• W Himmel and M M Kochen.
• Department of General Practice, University of Göttingen, Germany.
• Br J Gen Pract. 1995 May 1; 45 (394): 231-4.

BackgroundCompared with other clinical disciplines, academic general practice is in a difficult situation with respect to patient care. There are at least three different possible models of working arrangements for heads of departments of general practice: to work in a surgery in a medical school; to work in a surgery in the community, separate from a part-time university post; or to work part-time in a surgery in the community, separate from a university post.AimA study was undertaken to explore these models and to gain an understanding of academic teachers' organization of patient care in Europe.MethodA total of 77 heads of departments in universities in 12 European countries were sent a questionnaire enquiring about important characteristics of their department, the number of patients they treated per week and how they allocated their time.ResultsSixty nine heads of department (90%) responded. Of respondents, 55% worked part-time in a surgery, separate from a university post, nearly one third worked mainly in a surgery, separate from a part-time university post, and 16% worked in a surgery in a medical school. Those working in a surgery with only a part-time university post spent most time in patient care compared with those working in other models (mean of 57%). Respondents working in a surgery in a medical school spent most time on administration (34%); they spent 22% of their time on patient care and 20% on education. Respondents working in a surgery in a medical school spent 25% of their time on research, those working in a surgery separate from a part-time university post spent 12% of their time on research, and those working mainly in a university with a part-time practice post spent 24% of their time on research. Those working mainly in a university post spent only 17% of their time in patient care.ConclusionWorking in a surgery in a medical school represented a well-balanced model of time allocation between patient care, research and education and seemed to be a good approach for the integration of general practice into medical schools. Working part-time in a surgery with a university post is an appropriate model for academic integration, but patient care seemed to be neglected. Those doctors working mainly in the community with a part-time university post were able to provide continuity of care and to come into close contact with the everyday problems of general practitioners. However, they might have to struggle for academic recognition.

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