Report on Austrian national health care system approach to psychosomatic medicine

One of the last issue of Psychotherapy and Psychosomatics has a report on the characteristics of a training program in psychosomatic medicine that places Austria in a top position in Europe.

This paper deals with the Austrian national health care system approach to psychosomatic medicine. This approach has developed a strong focus on postgraduate training which is open to several medical specialties. It is intended to lead to a more structured implementation of biopsychosocial medicine. It should be mentioned that the Austrian health care system is financed by public money. Additional health care services are provided by the private sector.

20 years ago, a continuing medical education programme called 'Psy-Curricula' has been established. This long-term programme can be attended by physicians who have graduated at a medical university and work either as resident physicians or fully licensed physicians. Tuition fees have to be paid for all parts of these courses. The Psy-Curricula are geared towards doctors of all medical fields to facilitate integration of psychosomatic medicine into several areas, e.g. primary care, psychiatry, internal medicine and gynaecology. However, there is no medical specialty or subspecialty in psychosomatic medicine in Austria. The Psy-Curricula consist of three consecutive levels: 'psychosocial, psychosomatic and psychotherapeutic medicine'. Graduation at each level is documented by a diploma. Training for level 1 (Psy-1, Diploma for Psychosocial Medicine) takes approximately 1 year (180 h). At this level, training focuses on medical history taking based on the biopsychosocial model and on improving communication strategies. Furthermore, it informs physicians about treatment options in the psychosocial field [4] .

After an additional 2 years (480 h), trainees can complete level 2 (Psy-2, Diploma for Psychosomatic Medicine). Training at this level qualifies doctors for psychosomatic care including the diagnosis of complex biopsychosocial interaction and integrative approaches to treatment. At level 3 (Psy-3, Diploma for Psychotherapeutic Medicine), after a further 3 years of training (1,870 h), full psychotherapeutic competence is achieved. Supervision, Balint group training and participation in self-awareness groups are integrative parts of these Psy-Curricula. A continuously growing number of medical doctors has already completed one or more levels of this programme and has been certified by the Austrian Medical Association. About half of all physicians who have graduated with a Psy-3 diploma are psychiatrists. Thus, general practice and psychiatry contribute to this programme with the largest groups of participants. A synopsis of the described facts regarding the Austrian approach to psychosomatic medicine suggests a central role of postgraduate training in this field. This approach implies that postgraduate programmes addressing the 'biopsychosocial factor'should be open to all medical specialties to overcome the 'dangerous'parts which represent hindrances to a psychosomatic renewal in health care.