DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

1. Challenges of FAMILY MEDICINE PRACTICE in SAUDI ARABIA Dr. Nabil Al-Kurashi President Saudi Society of Family Medicine DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

2. FAMILY MEDICINE • is proved to be the most effective way to approach the mass population or the population as a whole DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

3. Family medicine • The medical specialty which provides continuing, comprehensive health care for the individual and family. • It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. • The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

4. Brief History of FAMILY MEDICINE in the ARAB WORLD • Late 70’s - the concept of Family Medicine in the Arab World started • Mid 80’s – programs were established and Saudi Board was created. • Early 90’s introduced short courses to improve the general practice. • Mid 90’s – Egyptian Board was organized DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

5. Challenges of FAMILY MEDICINE PRACTICE in the Arab World • Not have enough number of Family Physician in the Arab World • Family Physician for each individual • Unhappiness of Family Physicians • No training program in many countries • Family Medicine is not considered as a policy in most Ministries of Health in spite of its existence as a Postgraduate programs. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

6. Challenges of FAMILY MEDICINE PRACTICE in the Arab World • Not have enough number of Family Physician in the Arab World DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

7. Number and Percent Primary Care Doctors by Country DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

8. STATISTICS Arab World No. of total population : 281 million (410-459 million by 2020) Population growth rate (%) : 1.3 - 3.7 No. of Countries : 23 Area : more than 11 million square kilometers DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005 Source: UN Demographic Report 2004

9. STATISTICS No. of total Physician : 286,154 % of Family Physicians : ? No. of Medical School (Offering Family/Community Medicine : 70 No. of Arab Countries with Family Medicine Program : 17 DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

10. Facts about Family Medicine in K.S.A Population : 22,000,000 Family Doctors : ± 6,000 G.P. : ±5,000 No. of GP & FD needed : estimated 11,000 Deficit = 6,000 (by Nov. 2006) Future Population = 35 – 45 million (by year 2020) Requirements = 17,000 – 22,000 DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

11. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

12. Arab World Population

13. Total Number of Arab Physicians DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

14. Challenges of FAMILY MEDICINE PRACTICE in the Arab World • Family Physician for each individual Ratio : 1 Family Physician : 2000 individual Therefore we need : 140,500 Family Physicians : 281 million individuals • The lack of family physicians will cause a major problem since there will be no continuity of care. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

15. Challenges of FAMILY MEDICINE PRACTICE in the Arab World • Unhappiness of Family Physicians DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

16. Family Physician : • should be skillful, well-trained, well-equipped, well-paid and given the privilege to be professionals, innovative practitioners and not to be treated as an employee who will attend a specific time schedule • is the manager of the patient and of the family’s health problems • is the friend of the patient. • is the coordinator of care: • coordinate with all other colleagues and with all other specialties. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

17. Family Physician : • as the treating doctor who will be responsible to treat all his patients’ diseases (from children, to adult up to the old aged, from men and women, be it social, physical and mental aspect). • is capable to use the other health care team such as the nurses, psychologist, nutritionist, physiotherapist, social workers, medical technologist and all others • is also capable of activating and mobilizing the establishment of Home Health Care to minimize the pressure in the hospital and initiative at home DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

18. Family Physician : • can be easily capable on providing Health Education and in providing lots of which will lead to health promotion. • should be given the chance to manage their own staff • can easily think of new concepts of EBM practice in their approach when in their treatments DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

19. Kurashi Dome DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

20. Challenges of FAMILY MEDICINE PRACTICE in the Arab World No continuous family medicine practice, due to lack of : • Recognition of the practice by the health authorities. • Qualified family and community doctors • The members of the primary care team • The proper infrastructure and clinical guidelines.

21. Challenges of FAMILY MEDICINE PRACTICE in the Arab World • No training program in many countries • It is important that we should learn to give way to a qualified family physician. • In most Arab countries, a physician who does not have a Family Medicine Degree and are MBBS holder with or without specialty are recruited from various countries and appointed as General Practitioners provides Primary Health Care. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

22. How to Face the Challenges of Family Medicine Practice • It seems that we are encountering lots of obstacles and problems. • It seems that the Family Physician’s voice is weak to be heard by authority to let them speak out their minds. • The government should carefully listen to their thought and complaints and to clearly clarify the reasons of unhappiness and dissatisfaction of the family doctors of the Arab World. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

23. How to Face the Challenges of Family Medicine Practice • We should really start to change the current set up of having the ordinary Health Care centers run by Ministry of Health or of Directorate of Health and instead to be given to the Family Physician so they can operate with freedom of all the programs. • The Family Physician will be the one responsible to run the Health Care Center even the payment for the team. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

24. Conclusion Family Medicine practice is the solution • for most of the health problems in any community…. • to improve the health service quality in the clinic or through home health care • to the problem of ultimate patient satisfaction ….. • for maintaining good health of people, of mothers and their children, of the adolescents and the elderly …. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

25. Family Medicine practice is the solution • for improving the people awareness of their health problems …… • for providing the best medical practice, the best physicians, and the best health team working with them….. • for better health economics DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

26. Recomendation 1. New Model of Family MedicineFamily medicine will redesign the work and workplaces of family physicians. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

27. Comparison of Traditional vs New Model Practices

28. Recomendation 2. Electronic Health RecordsElectronic health records that meet standards which support the New Model of family medicine will be implemented. 3. Family Medicine EducationFamily medicine will oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, expert in providing family medicine’s basket of services within the New Model of family medicine, skilled at adapting to varying patient and community needs, and prepared to embrace new evidence-based technologies. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

29. Basket of Services in the New Model of Family • Medicine Health care provided to children and adults • Integration of personal health care (coordinate and facilitate care) • Health assessment (evaluate health and risk status) • Disease prevention (early detection of asymptomatic disease) • Health promotion (primary prevention and health behavior/lifestyle modification) • Patient education and support for self-care • Diagnosis and management of acute injuries and illnesses • Diagnosis and management of chronic diseases • Supportive care, including end-of-life care • Maternity care; hospital care • Primary mental health care • Consultation and referral services as necessary • Advocacy for the patient within the health care system • Quality improvement and practice-based research DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

30. Recomendation 4. Lifelong LearningThe discipline of family medicine will develop a comprehensive, lifelong learning program. 5. Enhancing the Science of Family MedicineParticipation in the generation of new knowledge will be integral to the activities of all family physicians and will be incorporated into family medicine training. 6. Quality of CareClose working partnerships will be developed between academic family medicine, community-based family physicians, and other partners to address the quality goals. 7. Role of Family Medicine in Academic Health CentersDepartments of family medicine will individually and collectively analyze their position within the academic health center setting. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

31. Recomendation 8. Promoting A Sufficient Family Medicine WorkforceA comprehensive family medicine career development program and other strategies will be implemented to recruit and train a culturally diverse family physician workforce. 9. CommunicationsA unified communications strategy will be developed to promote an awareness and understanding of the New Model of family medicine and the concept of the personal medical home. 10. Leadership and AdvocacyA leadership center for family medicine and primary care will be established. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

32. Therefore, we should think big, start small and act now to build the new Family Medicine Dome. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005