Family practice departments were established in universities upon the decision of the Higher Education Council in 1993. Academicians from other non-surgical fields also chair some of the family medicine departments. 1 professor, 9 associate professors and 22 assistant professors of family medicine work at these departments. Also these scholars are successfully representing Turkey in international organizations like EQUIP, EURACT, EGPRW (now renamed as EGPRN) which continue their activities in Europe in relation to Wonca. The last spring meeting of EGPRN took place in Ankara in May 2003 and a research course will be organized by EGPRN in Antalya in May 2004. These are important turning points in the development of family practice in Turkey.

Turkish Association of Specialists on Family Practice (TAHUD) was established in 1990 to serve as a professional organisation for family physicians and improve the discipline of family practice. It has organized 5 national congresses and scientific meetings on specific subjects. In 1995 the first scientific journal in the field (Family Physician) was published by Kocaeli University. Today “Turkish Journal of Family Practice” is peridocally published by TAHUD as the only scientific journal in the field.

Currently there are 1300 family physicians in Turkey. Their workplaces are quite heterogeneous. Some of them are working at primary health care centers together with general practioners (medical doctors who complete 6 years basic medical education and have no specialization training in primary health care) , while others are working in various institutions that are not related primary health care.

The primary health care services in Turkey are regulated by the Law No. 224 on Socialization, which has been in effect since 1960s. However the regulations made according to this law have lost their functionality and the system is not working. According to the law, patients first have to apply to the primary health care centers and then if needed they should be referred to second and third levels but today this rule is almost never applied. People prefer to go directly to hospitals rather than primary health care clinics. The Ministry of Health has been working on a draft law aiming to reform the system in order to restore the confidence in the primary helath care services, prevent the overload in hospitals, and reintroduce the system of referral. The draft law aims to unite the three different social security institutions that serve 75% of the population under a single system of general health security. Also, it plans to employ family physicians in primary health care services. However the number of family physicians available right now is around 1300 while the number of family physicians needed for this project would be around 20000. So there are suggestions for giving general practioners at least 2 years of training in line with European Union and Wonca requirements and then employing them in the primary health care centers.

On the other hand, there is an ongoing process of restructuring in the medical education at the undergraduate level. The Medical and Health Sciences Council has made the following resolutions for this purpose: the standardization and improvement of the quality of medical education; adoption of a core curriculum in all medical schools; encouragement of active learning; no further opening of new medical schools without sufficient infrastructure; reduction of the number of incoming students in big and old medical schools; introduction of a comprehensive exam before graduation. The improvement of the quality of new graduates through this restructuring program, on the one hand, and the training of general practioners as qualified family physicians to be employed in primary health care services, on the other, may serve to restore the confidence in the primary health care system and improve health conditions in Turkey, where health indicators are quite lower than what is expected from economic indicators. At this point, the encouragement of the academic and scientific development of family practice as a discipline is crucial. It is important to note that Turkish family physicians gained academic status in 1993, in a period of ongoing struggles for the establishment of departments of family practice in European universities where the functionality of existing departments were under scrutiny. This is a significant gain that should be used in an effective way. The European and worldwide experiences should be taken into account in offering solutions to the problems. And lastly, family practice as a legitimate profession should be constantly improved at the national level through the cooperation of relevant authorities and persons.

REFERENCES:

1-Görpelioglu S, Korkut F, Aytekin F: Family Practice in Turkey. Family Practice 1995; 12(3) : 339-340.
2-Ersoy F, Sarp N: Restructuring the primary health care services and changing profile of family physicians in Turkey. Family Practice 1998; 15(6) : 576-78.
3-Topalli R. Family Medicine in Turkey [correspondence]. Family Practice 1997; 14: 262.
4-Yaman H. Continuing Medical Education In Turkey: Efforts Of The Turkish
Medical Association. BMC Med Educ. 2002 Jun 19;2(1):6.
5- Unluoglu I, Caglayaner H. Aile hekimliginde olusan akademik gelenek ve gelecek
(Academic tradition and future in Turkish family practice) Aile Hekimligi Dergisi (Turkish Journal of Family Practice) 1997 1(1); 46-49. (In Turkish).