SUSIČ, Asst/Prof Tonka Poplas
Slovenia - WONCA Europe 5-star doctor
Asst/Prof Tonka Poplas Susič, MD, PhD from Slovenia, is WONCA Europe's 5-star doctor for 2014
What work do you do now?
I have been working at the Health Centre Ljubljana (HCL) as a family physician for 25 years and as a medical director at the same health centre for last four years. I have more than 1600 registered patients (capitation). Health Centre Ljubljana the biggest primary care health centre in Slovenia with 1400 employees and more than 2.6 million patient visits per year. We provide medical care for the Ljubljana municipality region with 280,000 inhabitants (Slovenia has 2 million inhabitants in total ).
Additionally, I am a senior researcher at the Department of Family medicine, University of Ljubljana, a counsellor/tutor for medical students; a lecturer for medical students and vocational trainees in family practice; and speaker at various professionals’ meetings in Slovenia. I am also a lecturer at the Faculty of Health Care Jesenice.
What other interesting activities that you have been involved in?
I have been involved in different international research projects:
• Home-visits in general practice: a focus group research work (head of the project - Prof P Van Royen) in 1997-1998;
• ECATOD research (European community actions to support primary health care actions against tobacco consumption and hazardous drinking) in 1998- 2001;
• WHO - phase IV: Implementing Country-wide Opportunistic Identification and Brief Intervention Strategies in Primary Health Care from 2001-2003;
• IATPAD research project (Improvement of access to treatment for people with alcohol-and drug-related problems) in 2006- 2009;
• Montenegro Health System Improvement Project from 2011 until 2012: a component leader.
Research projects in Slovenia: Qualitative analysis of reports from Medical Faculty students about practical work in general practice in the period from 1991-1994; Information Technologies for communication with patients at family practice: 2010-in progress.
I was the Slovenian representative in WONCA Europe 2003-2010, a delegate at UEMO (European Union of General Practitioners/Family Physicians) from 2008-2012, a member of INEBRIA (International Network on Brief Interventions for Alcohol Problems) since 2006, and a member of EGPRN since 2006.
I am also a member and president of numerous Slovenian professional associations/ commissions (Commission for rational use of Antibiotics at Ministry of Health; Committee for waiting list at the Ministry of Health; Council of Experts of the Slovenian Medical Association; Commission for classification of medicaments on the list; Committee for accreditation at the Ministry of Health; etc)
I am an advisor to the Minister of Health for primary health care and a leader of the project “The Model practices in family medicine” which started in 2011, in which a new organisational and substantive concept of work in family practice was introduced.
In 2012, I was awarded as the GP who has most significantly contributed to the development of the profession by the Slovenian Medical Association – Slovene Family Medicine Society and in 2014, I have been awarded the “5-star doctor” award by WONCA Europe.
What are your interests as a GP and also outside work (e.g. hobbies)?
I am very interested in the development of integrated medical care for chronically ill patients and in involvement of high quality of work in every-day patient management . This is what I try to combine in my work on one hand, as a family physician and medical director at HCL; and on the other hand, as a researcher at the academic level.
I also enjoy sports; it is a vital part of my life. I like cycling, jogging, swimming and skiing. I relax by gardening around the house and cultivating of orchids. Due to lack of free time, I have postponed painting as one of my hobbies for a later time. Once a week I take dance lessons and find tango, one of the most impressive dances.
What is it like to be a family doctor in Slovenia?
In Slovenia, The National Insurance Company (NIC) pays the GPs medical program based on capitation, e.g. capitation per 1700 patients amounts to about 108,000 euros per year. That amount covers cost of materials, medicines used in the outpatient clinics, sanitary equipment and also administrative services, cleaning services, laboratory tests and salaries for the staff (GPs and nurses).
Therefore it is not important where the GP is employed, because for the same patient numbers the payment is the same. Two-thirds of GPs are employed in the public health centre and the rest of them are self-employed. Patients do not pay for medical services if they are insured. There are no private GPs (without a contract with the NIC).
In Slovenia, additional to the majority of clinical specialists who have the contract with the NIC (free of charge for insured patients), there are also private specialists (cardiologists, pulmonologists, gynaecologists, psychiatrists, ophthalmologists, dentists, surgeons, ultrasound, MRI…) who do not have a contract with the NIC. Patients are obliged to pay full price for their services, without the possibility of getting any money back.
Patients can visit their GP in the same day if it is necessary (acute illness/event, worsening of the chronic disease), the longest waiting time is 5-7 days (patients with stabile chronic illnesses). According to the nationwide study, an average consultation time with a GP lasts 7.5 minutes. Patients who only need prescription have shorter appointment times than patients with worsening health statuses.
GPs are the gate-keepers for all patients. It is impossible to see specialists in the hospital without a referral except when using self-paid private service, but in this case all costs have to be covered by patients themselves. Therefore patients usually use private services as a first visit to a clinical specialist (almost no waiting time) and after that enter the public-service system with a referral from their GP.
There is significant pressure on GPs to reduce health system costs. Firstly, HIC has decided to reduce labour costs by decreasing the contractually guaranteed annual amount of money. Because salaries of GPs are fixed nationwide (through a collective agreement for doctors), doctors then have to decrease other costs (laboratory, ampoules, material costs).
Secondly, HIC checks and controls drug prescription rates, frequency of prescribing of medical support equipment (e.g. wheelchairs, crutches, bandages), eligibility for sickness status over 30 days that is paid by HIC, referrals, and use of ambulances. Every mistake or deviation from the rules is financially penalised.
In July last year, prescribing by therapeutic group of drugs started and GPs will now have a key role in decreasing the costs of medicines through this initiative.