CAN WE IMPROVE PRIMARY CARE OF ADULT PATIENTS

In Chile, primary medical care of adult patients is delivered mostly by young physicians, who work with little or insufficient interaction with their referal centers and with the main teaching hospitals. These physicians have no defined expectancies of a professional career in the field of primary care and they generally resent the lack of a programmed post-graduate education. After 3 to 5 years as general practitioners, some of them may have access to a formal teaching program to become specialists in internal medicine but, as in many other countries, it usually becomes a transit stage leading them to a subspecialty. This position paper adopted most of the proposals raised in a recent meeting, with the participation of universities, scientific and medical organizations, and the Ministry of Health, and modifies some of them. Because financial limitations may hinder the possibility of residency training programs in primary care internal medicine (as established in the USA), primary care of adults is proposed to be organized as a basic medical specialty, with formal teaching activities designed, delivered or supervised by the universities and medical scientific societies, and given as "credits" to be taken along 3 to 5 years. Simultaneously, outpatient care facilities should be improved, in the hospitals and in community units, allowing them to be used in under-graduate and post-graduate teaching programs. General practitioners, focused in adult patients, would receive a new professional status with the stimulus of a specific program of continuing medical education.