Family Medicine in Lebanon Jinan Usta MD

University (Founded) Faculty of Medicine Established Student Number MDs/year American University of Beirut (AUB) (1866) 18677,00090 Université St. Joseph (1875) ,00065 Beirut Arab University (BAU) (1960) (Affil. of Alexandria University) , Lebanese University (LU) (1953) , Balamand University (1988) 20003, Université St. Esprit de Kaslik (1961) 20027, Lebanese American University (LAU) (1835) 20067,50064 Average MDs/ Year ~ 500 LEBANESE MEDICAL SCHOOLS

LEBANON: ~ 75% of MDs pursue PGME abroad (PGME)

Medical practice in Lebanon physicians From more than 75 countries Health care is mostly fee for service-out of pocket Limited number of reimbursed clinic visits per year of enrollment Side consultations/internet

Medical practice in Lebanon Abundance of Pediatricians and Obstetricians Everybody practices primary care One physician for every 375 but one GP for 1000 inhabitants Non academic practices More than 4819 registered medications – quality not guaranteed

History of Family Medicine in Lebanon 1979: AUB initiated the first Family Medicine (FM) training program in Lebanon and the Arab world The curriculum followed the guidelines of the ABFM and the requirements of the Arab Board The training takes place in ambulatory and hospital settings.

History of Family Medicine in Lebanon 1995: the University of Saint Joseph (USJ) established another program with the collaboration of the University of Montreal that is following the Canadian standards. The training occurs primarily in ambulatory settings. Residents of both programs perform well in the American and Arab Boards of Family Medicine

FM graduates 4-6 residents per year per program 120 graduates so far 60 practicing in Lebanon, 55 local graduates 20% in North America 19% gulf and SA Subspecialty?..

Family Medicine in Lebanon Most practice General medicine Decreasing tendency to go into private practice Almost all have administrative positions Primary care centers – Underpaid –Overworked: more referrals, lost to follow up – Political affiliation

Family Medicine in Lebanon Comprehensive care? Continuity of care? Coordination of care? Case advocate?

Family physician in Lebanon Competition with every physician Competition with para medicals Perceived as incompetent and less knowledgeable Referral doctor Not supported by the state, training

Solution Tailored training Self confidence Support of health care system More family physicians CME Family medicine vs primary care

Tahaddi- Challenge Infectious diseases- URT, GI Skin diseases Mental Health Chronic Diseases Domestic Violence Minor surgery

# of pts./session: 12.5 Age groups: 27% <5; 21%, 5-13; 17%, ;34%, 18-65; 1%, 65+ Gender: F, 59%; M, 41%

Advantages Family medicine Clinical medicine “ Sometimes I have to make a diagnosis without ordering tests like x-rays simply because they are not affordable, this helped to sharpen my clinical skills ” Closer to real life Research potential Good doctor patient relationship “ We have an opportunity to make a difference in the lives of people who need our help ”

Role of AFP Platform to share: –Best practices –Exchange of experiences –Develop algorithms/guidelines