Family doctor. Why is a key specialization for the patient and the health system not appreciated? Dr. Michał Sutkowski explains

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It is with them that patients have the most frequent contact and usually the greatest trust. And yet their role is sometimes marginalized. About family doctors, Michał Sutkowski, president-elect of the Association of the College of Family Physicians in Poland for the term 2026–2030, a specialist in internal medicine and family medicine, talks editor Aleksandra Sokalska from the monthly "Puls".

Aleksandra Sokalska: In patients' opinions, cardiologists, neurologists, endocrinologists, etc. are serious doctors, while a family doctor is rather less respected. Why is this?

Michał Sutkowski: Let's start with the fact that this opinion is shared not only by patients, but also by some doctors of other specializations. Firstly, it results from the use of terminology, which often reduces us to the role of medical secretaries of medical specialists . Lack of education in various areas and lack of knowledge result in perceiving us as " first contact doctors ". And I would like to say with a big smile that the doctor of the first and every subsequent contact is... an electrician.

MS: Unfortunately, the system was created in such a way that for many years the district doctor was often primarily the issuer of referrals to specialist clinics . And this state of affairs persists in the consciousness to this day. Meanwhile, a family doctor is a specialist. The name POZ is right, but the word "specialist", i.e. PSOZ, should also be included in this name. Not only for our better well-being. It would be good for patients and the system.

The second reason for this opinion about us is the fact that family medicine is a relatively young specialization, in our country it is only 33 years old. Its symbolic beginning is considered to be June 23, 1992, when the College of Family Physicians in Poland was established.

The third reason for the false perception of family doctors is the systemic solutions that do not use our capabilities. In the early 1990s, the system was supposed to be transformed in such a way that almost half of the students graduating from the Medical Academies of that time would work in primary health care. This assumption was based primarily on rural areas, based on the experience of the Institute of Rural Medicine in Lublin. As a result, family medicine in the countryside does indeed function more properly, but unfortunately the quality of work in primary care is not rewarded here either.

Dr. Michał Sutkowski, president-elect of the College of Family Physicians in Poland for the term of office 2026–2030, specialist in internal medicine and family medicine.

What does this mean?

If I do something extra I still get paid generally per capita. Coordinated care has changed this a bit, but certainly not to the extent that was needed.

Meanwhile, the system should treat a family doctor as a combination of an internist and a pediatrician, but also a doctor who, in the specialization process, learned minor surgery, minor gynecology, minor ophthalmology, minor laryngology, minor..., minor..., minor..., but still... To sum up, we treat people from birth to 150 years of age, we sew wounds, perform various minor procedures, but the system does not notice this at all. Theoretically, I do not have to do all this, I can give, for example, a referral to a surgeon. But living in Warsaw and commuting to work outside the city every day, I know that I am the only doctor within a radius of 15-17 kilometers, so the patient will often come to me faster than the ambulance can arrive. He cannot always get to this AOS on his own either.

That's how it is in small towns. And in large ones?

There, a doctor cannot always develop. And this is for various reasons, not only related to the workshop.

Or maybe patients simply prefer to go to a specialist if they have the option?

Patients often think, although not always rightly, that things will be better in a specialist clinic . Meanwhile, an experienced family doctor can replace a specific specialist in basic matters. Of course, not always and not in everything. There is nothing to prevent the system from being changed with the help of appropriate education at various levels so that the family doctor can fulfill his or her tasks in such a scope. Especially since political or scientific discussions about the health system always end with the statement that the family doctor is its foundation. This is true. White already said in 1961 that the most important doctor is the one who is on the front line. In 2003, research was conducted (Dovey) that showed that despite progress and technology, the family doctor is the basic link in solving the patient's problems. Barbara Starfield and Leiyu Shi stated in 2009 that increasing the number of family doctors, and not specialists in any other field, has a beneficial effect on reducing mortality in the population. Not because we are smarter, but because we are very close to the patient. And this is often a patient over 60 or 65 years of age, and this is usually a patient with multiple diseases. Specialists treat him - each within their specialty, and the family doctor must link these therapies into a whole, additionally taking into account the social and societal context of the patient.

So family medicine is a difficult specialization?

Very difficult, but very rewarding. Because once you get the bug, you stay loyal to this specialization forever. I worked in many places, I was on call in clinics, in various departments: neonatology, cardiology, internal medicine, in the ER and admissions rooms, but I was always, always a family doctor.

