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November 2007, Volume 57, Issue 11

Letter to the Editor

Competency Assurance of General Practitioners - Role of Regulatory Authority

Muhammad Ameen Rauf  ( The Aga Khan University Medical College, Karachi )
Abdul Basit Saeed  ( The Aga Khan University Medical College,Karachi )

Madam, general practitioners (GPs) constitute the back bone of any health care system. It can easily be said that they comprise the majority of health care providers in most parts of the world and therefore treat the major bulk of patients. The situation in Pakistan is no exception as GPs make up about 85% of all the registered doctors. They are responsible for initial assessment and treatment of around 80% of patients.1
The majority of GPs practice independently in their private clinics and therefore must be knowledgeable, skilful and abreast with the latest medical developments to deal with common health problems in the community. Pakistan, home to around 160 million people, faces the double burden of infectious diseases like malaria and tuberculosis which are endemic along with the impending threat of non communicable diseases like diabetes, asthma and cardiovascular diseases. Studies on tuberculosis, diabetes and asthma conducted in Pakistan on general practitioners' knowledge and skill to diagnose and manage such diseases conclude that they do not have the required acumen.1-3 This problem is not limited to Pakistan. Literature highlights the same issue with family physicians globally as well. Norman et al. reported in 2003 that around 10% of Ontario physicians had some performance difficulties.4
Professional isolation of the GPs can be the major contributing factor in this problem as they are cut off from the teaching atmosphere and have none or few opportunities to consult their colleagues.5 Countries like Canada have devised a Continued Medical Education (CME) program for GPs together with a competency assurance system to solve this problem.5 Unfortunately Pakistan still does not have any similar CME program or competency assurance system for GPs. Once licensed, GPs are not re-assessed for their competency. Goulet et al. in their study have suggested that "As part of their mission to protect the public, professional medical licensing authorities have the duty to ensure the professional competence of their members and the quality of the service they deliver."5
In view of the current state of knowledge and skill of GPs of Pakistan and the international evidence regarding CME, we recommend that Pakistan Medical and Dental Council, the national health regulatory authority, should formulate a structured CME curriculum and establish a competency assurance system for GPs in order to ensure the best possible health care delivery to the public.

Muhammad Ameen Rauf1, Abdul Basit Saeed2
Final Year Medical Student1.2, The Aga Khan University Medical College,


1.  Marsh D, Hashim R, Hassany F, Hussain N, Iqbal Z, Irfanullah A, et al. Front-line management of pulmonary tuberculosis: an analysis of tuberculosis and treatment practices in urban Sindh, Pakistan. Tuber Lung Dis 1996;77:86-92.
2.  Shera AS, Jawad F, Basit A. Diabetes related knowledge, attitude and practices of family physicians in Pakistan. J Pak Med Assoc 2002; 52: 465-70.
3.  Hussain SF, Zahid S, Khan JA, Haqqee R. Asthma management by general practitioners in Pakistan. Int J Tuberc Lung Dis 2004; 8:414-7.
4.  Norman GR, Davis DA, Lamb S, Hanna E, Caulford P, Kaigas T. Competency assessment of primary care physicians as part of a peer review program. JAMA. 1993;270:1046-51.
5.  Goulet F, Jacques A, Gagnon R. An innovative approach to remedial continuing medical education, 1992-2002. Acad Med 2005;80:533-40.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: