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Internal Medicine: Global Perspectives
Aron Benzadon Cohen, MD, FACP

Aron Benzadon Cohen, MD, FACPInternal Medicine: Global Perspectives is a feature designed to give our audience different perspectives from across the global medical community. Presidents of internal medicine societies worldwide share their thoughts on how medicine is practiced in their country, what they may stand to learn from other countries, as well as the challenges and rewards of leadership. This month we profile Aron Benzadon Cohen, MD, FACP, President of the Panamanian Society of Internal Medicine in Panama.

Panama At A Glance

  • Total population: 3,288,000
  • Number of physicians: 4,431
  • Physician-patient ratio: one physician for every 595 citizens
  • Life expectancy for women: 79
  • Life expectancy for men: 74

What inspired you to become a physician?

My wish to fulfill my father's dream that I become a doctor, as well as my own desire to help the society I live in.

What is the role of internist in Panama?

In Panama, an internist is thought of as a physician whose knowledge and therapeutic abilities enable him/her to perform well dealing with a broad array of diseases and conditions. An internist is also perceived as someone with in-depth knowledge of several medical specialties so that he/she can render treatment to patients with multiple conditions or pathologies.

What do patients and/or family members want or expect from their internist?

Patients expect that an internist is a well prepared physician, with the ability to recognize and treat the patient as an individual, rather than treat them through their specific organs or systems. They also expect an internist to have a little bit of knowledge about everything, so that he or she can become the patient's family doctor.

The Advocate

Are there special challenges internists in Panama face? What are your thoughts on the best way to meet these challenges?

One challenge internists face is how to position the internal medicine discipline among the most important public health disciplines in the country. To that end, it is important that internists get actively involved in the development of the country's sanitary policy, stressing the importance of preventive medicine, and the medical training of other medical specialties and generalists. And we need to project these things to the general population as well.

Are there enough young physicians choosing to be internists? What makes them do so? What are the barriers?

In Panama, society has had an important role promoting internal medicine as a highly scientific discipline/specialty. Internists are regarded as professionals with highly moral values who have prominence in the national medical life. However, in spite of that, there are not enough internists to provide for the entire country. We have observed a tendency over the past several years of internal medicine becoming a vehicle for attaining subspecialties—sometimes because physicians with such training are better rewarded by the population, and also enjoy a higher income in general. Insurance companies for example, pay higher compensation to subspecialties. Today there are fewer internists who are dedicated to straightforward internal medicine in Panama.

Is there public debate about Panama's health care system?

Definitely. The health system in Panama is dual. On the one hand, we have the Social Security System which covers all workers/contributors and their dependents (parents, spouses, and all children) with health care, retirement, disability pensions, and job related risks. On the other hand, we have the Health Ministry which is, by law, the authority that dictates health policy in the country and that also offers medical care to the general population (those who are contributors, because they have no formal job) through its health system. Both the Social Security System and the Health Ministry have their own web of hospitals, medical clinics, and healthcare professionals, sometimes duplicating services and therefore making health care more expensive. Both have invested in infrastructure, equipment, personnel and supplies.

In the Social Security System, dependents receive all benefits without contributing, regardless of the number of dependents, which is not limited. Of the total population of a little over 3 million, the Social Security System offers coverage to 60 to 70 percent of the total population. Recently, the Social Security System suffered modifications. In particular, its law was modified to increase the retirement age and include some other important measures that were not particularly popular among the population. Currently, retirement age is 57 for women and 62 for men. We experienced some political turmoil due to the proposed changes, but they were indeed necessary for the fiscal health of the institution. But despite all of the resources deployed to the health care system in general, the population perceives the system as insufficient and inefficient. We are currently debating unifying both the Social Security System and the Health Ministry system. The debate is at an impasse.

In your opinion, is access to electronic information or products influencing what patients want from their doctors in Panama?

Yes. On the one hand, patients are more aware of what is available worldwide because of the Internet. On the other hand, we are still learning to deal with electronic files for patients. This requires learning from both the patients and the healthcare professionals. Electronic information is available at private hospitals and clinics, only.

What could other countries learn from yours?

Other countries could perhaps learn from our mistakes. Duplication in health care systems is not a good practice. There should only be one functional unit providing all health care resources. This unit should be funded proportionally by government and private sources.

Natural Born Leader

What are your responsabilities as president of an IM society?

I need to raise awareness about the role of the internist in the public health. It is my responsibility to increase the participation of internists in the IM Society, as a way to collectively return a little bit to the society in general. So far, we've promoted and established two chapters in other cities in the interior of the country, and promoted collaboration with the University of Panama for the enhancement of medical training (bachelor degree), as well as with certification and re-certification in the IM specialty.

What motivated you to take on this role?

I am committed to do what I can to help improve the professional education of the internist in Panama. I also want to increase the relevance of internal medicine in health care in general and within public health policies.

What have you found to be the most challenging part of leadership? The most rewarding?

The most challenging is leading itself, inspiring participation, and achieving cooperation for all IM Society activities. The most rewarding has been the opportunity to recognize and reward a group of prominent IM professionals who, fifty years ago, contributed to the creation of the IM Society.

Does your society have collaborative relationships with other societies and if so, is it beneficial to your society and how?

We have collaborative relationships with most medical professional societies in Panama and the American College of Physicians.

What would you like to accomplish/contribute during your tenure?

Increase the participation of young internists in the IM Society and hopefully commit them before completion of their residential program. We have modified our bylaws to enable the participation of residents during the last year of their residential program. This way, we ensure that they will become familiar with the IM Society and its goals. Furthermore, I would like to consolidate the participation of the IM Society—in an organized manner—on every issue of interest to the Panamanian society.

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