From the Wonca President-Elect :
Embrace the Upcoming Generation
of Family Physicians
2
From the CEO’s Desk
:
The International Classification of Primary
3
Care (ICPC-2) - A Wonca Product
From the Editor
:
A Special Wonca 2007 Invitation to FP/GP
4
Journal Editors
FEATURE STORIES
5
• Call for Nominations for Wonca Award of Excellence in Health Care
• Wonca Establishes Working Party on Mental Health
• Register Online for Wonca 2007 in Singapore
Wonca REGIONAL NEWS
7
• Asia Pacific Holds Research Workshop in Bangkok
• Letter to Editor: Family Medicine and Culture in Argentina
and Greece
HEALTH AND HEALTH SYSTEM NEWS
9
• Primary Care Contributions to Health Systems and Health:
International Comparisons
MEMBER AND ORGANIZATIONAL NEWS
12
• AAFP International Family Medicine Updates
• Walter Rosser - Wonca Global Family Doctor for January
RESOURCES FOR THE FAMILY DOCTOR
14
• Women in Training
• Wonca Europe Region Online
WONCA CONFERENCES 2007-2011 AT A GLANCE
17
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
18
VOLUME 32
NUMBER 6
FEBRUARY 2007
CONTENTS
Wonca website:
http://www.GlobalFamilyDoctor.com
Wonca President
Prof Bruce Sparks, South Africa
2 Cruden Bay Road
Greenside
Johannesburg 2193
South Africa
Tel: 27 11 646 2140
Fax: 27 11 717 2558
Email: brucespa@global.co.za
Wonca Chief Executive Officer
Dr Alfred W T Loh
Wonca Administrative Manager
Ms Yvonne Chung
World Organization of Family Doctors
College of Medicine Building
16 College Road # 01-02
Singapore 169854
Tel: 65 6224 2886
Fax: 65 6324 2029
Email: admin@wonca.com.sg
Wonca President-Elect
Prof Chris van Weel, Netherlands
Wonca Immediate Past President
Dr Michael Boland, Ireland
Honorary Treasurer
Richard Roberts, MD, USA
Wonca Regional Presidents
Prof Khaya Mfenyana, Africa
Warren A Heffron, MD, North America
A/Prof Goh Lee Gan, Asia Pacific
Prof Igor Svab, Europe
Dr Shatendra K Gupta, Middle East
South Asia
Dr Adolfo Rubinstein,
Iberoamericana-CIMF
Wonca Executive Members at Large
Dr Javier Dominguez del Olmo, Mexico
Prof Michael Kidd, Australia
Richard Roberts, MD, USA
Chair, Bylaws and Regulations
Dan Ostergaard, MD, USA
Chair, Publications & Communications
Dr Geoffrey D Martin, Australia
Editor, Wonca News and Editorial Office
Marc L Rivo, MD
4566 Prairie Avenue
Miami Beach, Florida 33140, USA
Tel: 305 671 7327
Fax: 305 674 8839
Email: marcrivo@aol.com
WONCA GLOBAL SPONSORS
FROM THE WONCA PRESIDENT-ELECT:
EMBRACE THE UPCOMING GENERATION
OF FAMILY PHYSICIANS
A perception exists in parts of the world over of
family doctors - - - dropped off the career ladder of
specialization, overlooked by the medical and scientific
community, undervalued, even more underpaid,
overburdened by trivial complaints and heartsick
patients, toiling away in isolation. And not seldom do
family physicians themselves contribute to this
perception - - - complaining comes to some as second
nature. It is a dangerous habit, as it may become a self-
fulfilling prophecy. Who in his or her right mind would
like to join the ranks and files of such a profession?
Some factors contribute to genuine concern for our
future: a physician shortage exists in many parts of the
world, and future career choices are often a complex
process. How can we make sure the best students opt
for family medicine? How can we help the most
accomplished to chose to work in conditions where
clinical uncertainty may be likely?
Yet, no reason for pessimism exists. In international
exchanges and visits I am continually deeply impressed
by the talents, the motivation, the drive of students,
residents and young colleagues. This was highlighted
during my visit early this year to the annual conference,
in Angers, of French residents. France, with all its
contributions to the world, is not directly associated
with a leading role in family medicine. The current
family medicine developments the country is witnessing
are more a catching-up with most of their fellow-
European neighbours.
Yet, here in Angers was a vibrant conference
organized by and for family medicine residents. The
National organization brings together residents from the
more than forty training programs that are run in the
major French cities. The conference started with a review
of the national structure of family physicians’
reimbursement and moved on to primary care research
and academic support of family practice. At about half
past seven in the evening, when one would expect
conference participants to be out at restaurants and
bars, the French residents were actively participating
from their chairs in the convention hall.
WONCA
News
FROM THE WONCA PRESIDENT-ELECT
2
But do not think partying was anathema to them.
Once the meeting closed, we adjourned for a diner party
of exquisite food and the awarding of annual prizes. We
celebrated for the family medicine resident awarded
with the best research project of the year. And we
celebrated the confident display of a new generation
entering family medicine. The same confidence of these
family medicine residents must have had impressed the
French government a few days earlier. In negotiations on
more investments in family medicine research and
teaching, it appears that French universities are moving
at last to engage in primary care – thanks to the
persistence of the French residents and Colleges (SNGE
and SFMG).
France is not the exception in Europe. In the
European arena, residents and young family physicians
are united in the Vasco Da Gama movement. For Wonca,
for international family medicine, this offers a most
welcome platform to work together. I commend this
group to everyone organizing international family
medicine conferences – to involve them closely in any
activity; I am sure it will add to the success of the
meetings.
But I think we should do more: there is a need for a
platform for residents and young family physicians in
every Wonca region, and most importantly, at our World
Conferences. We should engage them in all the Wonca
working parties and special interest groups.
Wonca is all about the future of family medicine - - -
that is our joint future. Let us embrace in our Wonca
structure the residents and young family physicians of
the world.
Chris van Weel
President-elect
World Organization of Family Doctors (Wonca)
(Editor‘s Note. Due to personal circumstances, Wonca
President Bruce Sparks has been unable to write his
President’s Column. For that reason this Wonca News
features a “From the President-elect” Column)
WONCA
News
FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
THE INTERNATIONAL CLASSIFICATION OF
PRIMARY CARE (ICPC-2) - A WONCA
PRODUCT
At the first Wonca General Assembly in Melbourne,
Australia in 1972, it was resolved that a special Working
Party be established to consider and develop an agreed
classification in general practice/family medicine that
would be clearly related to the International
Classification of Disease (ICD) of the World Health
Organisation (WHO). Dr Robert Westbury of Canada was
appointed by Wonca Executive then to be the Convenor.
At the General Assembly in 1974, Dr Westbury
announced that an International Classification of Health
Problems in Primary Care (the ICHPPC) had been
developed to enable general practitioners/family
physicians to classify problems, as opposed to diseases,
which they encountered in their daily work. He also
reported that doctors in 300 practices in 9 countries
had tested this classification with further refinements
recommended.
By August 1976, after several rounds of
consultations, Dr Westbury was able to announce that
the ICHPPC had been finalized and distributed to all
Wonca Member Organisations. Work on the Primary
Care Classification system continued for several years
after that. By the end of 1978, ICHPPC-2 (the version
aligned to ICD-9) was distributed to Wonca Member
Organisations in typed form.
The printed version was published by Oxford
University Press (OUP) towards the end of 1979 with an
advanced payment of royalty of AUD$5,000 paid by
OUP. This was used to finance ongoing meetings of the
Classification Committee that by this time was working
on a conceptually new classification, namely Reasons
for Encounter Classification under the leadership of
Dr Henk Lamberts and a Glossary for Primary Care under
Dr Jack Froom. The Committee continued to work
enthusiastically on a number of classifications, some in
collaboration with WHO, during the years that followed.
