From the Wonca President:
Family Medicine is Also Alive and
Well in the East
2
From the CEO’s Desk:
Opportunities in a Wonca World
3
Conference
From the Editor
:
:
:
One Stop Shopping at Global Family
4
Doctor – Wonca Online
FEATURE STORIES
5
• Women in Academic Medicine
• Register Online for Wonca World 2007 in Singapore
Wonca REGIONAL NEWS
8
• Asia Pacific Family Medicine Journal Enters its Sixth Year
• The European Journal of General Practice Finds New Global Publisher
HEALTH AND HEALTH SYSTEM NEWS
10
• World Health Day 2007 Focuses on International Health Security
MEMBER AND ORGANIZATIONAL NEWS
11
• Linda French Joins Global Family Doctor’s Medical Editor Team
RESOURCES FOR THE FAMILY DOCTOR
12
• The Wonca Dictionary of General/Family Practice
• GFD – Wonca Online: Mailing Lists For Family Doctors
WONCA CONFERENCES 2007-2011 AT A GLANCE
16
GLOBAL MEETINGS FOR THE FAMILY DOCTOR
17
VOLUME 33
NUMBER 2
APRIL 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 :
FAMILY MEDICINE IS ALSO
ALIVE AND WELL IN THE
EAST
“If the principles (of Family
Medicine) ...have an enduring value,
they should be applicable to all
cultures and all social groups ..... I
believe firmly that these principles
have universal application. How
they are applied, however, will vary
according to circumstances. If there
is only one physician for 50,000
people, it is obvious that his or her
role as a manager of resources,
leader, teacher, and resource for
difficult problems will be
predominant......”
Professor Ian McWhinney
In Oxford Textbook of Primary
Medical Care,
OUP, 2004
During my three years of
international travel as President of
this remarkable organisation, and
through the preceding years on the
Executive, I have been repeatedly
impressed by the universality of the
foundations and principles of family
medicine. While the content and
ecology of family practice may vary
from country to country, the basic
characteristics of family doctors
permeate all systems. “A good
family doc is always a good family
doc, no matter where she or he is
practicing”!
This universal thread was once
more stressed during my recent
exciting visit to the Philippines. I
was invited to present a keynote
and Dr Ramon R. Angeles Memorial
Lecture at the 46 th Anniversary and
Annual Convention of the Philippine
Academy of Family Physicians. The
WONCA
News
FROM THE WONCA PRESIDENT
2
theme of their meeting was
“Looking back, moving forward from
illness to wellness”. Remarkably,
this organization, which began as
the Philippine Academy of General
Practitioners, was established in
1960 and it commenced its first
annual postgraduate course that
year. The Founding President was Dr
Ramon R. Angeles, a true and
humble community-based family
doctor in every sense, who has
become a legendary icon and
remarkable role-model within the
country. When Wonca was
established in 1972, he represented
the Academy, one of the 17
Founding Member Organisations. So
their organisation and its
practitioners have been essential
contributors to the World
organisation and family medicine for
nearly half a century.
Bruce Sparks and Alejandro Pineda, President
of Philippine Academy of Family Physicians
Bruce Sparks Sharing a Moment with Zorayda
“Dada” Leopando, Past Regional President of
the Asia Pacific Region
Three Philippine Academy Past Presidents,
from left to right: Raphael Bantayan,
Benjamin Chang, Edward Tordesillas
Philippine Family Medicine Resident Winners
of the Clinico-Pathological Conference
Bruce Sparks and Family of Founding
Philippine Academy President, Ramon
Angeles
The activities of this organisation
under the recently re-elected
President, Dr Alejandro Pineda, are
most exceptional; they not only
maintain high academic standards
and numerous activities through
contributions from all academic
departments of family medicine, and
national training programmes, but
also have specific community
programmes for the poor and
indigent. Academic endeavour has a
long history in the Philippines – The
University of Santo Tomas was
established in 1610, 26 years before
Harvard! It now has one of the many
excellent teaching hospitals in the
multi-island country.
