Medical workforce in Belgium: Assessment of future supply and requirements

The regulation of human resources is a controversial subject. In Belgium, after some years of political disputes, student strikes, and procrastination, quotas have been applied to new graduates in medicine (since 2004), dentistry, and physiotherapy. In this particular context, various models have been developed in order to forecast, on the assumption of an unchanged health system, the future workforce and the appropriate number of future medical graduates. By focusing on three of these models, we identify 1) some parameters which should be included in a forecast supply model and 2) the consequences of the Belgian regulation. The overall methodology of these models is similar. The projections are based on a base-year stock of physicians. The size of this stock will vary according to future inflows and outflows and the corresponding full-time equivalents will suffer from ageing and feminisation. In order to assess requirements for new medical graduates, these supply forecasts must be compared with the predicted future demand and requirements for medical doctors, inter allia the replacement requirements, taking into account the predicted outflow. Although they have used different parameters and estimates, the models have nonetheless reached similar results about the long-term future (2015-2020); if the present quota is maintained, some authors conclude that there might be a shortage of doctors. Some parameters of these models appear to us to be absolutely essential, in particular retention rates, volume of activity, impact of feminisation and ageing of the medical workforce. Projections for requirements also depend on the type of MDs considered, on the base year chosen in the model and on any oversupply that may exist in that base year and the size of the outflow. But, even if one regards the present situation as one of oversupply, there is reason to fear shortages in the future. Consequently, enlarging the present quota after 2013 would not bring about an increase in the future global workforce. The reasons: the retirement of substantial cohorts of graduates in the years 2015-2025 and an overly restrictive quota that, if remained unchanged, will not compensate for these departures. The introduction of these quotas came too late: a numerus clausus would have been very useful in the years between 1975 and 1990 (given the uncontrolled expansion in the numbers of new graduates at that time); being finally enforced, it will be appropriate for a few years (2004-2012), but afterwards it should be enlarged: at a time when European regulations aim to limit the working hours of young specialists in training, and when both the number of doctors leaving the profession and the needs of an ageing population are set to increase. Such enlargement has already begun (for 2012) and should be increased.