UEMS and Turkish Medical Association

UEMS and Turkish Medical Association

With its geopolitical stance located between Europe and Asia, and its specific and general issues characteristic for developing countries, Turkey is a country of exclusive importance offering abundant potential to the EU, to which it is en-route to membership. According to official statistics her population is 70,586,000; 28.3% of whom are middle-aged and half under the age of 28. There is an equal split in the population of men and women, with 70% living in urban areas and 30% in rural areas. There are about 110,000 medical doctors (MD) in Turkey, of whom 25-30 % are women and about 70 % men, with 45,000 being specialists. The distribution of MDs has mostly intensified in big cities with a discrepancy of MDs and medical facilities and services in rural sections.

TMA (the Turkish Medical Association) is the organized voice of the MDs in Turkey. Founded under constitutional guarantee with the act of 6023, running as a public institution and engulfing 80% of the MDs in the country, the organization raises its revenues by its fund raising activities, member fees and educational activities etc. and it receives no subsidies what so ever from the government. TMA tries to cover the expenditures by 20.4% from fees, 66% from educational activities, 10% from publications and 1.6% from other projects and all activities are conducted by the voluntary work of the members.

TMA is established for the following aims; to maintain and enhance the health of the people of Turkey and to work for good quality and cost effective healthcare that is in reach of every individual; to best preserve professional ethics; to raise a word in every field of medical education; to voice the interests of the profession at every platform; to guard the rights of the profession, and the moral and material welfare of the professionals.

TMA functions on issues of ensuring professional discipline, investigating patient complaints and determining private examination fees of MDs. It has "Chambers" in 54 provinces, where the number of MDs in each chamber exceeds 200. Membership applications are made through these chambers. The members elect the administrative board of these chambers and the number of trustees is 5-7 depending on the number of members. Besides the board of trustees there is the Ethics Committee, involved in matters of discipline, the Auditing Committee for finance, "The Delegates" that elect the central organs, and they constitute the local organization. There are about 85 000 members to these chambers.

The delegates of the local committees empowered in elections held in June every other year; elect the TMA Central Council of seven members, The Ethics Committee, and The Auditing Committee members again every other year. Whereas the technical work of the Central Council is carried out by divisions and committees, its major task is for the following; to facilitate functionality to the policies decided upon by the members at the Grand Assembly meetings; to ensure the coordination of the work of the organization; to issue central publications; to organize courses and finally to conduct negotiations with other entities on issues of the profession.

The active divisions and committees of TMA, mostly run by voluntary MDs, are the Law Bureau, the Public Health Division, the Courses Division, the medical education committee, the Accreditation Comittee, the Expertise Associations Coordination Comittee, the Occupational Health and the Workplace MD Division, the Medical Practitioner Division, the General Practitioner Institute, the Social Security Working Group, the Private Medicine Division, Human Rights, the Information Technology Working Group, the Students of Medicine Division, the Ethics Committee, Health Services for Extraordinary Situations, the Recruitment Working Group. TMA regularly publishes three journals and a news paper "The Public and the MD Magazine", "Journal of Occupational Health and Safety Magazine", "Journal of Continuing Medicine Education", and a twice monthly "The Medical Globe".

Together with the Turk Dental MDs Association, the Turk Pharmacist Association, and the Turk Veterinary MDs association, TMA is the nationwide founding member of the Health Profession Associations Group in addition to the realization of the collaboration and communication with labour unions. On an international scale, it is an active and participating member of the Forum generated by the World MDs Association, the European Medicine Education Association, and the World Health Organization. In addition, it is an "associate" member of UEMS and an "observer" member of the UEMO. TMA is prepared to improve relations with all the entities of medicine functioning in the EU and is looking for opportunities for this objective.

TMA watches over the occupational continual proficiency and education of the MDs by various means. Considering the importance of education of medicine, before graduation, in the application of the profession, for years the TMA has explicated the quantitative and qualitative analysis of medicine education on all platforms and has been trying to raise public awareness in order to enhance it. TMA is scripting reports about Specialization Education in Medicine and conveying them to the authorities and also is attending the Ministry of Health "Medicine Specialization Committee" as the 9th member and delivering opinions on specialization education. TMA holds the opinion that its priority is in the continual education of the MD. To serve this purpose, publications are made and sessions are conducted for education at the chambers   TMA has been conducting continuous vocational education courses on various subjects; 600 doctors have acquired certificates in "sports medicine", and 1,845 doctors have acquired certificates in "tourism and health" by attending the relevant courses. Among these courses "course in the workplace " has a special place. Today only doctors with certificates acquired by attending this course have the right to work as "workplace physicians" Up to date, over 28,000 doctors have acquired this certificate. In addition to these courses, TMA also conducts its work on doctors education with publications, conferences, and workshops.

