Photo credit: Marc Rouiller, Unisanté
On an Academic Journey from the Azores to Lake LĂ©man
Alexandre Gouveia has a particular interest in quality and patient safety, in postgraduate teaching, and in clinical research within the Department of Ambulatory Care at Unisanté (University of Lausanne, Switzerland).
Alexandre was appointed senior physician in 2021 and took on the responsibility of the Polyclinic of General Practice. In 2022, he began part-time training in medical education at Harvard University (Master of Medical Sciences in Medical Education). In 2023, he earned his Doctor of Medicine (MD) degree from the University of Lausanne, focusing on potentially avoidable hospitalizations in Switzerland.
After obtaining his medical degree from the Faculty of Medicine of the University of Lisbon in 2004 and completing his specialization in General Practice and Family Medicine in 2009, Alexandre Gouveia worked as a primary care physician in a group practice (Viana do Castelo, Portugal) for five years, and as a lecturer in Community Health at the School of Medicine of the University of Minho (Braga, Portugal).
 In 2014, he began his medical career in Switzerland as a resident physician at the University Medical Polyclinic in Lausanne and was appointed deputy chief resident in 2015. After earning a CAS in Clinical Research in 2017, he worked for two years in the Internal Medicine Department at CHUV as deputy chief resident and received his FMH title of specialist in General Internal Medicine in 2019.
Watch the video of the interview on Youtube, or listen to the Podcast on Spotify and all the major platforms
“….. I was always stunned by the way that they communicated, with the way they worked in this rural area taking care of patients, and all the stories we heard. It was really interesting, and that motivated me to become a doctor.”
Lake LĂ©man
Hello, I’m Domhnall MacAuley and welcome to MedicsVoices.com where we talk to key opinion leaders in health and medicine around the world. Today we’re in Switzerland and I’m talking to Doctor Alexandre Gouveia. Let’s take you back to the very beginning. What started your interest in medicine?
Alexandre Gouveia: Its been a long journey that started far away from Lausanne in Switzerland. It began in the middle of the Atlantic, in the Azores, where I grew up.  As a little boy, I was always fascinated by the two general practitioners that changed my life. My mother and my father are both GP’s, and I grew up in a family with my two brothers. I was always stunned by the way that they communicated, with the way they worked in this rural area taking care of patients, and all the stories we heard. It was really interesting, and that motivated me to become a doctor. I also connected a lot with their colleagues, the GP’s in the area. There was nice human side in medicine, not just technical, but in terms of connecting with people, understanding their lives, living their stories, and of course, helping them to get better. So, I grew up as a little boy in Ponta Delgada, which is the main city in the group of islands of the Azores.  We have nine islands and one of the biggest is San Miguel and that’s where I grew up until I was 17 years old.
I did my medical studies in Lisbon from 1998 until 2004 and my basic training in Lisbon. Afterwards I did my postgraduate GP training in the north of Portugal, in the small town of Viana do Castelo, with my wife, who also a GP. Later, in 2014, we decided to move to Switzerland and we’ve been living here for ten years.
DMacA: Let me bring you back to medical school in Portugal. Was family medicine part of the curriculum?
AG: Yes. We had the opportunity to learn family medicine, not only on the theoretical principles and basic foundations of primary care but also with some rotations in community medicine. I had the chance to do two or three rotations during my undergraduate studies that I found quite interesting and that confirmed my drive and my interest in primary care. The undergraduate exposure of medical students to family medicine in Portugal is quite important. We have an interesting history in primary care in Portugal. There was an important reform many years ago, not just the latest reform in 2006, but in the 80s and 90s, there were many innovations and developments in Portuguese primary care and in terms of  postgraduate studies, there was a consolidated and well developed vocational training program. And this, I think, created the foundations of the Portuguese primary care that we see now.  There have been some amazing results in terms of health care indicators and satisfaction in the primary care health workforce, and very interesting organization in terms of family health units and primary care teams that are now the core unit of the success of the Portuguese National Health System.
DMacA: Â You spent five years as a GP in Portugal and were part of a very dynamic, very enthusiastic, and very committed generation of Portuguese GPs.
AG: We were a group of people that finished training in that period from 2000 to 2015, and we had the benefit of great primary care leadership. I’m not going to list all the different names but, of course, there were people like Luis Pisco who was very engaged with WONCA in terms of international primary care development and later on we have João Sequeira Carlos who helped create the Vasco da Gama movement just to cite two leaders in primary care that were pushing forward. These were a group of brilliant colleagues interested in advancing primary care in Portugal in terms of clinical, teaching, and research. In terms of research, for example, we had Jaime Correia de Sousa a leader in research and development in primary care. These were three of the people that I would say created the momentum in the period from 2000 to 2015, and I think the peak of primary care development was the reform initiated in 2006, and consolidated from 2010 until 2015-16.
