Historically, common practitioners (also referred to as primary-care docs or household docs) have been the “first line of defence” in the case of well being. They look at people who find themselves unwell and refer them to a specialist if essential. In lots of European international locations, the career appears to be caught in a double bind: the inhabitants is rising and ageing, whereas GPs themselves are ageing and their numbers are struggling to maintain tempo.
A blanket scarcity of GPs
The causes are quite a few and sophisticated, and the scenario is changing into pervasive. “There are shortages of GPs everywhere in the world,” explains Tiago Villanueva, a GP in Portugal and president of the European Union of Common Practitioners (UEMO) for the interval 2023-2026. He sees this as a Europe-wide drawback, each inside and out of doors the EU. “Which means it isn’t only a drawback of pay […] and dealing circumstances”, he argues, citing as examples Norway and Denmark. Regardless of a top quality of life and good wages, each these international locations are additionally dealing with shortages.
Tiago Villanueva mentions different elements which will play an element. These embody a low regard for generalist medication in comparison with the specialist selection (notably in larger training); the problem of the job; lengthy journey instances; and the truth that shortages are sometimes in poorer and fewer fascinating areas.
A report by the World Well being Organisation (WHO) in 2023 summarises the scenario: “Many international locations are dealing with present and/or projected shortages of common practitioners, which can be exacerbated by the ageing and feminisation of the primary-care workforce, with feminine common practitioners extra more likely to work part-time”. The report additionally mentions “imbalances within the geographical distribution of major healthcare professionals, primarily between rural and concrete areas”.
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Utilizing the – very partial – knowledge we’ve got been in a position to retrieve at European degree, it’s attainable to sketch an image of the scenario in a number of international locations.
Not all GPs are the identical
The info collected for this text is fragmentary. Every nation counts its GP workforce otherwise, so making a physique of comparable knowledge is sophisticated. For the needs of this survey, we’ve got chosen to deal with GPs confirmed as being in follow within the reference yr (until in any other case specified).
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In some international locations, GPs usually are not the one docs who present major care. That is notably the case in Germany (for internists) and Greece (for pathologists). In consequence, our graphic doesn’t present the total vary of primary-care suppliers in these international locations. Until in any other case specified, the info additionally doesn’t have in mind different practitioners authorised to supply the identical sort of care, corresponding to medical assistants or docs present process specialisation.
The info analysed – and its sources – can be found right here: Germany (German Medical Affiliation), Belgium (Federal Public Service Public Well being), Bulgaria (Nationwide Statistical Institute), Croatia (Croatian Institute of Public Well being), France (Institut Nationwide de la Statistique et Etudes Economiques), Greece (Hellenic Statistical Authority), Eire (Medical Council), Italy (Ministry of Well being), the Netherlands (Netherlands Institute for Well being Companies Analysis), Portugal (Order of Medical doctors), and Slovenia (Nationwide Institute of Public Well being).
The dearth of constant knowledge on this space was highlighted within the annual report Well being at a Look: Europe 2024 by the Organisation for Financial Cooperation and Improvement (OECD).
Double ageing
One other drawback stems from the ageing of the inhabitants. Whereas Europe’s inhabitants – estimated at 449.2 million in 2024 – is rising, it’s renewing itself at a a lot slower price.
This case is described within the OECD’s annual report cited above: “The proportion of individuals aged 65 and over within the EU has risen from 16 % in 2000 to 21 % in 2023, and is anticipated to succeed in virtually 30 % by 2050 because of longer life expectancy and decrease fertility charges. This demographic shift is more likely to result in a pointy enhance in demand for healthcare and long-term care.”
In response to the OECD, the proportion of individuals aged over 65 in 2023 was notably excessive in Italy and Portugal, two international locations which, together with Greece, Spain and Lithuania, are anticipated to endure a big acceleration within the ageing of their populations between now and 2050.