Along with approximately 10 courses on "forensic medicine" and " medicine in extraordinary situations" in various cities, TMA expresses its attitude and point of view about medicine at various venues where it has been invited besides "the Higher Medical Assembly", "the Medical Speciality Board", "the Ministry of Health's Higher Board of Ethics" where it is a natural member.

TMA moulds public opinion about medicine, and informs parliament and other institutions. It also influences opinion of institutions such as the Ministry of Health and the Social Security Institution where large numbers of doctors are being employed and politics about health are being designated.

Over the past years, with TMA's intense work in the cooperation with the aforementioned institutions, profits have been achieved for the doctors. In situations where face-to-face discussions can not solve the problem, TMA organises actions like "white march".

UEMS and TMA's Relations, Council of Medical Specialists Association:

UEMS (Union Européenne des Médecins Spécialistes/ European Union of Medical Specialists) is the oldest, largest and one of the most active medical organisations in the EC at the moment. TMA and all the specialist associations in Turkey have been sharing the main objectives of UEMS, which are; study, promotion and harmonisation of the highest level of training of the medical specialists, medical practice and health care; and the defence of the professional interests of Medical Specialists. Believing the common principles of all the European specialist doctors associations, TMA became an associate member of UEMS 15 years ago.

Having learned in 1992 that only non governmental organisations that represent all the doctors in their countries can be a member of UEMS, the representative of the society informed "the Turkish Society of Plastic and Reconstructive Surgery"- one of the medical specialist associations- which had been working together with its European sister associations under the umbrella of UEMS. Therefore, in order to keep working in the working group, TMA contacted the UEMS administration, made ready all the documents necessary, and officially applied in order to be a member of the UEMS. In 1993, as a non-EC member country, Turkey was accepted as an associate member of UEMS and has been holding this position until today.

Turkey's membership of UEMS induced TMA and some of the Medical Specialist Associations, which had been working in the field of medical speciality together in our country, to build a new structure similar to UEMS "the Council of Medical Specialists Association, CMSA". Being a member of UEMS catalysed all the specialist associations working in different fields in our country, which lead to their amalgamation and the unification of their powers. Turkey's relation with UEMS has been carried out by this independent organisation, CMSA working under the umbrella of TMA.

TMA CMSA with its identity as a member of UEMS in a short time period with a reference organisaiton became the largest and most active institution in the field of medical speciality. With its democratic organisation and dynamic actions it started a lot of new studies, created commissions and working groups to organise and advance the standards of specialist medical education and practice in our country according to the contemporary values as well as the UEMS rules and objectives. Being a member of UEMS has always strengthened TMA CMSAs efforts.

CMSA's structure and operations has a lot of similarities with the UEMS's. The General Assembly is composed of the delegates of the member associations in different fields of medical specialities in our country. The members of the executive committee of CMSA, convening every month, are elected by the General Assembly every two years. 7 members are elected to form the executive committee, and they elect their president, vice president and accountant. The secretary general is elected among the candidates that are nominated by TMA by the general assembly. UEMS representatives are also elected by the General Assembly during the elections.

The executive committee with the Chambers of Medicine of Ankara, Istanbul and İzmir organises "the Congresses of Postgraduate Medical education" every year. These 3-day long congresses are the main and the most fruitful events that gather every institution and individual in the field to discuss the topics, which were decided by the organisation committee in the field of medical specialist education and practice. Last year the president and the secretary general of the UEMS honoured our congress with two eloquent talks, which were listened to with great interest by the participants.

Besides the congresses of postgraduate medical education, we have been organising "Teaching Hospitals Congresses" and similar gatherings every year. A very important young institution working under CMSA is the National Boards Committee (NBC), founded in 2004 to promote every specialist society to organise a board, to prepare the curriculum in their fields, to harmonise and standardise the methods of assessment and survey of the medical specialist education. NBC began its working with a questionnaire and at present with its independent elected executive organises meetings, workshops, seminars on subjects like; problems of boards, attandence of the trainees to the board's activities, visitation programs, re-certification, the update of log books and the core education programs in different fields. To date, 28 member associations of TMA CMSA have founded boards and commissions in their sections, 21 have prepared curriculum, 23 have prepared log-books, 17 have organised board examinations, and 1 has begun the visitation programs in its own section's teaching hospitals. These numbers are increasing every year and we aim to have active working boards on education in every specialist section in our country. Currently re-licensing does not occur. However, re-licensing is being discussed now in various boards and we believe it will start to be used within the next 7-10 years.