The International Classification of Family Medicine
(ICFM) was jointly developed by WHO and the Wonca
Classification Committee by 1986. It was edited by
Dr Henk Lamberts and Dr Maurice Woods after WHO
decided not to endorse the classification and was
published by OUP in a new agreement that gave OUP
the exclusive publishing rights to the printed version in
the English language. It was published as the
International Classification of Primary Care (ICPC) under
the auspices of Wonca.
The years following 1986 saw the use of the ICPC
being propagated by Wonca as the preferred
classification for Primary Care at its international
meetings and forums. Several primary care research
centres received permission from Wonca for the free use
of ICPC for their research projects.
The classification also drew interest from the non-
English speaking member organizations within Wonca as
the value of ICPC became more widely acknowledged
and accepted. As of 2006, ICPC has been translated
into 17 languages globally (Chinese, Czech, Danish,
Dutch, French, Greek, German, Japanese, Portuguese,
Romanian, Russian, Spanish, Azeri, Serbian, Finnish,
Swedish, and Turkish).
In December 2003, Wonca received the good news
that the WHO-Family of International Classications (FIC)
Network of the WHO Collaborating Centres had
endorsed ICPC as a member of the WHO-FIC. They had
concluded that the ICPC fulfilled the requirements for
membership as being a well developed, well used and
well maintained product. ICPC was hence accepted into
the Family of International Classifications as a
classification to be used for health information
registration in Primary Care around the world.
This membership of the WHO-FIC resulted in greater
interest in ICPC globally and enquiries began to be
received by the Wonca Secretariat on the purchase of
national rights for the exclusive use of ICPC by certain
countries. The Wonca Executive, based on the GDP and
GDP per capita of the country, then established a
formula for the calculation of national licenses for ICPC.
As of end 2006, two national licenses for ICPC have
been purchased from Wonca by the governments of
Belgian and Norway. In addition, the Portuguese
Association of General Practitioners has purchased a
national license. Several countries has expressed
interest in the English language version of ICPC .
However, with the publishing rights residing with OUP,
Wonca was unable to make the licenses available to
these countries.
The Wonca Executive, in 2004, endorsed a proposal
to re-acquire the publishing rights of the English
language version of ICPC back from OUP. After several
communications via email between the Wonca CEO and
OUP, an agreement was reached in that OUP would
WONCA
News
FROM THE CEO’S DESK / FROM THE EDITOR
4
return the publishing rights back to
Wonca. This agreement was finalized
in January 2007. Henceforth, this
will allow the use of the ICPC-2e
electronic version of in a large
number of the English speaking
countries that are members of
Wonca, as the book form of the
classification could now be
produced in its entirety or as a
manual in English.
Whilst it is likely that the
national Ministries of Health of most
countries will be the agencies keen
to acquire the national licenses for
ICPC-2e, it may be a financially
rewarding and a good move if the
Member Organisations of Wonca in
these countries take the initiative of
acquiring the national license for
themselves. To encourage this,
Wonca Executive has agreed that
Wonca Member Organisations be
given a 20% rebate on the national
licensing fee. The ICPC-2e is a
Wonca product and should,
therefore, be used to benefit Wonca
Member Organisations, their family
doctors and all those who care for
our patients around the world.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family
Doctors
FROM THE EDITOR:
A SPECIAL WONCA 2007 INVITATION TO FP/GP
JOURNAL EDITORS
This issue of Wonca News continues to report on important gatherings of
Wonca’s Regions, Working Parties and Member Organizations in the months
leading up to the 18
th
Wonca World Conference in Singapore from July 24-27,
2007.
I would like to extend a special Wonca 2007 invitation to the Editors of
the 50 or so FP/GP journals of Wonca member organizations. The FP/GP
journal editors and publication staffs serve an important role for Wonca by
disseminating key clinical, professional and organizational information to
our membership. They report on the country’s health and health care trends
that affect the organization’s political viability and influence. They record
and archive the history of our member organizations and their role in the
health of the public. They publish key articles, reports and publications in
the areas of practice, teaching and research that strengthen our specialty.
Editors of our FP/GP journals, or their designee, are invited to an FP/GP
Editors Forum in Singapore held in conjunction with the 18
th
Wonca World
Congress in Singapore. The purpose of the FP/GP Editors Forum is to
facilitate networking around the key FP/GP content areas, such as clinical
practice and evidenced based medicine, practice management, research,
medical education and family medicine development/association news.
Please email me if you plan to join us in Singapore, or if another
representative will join us on your behalf. Your recommendations for agenda
items are most welcome.
For those who have yet to register for the 18
th
Wonca World Conference
in Singapore, please register online at www.Wonca2007.com. I am looking
forward to our Wonca FP/GP Editors reunion in Singapore!
Marc L. Rivo, M.D, M.P.H.
Editor, Wonca News
marcrivo@aol.com
4566 Prairie Avenue
Miami Beach, FL 33140 USA
1-305-674-8839 (fax)
WONCA
News
FEATURE STORIES
5
FEATURE STORIES
CALL FOR NOMINATIONS FOR WONCA
AWARD OF EXCELLENCE IN HEALTH
CARE
Nominations are called for the Wonca Award of
Excellence in Health Care, otherwise known as “The 5-
Star Doctor” Award.
This is an award to be conferred on physicians, who
in the opinion of the Wonca World Council have made a
significant impact on the health of individual and
communities, through personal contributions to health
care and the profession. It was instituted to increase the
global development of Family Medicine, global
networking and partnerships. The award is preferably
given to those who are still active in the field for which
they are nominated. Nominations are not limited to
Wonca members.
The award will be offered on a Regional
(ie, “Regional” applies to the Wonca Regions as defined
in the Wonca Bylaws and Regulations, currently
constituting the Africa, Asia-Pacific, Europe,
Iberoamericana-CIMF, North America and Middle East
South Asia Regions) and Global basis. The Regional
Awards may be awarded on an annual basis and the
Global Award is being awarded every third year. The
award will take the form of a crystal trophy and a
certificate presented during the July 2007 Wonca World
Conference in Singapore.
The closing date for nominations for the Wonca
Award for Excellence in Health Care: The Five-Star
Doctor is March 31, 2007.
Suitably motivated and validated nominations for
Regional Awards should be submitted to the Wonca
Chairman of the Nominating and Awards Committee.
They will be forwarded to the relevant Regional
President for regional consideration. The Global Award
will be chosen from the recipients of Regional Awards
for that triennium.
The criteria to be considered by the selection
committee/s will include the following. These criteria
apply to both Regional and Global Awards, and include:
•Impact on healthy care of individuals and community
•Contribution to regional / global development
•Community perspective and involvement
•Networking for the benefit of the community
•Innovative services
•Development of services in previously underserved /
disadvantaged areas
•Demonstrated support of colleagues in another
region / country / college
•Performance of academic work of quality and
relevance including teaching and research
•Development of models which could be applied to
other regions / areas
•Best meet the criteria of the “5-star” health
professional
*Care provider
*Decision maker
*Communicator
*Health Advisor and Community Leader
*Team member
Please complete the nomination form and send by
email or also hard copy to:
Professor Chris van Weel
Chair, Nominating and Awards Committee
World Organization of Family Doctors (Wonca)
#01-02 College of Medicine Building
16 College Road
Singapore 169854
Email : admin@wonca.com.sg
Fax : +(65) 6324 2029
The nomination form is available at the Wonca
online website at www.GlobalFamilyDoctor.com and by
contacting Yvonne Chung, Wonca Administrative
Manager, at the Wonca Secretariat in Singapore at the
above email, fax or mailing address.
