An Academic Family Doctor Embedded in Practice
Sven is a Swiss general practitioner in a rural community (Konolfingen) and Professor in Primary Care at the University of Bern.
He co-leads the Master’s program and conducts research into interprofessional primary care. Prof Streit is past-president of the Swiss Organisation of Young GPs (JHaS, www.jhas.ch) and served as chair of the European Organisation of Young GPs (VdGM,www.vdgm.eu) and chairs the committee to promote general internal medicine of SGAIM (www.sgaim.ch). He trained in epidemiology (MSc) at the London School of Hygiene and Tropical Medicine (www.lshtm.ac.uk) and at Leiden University (PhD) (www.universiteitleiden.nl) in the Netherlands. He is a member of the European General Practice Research Network (EGPRN, www.egprn.org).
Watch the video, listen to the podcast, read the transcript below
“Some people say I’m only half a professor and others say that I’m only half of a GP… But, the more I engage with researchers and GPs, you need people that can build bridges and overcome all those silos we face in health care. Building bridges means you need one step in practice and the other one in the academic life.”
“the joy of living upstairs, working downstairs while enjoying the same beautiful view.”
In his own words he is a ”Happy family man with three children and a dog, enjoying co-leading a GP practice with his wife, and co-leading with a pharmacist a great team of interprofessional primary care clinicians and researchers at the Institute of Primary Health Care (BIHAM) at the University of Bern. I am thankful for all the professional support in my life through great mentors and to the academic institutions in Bern, London and Leiden.”
Sven Streit is a leader in one of the key primary care departments in Switzerland. Tell me about your current role and how you got there.
Sven Streit: Thank you so much for the invitation. I would not consider myself as “the” leader but I do think that we need role models in primary care, especially in Switzerland. And for me, that began when I saw demonstrations of GPs on the streets, back in 2006 when GP’s in Switzerland were very angry about the political framework and the decisions taken by politicians, mainly in limiting what we could offer as frontline workers. And from there I started my journey by training to become a general internist and primary care physician, but also as a researcher mainly in the area of polypharmacy and deprescribing. I always felt you need to go and talk to people and try to persuade them to become primary care physicians themselves. So here I am.
DMacA: Let me take you back to your training, because you’ve had a lot of international experience. You trained at the London School of Hygiene, and then you did your PhD in Leiden. Tell me about those two experiences.
SS: It was a very nice coincidence that I could combine them both. The London training was by distance learning and the PhD was in Leiden in the Netherlands. When I look back at that time, I am so fortunate that I have had such comprehensive training that I can compare to a backpack with lots of tools or, one could say, a Swiss knife with a lot of different tools to use. The Master’s training was more of the theoretical background, the methods I could use or the statistics I would need to apply in research. And the Ph.D. let me get involved in projects that colleagues were performing. I could then combine the theoretical elements and tools, together with the practical aspects like project management.
And so, when I consult with young colleagues, I highly recommend them to do something similar, not to think that research is easy to undertake and that you can do a little bit on the side of your clinical work, but to try to get proper training. And, that it brings you a lot of joy because you become an independent researcher.
“It’s called the WONCA virus. You get infected! And it started off very early in my professional life…I still attend such meetings within the EGPRN, which is the research group within the WONCA family. And for me that is always one of the best places to fully power up with inspiration, ideas and motivation.”
DMacA: Leiden is, of course, one of the centres of general practice research. Tell us about Leiden and what you gained from it.
SS: Well, I lost my heart in Leiden, and I’m happy. I have several chambers in my heart so I can still have my Bern heart and my Leiden heart. We went there as a family. Anja my wife is also a GP by training and she works with me in the office which we share. And, back in the day, we had three small children, our smallest was just one year old. It was a challenge, you know, to let go of everything, all your friends and family, and move abroad and live there. That’s also an experience that we can look back on.
One of the most memorable experiences I had was with my supervisor, Jacobijn Gussekloo who always started her meetings with me by asking: “How is your wife? How are your children? How is your life in Leiden?” And then, “How was Project A, B or C” And sometimes, things were not so good, or a child had had an accident. She would not continue the conversation until all the bullet points or box ticking was done. She was a role model for me and, in terms of looking after students, was certainly an inspiration.
DMacA: You have a number of students at the moment. Tell us about your experience of teaching and research with your students.
SS: I hope I can provide them with some of the elements that I think are key to successful research. That includes changing the old fashioned idea of hierarchies, vertical lines, and to be more on the same horizontal level. When I listen to my students, they give me feedback that I let them work away, encourage them to do what they are passionate about, and that they feel a great sense of trust. And for me, this is a key aspect. We come together because we all share the same interest and joy. But we also share the feeling that trust comes first, and that is most important. The pandemic meant that we had to work differently and, in this respect, it is more based on trust than on supervised meetings and checking that everything is done.
“When you ask patients, they might say that its really high quality, my doctor has time for me, he or she is available, but the majority will also say that it’s a struggle to find a GP… and is the result of a decades long (wrong) assumption that there would too many physicians in Switzerland. And, in this respect, too many GP’s.”
DMacA: You’ve been very involved in a number of national and international organizations for young GP’s. Tell us about that experience.
SS: It’s called the WONCA virus. You get infected! And it started off very early in my professional life. I went to the WONCA Europe meeting in Istanbul in Turkey and it made a huge impression on me as a young physician and GP to mingle with all those country representatives, and then to sit together and discuss the struggles they have, but also the solutions that they found within that struggle.
