REVIEW – February 2005

Professional development of family medicine: current stage and further development


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The specialist family doctor (FD) training programmes were launched in 1991-1992 according to the criteria of the European Union for training general practitioners/family doctors. By now 996 FDs (which corresponds to the Estonia’s need —one family doctor per 1600±400 inhabitants) passed the training of family physicians in Estonia. Training was organized in two ways: three-year in-service retraining courses for the existing PHC physicians (paediatricians, physicians of internal medicine)(937 FDs) and three-year full-time residency training for the physicians who have graduated from a medical faculty and have passed internship (59 FDs). The legal status and the basic job description of FDs were implemented. We learned from experience that development of family medicine in community is more promising when training is started on the academic level and is then proceeded with trained specialists in family medicine implementing the principles of family medicine in practice step-by-step by reforming the previous health care system. A defined general speciality (general practitioner/family doctor), lacking in primary health care, was established in the transition period during the following ten years. The priorities of the further development of family medicine in Estonia were defined: to promote comprehensiveness of care, to pay more attention to preventive work and follow-up of chronic diseases in adherence to guidelines, to facilitate flexibility of contracts and proper financing corresponding to the amount of work, to practice-based research and teaching with implementation of the principles of the part-time workload for performing such activities, to promote development of group practices, to define the role of local authorities in the family medicine system.