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Family medicine in Switzerland: training experiences in medical school and residency.

BACKGROUND AND OBJECTIVES
A shift away from family medicine to medical specialties is noticed in many of the competition-based health care systems in Western countries. Our study's objective was to learn about career development of young physicians in German-speaking countries, with a particular focus on Switzerland.


METHODS
We performed a qualitative assessment of data on physicians' training experiences in family medicine during medical school and residency. Data were obtained through a focus group interview with 12 participants, six of whom were family medicine residents, and data were analyzed by content analysis.


RESULTS
The results indicate that family medicine is not well established in medical school curricula, that family physicians are often discriminated against by specialists with regard to their professional competence, that there are no structured residency programs and a lack of information about residency posts in family medicine as well as family practices to be taken over, and that the competition-based health care system does not foster a gatekeeper model and favors financially the specialists' work to the detriment of that of family physicians.


CONCLUSIONS
Suggestions for improvement of the situation of family medicine include providing well-trained family physicians as educators in medical schools, early training courses in family practices in medical school for all students, well-structured residency programs, support by the Swiss Society of Family Medicine in planning to open a family practice, financial incentives for family physicians, and implementation of gatekeeper models.