November 2014

Strong teams

More and more young doctors are choosing to work in a group practice. There, they can devote their full attention to being a doctor, share medical knowledge and advise patients as part of a team, and try out new things. One such doctor is Marc Jungi, senior consultant at Sanacare Berne. His team of doctors involves practice assistants in caring for the chronically ill – an approach which has met with great success.

Sanacare

Consultations from 7.30 to 12 noon, lunch until 1, team meeting from 1 to 2, then more consultations until 4.30, and finally a job interview with a potential new practice doctor and, on the way home, a house call to a patient: it's all in a day's work for Marc Jungi. His schedule is always full to bursting.

The 48-year-old specialist in internal medicine (FMH) is one of 12 general practitioners working at the Sanacare group practice in Berne. In his role as senior consultant, he also bears responsibility together with his colleagues for the full range of administrative duties such as human resources, budgets and scheduling. Last but not least, Marc Jungi is also a member of the Executive Board of Sanacare AG, the parent company of now 13 Sanacare practices across Switzerland. He ended up with all this management responsibility quasi by accident: «I discovered my interest in such matters while I was already here at the group practice», he says. The fact that he is working here and not in a single practice is anything but an accident, however: the opportunity to work with other like-minded professionals under the same roof, to have a second opinion in the same building, to share the same expensive infrastructure, to enrich each other, to challenge each other, and also to take the pressure off each other when needed – for Marc Jungi, this was the obvious route. He came to this realisation way back in 1999 when the concept of a group practice was still a novelty and Marc Jungi was one of the first to test it out.

Fifteen years later, the model is attracting more and more young doctors. «It allows you to devote your full attention to medicine, provides a modern working environment, and offers the opportunity to work in a team and also part time,» she explains. Patients are opting for group practices in ever-higher numbers as well; not only patients with a managed care model, but also those with conventional insurance – so much so that they now make up almost one third of patients on the Sanacare roster. The major plus of a group practice for patients is that it offers comprehensive basic medical care all under one roof.

This is one of the main challenges facing Marc Jungi and his team. An optimal mix of specialist expertise within the practice is decisive here. Thanks to the wide-ranging fields of competence of the 12 doctors employed, Sanacare Berne has just such an offering, ranging from gynaecological basic care to psychosomatic medicine, paediatrics and traditional Chinese medicine, right through to x-rays and diagnostic ultrasounds. Marc Jungi, who obtained his specialisation in sports and manual medicine, can draw upon this knowledge at any time, and discuss his diagnoses with colleagues and obtain a second opinion. If a patient requires assistance extending beyond basic medical care, Marc Jungi and the other GPs at Sanacare Berne can refer them to an appropriate specialist. Interdisciplinarity – a buzzword in modern medicine – is all part of the package for these GPs.

Developing family medicine

Another major advantage of the group practice, says Marc Jungi, is that it provides an opportunity to develop family medicine. Quite the pioneer, Marc Jungi is at the very forefront of this development. The topic: «Two thirds of GPs are older than 55 and will retire in the next ten years», he explains. The diminishing number of GPs stands in sharp contrast to the growing need for medical care. This is being exacerbated not least by demographic trends: people are becoming older and older, and the older people become, the more frequently they suffer from chronic illnesses and require more extensive care. At Sanacare Berne, Marc Jungi and his team have launched a pilot project called Chronic Care Management (CCM). The idea is that trained medical practice assistants support the GPs in treating chronic illnesses. In the case of diabetics, for example, this could take the form of advising them on how to deal with their disease, promoting their self-management, and also taking care of certain medical necessities on behalf of the doctors. «This gives the doctors a much-needed extra pair of hands», says Marc Jungi. He has been testing out the model for the past 12 months. The feedback from patients has been «great», he says, «and with but a few exceptions all have signed up for the second cycle of the pilot project.» The response from the practice assistants involved has also been extremely positive. «These new duties have provided them with a new insight into their profession», says Marc Jungi. This has given rise to a new field in family medicine: interprofessionality.

CCM has set somewhat of a precedent within Sanacare, and in 2014 the programme has been extended to a further 13 practices. It will likely take some time before other GPs adopt the approach, however: the practice assistants need to be trained as coaches and tariff points defined for the services they will be providing in their new roles. The fact that Marc Jungi has been able to launch the CCM project in the first place is thanks in in no small part to Helsana, which is taking joint responsibility for the project, both financially as well as ideologically.

Text: Iris Kuhn-Spogat