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The "family physician" is often mistaken for being just another family doctor, or general practitioner (GP), when in fact he or she is a medical specialist equivalent to an obstetrician, paediatrician or surgeon.
A reason for this might be that family medicine is a new speciality that only became formally recognised in South Africa in 2007, with the first intake of registrars in 2008.
Since then, 545 family physicians have been registered in South Africa, and at a rate of less than 40 new specialist family physicians being produced every year, the country's modest target of 1 060 of these experts is still far from being realised.
So what is the family physician's area of expertise? Contrary to the general perception that a speciality is a specific focus area, the family physician is an expert generalist.
"In terms of regulation the family medicine training programme is on par with how you would train a specialist – it is a four-year MMed degree and you have to sit a college exam," says Prof Bob Mash, head of the Division of Family Medicine and Primary Care at Stellenbosch University's Faculty of Medicine and Health Sciences.
In addition to the training for primary care delivery, a family physician is equipped with advanced skills appropriate to the district hospital and would, for example, be able to do some anaesthetics, obstetrics, surgery and so forth.
This wide skills set makes the family physician a valuable asset in a country like South Africa, where a shortage of medical expertise has placed primary care in the hands of nurses and community health workers, and where there are major skills gaps at district and rural hospitals.
The Western Cape was the first province to create registrar posts for family physicians and has embraced the idea of the family physician as an expert generalist, particularly to improve the range and quality of services at district hospitals. Today there are 45 family physicians employed by the province and almost 50 registrars in training between Stellenbosch University and the University of Cape Town.
"Since 2008 this province has gone from virtually nothing to having a large number of registrars and employing family physicians – they are putting them in district hospitals and into community health centres," says Mash.
Since these positions were only created recently, Mash and his team have been tracking the impact of this new medical speciality on communities. "We are trying to document what difference they are making to the health system, so for the last couple of years we have been tracking the health indicators and interviewing district managers. The feedback has been overwhelmingly positive and we're seeing real improvement in clinical care and clinical governance in these areas," Mash explains.
"Due to skills shortages and financial constraints the South African health system relies heavily on nurses to be the main providers of health care. But you need the expertise of an expert generalist doctor to improve the quality of that care, to ensure that we foster a patient-centred system, and to look after the cases that are too complicated for the nurses to deal with," says Mash.
