Medical Manpower in the European Community PDF
Preview Medical Manpower in the European Community
Herbert Viefhues (Ed.) Medical Manpower in the European Community With 18 Figures and 74 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Prof. Or. Herbert Viefbues Institut für Sozialmedizin Ruhr-Universität Bochum Postfach 102148, 0-4630 Bochum ISBN 978-3-540-18733-2 ISBN 978-3-642-87464-2 (eBook) DOT 10.1007/978-3-642-87464-2 Library of Congress Cataloging-in-Publication Data Medical man power in the European community/Herbert Viefhues (Ed.). p.em. Contents: Denmark/1. P. Steensen - Medical man power in France / Bui Dang Ha Doan - Federal Republic of Germany / 1. F. V. Deneke - Greece / A. Kalandidi and A. Ritsatakis - Irelandl A. Walsh - Italy IP. L. Morosini - United Kingdoml S. Birch and A. Maynard - Problems related to future medical demography in the European community / A. Ritsatakis. 1. Medical personnel - European Economic Community count ries - Statistics. 2. European Economic Community countries - Statistics, Medical. RA41O.9.E85M43 1988 331.11'9161'094 - dc 19 88-1593 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication ofthis publication or parts thereofis only permitted under the provisions ofthe German Copyright Law of September 9, 1965, in its version of lune 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution aet ofthe German Copyright Law. © Springer-Verlag Berlin Heidelberg 1988 The use ofregistered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must cheek its accuracy by consulting other pharmaceuticallitera ture. Foreword The aim of this book is to provide a snapshot of medical manpower in each of the member countries of the European Community, an exhausting untertaking in view of the problems associated with the collection of data. Complications arise in trying to apply a reasonably uniform definition for doctors in employment; some women doctors work only part-time, some doctors fill two positions, and others are theoretically retired but continue to work. Assessment of the number of students training to become doctors is confounded by differences in university curricula and in pass rates for individual examinations, and, of course, by the changing demography of each country. Information on the number of nurses, technologists, and others working within the health service might have supplied some explanation for the striking disparities in the number of doctors employed per head of population between the European countries, but such international comparisons are undermined by differences in medical practice. Several of the member countries are striving to develop policies concerning the use of medically qualified manpower and to calculate their requirements. This is an exceedingly difficult task since medical practice and lay expectations of medical care are fluid. The number of qualified doctors practising today may be completely inappropriate in 20 years' time if dramatic changes in treatment or investigation are introduced or if patients demand lengthier consultations with their doctors. Medical and health service policies differ fundamentally between the member countries, and this will c1early influence projec tion for manpower requirements. The authors were charged with supplying a description of medical manpower in the European Community and not with providing a critique of manpower policies within each country. They are to be congratulated on the mammoth task involved in the assembly of these data, which, hopefully, will enable future manpower analyses to be put into prespective. E. Bennet Foreword The Epidemiology and Social Medicine panel comprises representatives of the Scientific Associations of Social Medicine and Epiderniology within the European Community. Its function is to advise the Com mision on policy issues and to initiate the collection of information relevant to the formulation of policy on a Community-wide basis. The development of a single medical manpower policy within the Community is a formidable and contentious responsibility. It must contend with the variation not only in the number of medical students each member country trains, but also in the training curriculum em ployed and in the pattern of medical practice. Furthermore, the nature of medical training and the delivery of health services have changed substantially over the past 40 years, and the chief handicap facing the Commission is the paucity of information regarding the medical training programmes and medical manpower policies in operation in member countries. The work reported in this book attempts to describe the current manpower policies of member countries. As chairman of the panel, 1 am most grateful to Professor Viefhues for the enormous amount of work that he and his colleagues have undertaken and which has served a fundamental purpose - plans for future policy can now be considered with reference to the contemporary picture. Walter W. Holland Contents H. Viefhues In troduction D. Deliege Belgium ..................................... 5 I.P. Steensen Denmark . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Bui Dang Ha Doan France ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 I.F V. Deneke Federal Republic of Germany 99 A. Kalandidi and A. Ritsataki Greece ...................................... 125 A. Walsh Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 137 PL Morosini Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 147 S. Birch and A. Maynard United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 159 A. Ritsatakis Problems Related to Future Medical Demography in the European Community . . . . . . . . . . . . . . . . . . . . . . .. 205 List of Authors Professor Herbert Viefhues MD DMSA (Edin.) Abteilung für Sozialmedizin and Epidemiologie Ruhr-Universität Bochum Stiepeler Straße 129, 4630 Bochum 1 , FRG Dr. E.A. Bennett Director Commission of the European Communities Batiment Jean Monnet, Plateau du Kirchberg, Luxembourg Professor W.W. Holland MD FRCGP FRCP FFCM Department of Community Medicine University of London S1. Thomas's Campus, London, SEI 7EH, Great Britain Dr. Stephen Birch Department of Community Medicine University of Sheffield Beech Hill Road Sheffie1d SI 0 2TN, Great Britain Dr. Bui Dang Ha Doan Directeur Centre de Sociologie et de Demographie Medicales 60, B1d de Latour-Maubourg, 75007 Paris, France Professor D. Deliege Faculte de Medecine Universite Catholeque de Louvain Clos Chapelle aux Champs 30.41,1200 Bruxelles, Be1gium Professor J.F. Volrad Deneke MD Axenfeldstraße 16,5300 Bonn-Bad Godesberg, FRG XII Anna Kalandidi MD Assistant Professor Department of Hygiene and Epidemiology School of Me dicine , University of Athens Athens (609) Goudi, Greece Professor Alan Maynard Director Centre for Health Economics, University of York York, YOl SDD, Great Britain Professor Peer Luigi Morosini MD Istituto Superiore di Sanita Laboratorio di Epidemiologia e Biostatistica Viale Regina Elena, 299, 00161 Roma-Nomentano, Italy Anna Ritsatakis Department of Hygiene and Epidemiology School of Medicine, University of Athens Athens (609) Goudi, Greece Jens Peter Steensen MD Danish Hospital Institute Nyropsgade 18,1602 Copenhagen, Denmark Dr. Alphonsus Walsh Chief Medical Officer Department of Health Custom House, Dublin 1, Ireland Introduction H. Viefhues 1 Medical Manpower - Present Situation in the European Economic Community . . 