October 3, 1999
About 400 medical students, educators, administrators and practicing physicians learned about family practice in Tashkent Oct. 2. They came to a six-hour symposium to hear about the new specialty that might take root in Uzbekistan.
"In the 1940s and 1950s, we in the United States created many specialties, which we needed. But by the 1960s, there were not enough doctors taking care of the whole family," said Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities. "So we created the new specialty of family practice."
Ostergaard charted the specialty's growth from no residencies in 1969 to 475 in 1999, and from no residents in 1969 to more than 10,000 residents in 1999. He also said the World Health Organization and the World Organization of Family Doctors have encouraged the development of family practice as a specialty that promotes the health of the world.
Dr. F.G. Nazirov, Uzbekistan's minister of public health, accented the need for both Uzbekistan and the United States to base their health systems on primary care. "You are very right in saying you don't have to break the system you have now, but shift it toward primary care, making doctors closer to families, closer to patients," Nazarov said.
In Uzbekistan, most health care and all health care education is government-funded. However, as in much of the Third World, the profession of medicine is undervalued. GPs' salaries may be $15 a month, anesthesiologists' salaries may be $20 a month, and restaurant owners and street cleaners may earn more. Audience members asked the FPs whether they were contented with what they made.
"I'm happy with what I earn," said AAFP Board Chair Lanny Copeland, M.D., of Albany, Ga. "But I do get frustrated that some subspecialists, such as gastroenterologists, cardiologists and cardiothoracic surgeons, make two to three times as much as I do." The audience applauded. Copeland had struck a chord common to U.S. and Uzbek generalists.
Audience members also asked, for example, how many forms FPs must complete, what types of statistical data their practices should conform to, how often they must take examinations in school and as they practice, and who funds the practices, clinics and residencies.
Copeland explained who receives government-assisted care and admitted about 15 percent of Americans, the working poor, have no health insurance. "Learn from our mistakes," he said.
AAFP member Don Ellsworth, M.D., of Andijon, Uzbekistan, commented on clinical decision-making. "In America, decisions we make on how to treat a patient are determined more by our knowledge and what we read in the latest clinical journals, not mandated by the government," said Ellsworth. "There are advantages both ways. If the decisions are mandated by the health ministry, you have uniformity. In America, it's easier to implement the latest clinical practices because you don't have to wait for legislative changes to take place."
Ellsworth also mentioned the joy of providing primary care. "The longer you stay in an area and practice medicine, the more your day is filled by people who are your friends, and you want to give your very best to help them get over their health problems," he said. "So getting up and going to work in the morning is always exciting, because you're sharing your life with your friends."
