Recognition of family medicine as a specialty in the EU remains a long-standing objective among these physicians. Sara Ares, MD, of the Federica Montseny Health Center in Madrid, Spain, leads the policy advocacy group of the World Organization of Family Doctors (WONCA Europe), established in 2023 in Brussels, Belgium. She outlined the challenges facing primary care in Europe, including workforce shortages and limited resources. She has been coordinating negotiations with several European countries. In an interview with El Médico Interactivo, part of the Medscape Professional Network, Ares described the ongoing work and resistance from some countries, while noting support from the Ministry of Health.

In 2005, the EU updated its framework to govern health professionals through Directive 2005/36/EC. Annex 5.1.4 places family doctors at the same level as medical graduates and does not classify them as specialists, whereas specialists are listed in Annex 5.1.3. Since then, the European Union of General Practitioners (UEMO) has tried to amend the legislation without success.

In 2023, WONCA Europe established a policy advocacy group to strengthen the visibility of family medicine within EU institutions. The initiative also receives support from the Spanish Society of Family and Community Medicine (Semfyc).

Clinical Impact

Ares outlined three reasons why recognition is essential. “First, European legislation should reflect national practice, where family medicine is already established as a specialty across all EU countries. Family physicians should be considered specialists, as they are, like other specialties.”

“Second, it is essential to ensure that the benefits of family medicine specialists are clearly defined and consistently demonstrated. These include improved health outcomes, higher survival rates, greater patient safety, more efficient use of hospital resources, and a person-centered approach to care. Therefore, patients in community settings should be treated by a family medicine specialist. And third, the EU should not convey the message that there are ‘first-class and second-class specialties.’”

Training Requirements

Ares noted that family medicine requires a structured training program lasting 3-6 years across all EU countries, supported by a well-established body of scientific evidence that demonstrates its benefits. However, its role should not be scientifically questioned. Scientific evidence should guide decision-making in all areas, including the formal recognition of family medicine as a discipline that warrants inclusion in EU legislation.

Ares explained that negotiations are ongoing at both the national and EU levels. “To amend the law, at least 11 countries must formally request the change from the European Commission. Malta, Slovenia, and Spain have already submitted requests, and additional countries are in active discussions.”

Policy Resistance

She acknowledged ongoing resistance. “Some national and EU authorities do not have a clear understanding of the benefits of family medicine. This leads to an underestimation of our role as specialists within the healthcare system. Presenting robust scientific evidence alongside national legislative frameworks is necessary to address this issue effectively.”

She added that formal recognition would ensure that institutions in Europe should consider family doctors as experts and “would enable a more active role in designing health policies.”

Amid increasing strain on publicly funded healthcare systems, she said that “the aim of this work is to ensure that everyone living in the EU can access a family medicine specialist, given the clear health benefits this provides.”

Legal Impact

Ares said that “if the specialty is not recognized and existing laws are not enforced, patients will not have access to improvements in survival or more appropriate use of health services, which is detrimental to both the population and the sustainability of healthcare systems. Our focus is, and always will be, patients.”

She acknowledged that WONCA Europe and UEMO are negotiating at both the national and EU levels, working jointly in line with each country’s national alliances. In Spain, this effort is supported by the Ministry of Health, which has formally reported the country’s situation to the European Commission.

She also noted support from the World Health Organization Europe, which, in recent years, has made advanced efforts to recognize family medicine physicians and family nurses working in primary care.

Workforce Leadership

She noted that the UEMO represents all registered family doctors in Europe, whereas WONCA Europe represents family doctors affiliated with scientific society. “Family doctors constitute the largest group of physicians in Europe, and together these organizations represent a substantial proportion of the workforce.”

She highlighted the contribution of María Pilar Astier-Peña, family doctor, member of the Semfyc, and president of WONCA. Her advocacy during her campaign for recognition of the specialty provided dedicated support for these efforts. “Her leadership is key to advancing recognition and improving patient safety in Europe and globally,” she concluded.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.