It is worth mentioning that for a family doctor, the smaller the community, the better. In large cities, it is really difficult to be on your own in this specialization. There should be a public-private partnership for young family doctors (and not only young ones). Doctors often want to take matters into their own hands and develop their own practices. They need help in this. 2025 will be the 30th anniversary of the opening of the first family doctor practice in Poland, heck, in the whole of Central and Eastern Europe, so this may be a symbolic moment to give these young people a chance for success.

Do doctors like to choose family medicine as a specialization?

It used to be like that. When the specialization was created, in 1994, 118 people finished the session. A year later – 327 people, in the following years already about 700-800 people. I took the exam in 1998. In the Congress Hall we sat then like sprats in a very tight can – then, note: 1172 people passed! But then came the year 2016, when only 153 passed.

What caused this significantly lower interest?

From the system. If family medicine doctors are treated disrespectfully by the system, if they do not see the possibility of development, then few want to associate themselves with this specialization. Now it is a bit better - usually about 300-350 people pass per year.

And this number is sufficient?

No, it has not been sufficient for years. There are about 22 thousand "leading" doctors who work in clinics every day. There are 33 thousand of all those working in primary care, including 13 thousand family medicine specialists, which is far too few. The remaining doctors include internists, pediatricians, and doctors without specializations but with long experience. We counted 70 specializations, so we can say that representatives of probably all medical specializations work in primary care. If it were not for them, this system would completely collapse. We should do everything to raise the rank of family medicine so that there are more people willing to do it.

I am a lecturer at Lazarski University, where family medicine is taught in the fifth and sixth year, like at any other university. Definitely too late! It should be taught together with the introduction to internal medicine , pediatrics in the third year, because it is by definition a holistic science. The scope of this specialization is very wide, hence its difficulty, but also the "charm of causative power".

What qualities should a family doctor have?

Since it provides primary care , focused on the patient, it must be characterized by a comprehensive approach and be oriented towards the local community. It must treat well, and at the same time cooperate with specialist care, hospitals, and emergency care. It is worth mentioning that in Poland, 11% of the payer's budget is allocated to primary care, while worldwide it is as much as 22%. This is a serious mistake and someone will finally have to notice it.

A family doctor, due to his constant contact with patients in a specific community, must demonstrate a high ethical attitude, as well as empathy and well-developed communication skills. He must also constantly educate himself. However, these are not special features that should distinguish him from other specialties. This is simply how a doctor should be.

The most beautiful definition of family medicine comes from the words of Dr. Jacek Putz, who said that it was born out of a longing for a free, independent profession, as well as a patient's longing for a doctor-friend.

One might get the impression that the job of a family doctor is quite relaxed.

Sometimes it really is. There are days full of routine and peaceful activities. But there are also days when we have a heart attack, resuscitation, anaphylactic shock, a patient with cancer, depression, a demanding, quarrelsome person in the clinic. We often have to explain ourselves to patients for the system, because we are on the front line. We would like to devote this time to education, prevention, and not constant and constant corrective medicine.

If patients knew what we know about the system, they would probably take to the streets. The system and those politicians who believe in the paradigm that "it can't be done" need to be replaced!

How intensively do family doctors work?

They usually work without shifts, which is undoubtedly a plus. But they often work in other centers, hospitals, night and holiday medical assistance, which is not so easy to reconcile. In addition, if a family doctor is on his own, he is not only responsible for treatment, but also for management, finances, administration, IT, etc.

The work of a family doctor is a job of constant attention and tension. We often see 50, 70 patients a day, or even more. My record is 111 patients and 7 home visits. At that time I worked in two clinics, I started at 6 a.m. and finished at 11:30 p.m. But this is not something to be proud of, only to be worried about, and I would never want to repeat it. This cannot be a factory, you can't make a mistake here!

So do family doctors often suffer from burnout?

We give in, but the social dimension of our work is an undoubted consolation for us. We simply feel a mission. Which of course does not mean that we do not need systemic changes, quite the opposite.

Which ones first?

30 years ago in the Netherlands, a commission led by economist Wisse Dekker revolutionized the system. It separated its work from current political and medical issues and implemented the best models from the best systems in the world into the national system. In this way, the Netherlands has grown into a world leader in health. I recommend such a commission to all rulers - now and in the future. The system will not survive without changes. The patient and the doctor too. Let's do it quickly, without idle chatter.

author: Aleksandra Sokalska. Editorial office of "Puls" - monthly magazine District Medical Chamber in Warsaw.