International primary care snapshots: Israel and China.

Abstract

For many years community medicine has been the ‘stepdaughter’ of medicine in Israel since most medical training took place in hospitals, and community medicine was perceived as second best. This has changed dramatically in the past decades. Since 1995, in accordance with Israeli national health law, all residents of the state of Israel are entitled to receive health care, provided by four health maintenance organisations (HMOs). The service is based on primary care clinics spread across the country. Today there are around 5500 GPs, of which approximately 1600 are board-certified family physicians and employed by the four HMOs. The training programme in family medicine in Israel began in 1969, and since the early 1990s, there has been a significant increase in the number of physicians specialising in family medicine. Each HMO has at least one department of family medicine responsible for the training programme. The 4-year internship in family medicine has undergone numerous changes in recent years. The portion of internship in family medicine has been extended at the expense of hospital wards, in order to shift the teaching paradigm to primary care. Board exams were modified to include standard parts enabling more uniform testing and reducing examiner dependent bias. ### Moving to the front of the stage Excellent primary care is the key to good medicine. Changes in the healthcare system led to moving services from hospitals into the community to reduce costs and improve availability, in turn leading to an increment in the exposure of community medicine in medical schools. Yet the vast majority of clinical teaching is still hospital oriented. Clerkship of family medicine became an integral, mandatory part of medical studies in all medical schools in Israel, and clerkship of exposure to community medicine have been added. The medical school, opened in 2012 at the Safed branch of Bar-Ilan University, includes about one-quarter of …