New UvA student doctor: “Now I can apply my research in practice”
After the departure of Peter Vonk last November, Bureau Studentenhuisartsen got a new director. Sietse Wieringa is a “fake Frisian,” a seasoned researcher, and a family doctor. As it turns out, he is just as bad at sitting still as his predecessor. “I am someone who works permanently and doesn't stop after 40 hours.”
Sietse Wieringa, in jeans, first gives a brief tour of the general practice on the Oude Turfmarkt: a greeting from the telephone triage service, a look in the cozy cafeteria, and entry into the new consulting room of the practice's brand-new director.
Wieringa works in a different room from the one that housed former director Peter Vonk - “I’m also going to do things differently than Peter Vonk” - and the tall, still rather bare, white space is brightened by a life-size painting of rice fields in Indonesia. Wieringa’s choice, he confirms. “Yes, I had that one hung here. Although it now hangs 10 centimeters too high; the UvA, huh.”
Peter Vonk has left for Friesland, and Sietse Wieringa seems like a Frisian name. Are you from Friesland?
“No, I'm a fake Frisian. By the way, Wieringa is a Groningen name. I was born in Delft and my father is from Arnhem. I studied in Groningen twice: hospital medicine. Very nice, because everyone is called Wieringa there.”
1976 Born in Delft
1995 - 2002 medicine (cum laude), Leiden
2004 - 2006 master care management, EUR
2004 - 2006 training in family medicine, Leiden
2016 - 2020 doctorate in evidence-based medicine, Oxford
2018 - 2021 training in hospital medicine, Leiden
2021 - Present postdoc Centre for Sustainable Healthcare Education (SHE) (inter alia), University of Oslo
2022 - Current director and general practitioner, Office of Student Doctors, UvA
You have an impressive resume: a PhD candidate in Oxford, a year at Harvard, and postdoc in Oslo. What do you come here to do as a student physician?
“For me, several things are interesting. First, my management role here is bigger than what I’ve had before. As a scientist, I do research on the organization of health care. In Norway this is the sustainability of primary care, in England I research online working and eHealth solutions. The core of my research is about evidence-based medicine, the decision-making of how to do it, and the system around it. What motivates GPs, nurses, and clinicians to make good decisions? Now I can apply that in practice at the Bureau of Student General Practitioners, a very interesting practice because it is so closely affiliated with the UvA. It’s an academic workshop at the same time. We employ a researcher and train a lot of people, so I find it to be a very interesting position.”
You haven’t worked at the UvA before?
“No, the UvA is completely new to me. Oddly enough, I know the VU better. I worked there a lot in the Academic Network of General Medicine. Then suddenly there turned out to be another university in Amsterdam. Being new at the UvA has disadvantages because you don’t yet have a real network within the university. On the other hand, I come in fresh, without baggage, and sometimes ask myself: gosh, can’t it be done differently? And then things can sometimes be different than everyone thought.”
Can you give an example?
“We have a shortage of physician assistants, while at the same time, in recent years it has become increasingly busy. We’d like to be accessible, approachable, and open, but how do you do that with fewer and fewer people? That’s why we need to rethink our triage system: how can people call us and how we can determine the level of urgency. I’m installing a system here that I know from England, where people can make an appointment online, see their file, and review results so that we have enough time in the day for the acute cases.”
When did it become busier here?
“Gradually, but Covid has had a significant impact. We now see that people are calling more often anyway. Somehow the demand for care is increasing again, also in England and in Norway.”
You worked in England for a time. What are the biggest differences between the Dutch and English healthcare systems?
“In the last 10 years that I was in England, I saw the English systems deteriorate. There have been so many cuts there that the whole system has been eroded. There are insane shortages of general practitioners and support staff; practices have their backs to the wall. In that respect, we are doing a lot better in the Netherlands. There is less stress, and the importance of the family doctor for the healthcare system is emphasized more here. And the Netherlands just has a different medical culture.”
How is the medical culture in the Netherlands different?
“Less hierarchical. Here, I can wear jeans. If I did that in England, I would sometimes hear, “Well, doctor, this is not your free time.” So in England, you are expected to come in dress pants or a suit, even as a GP. In the Netherlands, we think that’s showing off. Manners are also different. We see doctors and doctors’ assistants much more as one team. You also see in England that the economic differences between social groups are much greater than in the Netherlands. Here we still have social safety nets; in England, they are limited.”
What is the division of work at the Office of Student Doctors between being a director and being a GP?
“I don’t really feel like a director, although I am. It’s more that I also do management tasks. I like that equivalent. I form a duo with the practice manager. That works well because we have a large practice with 30 staff, 12,000 patients, and two locations. And for the other half, I still work as a general practitioner.”
So you still get to do research?
“Yes, I do. But I am someone who works permanently and doesn’t stop after 40 hours. That’s a bit unusual and I certainly don’t recommend it to everyone. But I can’t sit still very well, so the research fits in. I don’t need very much sleep.”
Your predecessor noted a huge increase in the number of students with mental health problems. What is your take on that?
“I have also observed that. Among students, mental health is by far the biggest problem. We refer an awful lot of students to primary and specialty health care. At the same time, we also have to ask ourselves: why do students have mental health problems? After all, we know that students are unhealthier than their non-student peers. We don’t know if that’s directly due to studying, but it’s important to pay attention to it because the last thing you want is for studying to make you sick. We must keep our attention focused on that. After all, studying is an important phase of life.”
How can you help all these students with mental health issues?
“We participate in Caring Universities, a treatment and research platform among several universities and colleges to see if we can help students with mental health issues earlier and more easily. Not everyone has depression, but we all feel down from time to time. By providing help early, we want to prevent people from being diagnosed with depression or ADHD. We created an online program for that. That could reduce referrals.”
Not only are physician assistants hard to find, but family physicians who want to make a long-term commitment to a practice are becoming scarcer. How will you solve that?
“I am very happy that we have just hired a new GP, but it is indeed a problem that many GPs work as freelancers and do not commit to a practice. We need more doctors who want to commit to a group of patients for a long time, 20 or 30 years, as Peter Vonk did. Continuity is very important in family medicine. It has also been proven that fewer patients die as a result, but many people do a job for five years and then move on. We need to think about how to build a system so that a family physician remains committed to a patient population.”
Should the registration requirement for family physicians be expanded to include a requirement to commit to a practice for a long time?
“I think you have to push several buttons at once. You’ll have to look at pay, registration, training, and the systems around it. Is there a way to provide more flexibility for the general practitioner while still having patients attached to one general practitioner? That’s what we’re going to explore over the next few years.”
Do you see yourself staying here for another 20 years?
“Yes, I do. I like the fact that there are so many facets to this practice and that there is a scientific arm to it. Plus, you’re right in the middle of Amsterdam, there’s a lot of collaboration with students and trainees, the Amsterdam UMC is close by, and a lot of great things come this way. I’ll be here for a while.”