What has really impressed me
during my tenure had been the rigor
and standards of research in family
practice in our member
organisations. While much of the
research in developing countries will
not see the ink of major
international publications, due to
the apparent and reported bias in
paper selection, the projects being
carried out are generally of major
WONCA
News
FROM THE WONCA PRESIDENT / FROM THE CEO’S DESK
3
FROM THE CEO’S DESK:
OPPORTUNITIES IN A
WONCA WORLD
CONFERENCE
A Wonca World Conference is
held only once every three years.
The next World Conference will be
held in Singapore in July 2007 over
a three-day period. Preparations are
now in their final stages.
As has been the policy over the
past twenty odd years, the World
Conference will be preceded by a
Full Wonca Executive Meeting lasting
three days, followed by a day of
Regional Council Meetings for the
six Wonca Regions and by three full
days of the Wonca World Council.
This then leads onto the conference
proper lasting three days.
This gathering of the leaders of
Family Medicine from the various
Wonca Full and Associate Member
Organizations, as well as
Organizations in Collaborative
Relations with Wonca, provides a
unique opportunity that presents
itself only once in a triennium.
Besides the many opportunities for
the renewal of friendships, side-
discussions on issues of mutual
interest, networking and learning for
these leaders, the occasion also
presents opportunities for several
other events to occur. I hope in this
short article to suggest some of
these that may be worth
considering.
Firstly, whilst the growth of
Wonca over the past decade has
been characterized by the increase
in the number of member
organizations, there has also been
an increase in the number of sub-
groups that have been established
for which Wonca has agreed to
importance locally to the
communities and to the health
workers in these countries. This was
very evident in the academic
programme of the convention and
the innovative research competition
held during the convention in
Manila. Equally exciting were the
finals of the Clinico-Pathological
Conference. Teams of Family
Medicine Residents from training
programmes throughout the country
had been assessed at preliminary
rounds prior to the meeting. The
presentations by the finalists, of
their understanding of a patient
with a complex hepatic disease, had
the excitement and tension of a
World Cup final! It was a test not
only of their academic rigour and
ability to problem solving, but also
essential family doctor
characteristics of teamwork,
collaboration, humility and respect.
Among my most rewarding
experiences were the times I spent
with residents, discussing their
patients, course work, learning
styles, and aspirations. It was in
them that I particularly experienced
the universal family medicine
thread. Their enthusiasm of the
discipline was especially
encouraging, as was their
biopsychosocial approach to patient
care. This I had also experienced
during the refreshing time I spent
with the Taiwanese residency
program last year. I am reassured
that the quality of our up and
coming leaders in the discipline will
move us to new heights. Not only
are they clinically very sound but
they have embraced the best of the
past with the challenges of the
future, while maintaining the core
values of being a ‘good family
doctor’.
The lessons I learnt are
numerous, but perhaps the most
refreshing was the enthusiasm
instilled in the discipline by the
senior family practitioner leaders in
the Philippines, not least of all
Zorayda (Dada) Leopando, well
known for her dedicated enthusiasm
and nurturing of the discipline over
the years and during her tenure as
President of the Wonca Asia-Pacific
Region. In no other organisation
have I witnessed such continued
active participation of past-
Presidents in the affairs of the body
– their wisdom and experience is
silently influential throughout its
activities without stifling growth and
change. Another lesson is that of
palpable commitment to improving
the plight and health status of their
practice populations.
My friends would know that my
message would not be complete
without a suitable quote from Sir
William Osler. Perhaps the most
appropriate one which reflects my
visit to the Philippines, with its rich,
long history of family medicine and
which incorporates the wisdom of
the past in its exciting new
activities, would be from
Aequanimitas, “The past is always
with us, never to be escaped; it
alone is enduring; but amidst the
changes and chances which succeed
one another so rapidly in this life,
we are apt to live too much for the
present and too much in the future.
Professor Bruce Sparks
Wonca World President
PS. Regretfully due to illness close
to my family I was unable to submit
my usual column in earlier editions.
I express my family’s gratitude to
Professor Chris van Weel, Wonca
President Elect, for standing in for
me over this period.
WONCA
News
FROM THE CEO’S DESK
4
provide financial and organizational support. These
would include the Women in Family Medicine, Mental
Health, and the Education Working Parties.