Wonca Establishes Working Party on
Mental Health
A proposal to establish the Wonca Working Party on
Mental Health (formerly the Special Interest Group on
Psychiatry and Neurology) was approved by the Wonca
Executive during its October 2006 meeting in Buenos
Aries. The Wonca Working Party on Mental Health
(WWPMH) will serve as a focus for the development of
mental health issues for Wonca worldwide. This Working
Party provides the opportunity for the discipline of
Primary Care Mental Health to become a priority for
Wonca and the Wonca family, especially as mental
health issues have a major impact on our day-to-day
care of our patients.
WONCA
News
FEATURE STORIES
6
The mission and vision of the
Working Party on Mental Health is
to improve mental health care
around the world by providing a
universal gold standard of care for
mental health through
empowerment of primary care and
in collaboration with all interested
stakeholders.
WPA Conference in Istanbul in July 2006
showing our delegation of speakers talking
on ‘From Conception to Death: A Mental
Health Primary Care Pathway’
Wonca Europe Regional Meeting in Florence
in August 2006 showing our workshop held
on ‘Dementia Management in Primary Care’
Current objectives are to
•Promote standards of excellence
in the primary care management
of mental health, consistent with
patient and professional values
and with reference to evidence
based health care;
•Promote the concept of mental
health & well-being;
•Develop and promote mental
health research in primary care
and the primary care – mental
health interface
•Hold scientific meetings, which
may include sessions and
workshops, to present original
papers and to address broader
educational issues through
discussion, training and debate
during Wonca Regional and
World conferences;
•Promote and develop patient
information about mental health
issues;
•Develop and promote
appropriate literature for primary
care professionals using a variety
of resources, including Wonca
Online;
•Promote the discipline of primary
care mental health world-wide
through collaborative working
within Wonca, NGO’s,
government organisations,
patient groups & other medical
colleges;
•Address the issue of stigma
associated with mental health
conditions.
We plan to undertake the
following activities:
•Guideline development on
mental health issues
•Scientific presentations on
mental health issues
•Advice to Wonca and its member
organizations on mental health
issues
•Participation in Wonca activities
and conferences with a focus on
the mental health agenda
•Working with WHO to develop a
resource book on the integration
of mental health into primary
care
•Provision of a regular Working
Party newsletter and educational
materials
•Supporting the mental health
curriculum in primary care
education
•Organising regular online Primary
Care Mental Health Grand
Rounds
•Developing and supporting
postgraduate accreditation
programmes for General
Practitioners with a special
interest in mental health
In early 2007, the WWPMH met to
discuss and plan an implementation
timetable for our stated objectives
and prepare for the Wonca World
conference in Singapore. I would like
to encourage as many of you as
possible to join us in Singapore for
the Wonca World Conference, where
we will celebrate our new Working
Party status and will be holding a
pre-conference workshop for all our
members and interested parties.
Please get back to me with your
suggestions of issues or topics you
think we should cover in Singapore.
We will also use the opportunity to
make a mental health declaration at
the end of this meeting. I would be
grateful if you could let me know the
key topics this declaration should
cover.
At the Wonca Europe Regional
Conference in Paris: 17th - 20th
October 2007, we will be presenting
a session on ‘Recent Advances in
Primary Care Mental Health.’ We plan
to hold both theoretical and practical
skills sessions and hope that as
many of you as possible will be able
to attend and contribute. Please
send me any ideas about the
practical skills you would like the
teaching session to address. We also
plan to contribute to the 19
th
– 21
st
June 2008 – World Psychiatry
Association conference on
‘Depression and Relevant Psychiatric
Conditions in Primary Care’ in
Granada, Spain.
The WWPMH is soliciting
representation from individuals
interested in improving mental
health standards from our member
Colleges and all Wonca regions. If
you would like to support or
contribute to this Working Party
please register your interest by
contacting me.
Dr Gabriel Ivbijaro
Chair, Working Party on Mental
Health
gabriel.ivbijaro@gmail.com
WONCA
News
FEATURE STORIES / REGIONAL NEWS
7
Register Online for Wonca
World 2007 in Singapore
Singapore beckons! As we gear
up in our preparations for the 18
th
Wonca World Conference from 24-27
July 2007, Singapore promises a
host of exciting attractions and
activities. Besides getting updates
on the latest advances that
genomics and biomedical sciences
have to offer, the scientific program
also promises a whole new
paradigm in delivery of lectures and
plenary sessions. You may register
online for the 18
th
Wonca World
Conference at www.Wonca2007.com.
Officially opened on 30 August
1995, Suntec Singapore is a world-
renowned, international venue that
has the perfect location for
meetings, conventions and
exhibitions. Suntec Singapore is
situated in the Central Business
District, only 20 minutes’ drive from
Changi International Airport. Suntec
Singapore is in the heart of a self-
contained, totally integrated events
infrastructure. In addition to its
first-class facilities, Suntec
Singapore offers direct access to
5,200 hotel rooms, 1,000 retail
stores, 300 restaurants and the
region’s new centre for the
performing arts, Esplanade –
Theatres on the Bay.
The medical technology
exhibition will also provide a unique
business matching opportunity for
all family physicians and medical
groups wanting to scale up their
practice profiles and offer an
improved and vastly increased range
of point of care testing services for
their patients.
In addition to work and
academic schedules, the organizing
committee also promises to host a
dazzling array of social programs for
your partners and family members.
Thinking of bringing along your
loved ones? Fret not, as
arrangements have been made for
the more than 100 nurseries and
child care centers to take care of
your kids daily so that you can
attend all of our programs and
social activities with complete
freedom from worries of caring for
the needs of your young ones.
Shop till you drop, feast on
some of the greatest culinary
delights as well as attend world-
class performances at our latest
state of the art architectural marvel,
the Esplanade. You will never have a
dull moment in Singapore, the city
that never sleeps!
So, stay tuned and make a date
with Singapore for the Wonca 2007
World Conference, 24 to 27 July
2007!
Dr Tan See Leng
Chairman
Host Organizing Committee
Wonca World Conference 2007
Email: contact@cfps.org.sg
Website: www.wonca2007.com
WONCA REGIONAL NEWS
ASIA PACIFIC HOLDS RESEARCH WORKSHOP IN
BANGKOK
This research workshop held in Bangkok on 7 November 2006 was a
follow-up of the Wonca Kingston Conference recommendations in March
2003 (van Weel C, Rosser WW (ed). Improving Health Globally and the Need
for Primary Care Research: Report of the Wonca Kingston Conference. Ann
Fam Med 2004;2Suppl). Following the Kingston Conference, Asia Pacific
took the momentum to organize a research meeting in Phuket, Thailand in
July 2004 to initiate the Research Network of the Asia Pacific. A meeting in
Genting, Malaysia in February 2005 followed this research meeting.
The Bangkok research workshop was held in the Royal Golden Jubilee, in
the heart of the bustling city of Thailand. The workshop was well attended
and well received. It attracted delegates from Thailand, Malaysia, Singapore,
Indonesia, Philippines, Korea, Taiwan and Australia among other countries.
The aim of the Bangkok research workshop was to report on the
experiences and progress from the Asia Pacific countries following the
Phuket and Genting meetings, and to discuss the future direction of the
research group in the region. We
tried to identify possible ways to
strengthen research collaboration
among countries.
The Bangkok research workshop
was held within the main conference
in order to attract as many
participants as possible as well as
to save costs and time in having to
attend another meeting. The title of
the workshop was “Research
networks in Asia Pacific region,
where are we and how do we go
from here?” Professor Goh Lee Gan,
the Regional President for WONCA
Asia Pacific, served as chair. He was
also a speaker (from Singapore).
The other speakers were: Professor
Somjit Prueksaritanond (Thailand),
Dr Zailinawati Abu Hassan
(Malaysia), Professor Justin Bielby
(Australia) and Professor Chris van
Weel (Netherlands). This was
followed by a lively discussion.
