playing time.
Through June 29 last year, he had 13 home runs en route to a 20-home run season with the AL champion Tampa Bay Rays. He won the rookie award with Toronto in 2002, when he hit .279 with 24 homers and 84 RBIs, and was a member of Boston's World Series championship team in 2007.
The 23-year-old Erickson was 3-3 with a 2.25 ERA in three starts and 18 relief appearances at Class A Charleston this season. Fryer, also 23, hit .250 with 11 doubles, two homers, 24 RBIs and 11 steals for Class A Tampa after leading the South Atlantic League with a .335 average last year for West Virginia. He was obtained by the Yankees in February for left-hander Chase Wright.
To fill Hinske's roster spot, Pittsburgh purchased the contract of 28-year-old outfielder Garrett Jones from Triple-A Indianapolis, where he hit .307 with 18 doubles, 12 homers, 48 RBIs and 14 steals.

LOS ANGELES – Santa Barbara County officials are in a meeting about Michael Jackson plans, and E! Online reports they are discussing a possible memorial service at his Neverland Ranch.
Lt. Butch Arnoldi, a Sheriff's Department spokesman, told E!: "Our guys are meeting as we speak with the California Highway Patrol to discuss the security issues."
Santa Barbara County Fire spokesman Capt. David Sadecki confirmed to The Associated Press that fire officials, California Highway Patrol and county sheriffs officials were meeting Tuesday morning to discuss "the whole Michael Jackson thing."
"The Santa Barbara County Fire Department is willing to accommodate the Jackson family with whatever request they have regarding a funeral procession should they have one," Sadecki said.
Sadecki said he had not yet talked representatives in the ongoing meeting but expected an update later in the afternoon.
Neverland is located in the rolling hills of central California's wine country, about 150 miles northwest of Los Angeles.
Rick Quintero, a spokesman for the California Highway Patrol, said the CHP had not received a request for a motorcade as of Tuesday morning. He said if the motorcade crosses through CHP jurisdiction, as it likely would from Los Angeles to Neverland, they would need to be notified.
"They would definitely need to notify us because it's going to impact the motoring public. At the point they decide it is going to happen we have to be involved because it's going to impact our jurisdiction," Quintero said.
At once a symbol of Jackson's success and excesses, Neverland became the site of a makeshift memorial after his death Thursday. Scores of fans have streamed past the gated entrance to leave handwritten notes, photographs, balloons and flowers.
He was 29 and at the height of his popularity when he bought the ranch, naming it after the mythical land of Peter Pan, where boys never grow up. There, he surrounded himself with animals, rides and children.
Jackson fled the ranch — and the country — after his acquittal on charges that he molested a 13-year-old cancer survivor in 2003 at the estate after getting him drunk.
Jackson moved luxury cars, artwork, jewelry, costumes and other property off the ranch last year for an auction that never occurred.