I still attend such meetings within the EGPRN, which is the research group within the WONCA family. And for me that is always one of the best places to fully power up with inspiration, ideas and motivation.
DMacA: A research career is a challenge in Switzerland, and you spoke about those challenges very briefly. You’re clearly a committed GP, but you’re also an academic. How do you balance those two?
SS: Some people say I’m only half a professor and others say that I’m only half of a GP. I needed some time to reflect on that. Now I consider myself a full time clinical researcher. It’s a combination of my work as a GP, seeing my own patients, and navigating the system in order to have your own practice and to deal with all things that happen, but also combining it with research. Certainly, its a bit of a split to do both at the same time. But, the more I engage with researchers and GPs, you need people that can build bridges and overcome all those silos we face in health care. Building bridges means you need one step in practice and the other one in the academic life.
DMacA: And how does that work for young GP’s in Switzerland? You went away to do your research in Leiden and through the London School. Can you do that in Switzerland?
SS: We are very fortunate that at our university in Bern we have a so-called 50:50 PhD program that allows you to continue your postgraduate education, to become a specialist, specialized in general practice, alongside a Ph.D. And in our team, we have a strong interprofessional spirit. So I’m leading a group within the Institute that is called Interprofessional Primary Care. We offer those positions not only to physicians but also to pharmacists and researchers from other backgrounds so they can combine their clinical work together with starting an academic career. I think this is a big game changer. On the other hand, we still encourage people to go abroad and we also receive people from abroad, because I think that’s another crucial element- to try to be involved with others, work with them, find solutions, collaborate with them
“… my students…I let them work away, encourage them to do what they are passionate about, and that they feel a great sense of trust. And for me, this is a key aspect. We come together because we all share the same interest and joy. But we also share the feeling that trust comes first, and that is most important.”
DMacA: You started off talking about demonstrating on the street to improve the lot of general practice. Tell us about general practice in Switzerland at the moment and how it’s working.
SS: When you ask patients, they might say that its really high quality, my doctor has time for me, he or she is available, but the majority will also say that it’s a struggle to find a GP. We live in the system where GPs do not have predefined lists of patients, but patients themselves search out a GP. And so, for our patients, this is a struggle and is the result of a decades long (wrong) assumption that there would too many physicians in Switzerland. And, in this respect, too many GP’s. But our workforce is currently struggling because we have a baby boomer generation about to retire. I think this is an international situation and not specific to Switzerland, but what I feel is specific in Switzerland is that we need to act very swiftly to fill this gap, because training takes so long. If we convince a young student to become a GP it takes on average 15 years from that day for this young doctor to enter practice. On one hand we find ourselves in this situation with a shortage of GPs but, when I look at the universities, I have high hopes because the younger generation express more and more interest in becoming general internists, and primary care physicians. So it’s a bit of a glass half full, but half empty situation.
DMacA: Many countries have a problem providing general practice in rural areas. Is that the same in Switzerland?
SS: When you come from abroad, especially from a large country, you may not see Switzerland as a country with rural issues. When I talk to my colleagues within EURIPA, which is the Rural Association of European Doctors, they might think differently. But, when you live here, we see that distance sometimes plays a role because you may be more remote, or you lack resources, or day care, or the other elements you would need to live as a physician or as a GP in the region. When we survey young colleagues, however, we see that most of them prefer to live in the countryside or outside of the bigger cities, which is comforting as this might help. But again, if you ask the population, do you have a GP and is he or she accessible, it is mostly in the remote areas that the pressure is most pronounced.
… this really is my dream come true. I love this profession…You can become a very dedicated GP in a rural area, or you become a GP that is involved in research as in my case, or you get involved in the political arena and fight for healthcare or primary care. There are so many open roads for you to discover and it is one of the best professions that a young colleague could join.”
DMacA: Coming back to your overall view of general practice, when a young doctor comes to you and asks what career path should I follow, what do you say to them?
SS: It’s your dream come true. For me, this really is my dream come true. I love this profession. And I think it needs to start with passion. There are, as they say, several roads to Rome, just as it is with becoming a GP. We see a lot of challenges. But I would also stress the fact that we have a lot of opportunities. You can become a very dedicated GP in a rural area, or you become a GP that is involved in research as in my case, or you get involved in the political arena and fight for healthcare or primary care. There are so many open roads for you to discover and it is one of the best professions that a young colleague could join.
However, I would also tell him or her to start early on with a mentoring program, and I would reassure them that, while training and becoming a GP can seem to be a bit of a jungle, it becomes a little bit easier to adjust.
DMacA: Finally, let me ask you a general question, are you optimistic about the future of general practice itself?
SS: Yes, I am, with some caveats. I think we should have more a sense of primary care as a broader domain, maybe not just one profession but a multitude of professions, with less hierarchy and more as teams.
And, hopefully, at least when it comes to Switzerland, we would have more digital support in how we make up decisions, how we treat patients, and how we communicate with other professions.
I’m very positive about the fact that the stronger the primary care domain, the healthier the population. We see this when we look at different countries.
In the political arena, sometimes those shouting most are heard, often bigger players like hospitals or larger regions, and primary care still misses a strong voice to be heard.
DMacA: Sven, has been a pleasure talking to you. Thank you very much for sharing your optimism and your positive outlook for general practice. Primary care. Thank you very much indeed. Thank you so much.