WONCA
News
REGIONAL NEWS
8
Professor Somjit Prueksaritanond
from Mahidol University, Thailand,
started off the session with a report
of the activities held in the Phuket
workshop in 2004. A steering group
was formed during that meeting
with the hope of starting and
driving the research network in the
region. At the end of the 3 days
conference four research proposals
were formulated.
This was followed by a
presentation on the progress made
in Malaysia by Dr Zailinawati Abu
Hassan. The Malaysian Primary Care
Research Group (MPCRG) is a special
interest group within the Academy
of Family Physicians of Malaysia
(AFPM) that was formed by the
Malaysian delegates who
participated in the Phuket meeting.
They have successfully run research
workshops bi-annually, mentoring
more than 10 research projects
during the past two years and had
managed to gather the main
stakeholders of primary care in the
country. Some of the barriers noted
was lack of funding, lack of
sustainable capacity building efforts
and the lack of success in attracting
practicing family doctors to be
involved in research.
Professor Justin Bielby observed
that primary care has diverse
backgrounds in Asia Pacific and
competitive leaders could work
together for the growth of the
region. He shared his experience of
how research development in
Australia flourished over past years.
With government support and
tireless efforts from the general
practitioners, they obtained funds
and career support from various
general practitioner organizations to
establish practice-based research
network and initiatives. He further
observed that the success in
Australia was the result of
partnerships between organisations,
disciplines and policy makers.
General Practitioners asking and
Alex, the President of the
Philippines General Practice College,
shared their research experience in
Philippines primary care settings.
They have expertise such as medical
statistics, epidemiology and
pharmaco-economics that can be
shared among the region.
This cross-borders workshop
provided a variety of discussions,
research proposals and
recommendations to strengthen the
research network. The research
network hoped to set a meeting in
the near future probably in April
2007 (in Malaysia) before meeting
again in the World Wonca in
Singapore 2007. We hope that this
meeting has created a new
milestone in research in this region.
Those who are interested to know
more or get involve with the
research network, please contact
Dr Zailina at zailina@nasioncom.net.
Dr Zailinawati Abu Hassan
(zailina@nasioncom.net)
Professor Goh Lee Gan
Professor Somjit Prueksaritanond
Professor Justin Bielby
Professor Chris vanWeel
Letter to Editor: Family
Medicine and Culture in
Argentina and Greece
As the former Chairman of the
International Committee and the
present Chairman of General Affairs
for Japanese Academy of Primary
Care Physicians, I attended the 1st
Wonca Iberoamericana-CIMF
Regional Conference held in Buenos
Aires from Oct 11-14, 2006. The
scientific program, coordinated by
Dr Ezequiel Lopez, and the overall
conference, chaired by Professor
Sergio Solmesky, was outstanding.
In addition, I had the pleasure of
attending the 2005 Wonca Europe
Regional Conference in Kos Island of
Greece in September 2005.
answering relevant local questions
led it. He believed that the research
network in Asia-Pacific region could
work together via collaboration and
partnership.
Left to Right: Asia Pacific Research Meeting
participants: (Standing from left to right)
Professor Goh Lee Gan, Professor Chris
vanWeel, Professor Michael Kidd, Dr Daniel M
Thuraiapah, (Sitting) Professor Justin Bielby,
Assistant Professor Somjit Prueksaritanond,
Dr Zailinawati Abu Hassan.
Professor Chris van Weel in his
presentation emphasised that we
ought to do research on what
matters to people, communities and
government. The network could
work together in between countries
to foster research, with the aim of
better health outcomes for the
region. We could combine efforts,
resources, and collaborate with
other disciplines to achieve results.
Professor Goh Lee Gan then
summarised how we from diverse
backgrounds and culture could have
a common goal towards improving
health globally by promoting a
culture of research among the
primary care practitioners. He said
that he would like to propose three
ideas for participants to think
about: (1) the family life cycle in
Asia Pacific, (2) chronic disease
management, and (3) teaching
related research.
During the workshop view from
the participants were sought. Dr
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News
REGIONAL NEWS / HEALTH AND HEALTH SYSTEM NEWS
9
These wonderful meetings
expanded my understanding of
family medicine and cultural
diversity. In ancient Greece, I
learned about Hippocrates, the
father of the western medicine, and
how he taught his physician
students and colleagues. In Buenos
Aires, I learned how family medicine
in Argentina, and throughout Central
and South America, was influenced
by history, politics, economy and
culture.
Every time I attend Wonca
Regional Conference, I have learned
not only about family medicine but
the political, socioeconomic and
cultural aspects of the region and
its countries. We family physicians
must always pay attention to the
relationship among medicine and
health, and the history, politics,
economy, and culture of each
country.
Dr. Hiroshi BANDO
Chairman of General Affairs,
Japanese Academy of Primary Care
Physicians
pianomed@bronze.ocn.ne.jp
HEALTH AND HEALTH
SYSTEM NEWS
PRIMARY CARE
CONTRIBUTIONS TO
HEALTH SYSTEMS AND
HEALTH: INTERNATIONAL
COMPARISONS
(Editor’s Note: Dr Barbara
Starfield, a world renowned health
services researcher, has published
and spoken extensively on the
contribution of primary care to
health system and health
improvement. Dr Starfield, Dr Shi
and Dr Macinko published a
landmark article in this field entitled
“Primary Care Contributions to
Health Systems and Health” in the
Milbank Quarterly (Volume 83,
Number 3, 2005), a highly
respected multidisciplinary journal
of population health and health
policy). The first excerpt of this
article, published with the
permission of Dr Starfield and the
Milbank Quarterly in the October
2006 issue of Wonca News, focused
on her research in the United
States, where Dr Starfield lives.
This second excerpt focuses on
international comparisons. The
entire Milbank Quarterly article and
references, as well as additional
related resources, may be
downloaded from the Wonca Global
Resource Directory at
www.GlobalFamilyDoctor.com.
Studies based on the
characteristics of different health
systems around the world are
particularly useful because they
make it possible to assess the
impact of various policy
characteristics on the practice and
outcomes of primary care. Three
studies, one using data from the
mid-1980s and two from a decade
later, demonstrated not only that
countries with stronger primary care
generally have better health but
also that certain aspects of policy
are important in establishing strong
primary care practice.
The first study examined the
association of primary care with
health outcomes by means of an
international comparison conducted
in 11 industrialized countries in the
early 1990s. Primary care in each
country was rated according to the
four main characteristics of primary
care practice: first-contact care;
person focused care over time;
comprehensiveness of care, and
coordination of care, as well as two
additional characteristics: family
orientation and community
orientation.
Policy characteristics consisted of
attempts to distribute health
services resources equitably
(according to extent of health needs
in different areas of the country);
universal or near universal financial
coverage guaranteed by a publicly
accountable body (government or
government regulated insurance
carriers); low or no co-payments for
health services; percentage of
physicians who are not primary care
physicians; and professional
earnings of primary care physicians
relative to other specialists.
The first important finding is that
the score for the practice
characteristics was highly correlated
with the score for the policy
characteristics. That is, the adequate
delivery of primary care services is
associated with supportive
governmental policies. The second
point is that those countries with
low primary care scores as a group
had poorer health outcomes, most
notably for indicators in early
childhood, particularly low birth
weight and post neonatal mortality.
