“World Family Doctor Day” focuses on family physicians and their interdisciplinary expertise in the healthcare system. In recent years, not only have the demands and job description changed significantly, but also the challenges. Students in their first semester of medicine at Johannes Kepler University Linz are required to complete an internship at a general medicine practice. 

As general medicine is a particularly intensive subject area in the field of medical education as well as an important component of the JKU’s medical degree program, General Medicine has its own department and chair. Under the direction of Prof. Dr. Erika Zelko, the Department of General Medicine bridges the gap between clinical scientific medicine and outpatient family practice. In an effort to encourage medical students to consider family medicine, over 100 faculty members teach a wide range of subject areas in both theory and practice, showing students just how versatile and interesting this area of medicine is.          

JKU Rector Meinhard Lukas remarked: "The JKU has created a 21^st century medical school featuring an approach that also reflects how and what we teach. Our approach to medical education is more tangible, hands-on, and modern, ranging from digital anatomy at the JKU’s medSPACE and hands-on learning at the skills labs to the numerous on-site opportunities to learn from top physicians. The foundation is a more holistic focus on medicine and healthcare and this why general physicians of tomorrow require a solid, sound education."  

A Scholarship for Clinical Internships in General Medicine
During the 2022-2024 performance period, the Faculty of Medicine aims to focus more on General Medicine by offering a scholarship to support clinical internships at general practices.

Elgin Drda, Vice-Rector for Medicine at the JKU added: "We understand that as a medical faculty we also bear a degree of social responsibility. The healthcare GPs provide serves as the foundation of our healthcare system and the new scholarship in the amount of € 400 for a four-week internship in general medicine aims to encourage students to become family physicians and study general medicine early on during their studies."

General Medicine in the 21^st Century
In order to continue offering high quality medical care in Upper Austria, training GPs as part of an interdisciplinary curriculum is essential. General medicine will, however, face challenges in the near future and not on account of demographic reasons: There are currently 1,033 contracted physicians (incl. secondary care) in Upper Austria (last update: April 27, 2022). Some 440 of them belong to the "baby boomer generation" (1946-1964) and will turn 60+ by 2025. The first half of "Gen X" (1965-1973) includes 293 physicians who will retire between 2025 and 2033. This results in a 79% decrease in private practice over the next 10 years.

Univ.Prof. Dr. Erika Zelko remarked: "We would like use the time frame between 2025 and 2030 to guarantee that we can educate future physicians between these generations of physicians."

Prof. Zelko added: "Sustainable teaching and research will help us address future challenges and raise evidence-based general medicine to the same level as specialized medicine. When it comes to regional healthcare, we have established a medical program that puts patients and their families at the center. We offer of 175 courses per semester, providing the best possible education to train future general practitioners."    

The common goal is for general practitioners to be able to provide patients in Upper Austria with state-of-the-art, high quality, and reliable services.

Group Practice in Sandl: Dr. Johanna Holzhaider, GP
In 2006, GP Johanna Holzhaider took over a practice in Sandl, previously operated as an individual practice. In 2014, she and a former colleague, Dr. Hedwig Eichler, decided to work together and form a job-sharing group practice. The job-sharing model is strictly regulated by a schedule. Both doctors work together on Monday mornings, which leaves more time for longer patient consultations and for meetings between the two physicians and their team. They divide the other office hours up.

Dr. Holzhaider remarked: "I never regarded being my own boss as a burden, but rather as a continual, dynamic process and having the creative freedom I need to make decisions in regard to scheduling, work allocation, and patient volume. I appreciate the family-friendly aspect on account of the flexible office hours, especially since installing HÄND (family physician emergency services); this has significantly reduced the strain of night services. The continuity of care enables us to 'live with' our patients."

