Family medicine practices of the future

Beset with high costs, staff crises and changing patient requirements, traditional family medicine practices are in flux. The example of Sanacare shows how it can be done differently.

Text: Katharina Rilling; photo: Sanitas

Media headlines reveal increasing criticism of the high costs and inefficiency of the healthcare system. More and more medical practices are closing their doors, and there is a general shortage of staff and fewer physicians who want to work as family doctors. There are many reasons for this.

For example, who wants to take up a practice at the age of 35 and know that they will be there until the end of their career? Who is willing to be on call around the clock? Shoulder all the responsibility alone? Men and women alike want greater flexibility, more opportunities for part-time work and exchange of information with colleagues. Group practices can meet these requirements. We are currently seeing these practices popping up in metropolitan areas. The example of the Sanacare group practices is showing how they are changing the daily work of doctors and patient care. 

Trend 1: Joining forces in group practices instead of going it alone

In large group practices, doctors work as salaried employees without a share of the profits, which means they can pursue their dream job of being a family doctor while still having a private life. Marc Jungi, specialist in general internal medicine and deputy managing director of Sanacare, gives another advantage: “Centralised administration takes on time-consuming tasks such as finance, IT and facility management, thus giving doctors more time to focus on their actual job: treating patients. This relieves the pressure and cuts costs.”

In thirteen Sanacare group practices in nine locations, some 120,000 patients are cared for by over 250 doctors and medical practice assistants (MPAs). This means: a lot of cases, a great deal of expertise, a lively exchange of information – and ultimately a steep learning curve with a high quality of care.

But doesn’t this mean that patients are just a number? “Not at all! Quite the opposite in fact”, says Jungi. “Every patient is assigned to a family doctor who has a duty of responsibility to them. In more complex cases, a treatment team may be set up.” This ensures greater continuity than with family doctors who work alone, because they sometimes also have to take time off, and their work then has to be done by an external locum doctor. In a group practice, a familiar face takes over and – thanks to digitalisation – they have access to the patient’s file at any time.

“Although there is a clear trend towards group practices, individual family doctors won’t disappear completely, because the patient density in rural areas is too low for big practices”, predicts Jungi. However, he adds, small family medicine practices will also have to change to be able to keep up with digital developments.

Trend 2: Digitalisation – fewer visits to the practice, more intensive exchange

There’s no getting around the fact that digitalisation will play a big role in medical practices in the future. It will penetrate all areas of practice work, taking in everything from optimising processes and preventive care through to treatment and follow-up support. It starts with small improvements, e.g. patients book appointments online instead of phoning the practice, which quickly takes a lot of pressure off the whole team. And patients could fill in forms electronically at home instead of coming to the practice. The new Sanacare practice in Bern is already seeing the effects of digitalisation. Here, for example, doctors can order medicines from the practice assistants online directly from the treatment room. The medicines are then sent to the treatment zone via pneumatic dispatch system. This saves time for both the patients and the treatment team. 

In the future, digitalisation won’t end at the practice door, with online coaches helping patients to adopt a healthy lifestyle in the comfort of their own home. Wearables with sensors will monitor a patient’s state of health, collect real-time data and feed the information directly into the medical practice’s system. Artificial intelligence will sound the alarm as soon as the data shows irregularities. This will make it possible to implement necessary measures faster and track successes more easily. 

If a patient takes their blood pressure and measures their blood sugar levels at home, the data will be sent directly to the practice. It will also be possible, for example, to listen to the heartbeat over long distances. The dosage of medication will be adjusted to the data, with the information being sent directly to the medicine cabinet. And where the assistance of medical professionals is required, video telephony will replace time-consuming journeys to the doctor.  

Trend 3: Shift in competencies – leveraging a wide range of expertise

A further change will take place at the human rather than the digital level: “Health advice and care will play an increasingly important role. In Scandinavian countries, they are already being more closely integrated – with success”, says Marc Jungi. This way, doctors don’t always have to be the first point of contact. For example, pharmacies, Spitex services and laboratories can take care of blood tests under the umbrella term of chronic care management.

At Sanacare, medical practice coordinators are already taking on more clinical responsibility and helping patients to gain knowledge and a better understanding of their illness, for example, by providing nutrition advice. “This helps to compensate a little for the shortage of skilled workers.” Coordinators and patients work together to draw up trackable treatment goals and plans. And this cooperation is usually very successful. The service quality is high, even though patients have fewer appointments with the doctor. And the patients are happy.