A man who stubbed his toe really hard? GP Paula van Bergen uses her video connection to check whether the toe is still straight and can still move. If so, then there is nothing serious going on: “We don’t have to do anything else.”
A “17-year-old girl” with heavy periods, who is very tired and has dizziness? Get your blood pressure checked just to be sure.
Van Bergen is a general practitioner in Leiden. She just sits at home during her shift, behind her screen, on her own office chair. She emails, telephones or makes video calls with patients.
Van Bergen works for the digital general practice Arene, officially located in Etten-Leur in North Brabant. But Arene does not have a physical practice there. All 25 GPs are spread across the Netherlands, a few are abroad – one is even traveling in Asia and works a number of hours a week on the road.
Arene patients report online if they need help and are then contacted by one of Arene’s general practitioners. They can schedule a time themselves, and they can also indicate a preference for a doctor. About 80 to 85 percent of all healthcare questions are handled digitally. In the other cases, someone is referred to a physical GP practice near the patient – one that works with Arene.
The majority of patients are therefore not seen physically, but they usually do not have to, says Van Bergen. “Take a sore ankle after a fall. Then I ask them to show it in front of the screen and I ask: ‘Can you still do this, can you still do that?’ I just don’t necessarily have to touch it. And if I can’t see something properly or if I’m in doubt, I’ll have someone physically examined at a GP nearby.” It does not increase the chance of an incorrect diagnosis, says Van Bergen: “It always remains a risk assessment. But you also have that in practice.”
She has an average of twenty minutes online for a patient, more than the ten-minute appointment in a physical practice. Enough time to introduce yourself, to explain how Arene works and to make a diagnosis.
Van Bergen (51) ran his own practice for many years in a health center in Zoeterwoude, near Leiden. She also owned the building where, among others, a physiotherapist, a speech therapist and a dietician also worked. It caused a lot of work, a lot of pressure, a lot of stress. Is anyone on the phone on Monday? How much administration do I still have to get rid of? Do I have an evening shift again? And then the arrangement. “When I stuck my head around the corner of the door, everyone immediately wanted something from me.”
She stopped in May last year and luckily found successors. “I wanted freedom, to be flexible, to work more from home. I can start my office hours at 11am. I can go a little longer in the afternoon if needed. I can do my work very quietly, I won’t be disturbed and I don’t have to leave my room anymore. Delicious.” She now works 25 to 30 hours a week for Arene. Only three to four patients per week are referred. “I am strict, because I do not want to burden my colleagues. I watch it very carefully.”
Shortage of GPs
Arene doesn’t come out of the blue. The number of GPs in the Netherlands is slowly increasing (from 12,766 in 2019 to 13,492 in 2022, according to Numbers of the Capacity Body that advises the cabinet on the required training places), but there is also a relatively rapid outflow; almost 30 percent will retire in the next ten years. This is mainly due to retirement, but also because some of the GPs leave the profession earlier. General practitioners with their own practice are finding it increasingly difficult to find a successor. Younger GPs are also more likely to want to work part-time. The number of training places has increased in recent years, but interest in the training is actually declining: not all places are being filled. Nevertheless, the cabinet decided on Tuesday to gradually increase the number of training places in the coming years, from 850 now to 1,035 in 2026.
At the same time, the demand for GP care is increasing – due to the aging population, the transfer of care from the hospital to the GP, and the widely shared desire for ‘more time for the patient’. “General practitioner care is already under great pressure at the moment and that pressure will increase in the coming years,” Minister Kuipers (Health Care, D66) wrote in a letter last month. letter to the House of Representatives.
Kuipers is therefore in favor of further digitization. He called this “crucial” during a major conference on digital care last year. “If we don’t do it, we’ll fall further and further behind.” After the Congress he wrote on LinkedIn: “The starting point is: yourself if possible, at home if possible, digital if possible.”
Read also: The ‘digital doctor’ doesn’t call back: how Quin Dokters causes unrest among patients
Jan Frans Mutsaerts was one of the four founders of Arene, precisely with that general practitioner shortage in mind. Mutsaerts has her own practice in Etten-Leur and ‘already did a lot with digital applications’. “I thought: can’t we expand this if you know that there are areas where the shortage of GPs is huge?”
“Many GPs first try to solve it themselves a bit and that is just about possible, until two or three GPs say: we are retiring, and then it turns out that there is no successor,” says Tom Kliphuis, director at Arene. Kliphuis is former chairman of the board of health insurer VGZ and of Nationale Nederlanden.