The work day usually starts with blood samples and treating patients who have acute concerns, then we schedule time to discuss findings, examinations, and treatments for non-infectious patients; infectious patients are scheduled towards the end of office hours. After regular office hours, the physicians take turns making house calls. Time for telephone calls and acute situations must also be scheduled in.
Dr. Holzhaider added: "Every day we try to balance the challenges as best we can and we have been able to address both the medical challenges as well as the logistics of it all."

At the Practice: Edith Eicher, JKU medical student
Edith Eicher is in her 8th semester of the medical degree program at the JKU’s Faculty of Medicine.

Edith Eicher commented: "My idea about the job is very diverse, as GPs are needed in a wide variety of areas. Whether in private practice, at health resorts, or at schools, I think there are many doors open to GPs. I find the long-term relationship with patients and the opportunity to become very involved with patients and their environment is particularly inspiring, on a medical, social, and psychological level."

Edith Eicher appreciates the fact that students have the opportunity to regularly learn from - and exchange ideas with - general practitioners early on in the program and throughout their studies as part of the "Ärztliche Fähigkeiten und Fertigkeiten" track. In addition, students can take "Summer School in General Medicine" during the summer to visit practices as well as attend classes and discussions in order to learn more about what GPs do. Another positive aspect is that faculty members are evaluated and are always open to suggestions to improve and be better; this also contributes to the quality of education.

Eicher added: "Naturally, a good way to encourage students to pursue general medicine is to provide more insight into medical practice in the form of clinical internships or summer school programs as well as learning more about diverse opportunities after graduation. Other ways to provide students with information about general medicine would also be to read reports by younger GPs about their experiences as well as have regular direct contact to general practice patients."

A Focus on General Medicine in the JKU’s Medical Degree Program
The JKU has 75 teaching contracts with general practitioners in Upper Austria, giving students a hands-on opportunity to experience what being in a GP practice is like. During the first two weeks of the first semester, students complete a mandatory internship at a general practice. As part of the mandatory clinical traineeship, students can spend up to four weeks working and learning at a GP practice. Students can also complete an additional 4-week clinical internship (8 weeks in total) to count toward autonomous coursework requirements.

Starting Winter Semester 2022, the JKU will offer a student scholarship in general medicine in which the JKU will award the student a one-time grant of € 400.

During the Clinical Practice Year (CPY), the Austrian Health Insurance Fund (ÖGK) and the Upper Austrian Medical Association (ÄKOÖ) have created a special funding opportunity in that students completing a four-week mandatory internship at a general medical teaching practice will receive € 650 a month in "pocket money". Students can complete an additional eight weeks as autonomous coursework during the CPY year and students will also receive € 650 in “pocket money” for a minimum of four weeks.

Since 2016/2017, 466 students have graduated from the JKU’s Faculty of Medicine (371 Bachelor's, 74 Master's, 1 PhD).

Statements about World Family Doctor Day
Mag. Christine Haberlander, Deputy Governor and State Health Minister, remarked: "World Family Doctor Day focuses on accomplishments by general practitioners as well as on positive developments to become a general practitioner. The healthcare system is facing a challenge to educate more local general practitioners, especially as many baby boomers will retire soon. The state aims to help where it can: Regional, primary healthcare models are highly attractive, especially for young physicians. The JKU continues to drive the curriculum in medical education forward by including more innovative educational concepts, especially by appointing a chair for General Medicine. Students at the JKU’s Faculty of Medicine have an opportunity to become better acquainted first-hand with family practices and a strong focus on general medicine is firmly anchored in the curriculum."

Dr. Peter Niedermoser, President of Upper Austria’s Medical Association, emphasized: "Establishing the Chair of General Medicine was - and is - an important and timely step. Students early on in their studies need to learn more about what being a GP is about, and this also applies to the clinical internship year. It is also important that the degree program is structured in a way that makes general medicine a basis. However, we also have to make sure there are enough resources to ensure hands-on training. We hope that more future colleagues will opt to pursue general medicine and become GPs. This is an important building block in support of basic medical care.”