Traditionally, human-resources planning has sought to forecast the gap between future supply and demand so that resources for closing the gap can be implemented in a timely manner. The healthcare organization and financing system designed in nineteenth-century Germany and later adopted by France does not allow an approach of that kind. The experience of recent decades shows that the gap between personnel supply and demand—i.e., shortage or oversupply—in such a system is highly elusive and even uncertain. Nevertheless, demographic projections of healthcare professions remain very useful, as they allow a preview of system participants’ collective perceptions. These can lead to decisions whose consequences might not be the most desirable two or three decades later.
The experience of the developed countries shows that the demand for medical care is, so to speak, infinitely extendable—owing, among other reasons, to technical progress and everyone’s desire for greater well-being. Only two factors can, if not halt, at least dampen demand in the health sector: the availability of local caregivers and the price that patients themselves must pay. Nowadays, however, most developed countries have adopted healthcare funding systems in which the patient’s deductible is very low or even zero. Therefore, the race to medical care now depends only on supply—chiefly the supply of doctors. Theoretically, when supply exceeds demand, the system is overstaffed. When supply fails to meet demand, the system is understaffed. Reality is more complex, as the French experience of recent decades shows.
In the 1980s, there was a broad consensus in France regarding the excess number of doctors. Between 1980 and 1993, the number of “omnipractitioners†(i.e. general physicians) in the private sector alone rose 36%, that of specialists 64%. During those thirteen years, the French population grew only 7%. Alarms sounded everywhere. Yet doctors’ activity, instead of falling, enjoyed a remarkable expansion. In the same period, the annual number of visits (home and office) rose 6% per general physician and 21% per specialist. Unsurprisingly, therefore, the total volume of visits rose 45% in general medicine and almost doubled in specialties between 1980 and 1993. The number of care providers—i.e. doctors—admittedly grew, but their ACTIVITY EXPANDED EVEN FASTER.
In 2003 the collective perception begins to be dominated by the spectre of shortage:
THE NUMBER OF YOUNG PRACTICIONERS under 40 years old was in the year 2000 about 46.600. In 2010 there are just about 17.000 medical practicioners under 40. The plunge is obviously due to the low university intake in the 1990s. It explains the reversal of opinion in 2000-2001, when the fear of shortage replaced the obsession with oversupply.
The predictions for 2025 are comforting, due to higher intake in medical students by the university. The 15 year gap between 2010 and 2025 gives opportunities for young practicioners from other countries.
Source of the article:
“Shortage and oversupply of doctors in France: contribution of demographic projections
