Martine Granek-Catarivas, Hayley Russ, Shani Afek, Oded Mazor · Emergency room 2 M Elective 1-Psychiatry 2 M Elective 2 2 M Training Practice 12 M +University Diploma Course May

Martine Granek-Catarivas, Hayley Russ, Shani Afek, Oded Mazor

Department of Family MedicineSharon Shomron District

Clalit Health ServicesIsrael

12017May Tel Aviv University

Background

Israel National Health Care relies mainly on a strong Primary Health Care.

The Lancet and its editor, The Lancet and its editor, Prof. Richard Horton, make an about-face and publish a volume dedicated to health in Israel, highlighting its achievements and challenges.

Published: 08.05.17 , 22:15


Background (Background (22))

In this context,In this context,In this context,In this context,

Family Family Medicine Medicine as evolved from as evolved from apprenticeship…apprenticeship…

2017May Tel Aviv University 3

Background (Background (33))

… to an academic discipline…… to an academic discipline…

In the sixties : compulsory In the sixties : compulsory clerkship clerkship in Family Medicinein Family Medicine In the seventies : introduction of a specialty training in FMIn the seventies : introduction of a specialty training in FM


Academic discipline : Curriculum of Academic discipline : Curriculum of

Specialty TrainingSpecialty Training

� Training Practice 15 M

� Internal Medicine 10 M

� Pediatrics 5 M� Pediatrics 5 M

� Emergency room 2 M

� Elective 1 - Psychiatry 2 M

� Elective 2 2 M

� Training Practice 12 M

+ University Diploma Course


Is this a reality?Is this a reality?


The purpose of the Survey� To provide data concerning the clinical boundaries of

Family Medicine in Europe.

� The results served as a basis to debates held at a conference about the future of the profession in Israel.

� Three fields of practice were sampled, being considered as the most challenging ones:

� Three fields of practice were sampled, being considered as the most challenging ones:

1. Pediatric care : do Family Physicians treat patients from cradle to grave ?

2. Gynecologic care: by Family Physicians or Gynecologists only ?

3. Sub specialties : why to some Family Physicians opt to sub specialize?


28 28 EURACT Countries participantsEURACT Countries participants










… Others who usually initiate … Others who usually initiate

pills treatmentpills treatment



Who else is usually responsible for Who else is usually responsible for

normal pregnancy follow up and care ?normal pregnancy follow up and care ?


Comments from DenmarkComments from Denmark

ALL GPs take care of children from birth and upwards.and upwards.


Comments from SwedenComments from Sweden

� Gynecology and care of children is a natural part of ordinary work in Family Medicine in Sweden and thus also a part of the specialty training with rotation and also a part of the specialty training with rotation and training in GP practice combined.


Comments from FinlandComments from Finland

� A GP cannot choose to care or not to care for children. A GP treats everyone who enters the clinic.

� And for specialist training to be a GP, all have a rotation in a healthy baby clinic and in a pregnancy clinic in communities. clinic in communities.

� Additionally most choose a voluntary rotation of pediatrics and ObGyn in a hospital setting.

� But: the social and health reform threatens this system: in future the GPs will probably not care for pregnant moms AND the children. We shall see how it goes.


Comments from RussiaComments from Russia

� In rural places GPs’ treat pediatric patients from birth, in urban places they treat adults only.

� Concerning additional specialty: it is rather rare to complete an additional training program in a sub-specialty for a separate license. One can take an additional training course or program for geriatric, etc


Comments from SwitzerlandComments from Switzerland

� A few years ago, the specialties of General Practice and Internal Medicine have merged to be General Internal Medicine.

� Three years of Internal Medicine in hospital are mandatory, two years are optional, with a vast choice.

� Training in Pediatrics is optional, usually in hospital setting.

� Many older GP’s have been trained in Pediatrics, a few in ObGyn.

� In many rural places, GPs care for healthy children’s vaccinations and minor ailments.

� The trend is towards pediatricians caring for kids…

� The only subspecialty in General Internal Medicine is Geriatrics. Endocrinology, Emergency Medicine, Infectiology are separate specialties.


Questions concerning the future

of Family Medicine

Should Curricula of Specialty Training undergo standardization concerning the training in pediatrics and ObGyn?

Are different European countries developing different policies concerning these fields?policies concerning these fields?

Are patients , parents and some market forces influencing the scope and boundaries of Family Medicine?

If Family Physicians take sub-specialties , is it in order to counteract professional burning out or improve their status?


From Global Family Doctor WONCA President’s message:

Prof. Amanda Howe

May 19th is our special day of the year, where we special day of the year, where we remind ourselves and the rest of the world that our work deserves recognition and celebration.




In Holland , In Holland ,

the assistants the assistants love the GP love the GP love the GP love the GP

(today only) !(today only) !

19 19 May May



Documents

Martine Granek-Catarivas, Hayley Russ, Shani Afek, Oded Mazor · Emergency room 2 M Elective 1-Psychiatry 2 M Elective 2 2 M Training Practice 12 M +University Diploma Course May