a1 Department of Family Medicine, The Aga Khan University, Karachi, Pakistan
a2 Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, USA
a3 Family Medicine Department, National Autonomous University of Mexico, Mexico
Background Health care systems are changing around the world; family doctors need to adapt and prepare for future challenges.
Aim To consider the present status of family doctors, anticipated changes in health care systems, the challenges these will bring and possible solutions.
Collection of information Collaborative enquiry amongst members of the International Federation for Primary Care Research Networks (IFPCRN). Six strategic questions were addressed by 37 contributors from 23 countries. Responses were collated and contributors invited to further comment on the interim report.
Findings Present status: Despite wide variability, common problems relate to delivery systems, funding and policy, lack of evidence-based medical practice, education and research. Role of family doctors: There is wide variability in roles and often poor interaction with other caregivers. Anticipated changes: An expansion of the family physician model is anticipated, alongside shortages of family doctors in the face of increased health care needs, increased complexity of problems and the shift to ambulatory care. Advances in information technology may be useful. Anticipated challenges and proposed actions: Address quality issues. This requires audit and quality assurance, promoting adaptability, promoting group practices and teamwork, coordinating care, incorporating information technology and ensuring ethical relationships with industry. Improve education and continuing professional development: Improved education and continuing professional development are needed, as are measures to prevent burnout and retain the workforce. Develop a robust research enterprise: Research in primary care is needed to develop relevant guidelines. Improve support for family doctors: Providing excellent patient care is essential for improved status and support. Achieving this requires engagement with policy makers, academic institutions and the public.
Conclusions While there is great variability across different countries, common themes relate to present status, anticipated changes in health systems and the responses needed from family medicine.
(Received June 2007)
(Accepted May 2008)