On September 1, 2021, Arene enrolled the first patient. In the beginning, the digital practice attracted many migrant workers in West Brabant who did not have a general practitioner, later about 25,000 Ukrainians followed. Some 10,000 Dutch people are now customers of Arene, including people who cannot find a doctor after moving house or who have moved to live in a new housing estate without a doctor.
Mutsaerts and Kliphuis believe that digital initiatives are essential to help solve the shortage of GPs and to reduce the workload. These can be medical apps (speak hours.nl, mijnhuisartsonline) with which you can make an appointment, email the GP, order a repeat prescription and view your medical file, but also a digital practice such as Arene. According to sector organizations such as the Dutch General Practitioners Association (NHG) and the National Association of General Practitioners (LHV), digitization is in line with the wishes of patients themselves, they wrote in their Vision digitization of general practitioner care 2019-2022: „The new patient is ‘well informedand quickly, and expect the same from those treating or guiding him or her. Digitization can, if applied properly, facilitate general practitioner care.” The Patient Federation of the Netherlands even thinks that people „have the right”. on digital care if they want it. “We are in favor of a structural embedding of digital care. Not a little video calling or pilots in some places that do not scale up nationally,” the organization writes on its website.
ChatGPT
General practitioner Vladan Ilic of the Westerdokters practice in Amsterdam has had a largely digital practice for some time now – he emails, texts, video calls and chats all day long. Before the corona pandemic, Ilic treated about 30 percent of his patients digitally, during corona that rose to about 85 percent – and it still is. “There is no reason to reverse that,” he says. It helps him in the fight against staff shortages (“We no longer have doctor’s assistants”), is more efficient (“You have more time for patients who really need it”) and many patients also want it (“The healthcare sector is very conservative, but many patients are ready for it a long time ago”). Westerdokters is a model for the Flexdokters cooperative, in which more than twenty ‘digital’ practices work together.
At Ilic’s practice, a ‘physical’ doctor and an ‘online’ doctor are always present. Ilic is always looking for new ways to automate.
Recently, patients can also chat with the practice. The patient describes his health problem in the chat and, according to Ilic, has chat contact with a GP within three minutes. Then you can see what else is needed. Ilic’s practice will soon also start with ChatGPT – which then summarizes the patient’s chat message for the doctor, so that he only has to think about the form of contact the patient needs.
Digitization does not make the relationship between patient and GP significantly different from what it used to be, says the Amsterdam GP. “We are just an old-fashioned practice, but with a modern twist. We are always here for you, but we are now in your back pocket, in your phone.”
This development cannot be stopped, thinks Ilic. “The regular GP around the corner no longer exists.” Tom Kliphuis van Arene also thinks about it: “Many GPs think: these 2,500 patients are mine and you are not allowed to touch them – they hold on to that idea. But how often do you actually see your doctor as a patient? Often there is an observer, or a GP in training, or your GP is on vacation. And after five in the afternoon you have to go to the doctor’s office anyway.”
Jochen Cals, general practitioner in Sittard and professor of effective diagnostics in general practice at Maastricht University, published recently conducted a study on digital GP initiatives with the conclusion that there is no evidence that they reduce workload, staff shortages or costs. “The belief in digital GP care is greater than the evidence. It is overrated,” says Cals, who speaks of “the digital lobby that is beating loudly.” For example, digitization often has a low threshold: people contact their GP more quickly, so that they become busier again. “Supply creates demand. You can send a message to your doctor at the touch of a button.” You also exclude people, says Cals, for example low-literate people or the elderly who find this difficult.
‘People want a doctor nearby’
He does not regard these digital initiatives as full-fledged general practitioner care, except for small, specific target groups such as Ukrainians; he sees it more as a ‘service’, because you can schedule appointments yourself and order repeat prescriptions. “But that comes on top of the permanent relationship you have with your doctor. Most people just want a GP nearby, someone they know.”
Digitization is therefore not going to change the entire GP care, believes Cals. “And that is not necessary if the administrative burden and regulations decrease and GPs can therefore see more patients. The question then remains whether there will be a shortage of GPs.”
Yet many patients are “surprisingly positive” about the digital doctor, notes GP Paula van Bergen. “People over 60 in particular first think: what am I supposed to do with such a telephone doctor? They are wary of the digital, don’t know what to expect.” When Van Bergen comes into the picture, they are “pleasantly surprised,” she says. “They say, ‘You’re actually quite nice. And I can ask you anything.’ And that is of course correct. We can do everything, we do everything, we just can’t touch you.”
#doctor #pocket #digitization #general #practitioner #care #increasing #rapidly