Currently all these and other established sub-groups
are actively pursuing their own agenda which in most
cases do not significantly compliment each other. There
is perhaps a need to have some common thread
connecting the agendas and objectives of these various
sub-groups. This will require that the gathering of the
many family medicine leaders prior to a world
conference be an occasion for Wonca to set some
specific goals for each triennium. Once these goals have
been identified, the various Wonca regions and sub-
groups could incorporate the identified goals in their
planning for the triennium’s activities. In this way, the
efforts of this global organization would be better
focused and the objectives more achievable through its
regions and sub-groups.
It is therefore with this in mind that the coming
Wonca World Council will devote some time to a break-
away session during which the leaders in smaller groups
will be requested to discuss in-depth on what some of
these specific Wonca goals should be. If this approach
proves successful and desirable, the same may become
a feature of all future Wonca World Councils.
Secondly, at each World Council, the Wonca
Executive and the various Wonca sub-groups present
their triennium’s work and reports and only issues of
importance are singled out for discussion. Even with
this selective approach to discussions, the Council is a
three full- day affair on account of the very lengthy
agenda. There is hardly any opportunity for dialogue
and discussions between the Wonca Executive and the
CEO with the representatives of the sub-groups. Such
dialogue if achievable may lead to better and closer co-
ordination, collaboration and working relationships
between these sub-groups and the Executive Committee.
We should perhaps explore the possibility of special
working lunch or dinner meeting between the Wonca
Executive and some representatives of each Wonca sub-
group to achieve this end. These dialogue sessions may
help the parties involved to better understand each
other and the priorities, planning, concerns and
limitations of the various programs proposed for each
triennium. Whilst there will be some cost to be incurred,
I believe the outcome will be worth the time and money
spent.
Finally, there should perhaps be incentives to
encourage all Wonca sub-groups to hold special events
in conjunction with a Wonca world conference. Currently,
most Wonca sub-groups do hold their business
meetings just prior to the world conference. But these
tend to only involve a small number of key persons of
the sub-groups and do not add much to the attractions
of attending the world conference for the vast majority
of delegates of the conference. If each and every sub-
group were to hold some educational programs specific
to its area of interest in conjunction with its business
meeting, these would increase the flavor and variety of
the conference.
Perhaps one of the ways this could be realized is to
encourage the use of the funds allocated to sub-groups
for the year of a world conference for the specific
purpose of holding such educational programs before or
during the conference. Such funding could be used to
sponsor speakers or help support participants from
developing countries to attend the programs and also
the world conference.
A Wonca World Conference, held once in a triennium,
is a very special event for the Organization. This is the
time when global leaders of Family Medicine gather to
exchange ideas, learn from each other, expand
networking and explore opportunities. I believe that
maximum advantage should be taken of such an
occasion, as most would have made significant effort
and sacrifice to be present.
Dr Alfred Loh
Chief Executive Officer
World Organization of Family Doctors
WONCA
News
FROM THE EDITOR / FEATURE STORIES
5
FEATURE STORIES
WOMEN IN ACADEMIC
MEDICINE
(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
Academic Medicine.)
Despite the increased proportion
of women entering medical training,
women are still under-represented in
academic medicine. Although
women are more likely than men to
choose an academic career, women
physicians’ advancement is slower
than that of their men colleagues.
We explored the individual,
institutional and societal factors that
contribute to this phenomenon.
Most of our evidence came from
North American literature, and might
differ from experiences elsewhere
that have not been reported as
widely.
Currently, women comprise 32
percent of faculty at US medical
schools. More women are advancing
to senior academic positions in
medical schools (27% of associate
and 15% of full professors) than
previously, but not as many as their
numbers in medicine would dictate
and not as fast as their numbers are
growing among medical students
(47%) and junior faculty (38% of
assistant professors). According to
the Association of American Medical
Colleges (AAMC), which gathers
comprehensive data each year on
students and faculty at US and
Canadian medical schools, women
FROM THE EDITOR:
ONE STOP SHOPPING AT
GLOBAL FAMILY DOCTOR
– WONCA ONLINE
The 18
th
Wonca World Conference
in Singapore, July 24-27th, is just
three months away. Time is running
out if you have not yet made travel
plans to attend this most
extraordinary gathering of family
doctors from around the world.