A more recent comparison, with
13 countries and an expanded set of
indicators of both primary care
10
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HEALTH AND HEALTH SYSTEM NEWS
policy characteristics and health
outcomes, also showed better
health outcomes for the primary
care-oriented countries even after
controlling for income inequality
and smoking rates, most
significantly so for post neonatal
mortality and rates of low birth
weight. Countries with weak
primary care also had poorer
performance on most major
aspects of health, including
aspects of mental health such as
years of potential life lost due to
suicide The positive impact of
primary care orientation on low
birth weight rates possibly reflects
a beneficial effect of primary care
on mothers’ health before
pregnancy. The characteristics of
primary care practice that were
present in countries with high
primary care scores and absent in
countries with low primary care
scores were degree of
comprehensiveness of primary care
(that is, the extent to which
primary care practitioners provided
a broader range of services rather
than making referrals to specialists
for those services) and a family
orientation (the degree to which
services were provided to all
family members by the same
practitioner). The most consistent
policy characteristics were
government attempts to distribute
resources equitably, universal
financial coverage that is either
under the aegis of the government
or regulated by the government,
and low or no patient cost sharing
for primary care services.
The positive contributions of
primary care to health were also
found in a much more extensive
time-series analysis including 18
industrialized countries. The
stronger the primary care
orientation of the country (as
measured by the same scoring
system as in the earlier
international comparison), the
lower the all-cause mortality, all-
cause premature mortality, and
cause-specific premature mortality
from asthma and bronchitis,
emphysema and pneumonia,
cardiovascular disease, and heart
disease. The relationship was robust
even after controlling for a variety of
system characteristics (Gross
Domestic Product per capita, total
physicians per 1000 population,
percentage of elderly people) and
population characteristics, including
average number of ambulatory care
visits, per capita income, alcohol
consumption, and tobacco
consumption. The analyses
estimated that increasing a country’s
primary care score by 5 points (on a
20-point scale) would be expected
to reduce premature deaths from
asthma and bronchitis by as much
as 6.5%; reduction in premature
mortality for heart disease could be
as high as 15%.
Data from this study were also
analyzed to ascertain the robustness
of primary care scores over time.
The average primary care score
increased by nearly one point from
the 1970s to the 1990s. Countries
that were high performers in the
1970s remained high performers in
each subsequent decade. When
countries were divided into high and
low performers (above or below the
mean for each decade), no country
crossed the threshold from low to
high or from high to low. However,
there were movements over time
within the two groups of high and
low performers. Only one country’s
score decreased over time; Germany
decreased access to ambulatory care
services by imposing increased co-
payments, thus lowering its overall
primary care score.
In general, policy changes over
time were parallel to improvements
in primary care practice. For
example, in the late 1980s and early
1990s, Spain strengthened primary
care by moving to a tax-based
financing system, improving
geographic allocation of funds, and
increasing the supply of family
physicians as well as by developing
primary health care centers that
improved integration, family
orientation, coordination of care,
and health promotion services.
Studies in two different areas of
Brazil confirmed the relationship
between the adequacy of primary
care delivery characteristics and self-
reported health. In a study in
Petropolis, showed that patients
who had better primary care
experiences were more likely to
report better health even after
adjusting for other salient
characteristics such as age of the
individual, whether or not they had
a chronic illness or a recent illness,
household wealth, educational level,
or type of facility in which they
received their care. Using reports of
parents about their children’s
primary care, these findings were
confirmed in a study conducted in
Porto Alegre.
The relationship between primary
care physician supply and better
health is demonstrated in England.
The standardized mortality ratio for
all cause mortality at 15-64 years of
age is lower in areas with a greater
supply of general practitioners. (In
England, pediatricians and internists
are not considered and do not
function as primary care physicians.)
Each additional general practitioner
per 10,000 population (a 15-20%
increase) is associated with a
decrease in mortality of about 6%.
In some health systems, people
normally go to their primary care
physician before seeking care
elsewhere (such as from another
type of physician). In Spain,
strengthening of primary care by
reorganizing services to better
achieve its main features was
mandated by a new law in the mid-
1980s, which led to the
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HEALTH AND HEALTH SYSTEM NEWS
11
establishment of a national program
of primary health care centers. The
impact of this reform on health was
evaluated after 10 years by
examining mortality for some major
causes of death. Death rates
associated with hypertension and
stroke fell most in those zones in
which reform was first implemented.
Outcomes of care after surgery in
Canada have also been shown to be
better when care was sought from a
primary care physician who then
referred children to specialists for
recurrent tonsillitis or otitis media,
as compared with self-referral to a
specialist. The referred children had
fewer postoperative complications,
fewer respiratory episodes following
surgery, and fewer episodes of otitis
media after surgery, thus suggesting
that specialist interventions are more
appropriate when patients are
referred from primary care.
Primary care programs aimed at
improving health in deprived
populations in less developed
countries succeed in narrowing gaps
in health between socially deprived
populations and more socially
advantaged ones. A matched case-
control study in Mexico found that
aspects of primary care delivery had
an important independent effect in
reducing the odds of children dying
in socially deprived areas. These
processes included adequate referral
mechanisms, continuity of care
(being seen by the same provider at
each visit), and being attended in a
public facility designed to provide
primary care. A study in Bolivia
found that a community-based
approach to planning primary health
care services in socially deprived
areas reduced under-five mortality as
compared with adjacent similar areas
or the country as a whole.
The case of Costa Rican primary
care reforms in the 1990s, which
were instituted first in the most
socially deprived areas, illustrates
the importance of primary care in
reducing health disparities. The
Costa Rican primary care reforms of
the 1990s included transfer of
responsibility for provision of health
care from the Ministry of Health to
the Costa Rican Social Security Fund.
Expansion of the number of primary
care facilities—particularly in
underserved areas, and the re-
organization of primary care into
“Integrated Primary Care Teams” or
EBAIS (Equipos Básicos de Atención
Integral en Salud) that consist of
teams of health professionals
assigned to a geographic region
consisting of about 1000
households. By 1985, Costa Rica’s
life expectancy reached 74 years,
and infant mortality rates improved
from 60/1,000 live births in 1970 to
19/1,000 live births – levels
comparable to those in more
developed countries. Primary health
care improvements were estimated
to have reduced infant mortality by
between 40% and 75%, depending
on the particular study. For every
five additional years after primary
health care (PHC) reform, child
mortality was reduced by 13%, and
adult mortality was reduced by 4%.
Studies in other developing
countries show the considerable
potential of primary care to reduce
the large disparities associated with
socioeconomic deprivation. In seven
African countries, the most wealthy
20% of the population receives well
over three times as much financial
benefit from overall government
spending as the lowest 20% of the
population (40% versus 12%). For
primary care services, the rich-poor
ratio in distribution of government
expenditures is notably lower (23%
to the top group versus 15% to the
lowest group), leading one
international expert to conclude that,
“from an equity perspective, the
move toward primary care represents
a clear step in the right direction”.
An analysis of preventable deaths in
children concluded that, in the 42
countries accounting for 90% of
child deaths worldwide, 63% of
deaths could have been prevented
by full implementation of primary
care. The primary care interventions
included integrated care that
addresses the very common
problems of diarrhea, pneumonia,
measles, malaria, HIV/AIDS, preterm
delivery, neonatal tetanus, and
neonatal sepsis.
Rationale for the Benefits of
Primary Care on Health
Six mechanisms, alone and in
combination, may account for the
beneficial impact of primary care on
population health.
1. Increased access to needed
services. Primary care, as the
point of first contact with health
services, facilitates entry to the
rest of the health system for
those who need it. Most other
industrialized countries have
achieved universal and equitable
access to primary health services,
some of them directly provided
and others through assurance of
financial coverage for visits.