Similar to the UEMS, TMA CMSA also has some working groups in its organisation. Current active working groups are "Ethics", "İmprovement of Public Health", "Manpower Planning", "CME-CPD", "İmprovement of Health Services", and "Scientific Research". To help the working groups functioning directives have been written and short and mid-term objectives have been designated. TMA CMSA has also clearly mentioned expectations from member associations in a recent paper, which has been approved in the general assembly.

CME CPD Activities:

CME/CPD is still voluntary in Turkey. The CME/CPD Accreditation Council of the Turkish Medical Association has accredited CME/CPD activities since 1994, provided the organizer applies through the accreditation process. The council has reviewed the by-laws and changed various aspects parallel to the EACCME principles. The Turkish Medical Association has signed an agreement with the UEMS (February 2006) for mutual recognition of CME credits and CME accreditation. The Turkish Medical Association has started to prepare a smart card for follow-up records of attendances at activities accredited by the council. Annually, 1,000-1,200 CME/CPD activities are reviewed for accreditation and 800-1,000 of these activities are accredited by the council. A total of 7,560 activities have been accredited and the Council has awarded 81,088 CME/CPD credits since 1994.  Annually, on avarage 8-9,000 CME/CPD credits are being awarded when the last 6 years are evaluated. The activities accredited between the years of 2002-2006 were provided by the professional societies in 38% of the cases, and respectively, medical faculties in 32 %, chambers of medicine/medical association in 19%, teaching hospitals in 6% and others in 5% of the cases. 27 activities in 2007 have been accredited jointly with EACCME:

Distance learning has been used in Turkey and is being discussed in greater detail these days. It is not widely used, but there are efforts to widen the spectrum. Activities in distance learning could be and are accredited by the CME/CPD Accreditation Council of Turkish Medicine.

Conflicts with Governmental Organisations:

The main obstacle to the efforts of TMA CMSA to organise and increase the standards of medical specialist[h1]  education and practice in Turkey is and has been the attitude and the practices of the Ministry of Health of the governments. The Ministry of Health in our country has been fighting to hold all the power to rule the field of medical specialities. TMA and CMSA with all the specialist associations and societies of medical specialists have been working to reorganise the field under a national authority which is organised by the equal representation of the government (Ministry of Health), non governmental organisations (TMA and the specialist medicine associations; CMSA) and the universities (Higher Education Council). For years, all sides had endless meetings and discussions and prepared manuscripts about the subject but although the Ministry of Health declared to accept the common wishes of TMA CMSA and the universities many times it never attempted to solve the dead lock situation in the field of medical specialist education with the fear of loosing the absolute political power that it has been using as a weapon in this field. The Ministry of Health has been trying to destroy the fruitful products of the TMA CMSA studies as the real owners of the field of medical specialist education. It has been applying unacceptable implementations in the field of specialist medication against the common front of TMA CMSA. The following examples are given to show how serious and destructive are the practices of the Ministry of Health in our field in Turkey.

Between the years 2004 and 2006 TMA CMSA prepared a by-law consisting of a 3- phase examination to appoint the trainers in medical specialist education for the chief positions in the teaching hospitals. The Ministry of Health accepted this by-law and many doctors took this examination to be eligible for the trainer positions in the teaching hospitals in order to train students in specialist medical education. But, in 1998 the ministry with a sudden change in by-laws appointed 71 individuals to the chief positions it created in the existing teaching hospitals. In the two-week period of time, where the court stopped the unlawful appointments of the ministry according to the application of TMA these 71 appointments were made for life and could not be revoked. In 2005, the same execution took place again and the ministry appointed 175 individuals as chiefs in teaching hospitals for life in a 41-day period again without any examinations or medical, scientific criteria. There are no criteria other than political polling of the ministry in these appointments. Last year, similar appointments for the sub-specialisation positions in the specialist medical education were stopped by the TMA's application to the court.

These examples show that the non governmental professional organisations; specialist medical associations and societies, who are the natural moderators of specialist medical education and practice in this field, must be responsible for the governing of this area in all UEMS countries. The Ministry of Health is very worried about TMA CCSA's being a member of the UEMS. As a proud member of the UEMS, the TMA CCSA, representing all the specialist associations in our country, we shall be working to achieve the main objectives of study, promotion and harmonisation of the highest level of training of the medical specialists, medical practice and health care; and the defence of the professional interests of medical specialists. In order to do so, we shall continue our battle with the governments unlawful and unacceptable interventions in our field and we want the support of our colleagues all over Europe.