And then we have a new generation of GP’s that were trained in Portugal, assumed different roles of leadership, for example in primary care teams, and maintained the developments of the previous years in some specific health care regions in Portugal. An interesting event to mention was the WONCA conference in Lisbon in 2014 which was when we reached a certain peak in terms of development and organization, in terms of leadership, in terms of training, and in terms of research. We still see this energy, this momentum, and I think we will see it again this year in September 2025 with the world WONCA conference in Lisbon.
“I just decided to reorient things a little because I was having a lot of difficulty trying to conduct research in primary care. I was really enthusiastic but it wasn’t feasible to take on a PhD in terms of work life balance and all my different roles.”
DMacA: Â After this period in Portugal, you moved to Switzerland, a very interesting move that further promoted your academic career.
AG:  That was one of the major goals in that period of my career. I was working as a GP in a primary care team. I was really happy with the work as a frontline primary care worker. We were a big team of eight GPs, eight family nurses and six clinical secretaries. In fact, I was working with my wife in the same practice, near to where we lived. And I was also working with Jaime Correia de Sousa at the University Department of Community Health in Braga, in University of Minho. I was in a situation in my life, where I had some clinical responsibilities and some academic responsibilities and I was also working at the executive board of the Portuguese Society of Family Medicine (APMGF).  I just decided to reorient things a little because I was having a lot of difficulty trying to conduct research in primary care. I was really enthusiastic but it wasn’t feasible to take on a PhD in terms of work life balance and all my different roles.
My wife and I discussed it a lot. She spent two years of her undergraduate studies in medicine in Paris so was quite fluent in French and we do have also some family in Paris. We just decided to change our perspectives in terms of professional development. There was also, I think, some impact from the difficulties the Portuguese NHS was facing after the 2012 economic crisis- a negative feeling of what might be possible in the following years. So, we decided, let’s try to reorient things a little bit. My main driver was to reinforce my academic knowledge and skills and, for my wife, it was to acquire more expertise in geriatrics.  She had just begun postgraduate studies in geriatrics and reoriented her career a little, from general practice to geriatrics. I had the opportunity to come to the university department of Primary Care in Lausanne and I’ve been working here, at the institution, since then.
DMacA: Â And you then had the opportunity then to do your doctorate, on a very interesting topic.
AG: First of all, I had to do my training in general internal medicine in Switzerland because primary care physicians and general practitioners from Europe are not automatically recognized. Our post-graduate training is not automatically recognized here because internal medicine and general practice are combined in a single specialty that has five full years training. So, between 2014 until 2019, I did my general internal medicine specialty training. After that, I initiated my doctorate, which was focused on quality of care and potentially avoidable hospitalizations. Â It was a study of ambulatory care sensitive conditions including asthma, COPD, diabetes and heart failure, in the 20 year period from 1998 until 2018. Some of the publications were completed last year. We found that these conditions have been increasing, with an important cost to the health care system, and which reflects, unfortunately, a little on the lack of training skills and pathways that exist in primary care to provide better and more care for these chronic conditions in terms of avoiding hospitalizations at the end of the health care chain.
 DMacA:  You’re still very interested in the international dimension and you’re doing some work at Harvard…
AG: When I finished my doctorate, I asked myself what the next step would be. I’m very interested in medical education and one of the missions of our department is to train family medicine residents. We have a big team of 50 family medicine residents that are supervised by 20 chief residents and senior physicians. We wanted to go a little further in terms of educational methods and also to understand the solutions we should provide in response to the current challenges that medical education and specifically family medicine face.
Read this article on the web page at Harvard Medical School
There was this opportunity to start a part time master’s in medical science at Harvard Medical School. I started in 2022 and am currently conducting my thesis work, focused on artificial intelligence and the management of uncertainty. If everything goes as predicted, I will finish my master’s next year in 2026.
“The challenges are European. Indeed, they are really worldwide. But in the Swiss context, two of the main challenges are the lack of primary care practitioners we are going to face in the next five, ten, 15 years. So, we do need to increase the number of trainees, and the number of primary care practitioners, the number of GP’s working in our country.”
DMacA:  I’d like to come back to artificial intelligence, but you also published an editorial in the autumn in the Swiss Medical Review, looking at the data behind general practice and the general practice workforce- because there are challenges in Switzerland.
AG: The challenges are European. Indeed, they are really worldwide. But in the Swiss context, two of the main challenges are the lack of primary care practitioners we are going to face in the next five, ten, 15 years. So, we do need to increase the number of trainees, and the number of primary care practitioners, the number of GP’s working in our country.