2. Better quality of care. Primary
care physicians do at least as
well as specialists in caring for
specific common diseases and do
better overall when the measures
of quality are generic. For less
common conditions, care
provided by primary care
physicians with appropriate back-
up from specialists may be
optimum; for rare conditions,
appropriate specialist care is
undoubtedly important, as
primary care physicians would
not see such conditions
frequently enough to maintain
competence in managing them
3. A greater focus on prevention.
The evidence is strong in
showing that it is in primary care
MEMBER AND
ORGANIZATIONAL NEWS
AAFP INTERNATIONAL
FAMILY MEDICINE
DEVELOPMENT
CONFERENCE UPDATES
The AAFP Center for International
Health Initiatives hosted its third
International Family Medicine
Development Workshop in Portland,
Maine on September 13-15, 2006
with 67 participants. The purpose of
this 2 day conference was to
provide family physicians and other
primary health care professionals
with information and resources to
help equip them for more effective
involvement with global family
medicine development and
consultation activities.
The conference included seven
plenary presentations on global
family medicine development
models by Jonathan Rodnick, MD;
Vincent Hunt, MD; Stephen Spann,
MD, MBA; Brian Jack, MD; Warren
Heffron, MD; Calvin Wilson, MD;
Edward Shahady, MD; Andrew
Bazemore, MD; Jeff Heck, MD; and
Daniel Ostergaard, MD. In addition,
there were 24 breakout
presentations that allowed for the
discussion of innovative
international family medicine
development ventures and future
opportunities. The inclusion of
family physicians, residents and
students, educators, researchers and
public health experts all interested
in global family medicine
development allowed for fruitful
networking and a lively exchange of
information and ideas.
12
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HEALTH AND HEALTH SYSTEM NEWS / MEMBER AND ORGANIZATIONAL NEWS
that preventive interventions not related to any one disease or organ
systems are best carried out. Examples of these “generic” (i.e., not
limited to a particular disease or type of disease) measures are
breastfeeding, not smoking, use of seat belts, use of smoke detectors,
physical activity, and healthy diets.
4. Early management of health problems. Another mechanism for the
benefit of primary care is its demonstrated impact on managing health
problems before they are serious enough to require hospitalizations or
emergency services
5. The accumulated contribution of primary care is more appropriate care.
The beneficial effects of primary care on mortality and morbidity can be
attributed, at least in part, to the focus of primary care on the person
rather than on the management of particular diseases. Person-focused
care is achieved when practitioners attend to overall aspects of people’s
health rather than to the care of specific diseases they may have; it
focuses on achieving better outcomes for health in all of its aspects
rather than on procedures directed at improving the processes or
outcomes of care for particular conditions.
6. The role of primary care in reducing unnecessary and potentially harmful
specialist care. Virtually all studies of specialist services have concluded
that there is either no effect or an adverse effect on major health
outcomes from increasing the supply of specialists of increased specialist
supply in the United States, which already has a much greater supply of
such physicians than other industrialized countries. The evidence is also
consistent that first contact with a primary care physician (before seeking
care from a specialist), is associated with more appropriate, more
effective, and less costly care.
At the very least, primary care has to be recognized as a distinct aspect
of a health services system. There are now well-validated methods to assess
both the presence and characteristics of primary care; all sources of data on
use of health services should include at least a minimum set of these
measures. Understanding people’s primary care experiences (rather than or
in addition to their satisfaction), including the extent to which they receive
the range of services appropriate to their needs and have the care they
receive elsewhere coordinated and integrated, are important aspects in
evaluating the adequacy of health services.
Barbara Starfield, MD, MPH
bstarfie@jhsph.edu
Leiyu Shi, DrPH, MBA
James Macinko, PhD
WONCA
News
MEMBER AND ORGANIZATIONAL NEWS
13
Announcement! 2007
AAFP International Family
Medicine Development
Workshop
The AAFP Center for International
Health Initiatives invites
international attendees to share
their experiences to promote global
quality primary health care
development at the 4th AAFP
International Family Medicine
Development Workshop to be held
September 12
th
-15
th
, 2007 at the
Sheraton Tucson Hotel & Suites in
Tucson, Arizona.
Submit your presentation
abstract online for the workshop
before April 30
th
at
www.aafp.org/intl/workshop2007
All submissions will be
considered. Particular interest will
be given to submissions for the
following themes:
•International resident and
student experiences -
preparations and value
•Breadth and depth of
international consultations
•International partnership
development - public and private
models
•Family physician training -
residency vs. retraining models
•Sustainability implications for
short term international projects
or partnerships
The Conference Educational Chair
is Edward J. Shahady, MD of
Fernandina Beach, Florida.
For more information, contact
Rebecca Janssen at
rjanssen@aafp.org or visit the
website at
www.aafp.org/intl/workshop2007
Walter Rosser – Wonca
Global Family Doctor for
January
Dr Rosser was born on December
9, 1941 in Ottawa, Canada. He is
known for his research, his
commitment to building capacity for
primary care research, and for his
international work.
Dr Rosser began as a young
family physician conducting research
in a discipline that was just trying to
find its feet. From simple
beginnings, his research developed
as he collaborated with others,
moved through different content
areas, became involved in practice
based networks, struggled with
conceptualizing how technology
could best be used in practice and
in research, and realized that family
medicine must build its research
capacity if it was to compete for
limited research funds.
Walter W. Rosser MD,
CCFP, FCFP, MRCGP (UK)
Canada
His academic career grew as he
became Professor and Chair of the
Department of Family Medicine
respectively in the universities of
Ottawa, McMaster, Toronto, and
since 2002, at Queen’s University in
Kingston. In each department, he
built research capacity and served
as a model for faculty members,
residents, and students looking to
become primary care researchers.
Overlying all of this was his work in
the political arena provincially,
nationally, and internationally,
always with the agenda of furthering
the cause of family medicine
through capacity building.
Internationally, be has spoken and
taught worldwide on primary care
topics and more recently on
evidence-based medicine. He has
written a textbook on evidence-
based family medicine and
developed online courses on
research methods and evidenced-
based medicine.
Dr Rosser has devoted his
energy to family medicine research
and made it his life’s work. There
are five areas of activity where
Dr. Rosser has been most influential
in contributing to primary care
research:
•Studies in methods of improving
delivery of preventive services in
family medicine.
•Research in Practice Based
Research Networks (PBRNs)
•Evidence Based Medicine.
•Primary Care Reform.
•Research Capacity Building in
Family Medicine.
In summary, Dr. Rosser has
worked to develop and influence
policy and guidelines that affect the
environment in which family
physicians practice, to make that
environment more conducive to
research and the application of
research evidence to practice. He
has worked for many years on the
development of practice-based
networks, which are the
‘laboratories’ in which primary care
research is conducted. He is known
and highly respected locally,
provincially, nationally, and
internationally.
Dr. Rosser is a deserving winner
of the Wonca Global Family Doctor
of the Month Award for January
2007.
Several studies have shown that
men are more likely to be influenced
by income, exposure to role models
prior to medical school, and beliefs
that medicine is a noble and
prestigious profession with many
opportunities for personal and
professional advancement. For
women, personal priorities such as
children, spouse and other familial
obligations, personal and social
values, and opportunities for clinical
experience with the community and
the underserved are more likely to
influence their choice of specialty. A
UK study found that community
medicine training settings had a
greater influence on career choice of
women than men, and that the
presence or absence of strong role
models can shape career decisions
during the early years of medical
training. The high concentration of
women role models in primary care
has the potential to further
strengthen women’s presence in
family practice.
Women planning to practice in
rural settings face unique challenges
distinct from men and from their
urban women colleagues. Studies in
Canada and in Australia have found
that the increased workload in rural
communities and the lack of career
and educational opportunities for
spouses and children affect women
physicians’ decision to work in rural
areas, and their satisfaction with
this work. These realities often
result in alterations in women’s
practice patterns to accommodate
family responsibilities.
