The future of Internal Medicine in Europe
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The future of Internal Medicine in Europe Presentation Transcript

  • 1. Internal Medicine in Europe Daniel SERENI EUROPEAN FEDERATION OF INTERNAL MEDICINE Brussels 5 May 2007
  • 2. Internal Medicine in Europe
    • 30 000 to 40 000 Internists
    • Diversity of Internal Medicine in Europe
    • Challenges to Internal Medicine
    • Need for Internal Medicine in Europe
  • 3. How Long Is Training In Internal Medicine?
    • 3 years: Latvia
    • 4,5 years: Israel
    • 5 years: most countries
    • 6 years: Netherlands, Finland, Czech Rep.
    • 6-7 years: UK
    • 7 years: Denmark, Slovakia, Germany, Malta.
  • 4. Countries With Mandatory Common Trunk For Sub-specialists.How Long?
    • Exists in ALL COUNTRIES EXCEPT: Spain, Italy, France
    • and Portugal.
    • DURATION (in years).
      • 2: Greece, Slovakia, Slovenia, UK, Malta.
      • 3 : Belgium, Switzerland, Finland, Czech Rep,
      • Israel, Latvia
      • 4 : Netherlands
      • 4,5 : Denmark
      • 5 : Sweden, Turkey, Poland
      • 6 : Germany.
      • Recommended in Estonia and Israel
  • 5.
    • YES
    • Greece, Spain, Netherlands, Latvia, Switzerland, Sweden, Finland, Poland, Czech Rep, Estonia, Slovakia, UK Portugal and Israel
    • NO
    • Italy, France, Belgium, Denmark, Turkey, Slovenia, Germany, Malta
    Countries Where Teaching Diagnostic Techniques for Internists are Defined
  • 6. Percentage of Internists Working In Hospitals
    • Over 80% of Internists in most countries work primarily in hospitals
    • Except:
      • Germany 45 %
      • Czech Rep 25%
      • Greece 20%
      • Switzerland 20%
      • Latvia 15%
  • 7. Medicine In Europe Is Characterised By Diversity
    • Healthcare systems may be
        • state driven : UK, NL, Sweden
        • state and private : Fr, It, Sp, Germany, CH, Pl
    • % of GNP spent for healthcare varies from
    • <5 % to 13%
    • Organis a tion of health care
    • Medical density in EU varies from <1 50
    • to 578 (Ita) per 100 000 population
  • 8. 40 000 Internists intermediate Medical density 2500 internists HOSPITALS
  • 9. High medical density >10 000 Internists office practice/ hosp
  • 10. High medical density 2 000 Internists Hospitals
  • 11. Low medical density 3 000 Internists Hospital /office
  • 12. Elements In Favour Of Harmonisation
    • Professional values and principles do not differ among European doctors
    • Harmonisation would focus on main issues
        • Duration and quality of training
        • Qualification
        • Continuing Professional Development (CPD) , Continuing Medical Education (CME)
    • Increasing need for doctors in some countries : UK , France, Sweden…: mobility
  • 13. EFIM - Educational Activities
    • European Congresses
      • 1997 Maastricht, 1999 Florence, 2001 Edinburgh, 2003 Berlin, 2005 Paris, May 2007 Lisbon , 2008 Rome ,
      • 2009 Istambul , 2010 Copenhagen
    • European School of Internal Medicine
      • Alicante 1998 – 2005
      • Sintra / Lisbon 2006- 2008
    • European Journal of Internal Medicine
      • 1989 - present (Pub. Elsevier)
    • Course on Clinical Research, Paris
    • European Diploma MRCP
  • 14. Recognition of Qualifications
    • 1957 - Treaty of Rome
    • 1959 - Standing Committee of Doctors (CP)
    • 1959 - Union of Medical Specialists (UEMS)
    • 1975 - Advisory Committee on Medical Training (ACMT)
    • 1991 - UEMS Monospecialty Boards
    • 2005- Directive on the recognition of professional qualifications
  • 15. Examples from other continents
    • American College of Physicians
      • > 120 000 internists
      • Including «  hospitalists »
      • Mostly out -practice
      • Clear messages to the public
        • «  doctors for adults »
        • «  caring for the whole patient »
        • Longer training than « family physicians » or GPs
      • Annals of Internal medicine
    • Australia
    • New Zealand
  • 16. Internal Medicine in Europe
    • Diversity of Internal Medicine in Europe
    • Challenges to Internal Medicine
    • Need for Internal Medicine in Europe
  • 17.
    • Context
    • technology
    • medical progress
    • competing fields
    • dismantling of IM departments in hospitals
    • limitation of resources
    • fashion and glamour: young doctors decreasingly attracted to IM
    • Also
    • Weakness of identity as a scientific discipline
    • Will of indepen den c y of former derivate specialities: cardiology
    Threats on Internal Medicine
  • 18. Who threatens Internal Medicine?
