1. Global Family Medicine Development – Applications for the Future Dr. Calvin Wilson University of Colorado Anschutz School of Medicine

2. 2 Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Dr. Calvin Wilson has indicated he has no relevant financial relationships to disclose.

3. Dedication This presentation is the first of the annual Daniel Ostergaard Memorial Lectureship, and is dedicated to that tireless, innovative, wise guardian of the heart of Family Medicine, and global servant leader: Dr. Daniel Ostergaard 3

4. Objectives Review the current state of global Family Medicine development Capture critical development lessons learned over the past 30 years Present the ideal role a Family Medicine teacher might play in a developing country over the coming decades Understand the potential risks, pitfalls, and rewards of global family medicine development 4

5. Current State of Global Family Medicine 130 countries with active Family Medicine Associations –Out of 195 countries in the world –33% with no formal Family Medicine Association 400,000 family physicians around the world –Greatest number of FPs in North America and Western Europe –110,000 from U.S. alone 5

6. Current State of Global Family Medicine Many developed countries with socialized medical system depend on FP for PHC –Eg. Netherlands, Scandinavia, Canada, Great Britain Most developing countries have small and often struggling Family Medicine programs 6

7. Current State of Global Family Medicine Current Family Medicine issues in majority, developing world: –Poorly funded and resourced –Few experienced family medicine teachers –Low prestige, low salary, absent career path of “generalists” –Lack of positions in health system framework Existing FP are often dedicated and passionate about their contribution 7

8. Lessons Learned There is a tremendous need for Family Medicine principles and practice around the world –Primary care system focuses primarily on the most basic elements –PHC often delivered through multiple vertical programs, and by non-physician health workers –Broader scope of care is missing – referrals and fragmented care frequent 8

9. Lessons Learned Appreciation of this need is variable around the world –All countries have some version of the medical school trained GP; for many health leaders this is “adequate for the masses”. –Many countries rely on a referral system that “gets patients in need to a real doctor” (a specialist); with varying degrees of success 9

10. Lessons Learned There will always be opposition to Family Medicine development –Established specialists - “turf battles” –Paternalism toward the poor and marginalized –“CAT Scan Envy” 10

11. Lessons Learned Family Medicine development can be either by Evolution (bottom up) or Revolution (top down) –Evolution – U.S., Peru, Argentina –Revolution – Venezuela, Egypt –Both – Ecuador, South Africa Where Evolution occurs, in most cases many parallels to U.S. Family Medicine development 11 Many thanks to Dr. Warren Heffron!

12. Applying these Lessons to the Future of Global Family Medicine  Ideal role of future global Family Medicine teachers: –Work alongside and behind the national leaders in health and education –Demonstrate and model wholistic Family Medicine care to those who are interested, not just lecture –Do not necessarily emulate the U.S. model in curriculum, training models, or practice 12

13. Applying these Lessons to the Future of Global Family Medicine Long-term involvement needed –Requires an ongoing commitment to a specific area with multiple encounters over time –In many cases a 1 - 5 year residence is best Most important elements taught are attitudes and principles of healing; not just clinical facts –Captured by modeling, not by reading or lectures 13

14. Applying these Lessons to the Future of Global Family Medicine Understand that the evolution of Family Medicine globally has many commonalities with our own development in the U.S. –Can be instructive in avoiding errors made and establishing best practices –Can be helpful in developing patience with the development of others 14

15. Applying these Lessons to the Future of Global Family Medicine Commonalities in Family Medicine development around the world: –Eagerness of general practitioners to know more and do better –FM unknown concept at first –Uncertain role within health system –Fear and rejection on part of specialists –Slow but gradual acceptance, especially by growing number of satisfied patients 15

16. Potential Risks We will never get rich doing global health development –FM Development poorly funded - often our efforts are at our own expense Frustration with U.S. health care system Becoming a “cultural mutant” 16

17. Potential Pitfalls Apparent rejection of Family Medicine by official health system Viewing another culture only through our own American cultural lens –“Why don’t they…?” “Bwana Syndrome” 17

18. Rewards!! Participate in transformation of a health system Observe students and doctors transformed into competent, capable, healing physicians –Genuinely care for the wellbeing of their patients and their families –Have the skills necessary to help improve that wellbeing 18

19. Thank You, Dr. Ostergaard! For nurturing a vision of the universal, global need for well-trained family physicians over many decades For your personal encouragement of national and expatriate family medicine teachers around the world For covering our backs when many of us were oblivious to the high level challenges facing Family Medicine in U.S. and around the world 19