For women doctors, the
enhanced training necessary to
provide a larger scope of services in
rural areas may present special
challenges. Additional time,
childcare support, and time away
from family may prevent women
physicians from acquiring these
skills. Several organizations in
Canada and Australia have
suggested the need for flexible
14
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RESOURCES FOR THE FAMILY DOCTOR
RESOURCES FOR THE FAMILY DOCTOR
WOMEN IN TRAINING
(This article is one of a series done by the authors on behalf of the
Wonca Working Party on Women and Family Medicine (WWPWFM)
published in Wonca News over the past few months. Please see
www.womenandfamilymedicine.com for the full monograph, literature
review, summary and annotated bibliography on Women in Training.)
Although women are achieving numerical parity with men in medical
school and residency training programs in many countries, men and women
often have different experiences in training because of various social,
political, cultural and religious factors in the broader society. Based on our
review of the literature (largely North American and European) we offer some
thoughts on the current state of women in medical training.
Mainstream medical curricula have frequently not recognized the ways
that gender can affect health issues, patient care, and trainee/physician
choices. For instance, until recently medical textbooks depicted men as the
norm or standard of health, and portrayed examples of women mainly in
the context of reproductive health. To counter such stereotypes, in the last
few years women physicians and medical educators have joined together to
develop several innovative educational projects that reflect a gender issues
perspective (for example, the Gender and Health Collaborative Curriculum
Project (available at www.genderandhealth.ca), and the Medical Women
International Association’s Training Manual for Gender Mainstreaming in
Health
(available at http://www.mwia.net/gmanual.pdf). In the realm of
research, women have historically been under-represented in clinical trials,
and until the last decade, investigators incorrectly assumed that findings
from studies based on men were universally applicable to women.
Increasingly, thoughtful researchers are now questioning this gender bias
and designing new strategies to examine outcomes relevant to women.
Numerous studies from many countries have shown an uneven
distribution of men and women physicians across disciplines. Women are
more likely to choose primary care specialties, particularly pediatrics and
family medicine, whereas men are more frequently drawn to surgery and
internal medicine. Interestingly, women often do not start out with these
intentions. In a Norwegian study, physicians of both sexes were just as
likely to begin their career in surgery or internal medicine, although men
were far more likely than women to complete their specialist training. This
finding suggests that it is may not be for lack of interest that women are
under-represented in certain areas and over-represented in others, but rather
that the training process itself promotes this segregation of the sexes.
Career choices for medical school graduates also reflect gender
differences in values and socialization. The large numbers of women
entering primary care and family practice suggest trainees choose this
specialty because it allows for personal flexibility (type of practice, limited
work hours, etc.), direct interactions with the community, and in some
countries a relatively short residency program.
WONCA
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RESOURCES FOR THE FAMILY DOCTOR
15
training of rural physicians, specifically with respect to
providing professional support (locum programmes) and
continuing medical education accessible to women in
terms of cost, travel, child care availability and
manageable hours of work.
Both men and women students and residents
experience harassment and intimidation during their
training, with women reporting such experiences more
frequently than men colleagues. Unfortunately, trainees
are often reluctant to speak out against harassment, be
it sexual or not, for fear of being labeled “overly
sensitive.” Harassment itself has a negative effect on
women’s performance and their feelings about
themselves and their work. Educational, behavioral and
structural initiatives may help prevent the perpetuation
of harassing attitudes and behaviors for future
generations of residents and medical students.
Institutions that take a strong public position against
gender harassment are likely to make the medical
workplace a healthier environment.
As medical school and residency training coincides
with the childbearing years, many women will give birth
during their training. However, women trainees may be
reluctant to ask for special arrangements during their
pregnancies or while they are breastfeeding. Taking time
off for childbearing and childrearing during residency
interrupts the academic schedule and can increase the
stress for other residents who may be asked to cover
their colleagues’ clinical responsibilities.
In order to address the reality of increased numbers
of pregnant trainees, residency programs will need to
develop more flexibility within their training programs to
be consistent with national maternity/parental leave
policies. Programs that maintain their usual quotas for
total time and quality of training within a flexible
framework will allow women physicians to better
combine their professional obligations and family
responsibilities.
The physical demands posed by residency training
programs, clinical practice and on-call responsibilities
can influence pregnancy outcome. Pregnant residents
who continue to work long hours, with frequent periods
of sleep deprivation and long periods of walking,
running and standing, have a higher rate of pregnancy
complications, such as preterm delivery and low birth
weight, than women in the general population. A US
study of board-certified women obstetricians found that
infants delivered during residency were 7.5 times more
likely to have intrauterine growth restriction than those
delivered outside of residency. Another US study found
that women residents were approximately three times
more likely than the spouses of men residents to
terminate their pregnancies voluntarily. In Israel, 33% of
residents reported major pregnancy complications (a
much higher percentage than seen in the general
population) and their rate of premature delivery was
two times higher than that of same age controls. In
Turkey, women physicians were two times more likely
than bank workers to have low birth weight babies.
Interestingly, studies in Australia and Finland, where
maternity leave and training policies are more flexible
than in the US, found no significant differences in the
rate of pregnancy complications for health workers
compared to the general population.
The increasing diversity of the medical profession, in
terms of sex, gender, religion and culture, presents
other new challenges, especially as many trainees seek
part or all of their training outside of their home
communities. Some cultural and religious practices
prohibit certain aspects of the physical exam when the
patient and the physician are not of the same sex;
however educational programs and certification
processes require physician competence with
comprehensive physical examination of both sexes. In
addition, patients may decline to be examined and/or
treated by certain groups of learners or clinicians.
Resolving such situations in ways that respect the
patient, the trainee/clinician and the medical setting can
be ethically challenging for educators and their
institutions.
Women are achieving numerical parity with men in
medical school and will soon become the majority of
trainees in primary care fields. Nevertheless, women in
training still face bias, harassment, unfavorable
maternity leave policies, and culture and religious
discrimination above and beyond the experiences of
men. To address the needs of the increasing numbers of
women and ensure their full development as physicians,
medical schools, residency training programs and
clinical institutions will need to develop new ways to
support women in training.
Barbara Lent MD
Cheryl Levitt MB, BCh
Lucy Candib MD
Michelle Howard MSc
Wonca Europe Region Online
Wonca Europe is the European regional branch of
Wonca. It has more than 30 member organisations and
represents more than 45,000 family physicians in
Europe. Wonca Europe has about 400 direct members.
The society aims to stimulate networking among GPs
with an interest in professional development, research,
education and quality improvement. To this end the
society arranges an annual European conference and
other meetings.
The Society has a small amount of money available
to support special projects that stimulate development
and research in General Practice in Europe.
The society has set 10 strategic tasks to be fulfilled
in each member country within the next decade:
1. Mandatory undergraduate education in family
medicine/general practice at all medical schools in
Europe
2. Academic departments of family medicine/general
practice at all university medical schools in Europe.
3. All doctors undergoing postgraduate medical training
must spend time in the discipline of family medicine/
general practice
4. Specific vocational training for general practice at
least in accord with the European Union directive
should be established in all EU countries, and
developed in non-EU countries
5. Continuing development of family medicine based on
research
The society is the academic and scientific society for
general practitioners in Europe. Its objective is to
improve the quality of life of the peoples of the world
through fostering and maintaining high standards of
care in general practice/family medicine by providing a
forum for exchange of knowledge and information;
encouraging and supporting the development of
academic organizations of general practitioners/family
physicians; and representing the educational, research
and service provision activities of general practitioners/
family physicians before other world organizations and
forums concerned with health and medical care.
WONCA
News
RESOURCES FOR THE FAMILY DOCTOR
16
The Wonca Europe Region coordinates its research,
academic and quality initiatives through the European
General Practice Research Network (EGPRN), European
Academy of Teachers in General Practive (EURACT) and
the European Association for Quality in General Practice
(EQUIP), respectively. The European Journal of General
Practice is the scholarly publication of the Wonca
Europe Region.