Would you like to register for the
Wonca World Conference? Learn
more about the World Organization
of Family Doctors? Keep up with
relevant family medicine / general
practice knowledge? Find a link to a
Wonca Member Organization’s
website?
All of this valuable information
and much more are but one web
click away at
www.GlobalFamilyDoctor.com
Professor Wes Fabb has served
with great distinction as GFD’s
Medical Editor since its inception in
2001. Stephen Wilkinson joined as
Medical Editor in 2004, Jim Vause in
2005 and Linda French in 2007. The
Wonca GFD Medical Editors scan
5,000 article titles each month from
over 200 family medicine, general
and specialist online journals for
articles relevant to family doctors.
This valuable service available to
you through GFD allows you to
maintain current as a family doctor
with minimal time and effort.
In additional, GFD contains
everything you need to know to
quickly become knowledgeable
about Wonca, its member
organizations, working groups,
relevant global meetings for the
family doctor, and other useful
resources. Each bimonthly
publication of Wonca News is
posted and can be downloaded
from GFD, including archived issues
back to 2001.
This issue of Wonca New will
give you just a taste of what is
available to you on GFD.
The Wonca GFD Medical Editors,
Publications Committee Chair Geoff
Martin, CEO Alfred Loh and the
Wonca Executive are continually
looking for ways to make Global
Family Doctor – Wonca Online even
more relevant to you.
I continue to be amazed upon
meeting family doctors who have
not yet discovered a website that is
so relevant and important to their
professional lives. If you are already
a regular GFD visitor, would you
please do your part to inform your
fellow family doctors about this
invaluable resource at
www.GlobalFamilyDoctor.com
For those who have yet to
register for the 18th Wonca World
Conference in Singapore, please
register online through GFD. I look
forward to seeing you in Singapore!
Marc L. Rivo, M.D, M.P.H.
Editor, Wonca News
marcrivo@aol.com
4566 Prairie Avenue
Miami Beach,
FL 33140 USA
WONCA
News
FEATURE STORIES
6
are making slow gains from
assistant professor to full professor,
but the rate of promotion to full
professor has been stagnant at 25%
of promotions for the past 5 years
(currently an average of three
women faculty per medical school).
The number of women deans (10%)
and department chairs (11%) is still
small, but has increased
substantially in the last decade,
although women’s participation as
associate and vice deans is
proportional to their representation
among senior faculty.
One key measure of academic
productivity is the number and
quality of publications. Increasingly,
women fill the ranks of first and last
authors of articles and editorial
commentators in prestigious medical
journals, especially in fields like
pediatrics and ob-gyn with strong
women’s presence, but overall
women still make up the minority of
authors. A 2004 study showed that
women comprised 29.3% of first
authors and 19.3% of senior authors
in six prestigious U.S. medical
journals, and 11.4% of guest
editorialists in NEJM and 18.8% in
JAMA. The percentage of women
editorialists could change
dramatically, as the editors of
medical journals have the explicit
power to select the authors of guest
editorials.
Historically, women have
reported less infrastructure support
than men in laboratory space and
research assistance, and even when
their research output was equivalent
to men peers, their financial
compensation has typically lagged.
Several studies have shown that
women academic physicians in the
US received lower salaries than
comparable men colleagues, a
deficit in compensation worse than
that for non-physician women and
more exaggerated in women with
greater seniority. In addition, of
faculty with children in the US,
women researchers report less
research funding and less secretarial
support than men, with resulting
fewer publications, slower progress,
and less career satisfaction –
differences that did not occur
among faculty without children. At
the personal level, letters of
recommendation about highly
qualified women used tame and flat
language to describe their
accomplishments compared to the
superlatives in men’s letters of
recommendation. To make headway
in such difficult circumstances,
women believe that mentoring is
important. Nevertheless, they feel
that they have more trouble finding
a mentor than their men colleagues.
A recent UK study at one medical
school showed that randomly
selected medical students valued
men faculty as role models “in
relation to their knowledge,
professional power, and authority”
while they viewed the women
faculty role models for the qualities
of tolerance, integrity,
respectfulness, and support towards
students.