    • Doctors lobbies
      • General practitioners
      • Specialists
      • «  there is only one pie to share »
    • Health care providers
      • Tend to focus on GPs for out - practice and on medico-technologic- subspecialties in hospitals
        • «  what is new is more attractive »
    • Patients
      • They have a poor knowledge of what internal medicine and internists are.
  • 19.
    • Do the broad scope of Internal Medicine and the variety of its practices mean that Internists can take care of all patients?
    • In primary care?
    • In hospitals ?
    • As specialists only ?
    • With or without a sub-specialisation ?
    • Lack of visibility
    • Competition
    • CHOICE
    Need for a definition of IM adapted to local situation
  • 20. Medical practice
    • General medicine / family medicine
      • All ages
      • Prevention
      • Frequent hea l th problems
      • Home care
    • Sub - specialists
      • Use of specific medical technology
      • Narrow fields of pr a ctice
    • General internists
      • Specialists in diagnosis
      • Rare and systemic disease s
      • Integrated care , associated morbidities
  • 21. Practice of Internal Medicine in France, a survey in 2002
    • 90 % in hospitals
    • About half have a subspecialty: infectious diseases, gastro-enterology, diabetes, geriatrics, nephrology, vascular disea s es, etc…
    • Most frequent diagnosis for inpatients
      • Infections 17% , vascular diseaes 10% , h ea matologic disord er s 8.5% , cancers 8% , systemic diseases 7.5% , gastro-enterology 7% , cardiology 6%
    • Out-patients
      • Mostly referred by GPs or other specialists
      • Asking for diagnostic or therapeutic advise
  • 22. Diversity of competence and knowledge Level of excellence subspecialists GPs internal medicine internal medicine
  • 23. Internal Medicine in Europe
    • Diversity of Internal Medicine in Europe
    • Challenges to Internal Medicine
    • Need for Internal Medicine in Europe
  • 24.
    • Government
    • to control expenses
    • to regulate manpower
    • to obtain cost effectiveness political debates
    • Society
    • equitable access to care
    • quality of care
    • doctors competency
      • ethical and professional Issue
    Health care is a challenging political issue
  • 25.
    • undifferentiated situations
    • combinations of diseases
    • general and systemic diseases
    • new fields in medicine
    • the internist has received a long and adequate training enabling him/her to take care of such patients
    Internal medicine as an answer to the needs of the patients
  • 26. Role of Internists in Medical Training
    • Faculty teaching
      • Se me iology
      • General diseases
      • All major general text books refer to Internal M e dicine
    • Practical training
      • Studen t s
      • Interns, residents
  • 27. New fields for Internists
    • Hospitalists ( USA)
      • 12 000
      • Links with emergency care
      • Care of inpatients ( 85% of them are internists)
    • «  acute geriatr ics  »
    • Internists in the Emergency Room
    • Medico- social aspects
    • Hospital primary care
    • Palliative care
    • Integrated care
    • Emergence of new sub-specialties
  • 28. Internists And Research
    • Mainly at University Hospitals
    • Oriented towards particular fields of I.M.
    • Difficulties related to: time, money and support
    • Content: clinical epidemiology, clinical pharmacology, clinical assays, multicentre studies, basic patho-physiology, audit of clinical management, vascular diseases, vasculitis, systemic diseases, diabetes and metabolism, geriatrics, etc..
    • Need for a europan clinical research network in IM
  • 29. Internal Medicine in Europe: Strengths
    • Historical role in patients care
    • Most internists hospital-based
    • Remains the basis of student training
    • Provides Common Trunk for sub-speciality training in most countries
    • Training programme for IM fairly uniform
    • Internists opinion leaders
    • Active IM societies
  • 30.  
  • 31. Lobbying for Internal Medicine
    • Internal Medicine is adapted to the present situation because of its capacity to solve complex and combined medical problems .
    • In hospitals, Internists and Internal Medicine Departments or Services are indispensable for the care of a number of patients who do not require specialised medical technology
    • A majority of patients and primarily the elderly need an integrated care : in complex situations, Internists are the only doctors dedicated to the task.
    • Internists can deliver a cost effective medical care thanks to their ability to develop standards and guideline with an holistic point of view and to integrate quality of care assessment in a wide range of clinical situations.
  • 32. Lobbying for Internal Medicine
    • Training of Students must remain based on a common trunk in Internal Medicine
    • Residents should get a minimum training in IM medicine before subspecialisation
    • In a health care system based on GPs “gate keepers”, Internists are necessary as consultants and responsible for coordination of patients care
    • Internists in other countries may be in charge of primary care
    • Whatever the organisation of the primary care, Hospitals need Internal Medicine Departments or Services
    • Internal Medicine is an Indispensable Specialty