The solution is not just in increasing the number of primary care training units, but it’s also how we can respond in terms of what primary care practitioner actually do in their daily lives. There is this interconnection with the second challenge, which is the content and the objectives of primary care. So, in terms of solutions, the redefinition of the core business of primary care and the activity of general practice, will be related to interprofessionality, to task delegation, working with other health care professionals like pharmacists, primary care nurses, physician assistants, and eventually integrating the future health care workforce such as medical students and trainees working side by side with general practitioners. So redesigning the primary care network and the primary care work field in terms of trying to make it more adaptive, more dynamic, and to make it more flexible.  Because the needs of patients shift quite quickly and sometimes the old fashioned model of a single owned primary care practice is not a good fit for current and future needs.
Primary care teams, interprofessional task delegation, and integrating information technologies are the next challenges. We need to look closely at how we can integrate what we already know, to learn, and then to teach future general practitioners.
DMacA:Â To introduce the primary care team and medical home is going to be a big challenge and will require a major evolution in Swiss family medicine. How do you see that changing?
AG:  Diversity is an opportunity but, of course, it’s also a challenge. We need all the stakeholders, policymakers, and decision makers to work together, to exchange more and more so that we can find solutions that are adaptable.  We need to reinforce communication and collaboration to provide solutions that are locally adapted and, of course, guided by the best evidence that exists internationally. In Switzerland, although we do have a lot of innovation in the healthcare system and we have a lot resources, it’s a very expensive healthcare system. In recent years, although there has been some reorientation, there has been a lot of financing of hospital specialties and although most healthcare is provided in primary care, we need an improved balance between the money given to secondary care and the money provided to primary care.
Payment to doctors, for example, is one of the barriers and this is an element that our national organizations have been working on in terms of reinforcing the image and in terms of increasing the value attributed to primary care practitioners in the way the health care system functions. It’s a challenge, but we do need to encourage all the actors to keep communicating and to reinforce the discussion because, if we don’t change the way the system is organized, it’s not going to be attractive to the next generation. The fact is that we have a very bottom-up way of organizing this system, a liberal system with a range of opportunities. In terms of creating of primary care teams and practices, GP’s have a certain freedom to work where they want. It’s not state owned or state organized. The regions, the health care authorities, provide a type of validation in terms of competencies and skills in order to become a GP working in ambulatory care. But where you work or where you open your practice is not determined. So, in terms of public health, we need more planning and with this there would probably be less freedom in terms of the opportunities for GP’s to work where they want. It’s mostly market driven so that, if there is a lot of competition, GP’s will not work in a particular place. But, in terms of public health, in terms of accessibility to primary care, we should perhaps identify certain areas where GP’s could be better reimbursed to encourage practitioners to work in those primary care deprived areas. That could be, for example, one of the specific policies and strategies adopted, while still accepting the diversity that we have.
“…in terms of primary care services provided, accessibility, continuity, and also the quality of the service provided, there is going to be a lot of help from artificial intelligence algorithms and electronic health records that integrate some specific algorithms.”
DMacA: Looking at your two major interests together; the workforce and the future of the team, together with your expertise in artificial intelligence, which some people think is going to solve all those problems, give us a vision of where you think artificial intelligence fits in the future of primary care.
AG: I think it’s going to make primary care evolve, but it’s not going to completely revolutionize healthcare as some propose or advocate. What I think will happen is, as we saw with internet, that doctors or teams that use artificial intelligence will eventually replace primary care professionals that don’t use it.  Because in terms of primary care services provided, accessibility, continuity, and also the quality of the service provided, there is going to be a lot of help from artificial intelligence algorithms and electronic health records that integrate some specific algorithms. These algorithms, of course need to be calibrated, need to be adapted, and need to be validated. But I think they will be really useful in terms of time allocation, for example, time to see patients versus administrative tasks done by doctors. Doctors will be faced with these new tools and they will have to choose whether they would use AI tools or not.
And, because of the benefit of using time more efficiently and eventually diminishing cost, doctors will be pushed towards AI integrated technologies. If we integrate artificial intelligence smoothly and in an intelligent way, in our clinical reasoning and in administrative tasks respecting, of course, safety and data protection, we can improve the use of our time and make better use of our skills for complex situations, for difficult relationships, or in terms of applying our expertise in situations where we are not replaceable.
DMacA:  It’s been a fascinating journey from your traditional family medicine childhood in the Azores, to this vision of the future of family medicine integrated with artificial intelligence. Thank you very much for sharing so much of your life and career.
Some key research works:
Trends in Avoidable Hospitalizations for Heart Failure in Switzerland (1998-2018): A Cross-Sectional Analysis https://pubmed.ncbi.nlm.nih.gov/39765974/
Twenty-year trends of potentially avoidable hospitalizations for hypertension in Switzerland https://pubmed.ncbi.nlm.nih.gov/39169149/
Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study https://pubmed.ncbi.nlm.nih.gov/37174771/
Trends in potentially avoidable hospitalizations for diabetes in Switzerland, 1998 to 2018: Data from multiple cross-sectional studies https://pubmed.ncbi.nlm.nih.gov/39687144/
For further career details see:  LinkedIn www.linkedin.com/in/agouveia