1 2 Planning and Regulation of Medical Manpower . . . . . . . . . . . . . . . . . . . . . . . . 3 3 Necessary Steps for Intervention by the European Economic Community . . . . . . 4 1 Medical Manpower - Present Situation in the European Economic Community The most important results of this study can be summarized in the following points: The number 01 doctors in the European Economic Community (EEC) has almost doubled over the last 20 years. The general opinion is that supply will exceed demand, if the present number of doctors increases to the same extent as before, and that demand will still be exceeded even if there is a slight increase. This leads to the question of the demand for doctors1, which is a very crucial point. The general demand is governed by the following three factors. 1. The demographie factor, Le. whether the population is increasing or decreasing. It is gene rally estimated that the overall population figure will fall, the number of elderly « people (> 65 years) will increase and the proportion of the very young 1 year) will decrease. Futhermore, the general morbidity of the elderly (> 65 years) is 4 times as high as within the under 30 group and the general morbidity of women is 29% higher than that of men. We have to take these ratios into consideration when we try to assess the demand for doctors. 2. Socio-economic factors. The growth of urbanization (morbidity in cities with more than 100000 inhibitants is 50% higher than in small communities) is such that a concentra tion of a maximum of 50% of the population in cities with over 100000 inhabitants equals a growth in demand of about 8%. In the United States, the number of doctor-patient contacts depends on the patient's educational level (which corresponds to his income), and the same pattern of health behaviour is found in the Federal Republic of Germany, for example, where a free insurance scheme covers 98% of the population. It is estimated that a maximum up grading of the educationallevel would raise the demand for doctors by ab out 12%. Since The estimations of medical demand given here are based on those contained in Hoch schulabsolventen im Beruf - Ausbildungsbedarf für Mediziner bis zum Jahr 2000. McKinsey & Co. Inc., Munieh, 1974. 2 the demographically caused increase in demand will not exceed 8%, the socio-economic factor may entail an increase of 15% in the next 20 years. 3. Development in the progress of medical case. The most intensive factors in raising the demand willlie not so much in the curative sector of medieine as in the preventive one (primary and secondary prevention, e.g. early detection and treatment of disease). In the same way as the preventive sector , occupational health will expand and a growing proportion of doctors may work full-time in tbis field. Progress in curative medicine and development of psychiatrie care (including psycho therapy) will perhaps create a growing demand of 5%-15%, so that as a result of the advances in medicine, these may represent an overall growth of 20%-30%. Even if one adds together all the above-mentioned factors in an optimistic spirit, one will still be led to predict a growth in demand of 50%-60% within the next 20 years, compared with an increase of 100% in the number of doctors, if it is assumed that the present growth will continue. The composition of the medical profession as a social group will be less coherent than before. Doctors as a group with high-group cohesion will experience conflicts between the generations, because the profession is constantly becoming younger, and between the sexes, because the number of women in the profession is constantly growing. These con flicts will increase, as will competition. As the number of doctors grows and the income of each physician decreases, the in-group prestige will decline. The geographical distribution of doctors is une qual in all countries. Regions with a high density of physieians contrast with those of lower density. Doctors in some countries con gregate in lager cities, around universities, in regions with greater recreational facilities, better climatic conditions, etc. But tbis applies mostly to highly specialized physicians and not to general practitioners (GPs), but even among specialists the tendency to settle in formerly neglected or in unattractive regions is constantly growing. However, these geo graphical inequalities will not be so important in the future because as a result of the growing density of the transport and communications network, "remote" regions will no longer exist, and there will be access to practically every medical speciality. Especially within the densly populated countries of the EEC (e.g. Netherlands, Belgium, Federal Republic of Germany), almost every medical facility is available to everyone. However, it has to be admitted that lack of an adequate transport and communications network in some countries creates areas with too few doctors, with the result that there is liUle room for an additional supply of medical manpower . Within the medical profession the division of /abour is traditionally quite different between the United Kingdom and the continental European countries, and within the latter countries themselves. The same is true of the demarcation between the activities of doctors and those of ancillary services. It is therefore virtually impossible to make general izations about the redistribution of tasks in future years and how this may lead to a greater demand for doctors. It has to be borne in mind, moreover, that medicine is practised in different national and therefore cultural settings. Indeed, the socio-cultural setting may have hitherto prevented a "migration" of the "medical nations" from taking place. An up-grading of the position of GPs is noticeable in all countries, but their numbcr is increasing in some count ries and falling in others, compared with the number of specialists. In some countries, the GP is increasingly being replaced by the specialist in internal me dicine, who takes over the tasks of a farnily doctor in the coordination and integration of the work of the specialists.
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