METSEMAKERS, Prof Job FM (English/español)
The Netherlands: WONCA leader
Professor Job FM Metsemakers MD PhD, generously agreed to be interviewed by the WONCA editor, in Vienna, in July 2012. He has been secretary of WONCA Europe for five years. This interview ended with the editor asking why WONCA colleagues might be interested in Job’s story. Job’s reply was: “After all, I am just an ordinary guy….”. But most WONCA colleagues are not ordinary, so we leave it to the reader to decide.
WONCA Editor: Where do you currently work?
I do a day a week in clinical practice in Geulle, a small village near Maastricht, in the Netherlands, where I have practised for over 30 years.
I am also the Chair of General Practice/Family Medicine at Maastricht University in the Netherlands. As chair of the department I am responsible for overseeing the undergraduate and the postgraduate program, our research activities and also our relations with the family practices in the region. The people who work in my Department are all professionals, so my main role with them is coaching and mentoring, to enable them to grow in their roles and careers. Although officially the leader, I am very much just part of the team.
Actually, I usually translate the Dutch term “huisarts” to Family Physician, instead of General Practitioner. In some countries, there is a distinction between General Practitioner and Family Physician or Family Medicine Specialist, with General Practitioner implying the doctor has no special training in our discipline and this does not adequately reflect our specialist status.
WONCA Editor: How long have you been at Maastricht University?
I have been Professor and Chair of Department since 2002; but in 1974, I was in the first intake of 50 medical students, at Maastricht University, in a new course based on problem based learning. This was new, suited my way of learning. It was a choice of one of 50 places in Maastricht, with the probability that nearly all students would be guided to graduate; or be one of 250 elsewhere with 40% of students being culled after first year.
In my third year, at medical school, I did an elective on Health Services research; and later a 14 week elective at Rochford, Illinois, USA. Most courses in those days had no research electives, but the Maastricht curriculum was new and provided that opportunity. So I was already involved in research and education at medical school.
Two things I knew by the time I graduated were: that I wanted to do Family Medicine, but I didn’t wanted to do it full time. So, I entered a practice where I could still pursue my research and education interests at Maastricht.
WONCA Editor: What are your research interests?
My own research interests are medical record keeping, medical registration; classifications such as ICPC, and the use of data for research. I did my PhD, in 1994, at Maastricht, on The Registration Network Family Practices. We used routine health care data from electronic medical records for several research projects. Furthermore I have a broad interest in research topics which have direct relevance for clinical practice. I try to work with researchers on the message they have for practising doctors, and on the implications for their daily work. The transfer of knowledge from research into practice, and implementation in the practice setting are difficult steps.
WONCA Editor: You are not doing much clinical practice any more – how does that work out?
I have been in the same practice 30 years so I am now seeing the babies of people who I first saw as newborn babies. Seeing such ageing of a generation is rewarding for me. I believe in doing home visits as I can see the people in their context (where and with whom they live), which I find an important characteristic of our profession..
WONCA Editor: What are your passions outside work?
Reading fiction and non-fiction, but it really only happens on holidays; running and I also like going to the theatre and modern dance performances with my wife.
WONCA Editor: What have you enjoyed about your involvement with WONCA?
Working with other colleagues to develop or strengthen primary health care systems where every family has access to a family doctor. That is not an issue in the Netherlands but within and outside Europe there are still many countries where people lack the care they need, and primary care needs to be developed. I like setting things up and supporting others and I want to contribute to this future. It is a future with quality health professionals and for that you need education and programs to sustain our specialty. WONCA provides a framework for working on this and for meeting others with the same vision. I am committed to continue my activities within that WONCA family.
WONCA Editor: You haven’t told me about the work you are doing in Indonesia?
In 2008, Maastricht University got engaged in a project in Yogyakarta to set up a skills lab, make the curriculum more problem based, and renew the clinical clerkships. Furthermore there was a government regulation that family medicine concepts should be introduced in the curriculum. The question to us as consultants was, “what was the scope of family medicine apart from being holistic”. The European Definition of Family Medicine proved a very useful tool to use. The project has finished but I remain committed to support them, as they are now on the long and difficult road of trying to establish the Family Medicine specialists, who will eventually replace the GPs without additional training. Why? Well, I believe in what Michael Kidd, WONCA President Elect, said “a family doctor for each family in every village”.
WONCA Editor: What is the system in which family doctors work in your country?
In our health care setting the family doctor has a central role. He, and more often she, will see patients of all ages with all kind of complaints and problems. As patients/families are on his patient list he knows his population which with the exception of the real big cities (Amsterdam, Rotterdam, Den Hague and Utrecht) remains very stable (migration rate, less than 10% per year). In that way the family doctor provides continuity of care and is also responsible for service out of hours, although not in person but as profession.
Patients need a referral by the family doctor to visit a specialist, who are mainly hospital based.
The practice setting has changed in the last few years. Solo practices are becoming less common. Most family doctors work in group practices or health centres, in a team with a practice assistant, a nurse for disease management programs, a physiotherapist and sometimes linked to a pharmacy.
Health care is a private enterprise which is regulated by the government and the health care insurance companies. All patients are insured for a basic package of care, including the most common procedures. Additional payment is becoming more common for certain medications. Most patients take out an additional insurance covering, for instance, dental costs ( partly) and physiotherapy.
Family Physicians have taken over much of the care from hospital based specialists, of patients with chronic conditions such as diabetes, COPD, stable cardiac patients, and depression.. This was a shift from secondary care to primary care. It has led to more collaboration along the lines of the ‘Chronic Care Model’. The government supports this position as they see that family doctors take care of 95% of the health problems by themselves for 5% of the health care budget.
Prof Job FM Metsemakers
Professor and Chair Department of General Practice/Family Medicine