1. ECPCP, Prague 2015 Primary Care Paediatrics (PCP) in Europe* Demography of Care and Forecast for the Profession Manuel Katz MD, MPH President Israel Ambulatory Paediatric Society, Fmer President Israel Pediatric Society Ben Gurion University, Israel and Maimonides University, Argentina Fmer EPA Secretary General, EPCPC Tertiary care group representative to EAP ISSOP board\council member, President, Global Initiative for Consensus in Pediatrics, CIP WHO technical advisor

2. ECPCP, Prague 2015 Objectives To describe the organisation of the Paediatric Care at the Community and Primary Care level in the European countries To identify different types of Paediatricians working in the community. To understand variations of care for children between and within countries. To determine type of training offered to doctors who look after children at the Primary Care level. *Katz M et al. Pediatrics Vol 109 No 5, May 2002

3. ECPCP, Prague 2015 The Mini-Questionnaire  Total number of Paediatricians  Number of Primary Care Paediatricians  Number of General Practitioners/Family Doctors  Number of Community Paediatricians  Paediatric Primary Care system in your country  Training in Primary Paediatric Care included in postgraduate paediatric education  Training in Community Paediatrics included in postgraduate paediatric education  Training in Primary Paediatric Care included in postgraduate paediatric education for General Practitioners/Family Doctors  Training in Community Paediatrics included in postgraduate paediatric education for General Practitioners/Family Doctors  Proportion of children by age seen by a Primary Care Paediatrician

4. ECPCP, Prague 2015 Definitions Paediatrician - A physician who finished his/her formal training for paediatrics approved by the local health authorities or academic bodies in the country (either after under/post-graduate training). Primary Care Paediatrician - Paediatrician who offers curative and preventive services for acute and chronic problems in out- patient/ambulatory settings (primary care level). Community Paediatrician - Paediatrician who devotes to the comprehensive recognition and understanding, prevention and treatment of community related health problems (secondary/tertiary care level).

5. ECPCP, Prague 2015 PRIMARY CARE PEDIATRICIAN Offers curative (general practice ) and health promotion (immunizations, school-care, etc.) for acute and chronic illnesses in out-patient or ambulatory settings like dispensaries, primary care clinics, health community centers or in private practice Katz - 2001

6. ECPCP, Prague 2015 COMMUNITY PEDIATRICIAN Devoted to the comprehensive recognition, prevention and treatment of community related health problems such as child protection, children in need, behavior problems, learning disorders, growth, developmental pediatrics, school medicine, etc. Katz - 2001

7. ECPCP, Prague 2015 Definitions Primary Care Systems for children - defined according to the proportion of the country’s children aged < 15 years seen at the Primary Care level by either Paediatricians or General Practitioners/Family Doctors. –More than 75% of children seen in the Paediatric System. –50% ± 25% children seen by both paediatricians and GPs offering primary care - Combined System. –More than 75% of children seen by General Practitioner/Family Doctor - GP System.

8. ECPCP, Prague 2015 Differences in between and within countries Demography Socio-economic characteristics Background and culture Pathology

9. ECPCP, Prague 2015 Results

10. Results

11. In Israel: 2013 2180 Board certified Paediatricians 1000~ Non certified Paediatricians 1658 General- Family Doctors 1 to 800 children up to 18 ECPCP, Prague 2015

12. Patterns for Paediatric Care (Europe 2002, Katz and 2008, VanEsso) mapa pediátrico Medicina familiar combinado Falta de datos

13. ECPCP, Prague 2015 Training Received in Primary Care (PCP) and Community Paediatrics (CP)

14. ECPCP, Prague 2015

15. Both PC& Community Community Primary care Neither PC nor Community Type of training (32 countries) ECPCP, Prague 2015

16. WHO IS CARING FOR CHILDREN IN THE COMMUNITY? Board certified family physicians General practitioners Board certified pediatricians Pediatricians with special training in primary care General practitioners with special training in pediatric primary care Nurse practioner

17. ECPCP, Prague 2015 CONCERNS ABOUT THE PROFESSIONAL FUTURE OF PEDIATRICS Few pediatric hospital positions available Growing tendency to reduce the number of hospital pediatric wards Growing tendency to shift positions from the hospital to the community

18. ECPCP, Prague 2015 CONCERNS ABOUT THE PROFESSIONAL FUTURE OF PEDIATRICS Health policy decisions regarding who should provide pediatric care at the primary care level: Who care for “new morbility” Family physicians/general practitioners; Pediatricians as consultants only; Limiting the age of care by pediatricians (up to 2-to8- to12-to18-to21?)

19. ECPCP, Prague 2015 FORECAST FOR THE PROFESSION Less candidates for residency in pediatrics Lack of academic positions at the community level Community positions filled by family physicians and by general practitioners with special training Non “profitable”profession Non attractive profession Gender related profession?

20. ECPCP, Prague 2015 FORECAST FOR THE PROFESSION Lack of planning for career development in community pediatrics Pediatrics to become a high technology, intensive care profession, forgetting its role in health promotion and health maintenance

21. ECPCP, Prague 2015 HOSPITAL, COMMUNITY AND UNIVERSITY COMMITMENT IS ESSENTIAL

22. ECPCP, Prague 2015 TO PROMOTE CAREERS IN COMMUNITY PEDIATRICS: Create an early community experience for medical students Promote mentoring and learning activities for pediatric residents Ensure presence of academic primary and community pediatrics Focus support on pediatricians working in the community

23. ECPCP, Prague 2015 THANK YOU FOR YOUR ATTENTION For comments and ideas: Manuel Katz MD, MPH Katzmanuel gmail.com Phone + 972 50 6243342 Katz - 2005