Journal of Preventive Medicine

Dear editor
The study of the health systems in developed countries shows that the prevention of disease is considered as an important and undeniable component in the success of health systems. One of the effective methods to achieve disease prevention at all levels is the use of family physicians. The World Health Organization (WHO) has also mentioned the implementation of the family physician program as an effective strategy in improving service delivery, reducing costs and establishing equity in health care delivery [1]. The family physician, as the leader of the family health team, is responsible for management, providing services, making decisions, guiding and leading the health team and communicating with the covered population. The type of communication between members of the family health team should be determined based on the levels of prevention and the conditions of patients [2]. In Iran, according to the current laws and regulations, expanding the family physician program has been one of the duties of the government, and mandated the Ministry of Health and Medical Education to give priority to prevention over treatment and focus on the family physician program and the referral system [3, 4, 5, 6].
The family physician program in Iran was implemented for the first time in 2005 for all villages and cities with less than 20 thousand people. Since 2012, with the aim of expanding the mentioned program to cities with more population, the implementation of the family physician program was started as a trial in Fars and Mazandaran Provinces. After more than 10 years, based on the results, it has been decided that by the end of the first year of implementation of the seventh program (2025), all the cities of Iran will benefit from the presence of family physicians. Currently, the implementation of this program in cities of Iran is optional, but in the future, it should be mandatory by providing the necessary incentives and covering all the people living in the cities. In this regard, the need to educate and inform people about the advantages and benefits of this program seems very necessary and plays an undeniable role in people’s willingness to use this program.
Four of the most important challenges to the implementation of this program include:
1. Change of the general policies of the program with the change of governments: The family physician program is a government program. With the end of the tenure of a government and the coming of a new government, the executive policies of the program should not be changed. If the policies change, it will cause confusion for the administrators and providers as well as the users, in addition to imposing huge material and moral costs on the health system.
2. Weakness in the referral system and the lack of a health records database: The lack of proper and effective implementation of the referral system, as one of the great goals of implementing the family physician program is another challenge. Currently, many patients in Iran see their family physicians only as a means by which they can access specialists by spending a small amount of money. In this view, the position of the family physician has been reduced to referrers to the higher levels of the health system regardless of the necessity or lack of necessity of these specialized services, and it is not considered as a gatekeeper and preventer of unnecessary specialist visits and services. On the other hand, after referring to the second and third levels of service delivery, the necessary feedback to the family physician (the first level of service delivery) is not provided. This problem makes it impossible to create a database for the patient’s health records. 
3. Lack of proper and effective training of doctors to serve as family physicians: Currently, there is no specific curriculum regarding the family physician services with a preventive approach for medical students in Iran. Considering the main role of family physician in preventing the occurrence of diseases, there is a need to pay more attention to specialized training in this field. It is necessary to change the views about family physicians from a therapist to someone who prevents the occurrence of disease.
4. Lack of human resources in family physician program: According to the report of the Vice-Chancellor for Health of Iranian Ministry of Health and Medical Education in 2023, this department is facing a shortage of 60,000 healthcare providers [7]. Providing the necessary budget to employ the required workforces for the family physician program and providing the relevant incentives for them has a vital impact on the provision of family physician services.
5. Considering that the family physician program is one of the most efficient and effective strategies to achieve the disease prevention goal at all levels, addressing the major problems and challenges of the implementation of this program, as mentioned above, can pave the way for its successful implementation in the coming years.


References

1. Mehrolhassani MH, Jahromi VK, Dehnavieh R, Iranmanesh M. Underlying factors and challenges of implementing the urban family physician program in Iran. BMC Health Serv Res. 2021 Dec 14;21(1):1336. [DOI:10.1186/s12913-021-07367-3] [PMID]
2. Ministry of Health and Medical Education. Guidelines for family physician program and referral system in urban areas. Tehran: Ministry of Health and Medical Education; 2023. [Link]
3. Islamic Parliament Research Center Of The Islamic Republic of Iran. [The Fourth Development Plan Law of the Islamic Republic of Iran. (Persian)]. Tehran: Islamic Parliament Research Center Of The Islamic Republic of Iran; 2004. [Link]
4. Islamic Parliament Research Center of The Islamic Republic of Iran. [The fifth development plan law of the Islamic Republic of Iran (Persian)]. Tehran: Islamic Parliament Research Center of The Islamic Republic of Iran; 2011. [Link]
5. Islamic Parliament Research Center of The Islamic Republic of Iran. [The sixth development plan law of the Islamic Republic of Iran (Persian)]. Tehran: Islamic Parliament Research Center of The Islamic Republic of Iran; 2017. [Link]
6. Islamic Parliament Research Center of The Islamic Republic of Iran. [The seventh development plan bill of the Islamic Republic of Iran (Persian)]. Tehran: Islamic Parliament Research Center of The Islamic Republic of Iran; 2023. [Link]
7. Mehrnews. [Everyone is against the implementation of the family medicine program (Persian)] [Internet]. 2023 [Updated 22 June 2023]. Available from: [Link]