Habib Fanny is a doctor

Promotion of young talent - on the right track, but not yet there

Fanny Lindemanna, Julia Laukenmannb, Regula Kronenbergb, Sven Streita

a Bern Institute for Family Medicine (BIHAM); b Young family doctors in Switzerland

The offspring come, work part-time, choose smaller practices, also in rural areas and where they have worked as a practice assistant. A new JHaS study in collaboration with the Bern Institute for Family Medicine (BIHAM) was presented at a press conference on April 25, 2019 and met with great media interest. The results are briefly presented here.

Family medicine plays a key role in health care and is not only highly efficient and inexpensive, but also works closely with other professional groups (pharmacists, Spitex, hospitals, etc.). The goal is: the patient is the focus, the family doctor coordinates the care. In 2014, 88% voted in favor of a federal resolution on basic medical care, in which general practitioner medicine is shown as an important component.

Fighting the shortage of general practitioners with an attractive job profile among the next generation

At the same time, there is a pronounced shortage of general practitioners: A study by the Institute for General Practitioners in Basel in 2015 found that in just a few years, every second practice will be empty due to a lack of successors [1]. Various reasons could be identified that led to the shortage of general practitioners. What was particularly significant, however, was that medical students and young doctors lost their interest in it. In 2008, only 10% of students chose general practitioner medicine as their professional goal. This is where the Young Family Doctors in Switzerland (JHaS) come in: They cleared up the job description and thus became role models for their generation. Your JHaS congress soon became a place of exchange with more than 500 visitors annually.

The first positive signs - interest is growing among students and young doctors

Lately there have been increasing positive signs that the next generation is growing: in 2017, students were surveyed again and now 20% have definitely opted for family medicine. Another 40% said they were interested [2]. In 2016 we asked JHaS members how they saw their future form of practice, whereby the majority wanted to work part-time in smaller group practices in rural areas [3]. As gratifying as both studies were, intentions alone are not enough and we need to understand whether actions follow.

A new study by the JHaS aims to provide clarity

Together with the Bern Institute for Family Medicine (BIHAM), the JHaS therefore carried out a new survey in 2019 among its> 1100 members, who are mainly women and are either still in training, further education or already working in practice. Almost half took part in the study. In addition, on the basis of the approval for all YHaS members who already work in the practice, it was possible to find out where the practices are and whether there are actually enough young people working in agglomerations and in rural areas. For the first time, we were able to take a comprehensive look at the next generation of primary care physicians, because there has been no register of young doctors who have joined practices.

The offspring are coming

The survey found some points that are relevant for Switzerland and family medicine: The most important and most gratifying news is that the next generation of family doctors is coming. 30% of the JHaS members (more than 350 family doctors) are already active in the practice.

Part-time, in double and smaller group practices

Many have implemented their wishes and now work part-time. And yet: The amount of consultation hours they offer part-time is impressive: they look after around 700,000 patients during consultation hours, on the phone, during house calls or in the emergency service (Fig. 1). The most popular types of practice were double and smaller group practices with up to five doctors (73%). 17% chose even larger practices, 10% still chose an individual practice, so that this type of practice still exists (Fig. 2).

Practices opened where patients live - in urban, periurban and rural areas

Thanks to the approval register, we were able to divide the locations of the new practices into urban, periurban and rural (BFS Stadt / Landtypologie 2012) and compare the distribution with the permanent resident population (BFS 2015). We found: Young family doctors chose their location where the population also lives, balanced in all three sizes of the municipality, i.e. also in the countryside (Fig. 3).

The wishes were followed by deeds

The young family doctors work all over Switzerland. It was noticeable that> 40% took over or entered a practice where they had previously completed a so-called “practice assistant” as an assistant doctor (Fig. 4). General practitioners taught them there for usually six to twelve months so that the youngsters learn what they need to know (and be able to do) for their later daily practice. These practice assistance positions, which are mostly financed by the cantons (still missing in Ticino), work because they are the stirrups in the practice for the offspring. As gratifying as these key statements of the survey are, they also clearly show how important it is to make further efforts. For example, cantons can invest more in practice assistance programs.

Win-win-win situation

As an example, in the canton of Bern, the vacancy for practice assistants was unanimously increased from 21 to 35 in 2017, for which the BIHAM had to fight together with the doctors' organizations Ärztegesellschaft des Kantons Bern (BEKAG) and the Bernese Family and Pediatricians Association (VBHK). In order to evaluate the effectiveness of the program, the BIHAM is now simultaneously publishing a long-term study of all 165 former practice assistant doctors who have been looked after by the BIHAM over the past ten years. > 80% became general practitioners or are on their way to the practice, here too> 40% where the practice assistance was carried out [4]. A win-win-win situation: the canton is gaining family doctors, often also in rural areas, the family doctors find a successor through the program and the young family doctors enjoy optimal preparation for their practice in the practice assistance later profession. The program is popular in Bern, and despite the increase, applications have to be rejected because the positions for 2019 have already been filled in April.

Summary

- We are seeing a very positive development: Students are interested in family medicine, young doctors, especially after an assistant practice, make the step into a practice, spread all over Switzerland. The wishes were followed by deeds. But we are not there yet.

- If> 60% of the students express their interest in family medicine, we have to prepare them for practical work by means of attractive further training (curricula). This requires support (mentoring) from experienced family doctors who can actively support the youngsters in their professional goals and can advise and accompany them on topics such as self-employment or the compatibility of work and family. Long-term studies will continue to be important to keep a close eye on developments. The young talent promotion committee of the Swiss Society for General Internal Medicine (SGAIM) is committed to this together with its partners and with the support of the JHaS.

- Once the practice has been successful, we want to secure the practice activity in the long term in view of more and more patients (keyword increase in chronic diseases). Optimal care also requires health services research, as is now being carried out at several institutes for family medicine (SAFMED umbrella association, www.safmed.ch), thanks to the support of institutions such as the Swiss National Science Foundation and its national research program NRP 74 “Health Care” (www.nfp74.ch) become.

Thanks

The authors would like to thank Gabriela Rohrer, Linda Habib, Thomas Berger and Sandra Hügli-Jost for their assistance in carrying out the study and for their active support at the media conference. The graphics were created by Marc Siegenthaler, www.lesgraphistes.ch.

Credits

Headshot: ID 109808144 © Robert Kneschke | Dreamstime.com

Correspondence address

Prof. Sven Streit
Bern Institute for Family Medicine (BIHAM)
Head of youth development and networking for general practitioners
University of Bern
Mittelstrasse 43
CH-3012 Bern
sven.streit [at] biham.unibe.ch

literature

1 Zeller A. Work Force Study 2015: “Scientifically felt the pulse of the Swiss”. https://synapse-online.ch/de/article/doi/syn.2016.00324/.

2 Diallo B, Rozsnyai Z, Bachofner M, et al. Who is aiming for a family doctor career at the end of their medical studies? 60% of Swiss students show great interest. Submitted manuscript.

3 Gisler LB, Bachofner M, Moser-Bucher CN, et al. From practice employee to (co-) owner: young GPs predict their future careers. A cross-sectional survey. BMC Family Practice. 2017; 18 (1): 12.

4 Rozsnyai Z, Diallo B, Streit S. 10 years of practical assistance program in the Canton of Bern. Swiss medical newspaper. 2019; 100 (19): 642-3.

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