The family practitioner system first began in the northwestern province of Düzce, which was selected as a pilot region in 2005, and later started in other provinces before being implemented across all of Turkey on Dec. 13, 2010.

Public health centers across Turkey have now become Family Health Centers (ASMs) as part of Turkey’s efforts to harmonize its health care system with that of the European Union. The number of public health centers, which was 5,000, increased to 7,200 ASMs after the new system was put in place. The matching of patients to doctors was made by referring to an address-based population registration system. The number of doctors working for the public health care system was increased in line with the increase in the number of ASMs. While 14,000 practitioners were serving across 5,000 public health centers previously, the number of practitioners serving at the ASMs is now over 20,000.

The family practitioner system aims to care for and treat people of all ages. All members of the same family can be treated by the same family doctor. Family practitioners are different from specialists. They receive the same initial training, but they do not go on to specialize in any one branch of medicine such as cardiology or pediatrics. Family practitioners can provide initial diagnoses and treatment of all conditions. In cases that are beyond the scope of practice for the family practitioner, they can counsel patients and refer them to a specialist for more complex care. Family practitioners can continue to follow the health of their patients while they are being treated by specialists.

The family practitioner system does allow for individuals to change their family practitioner easily, but people are asked to wait for three months after the launch of the system before making this request.

At the ASMs, family practitioners can order diabetes testing, kidney function tests, hormone tests, pregnancy tests and blood tests. They can treat emergency patients or send them to hospitals in more serious cases or if there are complications.

There are currently 21,183 family practitioners in Turkey, which means a family practitioner needs to care for 3,500 patients. A family practitioner can see between 30-50 patients in an average day.

Associate Professor Turan Buzgan, Ministry of Health assistant undersecretary, said the biggest concern with the family practitioner system is the current shortage of family practitioners. Noting that there was an average of one doctor for 5,000 people at most public health centers, he said that the number of doctors must be increased for the new family practice system to operate effectively.

“The family practitioner system is a new concept in Turkey and has only recently been put into practice across the country. We are asking family practitioners to reach out to all of their patients, to make house calls or give them a phone call. This is a lengthy process. It is not easy for these doctors to meet with 3,500 people at once. People should get used to seeing their family practitioners. As time goes by, the dialogue between a patient and his/her family practitioner will improve and their mutual trust and confidence will grow,” he said.

One of the controversial issues about the family practitioner system is the salary system for doctors. The salaries of family practitioners can vary in accordance with the number of patients they care for and the province they are located in. The monthly salary of a family practitioner who cares an average of 3,500 patients is TL 4,500.

Noting that 80 percent of the people who have already used the new system are pleased with it, based on the findings of a survey by the Health Ministry, Buzgan said the ministry aims to increase the number of family practitioners so there is one family practitioner for every 2,000 people by 2023.

“The number of places available in universities for medical students has been increased to meet this need. However, we need to wait four or five years for the first of these students to graduate,” he added.

If the early experiences with the new system are anything to go by, some patients who establish a relationship with their family doctor will start to treat them like a member of the family and invite them to the family’s special events, such as weddings. In Trabzon, where the family practitioner system was put into practice earlier, Hasan Eraydın, a family practitioner and the secretary-general of the Family Physicians Associations Federation (AHEF), had an interesting exchange with one of his patients. Eraydın said an elderly man approached him to ask whether a patient, who had proposed marriage to his daughter, had any health problems. Eraydın said he could not reveal the confidential medical information of any of his patients, but was able to confirm that the patient was a decent person. Following this, Eraydın said the couple was married.