Guest Editorial

Global Exchange: Experience Primary Care Beyond Our Borders

June 25, 2014 03:15 pm Aaron George, D.O.

I recently had the privilege of spending a month in Vienna. And although the historic Austrian capital is known for its music and culture, this was no vacation. My trip was four weeks of intensive learning about primary care outside the United States.

[Aaron George, D.O., gives a presentation]

Aaron George, D.O., delivers a presentation on physician training to public health graduate students, rural general practitioners and others at the Center for Public Health in Vienna, Austria. George was the first U.S. physician to participate in the World Organization of Family Doctors' new Family Medicine 360° exchange program.

So how did I get there?

Traditional global health rotations and clinical experiences typically involve physicians traveling to one clinic or hospital and interacting with a specific population. Although this allows unique regional learning opportunities and observation of care at a single location, alternative models are emerging.

Our European counterparts in family medicine are transforming the global health rotation with the introduction of regional exchange programs. This has been led by the Vasco da Gama young doctors movement( of the World Organization of Family Doctors (Wonca) and has been enthusiastically embraced by young doctors movements in other Wonca regions.

Recognizing that learning can extend beyond the clinical setting, the Family Medicine 360° exchange program( includes components that have the potential to shift perspectives about how health care is delivered from a national and systemic standpoint. The primary goal is to support moving beyond unidirectional global health experiences and to increase interaction between young family physicians and physicians-in-training around the globe.

The secondary goal of the 360° exchange program is to place participants in unique settings. Although trainees are expected to work with both rural and urban family physicians, they are also encouraged to meet with public health entities, government offices and officials, community partners and leaders, and other key players in the overarching health care system in that country. In this way, participants are exposed to a true cultural perspective of how care is delivered from the ground up.

[Aaron George, D.O., right, observes as a rural physician in Austria works with his electronic medical record system]

Aaron George, D.O., right, observes as a rural physician in Austria works with his electronic medical record system. A third-year family medicine resident at Duke University, George spent four weeks in Austria as part of the Family Medicine 360° exchange program.

I had the opportunity to participate as the first U.S. resident in the 360° exchange program. I was fortunate to be selected and supported as an Andlinger fellow of the American Austrian Foundation through their collaboration with Duke University Medical Center. My rotation included four weeks of collaborating with the Center for Public Health in Vienna. I spent time in a variety of rural family physician offices, traveled with emergency medical services and observed home visits, and I also met with a host of academic, government and community leaders. I was fortunate to interact with rural family physicians from more than 20 countries.

Along the way, I was encouraged to evaluate regional social determinants of health, payment structures, system limitations, political implications and population perspectives on primary care. I left realizing that many of the problems we see in rural primary care in the United States -- such as payment disparities and diminishing student interest -- are shared around the world.

Moving beyond diagnosis and treatment, I developed an appreciation for the truly important role of establishing the best point of access for initial patient care. The most successful interventions are those that are located closest to where the service is most needed. I witnessed the global phenomenon of distance decay, which means that the further an individual lives from a health care facility, the later that person will seek care and the worse his or her outcomes will be. My experiences abroad have genuinely influenced how I perceive the problems -- and solutions -- that are a part of health care in the United States. And I feel fortunate to have developed a network of friends in family medicine that extends around the world.

I encourage U.S. primary care training programs to engage in the exchange program to move beyond simple observership in a unidirectional platform and to promote trainee awareness of global population health issues and increase international interaction. I am honored to be able to share my new perspectives on care delivery and population management and hope that our primary care trainees will be able to participate with our Wonca counterparts in this opportunity to transform how we interact in global health care and global training.

The great news is that the AAFP will be assisting in the exchange program, and you, too, can explore primary care in a different way. Whether you would be participating as a visiting resident or as a host physician or institution, the AAFP is eager to develop a network that will increase the role of the United States in international exchange opportunities. Participation would involve as many as four weeks of rotation time in an international setting or even within a different region of the United States. This is definitely a two-way street, and there are many leaders in the Vasco da Gama movement and other Wonca regional young doctors movements who are looking for reciprocal opportunities to experience health care in different parts of the world.

A recently formed young doctors movement for the North America region, dubbed Polaris, could facilitate exchanges to or from North America by early next year. In the meantime, AAFP members seeking more information or hoping to participate in the exchanges may email Julie Wood, M.D., AAFP vice president for health of the public and interprofessional activities, or Alex Ivanov, M.B.A., manager for international Activities. I also would be happy to share my experiences and help connect you or your institution to international networks, so feel free to contact me if I can help in any way.

Aaron George, D.O., is a third-year resident at the Duke Family Medicine Residency in Durham, N.C.