title: Physician's self-perceived abilities at primary care settings in Indonesia.
abstract: BACKGROUND
  Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities.
  
  
  METHODS
  This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations.
  
  
  RESULTS
  This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking.
  
  
  CONCLUSIONS
  Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.
authors.affiliation: Department of Family and Community Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Wahyudi
authors.initials: W
authors.lastname: Istiono
authors.affiliation: Department of Medical Education, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Mora
authors.initials: M
authors.lastname: Claramita
authors.affiliation: Department of Family and Community Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Fitriana Murriya
authors.initials: FM
authors.lastname: Ekawati
authors.affiliation: Department of Family and Community Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Aghnaa
authors.initials: A
authors.lastname: Gayatri
authors.affiliation: Department of Family and Community Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Adi Heru
authors.initials: AH
authors.lastname: Sutomo
authors.affiliation: Department of Family and Community Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Hari
authors.initials: H
authors.lastname: Kusnanto
authors.affiliation: Department of Family Medicine, Carver College of Medicine, the University of Iowa, USA.
authors.forename: Mark Alan
authors.initials: MA
authors.lastname: Graber
keywords: Ability; competency; family medicine; physicians’ competences/abilities; primary health care