The challenge of the changing
health labor market
GILLES DUSSAULT
EUREGIO III
3RD MASTER CLASS PROGRAMME
23 MARCH, 2011
Overview
• Why discuss health workforce
issues (HW) now?
• What needs to be done to find the
right balance?
Why discuss HW issues now?
Needs change
Demand changes
Supply changes
Many alerts: WHO reports, EU
Green paper/Conclusions
• Time lag
•
•
•
•
A simple model of health labour market dynamics
(stock and flows)
Education
pipeline
Nationals
trained
abroad
Immigration
Stock/ supply
of health
workers
Composition
Distribution
Statutory
retirement
Attrition
Emigration
Contracting
Returners
Socio-demographic, economic,
organizational, legal determinants
Needs change
• Aging population
• Epidemiological profile (chronic
diseases, mental health,
re/emerging diseases)
• Values (religious requests,
palliative care, euthanasia)
• New diagnosis/treatment tools and
strategies
Aging in the WHO-EUROPE
Region, EU and CIS
Demand changes
• EU Health Policy, Cross-border
directive
• WHO renewed primary care policy
• New organizational strategies: team
work, integration of services,
ambulatory/home care. Telemedicine
• Medicalization of healthy life
• Better informed, more demanding
users (average time of consultations)
Supply changes
• Aging: Average/nurses = 41-45 in Den.,
Isl., Nor., Swe., Fra.
• Scaling-up of general practice, of
nursing (expanded functions)
• Values and expectations (work-life
balance, non-financial incentives)
• Mobility: within countries, between
countries, im/emigration (freedom of
movement, Bologna process, Blue EU
Labour Card)
GPs, Denmark
100%
90%
4%
7%
9%
2%
2%
6%
4%
14%
12%
20%
70+
80%
11%
70%
29%
60%
65-69
26%
24%
19%
55-59
50%
25%
20%
40%
30%
50-54
28%
34%
45-49
17%
14%
11%
12%
35-39
4%
4%
5%
30-34
1996
2004
2007
20%
19%
10%
60-64
16%
0%
1987
40-44
Predicted shortages
•
•
•
•
•
England 2010: 14,000 nurses (Mooney H, 2007)
Netherlands: 7,000 nurses (Simoens et al 2005)
Norway: 3,300 nurses (Askildsen et al 2003)
Switzerland: 3000 nurses (Irving J 2001)
USA
– 500000 nurses (2025) (Buerhaus et al. in print)
– 44000 (2025) family practitioners (Colwill 2008)
Estimated shortage of HRH
(DG-SANCO)
Health professionals or
other health workers
Physicians
Dentists, pharmacists and
physiotherapists
Nurse
Total
Estimated shortage by
2020
230.000
Estimated percentage of
care not covered
13,5%
150.000
590.000
970.000
13,5%
14,0%
13,8%
12
Migratory flows: ‘push’ e ‘pull’
•
•
•
•
•
•
Compensation
Working conditions
Working environment
Better career opportunities
Access to specialized training
More security and stability
• “Global Code of Practice on the International Recruitment of
health personnel”
Source: Buchan J et al 2003
%
% physicians and nurses with foreign nationality
(OECD 2007)
50
45
40
35
30
25
20
15
10
5
0
Austria
Finland
Ireland
New
Zealand
Doctors
Norway
Nurses
Portugal
UK
USA
Which workforce?
• First, need to answer a few tricky
questions:
– Where do we start from?
– Future health needs?
– Which services? How will they be
organized?
– Who will do what?
– How will supply and labour market
evolve?
– How much are we prepared to spend?
Which workforce?
• What is the capacity of the country, of individual
organizations?
– To attract/recruit the right type of future health
workers
– To educate/train them
– To employ them
– To retain them
What countries can (should) do?
• HW policy in line with services and health
policies
• Build the information base (numbers,
availability, productivity, projections,
expectations, multiple employment, private
sector)
• Mobilize stakeholders in support of change
• Mobilize resources and capacity
Conclusions
• The toughest challenge: building
the workforce of tomorrow
• A global approach is needed
• How to move from awareness to
effective action ?