Swiss Review 2/2019

Swiss Review / March 2019 / No.2 8 Focus part-time for a better work-life bal- ance. The proportion of female doc- tors is increasing, with more women than men now studying medicine. This is probably one of the reasons why group practices are becoming more popular. Such set-ups allowdoc- tors to share the workload including emergency on-call commitments, as well as infrastructure and administra- tive tasks. Over half of GP practices in Switzerland are still individual prac- tices, but the number of group prac- tices has tripled in recent years. Streit is unequivocal: “The structural shift will continue.” Older doctors are also discovering the benefits of being part of a group practice. One them is Philippe Luchsinger, Chairman of the Associa- tion of Swiss General Practitioners and Paediatricians (MFE). The GP practice that Luchsinger took over in Affoltern am Albis (canton of Zurich) more than 30 years ago is nowa group practice. “We need to get away from the image of a GP as someone who goes it alone,” he says, adding that the GPs of tomorroware teamplayerswho are also seeking to collaborate with paramedical professionals such as nurses, physiotherapists and pharma- cists. Although voters decisively re- jected a proposal in favour of “man- aged care” systems in 2012, experts believe that the future lies in coordi- nated care. Advanced practice nurse relieves workload What does coordinated care look like in practice? One example is theMediz- entrum group practice in the rural municipality of Schüpfen (canton of Berne), where Christine Wyss works as an advanced practice nurse (APN) together with a team of GPs. Wyss, who graduatedwith amaster’s degree, has an extended range of responsibil- ities. “My main focus is on older, chronically ill patients who need long- term care,” she says. Wyss makes her- self available for consultations. She also administers infusions to patients, takes their pulse and blood pressure, discusses laboratory results with them, and gives them advice. In addi- tion she visits elderly patientswho are no longer as mobile as they used to be. Her duties include tasks traditionally carried out by doctors, but the scope of her activity is defined by the GP. “She is much more qualified than me in other areas,” says Hansulrich Blunier, a GP colleague at the Schüp- fen practice with many years’ experi- ence. For example, Wyss is able to teach patients how to cope with their illnesses on a day-to-day basis. This frees Blunier up to deal with more complex cases. Medizentrum offers procedures such as gastrointestinal endoscopies as well as chemotherapy. Blunier thinks that this arrangement enhances his profession. This work is pioneering because APNs in Switzer- land still do not have an official job de- scription. There is no official billing tariff either. Uri – a canton with nu- merous valley communities that have been hit particularly hard by the shortage of GPs – has now launched a three-year APN pilot project. Virtual GPs? Or is the future of GP practices online? Yes, says specialist physician Andrea Vincenzo Braga during a Skype call. Braga is ChiefMedical Officer at eedoc- tors, a Berne start-up that was estab- lished in 2017. “Digital platforms can play a part inoutpatient primary care,” he says. Patients can access eedoctors via a smartphone app and get medical advice through a video link. Prescrip- tions are sent directly to their smart- phones. “We fill a gap in the market whenever GPs aren’t available,” says Braga. This can be when they are on holiday, or in areas of the country where relatively few GPs operate. Braga says that his service is also a handy option for professionals with limited time, particularly as people commonly work and live in different places nowadays. More than 20 doc- tors work for eedoctors – from home. Braga believes that primary caremust movewith the times becausemanyGP consultations do not even require doc- tor and patient to be in the same room. According to Professor of Primary Care Sven Streit, Switzerlandprobably needs a variety of solutions (e.g. new communication channels, new prac- tice models) to reflect its regional di- versity. “No two regions are the same,” Streit says. He thinks that the tide has turned in addressing the shortage of GPs. Philippe Luchsinger is also de- lighted about increased levels of inter- est among young people. “Primary care is sexy again,” he says. However, he warns that Switzerland cannot af- ford to rest on its laurels. It will still take years before themedical students who are interested in primary care ac- tually become GPs. Until then, Swit- zerland will continue to be short of family doctors. Philippe Luchsinger speaks for the older generation of family doctors: “We need to get away from the image of a GP as someone who goes it alone.” Photo provided