Gp in Europe





Demography and economics

The size of Iceland is 103,000 square kilometres. Most of the country , ill suited for habitation, covered with mountains, ice caps, rough )va and desert highlands. For this reason the population is spread around the coast and Iceland's economy is focused on fisheries. Half of the Gross National Product (GNP) is related to fisheries and approximately 75 percent of all foreign exchange. There are about 266,000 inhabitants, living mostly in urban areas. About 50 per cent live in the capital, Reykjavik and its neighbouring towns.The other half live in small towns and villages, and in rural areas.The gross national income is high, inflation is about two per cent a year and unemployment 4.5 per cent. Perinatal mortal ity for the years 1990 to 1994 was 5-7/1,000 births and the average remaining lifetime at birth for men is 75 years and 80.1 years for women.


The medical profession

There are about 1,200 practising Icelandic physicians. Approximately 850 work in Iceland and of these 150 are young physicians, specialising. There are more than 300 Icelandic physicians working abroad, most obtaining a specialisation. Icelandic physicians provide medical services in everything that is known in the West, excluding organ transplants. For those services Iceland co-operates with a hospital in Gothenburg, Sweden.Icelandic general practitioners (GPs) were 174 at the beginning of 1996. They are all members of the Icelandic Medical Association and 1 55 are members of the Icelandic College of General Practitioners. The Icelandic Medical Association looks formally after the interests of general practitioners, who like other specialists do not form any special department within the Association. The Icelandic College of GPs is a professional association of GPs, but is very concerned about iheir interests, forming an effective pressure group within the Icelandic Medical Association, even though there is no formal connection.


General practice

Family medicine has been accepted as a specialty of its own in Iceland since 1970. Educational requirements have been the same as for other specialties or 4.5 years after becoming physicians, and of these two years should be in family medicine.There are 1 33 GPs who have specialised as such. Most have studied abroad, in Sweden, Canada, the United States (US), the United Kingdom (UK) or other European countries. At present most doctors studying family medicine are in Norway.As suggested by the Icelandic College of General Practitioners, the Faculty of Medicine at the University of Iceland has suggested to the Government that it should be possible to study family medicine in Iceland and all other specialisations according to a description of objectives and not only according to a time plan.The Icelandic College of General Practitioners has produced a description of objectives for family medicine and GPs may be able to specialise according to such a plan before too long.The Icelandic College of General Practitioners issues a regular news bulletin, operates an educational programme on its own and in consultation with others, encourages continuous education with a certain accreditation system, and has provided standards for the work and working conditions of physicians as well as software for healthcare centres. The continuous education of physicians takes place as much abroad as in Iceland and their wage agreements encourage this.Family medicine varies according to where the physician lives. This variation depends on factors such as district size, population, geography, weather, communications, types of local employment, number of cooperating physicians and distance to the nearest hospital. Each physician can expect to serve 400 to 2,300 individuals. The average number is 1,550. This is close to the standard set by the Icelandic College of General Practitioners, suggesting that a GP practising every aspect of family medicine, including healthcare, should have 1,500 registered patients and fewer if the workload is difficult.Most GPs work in groups, except where geography and few inhabitants call for one physician only. It is also the stated policy of the Icelandic College of General Practitioners that physicians do not work alone.



Most of the GPs are employees of the state, receiving a fixed salary and practising in healthcare centres owned and operated by the state. They are, however, considered independent physicians and practice as such for the National Health Service (NHS) which pays them a fee for services rendered. Colleagues such as registered nurses, midwives, paramedics, medical laboratory technologists and secretaries are employees of the state. The physician does therefore not hear o[x'r,ilion>il responsibility for their work, but can be professionally responsible in certain instances.Approximately ten per cent of GPs, only in Reykjavik, have a different type of contract with the NHS and are completely independent contractors. This is an older system which does in some ways make it difficult to meet the professional demands set by the Icelandic College of General Practitioners. It does, however, have the advantage that the physician is an unquestionable authority in his or her workplace, a fact that will probably be pointed to in some respect during negotiations with the state in the future. There is also an increasing interest among politicians to encourage more free enterprise within the NHS.


The national healthcare system and the medical profession

The Icelandic social security system is open. There is free access to all physicians. The system of compulsory referrals was abolished ten years ago. Authorities have twice tried to reinstate it but in vain, due to major resistance from independent specialists. Most specialised physicians hold posts in hospitals and operate their own practices as well outside the hospitals. When patients seek secondary medical help this is not supplied in the hospital ambulatory wards but by specialists in private practices. The patient may get a referral letter from his or her family physician or seek out the specialist him or herself. The share of cost incurred by the patient is the same, whether he or she goes to the family physician first or not. The authorities try only to direct the flow by having patients pay a lower amount to the family physician than to the specialist. However, both amounts are low and become even lower if the cost per individual exceeds a certain limit per annum.


The future

The main problem facing Icelandic GPs presently is that they cannot supply enough service due to a limited number of posts, which are determined by the state. On the other hand, we have an increasing number of specialised physicians who have 'de facto'an open and unhindered access to the NHS if practising conventional specialised medicine. This may be expected to be a major topic and task facing Icelandic physicians in the years to come.


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