From the President: Turkish delights
A photo gallery can be found at the end of this article
Lying on my hotel bed, the view was stunning through the window that framed the Bosporus Bridge. The soft lights of the low-rise buildings along both shores outlined the glassy black water that pulled my gaze to the bridge. My eyes refused to close, even though they were aching for sleep after 23 hours in transit followed by a late night dinner with my Turkish hosts. The dancing shapes of the violet-blue-white lights of the bridge were magical as they shimmered into the dark night sky and onto the black water. Months later, I continue to think back to that vista – it soothed me into deep slumber as I reflected on the wondrous place known as Istanbul.
Countless others have used the metaphor of a bridge to describe Istanbul. Yet, Istanbul is more than a peninsula where two continents connect. It is more than an inland passage linking the Black Sea and the Sea of Marmara. It is more than an exotic trove of Roman, Byzantine, Latin, and Ottoman antiquities. It is a complex mosaic with cultures layered onto each other, rather than an historical chalkboard that erases one empire when another replaces it. Mindful of its past, Istanbul is also very much about the present and the future. Its young demographics, expanding population (about 14 million), and vibrant economy position it as one of the great cities of the world. Against this backdrop of old world tradition and new world vitality, Family Medicine is beginning to find its place in the Turkish health care system.
Family Medicine is a relatively nascent specialty in Turkey. With a population of approximately 73 million, Turkey has about 111,000 doctors in active practice: 32,000 are general medical doctors (“practitioners”), 58,000 are specialists (2500 of whom are qualified family doctors) and 21,000 are residents in specialist training. There are 74 Turkish medical schools, with 16 private and 58 public. Collectively, they graduate 4800 new doctors each year. Each year, about 5% of medical school graduates choose to train in Family Medicine, which is a three-year program following the six years of medical school. The average pay of a Turkish family doctor is about USD 1500 per month. There are several distinct types of hospitals in Turkey: 61 University hospitals, 61 government hospitals with training programs, and 645 district hospitals without trainees. Turkish family physicians, especially in rural areas, are more likely to be involved with a hospital than family doctors in other parts of Europe.
Two important organizations represent Family Medicine in Turkey, TAHUD and TAHEV. TAHUD (Türkiye Aile Hekimleri Uzmanlık Derneği or Turkish Association of Family Physicians) is the national college that provides advocacy, education, and qualification of practicing family physicians. TAHUD has about 1000 members. TAHEV (Türkiye Aile Hekimliği Vakfı or Turkish Foundation of Family Medicine) is a foundation that brings together a number of key stakeholders in primary care and sponsors educational and other initiatives to promote primary care in Turkey. Both organizations play important roles in supporting family doctors and promoting primary care.
During my week in Turkey, I delivered plenary lectures at the 2nd Acibadem Family Medicine Symposium at Acibadem University in Istanbul and at the annual Family Medicine Fall School (Aile Hekimliği Güz Okulu) co-sponsored by TAHEV and TAHUD in Antalya. My travel to Turkey also gave me a chance to catch up with my good friend, Prof Chris van Weel, Immediate Past President of WONCA. Chris and I had the honor to be the visiting faculty for these important educational programs.
In addition to the Symposium, my one day in Istanbul included a whirlwind tour of several health centers, which were associated with training hospitals. At one of the hospitals, I toured the diabetes clinic, which was led by a family doctor, Dr Mehmet Sargin. I also visited a typical community-based primary health care center known as a “family health center” (Aile Sağlığı Merkezi) which was linked to the Ministry of Health and was not connected to any hospital. Dr Senem Aslan Tangürek is a qualified family physician; she has been at the center for seven years. The other doctor is Dr Ufuk Çağman; he is a practitioner, or general doctor, who has been at the center for two years and who hopes to train in pediatric surgery. They provide person-centered, community-responsive care to entire families, from newborns to the aged.
Although, I was not able to visit any practices outside Istanbul, the Family Medicine Fall School in Antalya provided a wonderful opportunity to speak with many family physicians from across Turkey. I enjoyed learning from them about their views of practice, Family Medicine, and the future of health care in Turkey. Antalya offered additional special pleasures – a beautiful seacoast, bright sunshine, and all inclusive resorts with great food and facilities.
My impressions after my brief visit are that there are similarities and differences between family physicians in Turkey and those in Europe and the surrounding region. Similarities include that family doctors are generally in small practices (1-4 physicians). In the cities, they are unlikely to attend births or patients in hospital, although in rural communities they more often provide these services. Many of the primary care practices are staffed by practitioners (general doctors) as there is a significant shortage of qualified family doctors.
Some differences are that Turkish family doctors and their practices appear to be more frequently and closely linked to hospitals, even though they may not be active in inpatient care. Compared to other family doctors in the region, Turkish family physicians look to be more involved with the care of entire families and all age groups.
My overall impression is that Family Medicine is on the rise in Turkey, with greater awareness of the need for qualified family doctors and an upsurge in the status of the discipline. Among the family doctors I met, there seemed to be a general sense of optimism and better days ahead. There was a feeling of shared purpose, a desire to do better, and a spirit of camaraderie and cohesion. These gains have not been accidental. They reflect the hard work of the leaders of TAHUD and TAHEV, the efforts of academic family physicians, and the commitment of practicing family doctors to improve Family Medicine, primary care, and health care in Turkey.
At the end of my week, I was happy to return home, as I always am, but I was sad to leave Turkey. The warm hospitality and weather, the energy and enthusiasm of the family physicians, and the growing importance of Family Medicine made for a most enjoyable and exciting stay. And I did not even have much of a chance to take in the tourist sites. All the better reason to plan for a return visit, watch bridge lights dancing on sky and water, and savor the Turkish delights.
I would like to offer a special thanks to Prof Pinar Topsever, who was an excellent host and who assisted with this column, including photographs and translation to Turkish.
Professor Richard Roberts