Structurally, academic institutions
could choose to be more flexible in
how they operate. Meetings still
frequently occur in the early
morning and evening hours, times
notably unfriendly to the parents of
small children. The promotions time
clock, in some universities, has not
slowed down for childbearing
women – or their spouses. In those
medical schools that do offer the
possibilities of tenure clock-
stopping and part-time approaches
to tenure (69% of U.S. medical
schools in 2005), these policies fail
to generate real change because so
few faculty make use of them.
Moreover, the creation of part-time
faculty positions has actually slowed
promotions, removed tenure options
and done little to resolve the
problems. Both men and women
may choose to work part-time: in
one US study in 1993, women were
more likely to split their hours
between faculty work and
childrearing while men divided their
hours between faculty work and
private practice. While medical
faculties may perceive part-time
members as valuable, women (and
parents of small children) believed
that part-time faculty was viewed as
less committed to their careers and
to the institution.
The academic environment
remains an inhospitable habitat for
women in the U.S., even though
professional development focusing
on the needs of women faculty is
widely available. The “hidden
curriculum” continues to foster
traditional assumptions about men
and women. And while the academic
organizations may call for leaders
with the skills to build consensus
and collaboration toward values-
based goals, competition, not
cooperation, continues to
characterize medical education
settings.
These challenges are not only a
matter of an unfriendly “climate.”
Harassment (including sexual
harassment) is a reality for many
medical students and residents
(estimates run up to 35% of 1st year
residents), usually from supervisors
who may be senior residents or
clinical faculty members. Sexual
harassment may include flirtation,
offensive language, sexual
propositions, sexual contact, sexual
bribery and assault, as well as
discriminatory grading and exclusion
from educational opportunities. The
experience of harassment leads to
poor self-esteem and low self-
confidence. Such experiences may
“frame” a student’s medical career
and lead to long-term career
dissatisfaction.
Multiple competing demands are
a reality for professional women.
Even highly trained academic women
in medicine define success as
WONCA
News
FEATURE STORIES
7
achieving a balance between work
and home. Among mid-career
women physicians in the U.S. who
had completed an academic
fellowship 15 years earlier, those
who were satisfied with their life in
academia had clear values and
goals and a sense of control over
their time. Those less satisfied with
their careers experienced struggle in
balancing their lives and confronted
institutional barriers, such as
unfriendly work environments,
limiting their potential. At exactly
the point in their early careers
where childbearing was on the
agenda, they were forced to choose
between high intensity work
inconsistent with family life, or
lower pressure jobs with defined
hours that would effectively remove
them from the academic track. Their
success, according to Kalet and her
colleagues writing in the Journal of
General Internal Medicine in 2006,
consisted of “making life work,”
“making work work,” and “defining,
navigating, and negotiating success”
through creating flexibility and
managing change.
The barriers facing women in
academic medicine are part of the
picture; another aspect may be
women’s own discouragement or
reluctance about the task. They may
also lack the negotiating skills to
argue for resources and
remuneration comparable to men.
Some may find the struggle to
succeed while maintaining a family
and home life to be too difficult and
that the achievement of balance is
not feasible in an academic setting.
Canadian data show that although
women physicians with children do
clinical work approximately eight
hours less per week than men, they
put in an additional 40 hours of
home-related work each week. New
graduates in many countries strive
to balance their professional and
personal/family responsibilities
differently from their more senior
colleagues. Incoming academic
women physicians may set more
limits on their work life. Accepting
part-time positions, slowing the
tenure clock, attending fewer
meetings, and accepting a slower
trajectory in academic promotion, or
even staying stationary on the
academic ladder, are all ways that
women might choose to achieve
balance and flexibility at the cost of
academic success.
Interventions to support
academic women physicians have
important ramifications for men as
well. An academic department that
implemented and studied strategies
to foster the careers of young
faculty showed that promotions for
both men and women can be
accelerated by a system of personal
mentoring. Moreover, changing the
timing of rounds from Saturday
morning to the usual work week led
to an increase in the numbers of
both men and women participants.
Increasingly men physicians in
families are recognizing what they
are missing out on in their pursuit
of academic success, and some are
asking for the same flexibility in
academic promotion as women have
chosen.
Change is also&n
