Guest Opinion

Family Medicine and Wonca on World Stage

July 07, 2010 03:40 pm Rich Roberts, M.D., J.D., President, World Organization of Family Doctors

On May 22, with family doctors from around the world bearing witness, I pledged to lead the World Organization of Family Doctors, or Wonca, to the utmost of my ability during my three-year term as Wonca president.

Former AAFP President Rich Roberts, M.D., J.D., (far right) poses with Wonca President-elect Michael Kidd, A.M., of Adelaide, Australia, (far left) and Wonca Past President Chris van Weel, Ph.D., of Nijmegen, The Netherlands. Roberts is the new president of the international organization of family physicians.

My installation, which took place at the 19th World Conference of Family Doctors in Cancun, Mexico, was a significant event in my life and also had larger significance because I'm the third American -- and the third AAFP past president -- to serve as Wonca president. To date, no other country has provided three presidents to lead Wonca. My predecessors were the late Ed Kowalewski, M.D., AAFP president in 1969-70, and Bob Higgins, M.D., AAFP president in 1984-85.

My term as Wonca president comes at a time when family medicine stands front and center in health care reform discussions around the globe. I'm proud to say that Wonca has played an important role in making this happen.

Growing Influence

Wonca began 38 years ago, when 18 national academies and colleges of family/general practice (including the AAFP) established the association as a venue for sharing ideas about training family doctors. From that modest beginning, Wonca has burgeoned to include 120 member organizations that represent some 250,000 family doctors and 100 countries, covering 90 percent of the world's population.

The Wonca Acronym

Why is the World Organization of Family Doctors known by the acronym Wonca?

The acronym comes from Wonca's full name, the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/ Family Physicians. A shorter version of Wonca's name is World Organization of Family Doctors.

In recent years, Wonca's influence and the influence of family medicine have grown enormously. For example, in 2002, Wonca and the World Health Organization, or WHO, published Improving Health Systems: The Contribution of Family Medicine -- A Guidebook, which positioned Wonca as the go-to organization for countries that want to organize their health care systems around primary care. Wonca and the WHO also collaborated on Integrating Mental Health Into Primary Care, published in 2008.

Also in 2008, the WHO's leading publication, the World Health Report, focused international attention on the importance of primary care. Wonca worked with the WHO on that report, titled "Primary Health Care (Now More Than Ever)."

These days, Wonca representatives participate in almost all major WHO initiatives, a further testament to Wonca's growing visibility.

Finally, two breakthroughs occurred at the WHO's 2009 World Health Assembly. Wonca's president addressed the assembly for the first time ever. The assembly also voted unanimously to commit to the idea that primary care should be the basis of all health care systems -- and that countries should be urged to train enough primary care workers, including family physicians, for their needs. The commitment to family physicians was new.

Great Expectations

Although Wonca has never been more influential than it is today, it also has never been more vulnerable. Why? Because great influence brings great expectations.

More and more, Wonca is called upon to help and to collaborate. For example, the health ministries of developing nations increasingly turn to Wonca, asking its leaders to consult on their health care systems. This opens up tremendous opportunities in areas where family medicine hasn't been well established.

But Wonca's ability to respond is hampered by its current structure and by its limited resources (made even worse by the economic downturn and reduced support from the pharmaceutical industry), leaving Wonca vulnerable to criticism if it can't help those who ask for assistance. Wonca's greatest challenge right now is to develop the capacity to meet those expectations.

To meet the challenge, Wonca has committed to transforming from an academic club focused on family physician training into an outward-looking professional association with the capacity to nurture family medicine worldwide. To improve the organization's effectiveness and boost its resources, Wonca hopes to take several actions, including

  • establishing a permanent Wonca secretariat -- perhaps in Geneva, which would facilitate collaboration with the WHO -- and the CEO as a full-time position;
  • convening the Wonca Executive more often than annually and the Wonca World Council more often than every three years;
  • developing a business plan to enable Wonca to provide global accreditation of family medicine training programs and global certification of individual family doctors, endorse the accreditation programs of member organizations, create a compendium of and an accreditation program for online education programs that bring together materials developed by member organizations, and develop a consulting service for those seeking help regarding primary care and health system redesign;
  • moving forward with developing the next version of Wonca's International Classification of Primary Care, which the WHO wants to use as the core of its next generation of International Classification of Diseases system and which could generate substantial royalty revenue for Wonca; and
  • holding the World Conference of Family Doctors more often than every three years, which would bring Wonca more revenue from registration fees.

These are among several changes proposed by a committee called the Group to Redesign the Operations of Wonca, or GROW. I chaired the GROW project as Wonca president-elect, so I'm very excited to work to accomplish the changes as president.

Another driver of transformation is a recently adopted Wonca bylaws change stipulating that the Wonca Executive shall be composed of at least 25 percent women. This constitutes a sea change for Wonca because the Executive has been nearly exclusively male since 1974.

As it transforms, Wonca will become an even better champion of family medicine throughout the world.

An Invitation

If you're still reading this guest opinion, it's clear that international family medicine interests you. Because AAFP members are indirectly Wonca members by virtue of their AAFP membership, I'd like to close by inviting Academy members to get involved with Wonca. Consider becoming a direct member, which is one way to support Wonca.

To get involved with Wonca's activities, go to the website( and click on the "Groups" tab on the right to learn more about Wonca's special interest groups, working parties and e-mail discussion groups. You'll enjoy communicating with your international colleagues, and you'll probably glean ideas you can use every day in your practice. I know I have.

Wonca embodies all of the collective aspirations and talents of the world's family doctors and their organizations, and I am enthusiastic and optimistic as I begin my term as Wonca president. I hope you'll join me in Wonca involvement. I know you'll find it fascinating and productive.