6. Evidence based quality development for family
medicine in all European countries
7. Support the development of and encourage the
debate on mandatory professionally led continuing
medical education and recertification
8. Support the establishment of departments and
research units for continuing medical education
9. Support a proper balance within family medicine in
relation to prevention, diagnosis, cure and care.
10. Raise the awareness of the responsibility of Family
Medicine both to individual patients and also to
society as a whole.
If interested in further information regarding Wonca
Europe, please visit our website at:
http://www.woncaeurope.org/
Professor Igor Svab
President, Wonca Europe Region
igor.svab@mf.uni-lj.si
Barbara Toplek
Administrative Secretary
Wonca Europe Secretariat
barbara.toplek@mf.uni-lj.si
National Colleges / Academies
National Trade Unions
WONCA
The World Organisation
EUROPEAN SOCIETY OF GP / FM
ESGP / FM
WONCA REGION EUROPE
EGPRW
Research
EURACT
Education
EQuiP
Quality
Euro J Gen Practice
Communication
UEMO
European Union of
General Practitioners
This figure shows the organisation and correlations of Wonca Europe.
WONCA
News
CONFERENCES 2007 – 2011
17
WONCA CONFERENCES 2007 – 2011 AT A GLANCE
**Wonca Direct Members enjoy lower conference registration fees
See Wonca Website www.GlobalFamilyDoctor.com for upates & membership information
2007
24 – 27 July
18th WONCA
SINGAPORE
Genomics and Family Medicine
WORLD CONFERENCE
17 – 20 Oct
European
Paris
Re-Thinking Primary Care in the European
Regional
FRANCE
Context: A New Challenge for General
Conference
Practice
2008
4 – 7 Sept
Europe
Istanbul
Theme to be confirmed
Regional
TURKEY
Conference
1 – 5 Oct
Asia Pacific
Melbourne
A Celebration of Diversity
Regional
AUSTRALIA
Conference
2009
5 – 8 June
Asia Pacific
Regional
Hong Kong
Building Bridges
Conference
16 – 19 Sept
Europe
Basel
The Fascination of Complexity -
Regional
SWITZERLAND
Dealing with Individuals in a
Conference
Field of Uncertainty
2010
26 – 30 May
19
th
WONCA
Cancun
Millennium Development Goals:
World
MEXICO
the Contribution of Family Medicine
Conference
Date to
Europe
Malaga
Theme to be confirmed
confirmed
Regional
SPAIN
Conference
2011
February 2011
Cebu
Paradigms of Family Medicine:
Asia Pacific
Regional
PHILIPPINES
Bridging Old Traditions with
Conference
New Concepts
Information correct as of February 2007.
May be subject to change.
18
WONCA
News
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
GLOBAL MEETINGS FOR THE
FAMILY DOCTOR
WONCA WORLD AND
REGIONAL CONFERENCE
CALENDAR
18th Wonca World Conference,
Singapore 2007
Host:College of Family Physicians,
Singapore
Theme:Genomics and Family
Medicine
Date:24-27 July, 2007
Venue:Singapore International
Convention and Exhibition
Centre
Contact:Dr Tan See Leng, Chairman,
Host Organizing Committee
College of Family Physicians,
Singapore
College of Medicine Building
16 College Road #01-02
Singapore 169854
Tel:65 6223 0606
Fax:65 6222 0204
Email:renawong@pacificworld.com
enquiry@wonca2007.com
registration@wonca2007.com
Web:www.wonca2007.com
Wonca Europe Regional Conference,
Paris, 2007
Host:French National College of
Teachers in General Practice
Theme:Rethinking Primary Care in
the European Context
Date:17-20 October, 2007
Venue:Palais des Congres
Paris, France
Contact:French National College of
Teachers in General Practice
6 rue des Deux Communes
94300 Vincennes, France
Tel:33-153 669 180
Email:cnge@cnge.fr
Web:www.cnge.fr
8
th
Wonca Rural Health Conference,
Nigeria 2008
Host:National Post-Graduate
Medical College of Nigeria
Theme:Frontline Medicine – From
Natural Disasters to Daily
Care
Date:20
th
– 23
rd
February 2008
Venue:Calabar, Cross River State,
Nigeria
Contact:Dr Ndifreke Udonwa
Chair Local Organizing
Committee
C/O Office of C.M.A.C
University of Calabar
Teaching Hospital,
GPO Box 147, Calabar
54001, Cross River State,
Nigeria.
Tel:234 (0) 803 341 6810
Fax:234 (0) 87 232 053
Email:nudonwa@yahoo.com
Wonca Europe Regional Conference,
Basel, Switzerland 2009
Host:Swiss Society of General
Medicine SSMG/SGAM
Theme:The Fascination of
Complexity - Dealing with
Individuals in a Field of
Uncertainty
Date:16 - 19 September 2009
Venue:Congress Center Basel,
Switzerland
Contact:Dr Bruno Kissling
Chair Host Organizing
Committee
Swiss Society of General
Medicine SSMG/SGAM
Elfenauweg 6, CH-3006 Bern
Switzerland
Tel:0041 352 48 50
Fax:0041 352 28 84
Email:bruno.kissling@hin.ch
Web:www.woncaeurope2009.org
19th Wonca World Conference, Cancun
2010
Host:Mexican College of Family
Medicine
Theme:Millennium Develop Goals:
The Contribution of Family
Medicine
Date:26-30 May, 2010
Venue:Cancun Conventions and
Exhibition Center, Cancun
Mexico
Contact:Mexican College of Family
Medicine
Anahuac #60
Colonia Roma Sur
06760 Mexico, D.F.
Tel:52-55 5574
Fax:52-55 5387
Email:
jdo14@hotmail.com
MEMBER ORGANIZATION AND RELATED
MEETINGS
4
th
AAFP International Family Medicine
Development Workshop
Tucson, 2007
Date:September 13-15, 2007
Location:Tucson, Arizona
Venue:Sheraton Tucson Hotel
&Suites
Chair:Edward J. Shahady, MD
Contact:Rebecca Janssen
Email:rjanssen@aafp.org
Web:
www.aafp.org/intl/workshop2007
American Academy of Family
Physicians (AAFP)
Annual Scientific Assembly, Chicago,
2007
Date:October 3-7, 2007
Venue:Chicago, Ilinois
Contact:AAFP
11400 Tomahawk Creek
Parkway
Leawood, Kansas
66211-2672, USA
Tel:1 913 906 6000
Fax:1 913 906 6075
Email:international@aafp.org
Web:http://www.aafp.org
The Royal Australian College of
General Practitioners
50th Annual Scientific Conference
Sydney, Australia 2007
Date: 4-7 October 2007
Venue: Sydney, Australia
Web: www.racgp.org.au
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eMedicine – a weekly clinical case for you to solve, with a visual cue: photo, ECG, radiograph
EBMsources – an appraisal of two evidence based medicine websites is posted every month
Cutting Edge – an interesting series about the latest medical hypotheses, posted weekly
Educational Resource Centre – a repository of educational materials for family doctors
Research – the latest on Wonca’s research activities, and opportunities for research
Conference updates – details of Wonca and other conferences
Publications – details of Wonca publications and Wonca News
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Global Resource Directory – where you can record you international projects, and view others
Medical Mirth – humor with a medical angle to lighten your day
Quotable Quotes – quotes you can use, many with a medical slant
Latest News – of coming meetings, conferences and events
Patient education – resources you can use to inform your patients
About Wonca – details of the Wonca organization, office bearers and Direct Members
Wonca Groups – details of Wonca’s committees and working groups
Information – Notice Board, Letters to the Editor, Doctor of the Month, list servers, mailing lists
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We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
We take days scanning the journals, so you need take only minutes.
Visit Global Family Doctor daily – and keep up to date
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