Successes and challenges of portuguese family medicine: a view from the outside

Abstract

This study is a consequence of the doctor interchange program between Portugal and the United Kingdom, which has been up and running since 1990, a joint initiative between the Royal College of General Practitioners and the Portuguese Association of General Practitioners. Aim: To identify successes in family medicine development in Portugal in the last two decades of the 20th century, as well as future challenges. Study type: Observational, descriptive cross-sectional. Qualitative data gathering through semi-structured interviews to key-informants, followed by discussion and data validation at a workshop. Population and setting: Portuguese general practitioners (GPs). Methods: In 2001 eighteen Portuguese GPs were interviewed. Twelve had participated in the interchange program, and the remaining were currently holding or had held relevant posts at the Portuguese Association. Content analysis of the interviews was performed. The respondents were asked to comment on the successes of Portuguese family medicine both as a career and as a service to the population, and on the challenges facing them. The results were later discussed and validated at a workshop attended by about 50 GPs. Results: A very positive view of the development of family medicine in terms of pregraduate education, vocational training and as a structured career with its own culture and identity. The improvement both in quality and accessibility to health care was clearly acknowledged. Concerns were raised on the lack of a structured system of continuing professional development and performance assessment, as well as on the high workload and stress levels. Several challenges were identified. These included the absence of connection between salary and workload, the slow development of computerized clinical information systems, deficient management systems, lack of a culture of team work-based clinical practice and a strong influence of the pharmaceutical industry.