‘Caribbean’ Family Physicians?
Cayman Islands
Is there a thing called a Caribbean Family Physician?
A lawyer, for example, is definable. (disclaimer-I’m no expert in the legal profession, but this illustrates my point, if you will bear with me). A lawyer requires a certain training period, a certain apprenticeship, and then practices in an environment where those around him are able to recognize his role and profession. There are ‘lawyer-related’ policies, and guidelines, and there are legal and political frameworks to determine the work of a lawyer. There are probably national policies to determine if governments require more lawyers, or less; and private organizations who employ lawyers are able to determine that it is in their interest to hire a new lawyer, because there is a thing to be done, and well, it requires a lawyer to do it.
The same principle can be applied to many professions in the Caribbean and beyond.
And in most developed territories the same could be said for Family Physicians too. A Family Physician in the US for example is also a known entity: there is a specified training process, there are policies and guidelines for the work of a FP, and when a FP moves on to practice, his role is recognized. When a healthcare provider determines that there are services that should not be managed by internists or gynaecologists, but by a Family Physician, then they hire one. They do not attempt to remedy the situation by finding a person who does not meet the specifications of a Family Physician, because in their context, a ‘Family Physician’ specification exists, and to hire person who doesnt meet that specification would be inappropriate.
In the Caribbean this sequence of thinking rarely happens, unfortunately as there is generally no recognized specification for FPs; there are few nations with policies to determine when specifically a Family Physician is required for a job as opposed to any other medical professional. When a primary care task is recognized in policy, there is, generally, no programmed necessity to find a Family Physician to do it.
In short, in the Caribbean, the concept of the Family Physician as a defined role does not (yet) exist.
This is of course because the Caribbean territories have looked to medical graduates (without postgraduate training) to staff primary care services, probably because this costs less, and because in the past, Primary Care issues, CNCDs among them, were probably thought to be manageable by strong Primary Health Care systems, with nurse- and public health-led personnel, with a doctor providing basic oversight.
If however, we accept that CNCDs need better management, and if we are to deliver on the worldwide joint promise to stem the expansion of CNCDs, options should be explored. Should we choose to train post-internship graduate doctors specifically in CNCDs, or require further postgraduate training, including expertice in CNCDs, before practice?
Another option of course is to do nothing new, and attempt to deliver improvement with Primary Health Care and Public Health strategies.There is evidence that this has not worked, for CNCDs.
The Caribbean nations of course accept that excellence in delivery of Primary Care services is essential, but I suspect that we are disadvantaged, compared to other nations who specifically train their frontline Primary Care physicians.
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Caribbean Family Physician.
While we read about physicians, physician assistants, nurse practitioners, clinical nurse specialists, health educators, registered dietitians and nutrition professional in other countries, these specific categories are not (yet, maybe?) identified in the Caribbean.The same is true for the "Family Physician" in the Caribbean. Equally importantly, there are no jobs nor job ladders created for many of these individuals with specific areas of medical training, even though the need to utilize a team approach to managing the chronic non-communicable diseases is well recognised and often repeated.
Post-graduate training in Family Medicine, as a means of developing a Caribbean Family Physician, has been recognised at the level of the University of the West Indies, and the various campuses all offer post-graduate training programs in Family Medicine. Caribbean governments, on the other hand, have traditionally embraced Public Health trained individuals only, although this course of action has not been shown to alter the management or the progress of the cncd's.
There is little evidence that this environment encourage individuals to become "Caribbean Family Physicians". No wonder it is hard to define one.