The ageing of the inhabitants additionally holds true for docs themselves, throughout all specialisations. The report Well being at a Look: Europe 2024 states: “The ageing of the doctor workforce is a rising concern in lots of EU international locations, with a considerable proportion of docs nearing retirement age and a non-negligible quantity already past it. In 2022, over one third (35%) of docs throughout EU international locations had been over 55 years outdated, with practically half of EU international locations having this proportion attain 40% or larger. Italy and Bulgaria are the 2 EU international locations dealing with essentially the most urgent considerations, with greater than half of their doctor populations aged over 55 and greater than a fifth aged over 65.”
“We’ll have main issues over the following ten years”, worries Villanueva. What is going to occur when the outdated guard retires? Will the inflow of younger docs into healthcare programs be sufficient to compensate for the loss of a big chunk of the career?”
In 2021, there have been 2,545 common practitioners aged over 65 in Belgium (based on figures from the Federal Public Well being Service), representing virtually 20 % of the workforce. In the identical yr, there have been 2,737 GPs aged between 25 and 34 – simply over 21 % of the overall. Retirements are all of the extra worrying provided that the brand new technology, which is extra centered on a balanced way of life, might not have the ability to compensate for this decline. “In the present day it’s estimated that it takes two younger docs to switch one on their retirement”, says Elodie Brunel, vice-president of the Société Scientifique de Médecine Générale (SSMG). To easily change a retiring physician with one other one will not be sufficient.
It’s laborious to say what the optimum variety of sufferers per physician is. The determine certainly varies relying on the nation and the particular scenario. “We estimate that 800/900 sufferers [per year] per physician is the brink past which it turns into troublesome to perform”, says Elodie Brunel. However that is with out bearing in mind the uneven regional distribution of the career, an issue that’s widespread all through Europe.
Divided international locations
Within the EU, inequalities in healthcare provision between rural and concrete areas are well-known and effectively documented. In France, the time period “déserts médicaux” (medical deserts), though disputed, has develop into extensively used to consult with areas (usually rural) with poor entry to healthcare.
An atlas of medical demography in France, drawn up by the French Nationwide Medical Council in 2022, sums up the scenario: “When it comes to numbers, common practitioners in common follow are extra quite a few in essentially the most densely populated départements. Then again, an ‘arc of vacancy’ appears to be rising from the northeast to the southwest of mainland France, with a low variety of GPs in common follow in these départements, which are sometimes sparsely populated.” In France, the départements within the centre of the nation are shedding GPs, whereas these on the Atlantic coast and within the abroad territories are tending to realize them. Since 2010, 84 départements (out of 101) have had a scarcity of GPs, based on the French Nationwide Medical Council.
EU international locations are responding to those shortages. In Romania and Belgium, subsidies exist to encourage household docs to arrange follow in areas of scarcity. Greece gives monetary incentives for docs who select to specialise usually medication or pathology. In 2020, France changed the “numerus clausus”, a system that restricted the variety of college students admitted to the second yr of medical college and which, for some, has contributed to the scarcity of practitioners in rural and high-demand areas.
No miracle remedy
In its 2023 report cited above, the WHO units out plenty of options for combating shortages. For instance: prioritizing common medication in larger training by way of internships or coaching periods; bettering salaries and dealing circumstances; and gaining a greater understanding of healthcare supply in order to have the ability to anticipate crises extra successfully.
“There’s not one ‘silver bullet’ primary-care mannequin to extend the attractiveness of major care, however moderately a continuum of primary-care fashions”, mentioned the report. “Primarily based on a contextual evaluation, parts of primary-care fashions must be developed and/or tailored to native wants and preferences of medical college students, the primary-care well being workforce, sufferers and most of the people.”
Tiago Villanueva of the European GPs’ union UEMO is guarded about encouraging the coaching of recent docs. “Governments usually select ‘damaging insurance policies’,” he worries. “They like issues like growing the variety of locations in medical colleges or coaching GPs. They attempt to enhance provide, principally. […] As a result of should you enhance provide, you offset demand, do not you?”
In Villanueva’s view, this strategy must be accompanied by “optimistic insurance policies” – in different phrases, measures that make the career extra engaging to aspiring younger GPs and make sure that the workforce is retained in the long run: “If you happen to do not make the career extra engaging, then you could inject extra docs into the system however they will not go into common follow. They’re going to select one other speciality or they will go away the nation.”
