PRIMARY HEALTH CARE in TURKEY Dr.Sümeyya KOKAÇYA Dr. Burhan BALABAN Dr. Saliha ŞAHİN

Stages of the Education System Pre-School Education: Optional kindergarten education, up to 6 years of age. Primary Education: Compulsory and free basic education for eight years (4 years elementary + 4 years secondary), 6-14 years of age.

Secondary Education: 4 years of High School or Vocational High School education, 15-17/18 years of age. Some schools might have an additional year of language study. High schools are mostly owned by the government and provide free education. 

Medical eduation in Turkey is 6 years. School of Medicine provides six years of medical education, excluding English preparatory year. In the first year, the students take the core education program of the University, equipping them with the required competencies for medical education.

Starting with the second and third years; basic medical courses and basic-clinical bridge topics are provided with an integrated program, to expose the students as early as possible to clinical medicine

In clinical years, fourth and fifth years, students work on the diagnosis and treatment of diseases through clerkship  training program. In the sixth year, as pre-graduate interns, they fulfil duties and responsibilities, under supervision, in the care of patients and thus complete their training.

Internship in Turkey Department Duration (month) Internal medicine 2 Pediatrics General Surgery 1 Gynecology and Obstetrics Psychiatry Emergency Care Public Health Selective Clinical Courses FAMILY MEDICINE

After medical education Medical doctor (M.D.) English Proficiency Exam Minumum 50 points, after that Medical Specilaization Exam

Family Medicine Training in Turkey Turkey has a 3 year residency training programme that began in 1985. 18 months in primary care setting 18 months in hospital setting

Rotations (Hospital setting) The Training Sites for Family Medicine Speciality Training Rotations (Hospital setting) Primary Care setting * Family Medicine - 18 months * Internal Medicine - 4 months * Pediatrics - 4 months * Obstetrics and Gynaecology - 3 months * Cardiology - 1 month * Pulmonary Diseases - 1 month * Emergency Medicine - 1 month * Dermatology - 1 month * Psychiatry - 2 months * Elective ( Neurology, Physical Therapy and Rehabilitation, General Surgery - 1 month)

Who is responsible for the family medicine specialty training? 1- Universities 2- Government 3- Professional body (Turkish Association of Family Physicians)

Family Medicine Training in Turkey Training and Research Hospital Number of; educational Training and Research Hospital, 17 Total trainer, 33 Residents, about 700 Universities: Number of; educational Universities, 55 Total trainer, 146 Residents, about 300

Family Medicine Training in Turkey We have; ‣ 40 Professor ‣ 85 Associate Professor ‣ 70 Assistant Professor ‣ 20 Chief Resident ‣ 10 Education and Administrative Officer ‣ 50 specialist at Training and Research Hospitals and Universities

Educational Goals 1. Professional Values and Ethics 2. Clinical Practices in Family Medicine 3. Communication 4. Education and Training 5. Research and Evidence-Based Medicine 6. Managerial Skills

Some problems on the residency of Family Medicine in Turkey Important issues are: • the date of change or transition, • the training sites for family medicine training, • the position and the role of the departments of family medicine,

The Date of Change or Transition Turkey has officially not set such a date which means that is still possible to go different routes to become a physician working in primary care. Turkey has also made some decisions in relation to the development of the Family Health centres. Transition can be done in two ways: Direct (residency) or CFPS (contracted family medicine specialty)

Training of Contracted Family Physicians in Turkey was initiated in 2014 by the Ministry of Health intended for family doctors in order to ensure that the family medicine services are provided by the family medicine specialists and to increase the number of experts in this scope. making family physicians while they are working in primary care to become family medicine specialists. was planned to continue until 2020 some basic problems were encountered. The most common problems are the low demand for education by family physicians, and the inability to disseminate education. duration 6 years 18 months rotation

The Position and the Role of the Departments of Family Medicine The academic environment is very necessary to gain more knowledge on a scientific basis. In this way, trainees also learn about research which is part of the profession. Medicine is an academic discipline and trainees should be aware of that. University departments of family medicine play a crucial role in this field which should be a part of the training. It seems the scientific environment is already developed but the link to the family medicine specialty training can be strengthened.

As a Family Medicine Specialist (FMS); Pamukkale/Denizli -one year compulsory service, mostly in rural areas -FMS is commissioned to work in: Secondary care hospital( emergency room or ambulatory care in practice office)_if there is place declared for FMS you can apply Community Health Centre Education&Training Hospital or University Hospital_if you have the right of ‘partner’s situation’.It’s kind of list of procedures’the government provides it for keeping the family together.

Beyoglu/Istanbul After compulsory service, FMSs can continue to work in current place or apply for a new place among declared by the government. ( sign a contract is obligatory) It’s not common to work in private clinics in early years of work, but after 5-10 years ones can prefer to work in elderly care centres or private hospitals’ different departments such as ER, wards etc.

Family Health Centres (FMC); Kapodokya/Nevsehır 2 kinds of FMCs buildings-- hired by the government, hired privately (FDs have to find a building and offer it to the Provincial Health Directorate, no standardized buildings) 1-6 doctors work in each FMC-Each FMS should have a nurse theoretically, it’s not possible most of the time. They are paid by the government. (salary: nearly 2500 Euros) All other expenses--Cleaning staff, secretary, extra nurse, rent charges,bills…are afforded by doctors.

FMCs are classified as A,B,C,D or non-classified ones Uskudar/Istanbul FMCs are classified as A,B,C,D or non-classified ones A is the best qualified clinic with extra equıpments and staff such as secretary, extra nurse,cleaning staff and security officer. The government give more money to FMC-A doctors! In a non-classified clinic, only one doctor and one nurse work, basic medical devices and materials are required.

Working conditions Black Sea Region Opening hours of FHCs: 8am-5pm Population: approksimately 3500-4000 patients per FMS. Daily examination: 50-60 patients Each examination lasts: 5-6 minutes Total working hours: 40 hours per week Home visits: 4 hours per week Laboratory Service: Blood samples are taken in certain hours and sent to a center laboratory in the city--Next day, results can be seen online . Electronical prescription is used.

Şirince village/Izmir Main Problems No gatekeeping system: People don’t have to apply primary care fist. They can go through the secondary or tertiary care by taking an appointment via national online system (182) No coordination: If one of your patients is seen in hospital or ER , FMS has no way to know what exactly happened, because a letter or note isn’t written to family doctors. Workload: FMS are responsible for vaccinations of children and adults, counselling for smoking cessation and obesity, all other issues related to chronic conditions( HT, DM, COPD,Asthma). There is no teamwork in primary care.

Teşekkürler! Thank you! Paldies! Gracias! Obrigado! Dzięki Díky! תודה!