How does the work of 2,215 Croatian family physicians currently look like? We discussed the situation in Croatian family medicine with Dr Nataša Ban Toskić.
The Croatian Family Physicians Coordination (KoHOM) is the largest vocational and professional cooperative of physicians practising general/family medicine. It was established in 2008 following dissatisfaction with the quality of healthcare in Croatia and the current social and organisational position of family physicians, with the goal of protecting the dignity of the family physician profession.
How many Croatian physicians, family medicine specialists, are there at the moment, and how many physicians are there who still work as family physicians but are not in the register?
According to the demographic atlas of the Croatian Medical Chamber, there are currently 2,215 family physicians working in Croatia, their mean age is 52 years and 78% of them are women. Of these, 774 colleagues are over 60 years old and 440 are over 55 years old. It is interesting that there are 189 colleagues older than 65 years and therefore retired and they are driven solely by enthusiasm and concern for patients. It is particularly concerning that in the system there are more than 100 empty offices without a physician, and the remaining physicians work double shifts to keep those offices running.
Of these, 74 colleagues are over 60 years old and 440 are over 55 years old.
How did Croatian family medicine evolve as a specialisation?
The family medicine specialisation was actually designed and started right here in Croatia in 1960 when experts from a number of countries came here to learn from us and then transferred our model into the world. However, in 1993, the first healthcare reform in the new Croatian state cancelled the specialisation.
It was restarted in 2003, but the ten-year long interruption led to a great loss in the number of specialists whom we have still not regained. Today, only 50% of physicians in family medicine have specialist training.
In all other disciplines, only the relevant specialists may work. This fact places major obstacles in the development of our profession and improvement of the quality of work in family medicine, and clearly indicates that health authorities and institutions fail to understand the nature, appeal and situation of family medicine in the healthcare system.
What is the current need for new family physicians, how many are still needed, and what is the outlook for the near future?
At this moment, there are a total of 204 trainees. They are a part of the total number of family physicians in the Healthcare Network, i.e. those who have offices or clinics, but the specialisation lasts 4 years during which they are not in their offices but in training and working in other institutions. It is clear that we are 300 physicians short even now, taking into account the teams with no members and colleagues aged over 65.
Over the next five years, we will lose 35% of physicians, and in the following ten years we will lose 50% of family physicians. This will leave over two million patients without a primary physician.
In Croatia, every patient sees their family physician 11 to 13 times per year on average. They see them regardless of their age, gender, type of disease or any complaint they cannot solve by themselves; regardless of their place of residence and financial situation. This is the point of family medicine – to be accessible to everyone without any barriers, and to provide continuous, comprehensive holistic care. When such a large part of family medicine goes missing, where will the patients find such accessible care?
Hospitals and emergency departments cannot accommodate for such a high number of health requirements and needs that the Croatians traditionally have and consider them as standard care.
The situation is bad, and the prognosis for the near future is even worse. Family medicine is not attracting young physicians, who mostly spend their time here in passing while waiting for another specialisation.
Over the next five years, we will lose 35% of physicians, and in the following ten years we will lose 50% of family physicians. This will leave over two million patients without a primary physician.
What are the most important daily challenges in Croatian family medicine at this moment and how are you dealing with them?
The significant administrative burden placed on both physicians and nurses, and the constant assignment of new tasks by all other stakeholders in the healthcare system as well as by non-health institutions, without any prior consultation with the profession.
The pandemic brought new burdens through vaccination and testing as well as managing several registers and sick leaves. A major challenge is also the Croatian Health Insurance Fund, which performed as many as 18,000 inspections last year at our offices, and such hyper control brings a lot of stress into our daily work.
It is a great challenge to attract new physicians into the system and then to keep them when they do come. To encourage them to dedicate their whole lives to this wonderful, but so undervalued, branch of medicine.
It is a great challenge to attract new physicians into the system and then to keep them when they do come.
KoHOM is active in the training and informing of its members. How does the transfer of medical information take place and what should be done in the training process to facilitate your work?
The KoHOM’s task as a cooperative is primarily to ensure the protection of the family medicine profession and of our members,
We carefully follow all that is going on at the legislative level and we immediately respond publicly. We are tenacious, consistent and uncompromising in protecting the interests of family medicine and our members as well as the patients who are victims of bad laws or poor decisions of the competent institutions, just as we are.
I am glad that this was specifically recognised by the entire Croatian public and media, which support us.
Year after year, at our Congress, we organise various training events, and our members participate at other congresses and trainings.
What KoHOM projects are you especially proud of?
We are proud of the Algorithms, which provide significant help to all colleagues in their daily work, and include most of the most common diseases and problems we encounter. We are proud of the “Learning with KoHOM” project, which concerns training workshops for our colleagues. We are proud of our FaMa journal, of the thirteen annual congresses we have organised, of the “Breast Panel” project, which is set to improve the prevention and control of breast cancer in a structured way, but is currently in the pilot phase. We are proud to have attracted more than 35% of all family physicians into our cooperative and to have prevented the disastrous Road Traffic Safety Act through our public engagement.
How would you assess the digital evolution and the knowledge and skills of Croatian family physicians?
We have been fully digitalised for fourteen years, resulting in our work being monitored on a daily basis. Unfortunately, we do not have an insight into a large part of data resulting from our work, which is collected and processed by the Croatian Health Insurance Fund. We have exceptional colleagues in family medicine who are highly innovative and have ideas for new IT solutions. We would like digitalisation to make our work easier and faster, relieve the administrative burden, automate many administrative tasks and provide accessible clinical decision algorithms and guidelines, thus contributing to quality and safety of our job.
For you personally, what does digitalisation in medicine mean?
First and foremost, this means consolidated health information about every patient. It also means computer-assisted diagnostics and therapy, where, based on health information of an individual patient and helped by modern predictive methods such as artificial intelligence, the risk for each condition or disease may be obtained in real time as well as a proposal for optimal therapy. Naturally, the physician makes the final decision based on the provided suggestions and in accordance with clinical judgement and their experience and knowledge.
The digitalisation of all health data eliminates the need for extensive administration, which takes up time that could be better spent caring for patients.
Personally, I follow the development of digitalisation and its implementation into daily routine of a family physician with great interest.