Planning the number of physicians: from research to health policy decisions
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Abstract
The first planning projections of physician number in Lithuania were drawn almost two decades ago; however, the accuracy of those and later planning efforts (conducted in 2003, 2004 and 2007) was never evaluated. This study aimed to overview the actual changes in the physician’s number in Lithuania in 1994-2011 and to compare them with previously drawn planning projections. Also, the study reviewed health policy decisions and other important factors, which possibly influenced actual changes in physician number.
Lithuania has retained stable physician per population ratio between 1994 and 2011. This was influenced by a combination of various factors as well as health policy decisions. First of all, the influence of declining overall population number should be noted; the number of population decreased by almost half a million (427 thousand) in 1994-2011. Because of that, while the overall number of physicians decreased by 12.3%, the physician to population ratio remained stable (41.7 per 10,000 population).
None of the planning projections proved to be very accurate; however they served as an important tool for policy makers in taking decisions regarding physician human resources.
Financial support of the EU Structural funds, which enabled renovation of most hospitals and supply of new medical equipment, contributed to significant changes in working conditions of physicians. The support was also given to physicians’ continuous professional development. Health policy decision to increase the salaries (they increased by 2.5 times between 2005 and 2011) also played an important role in retaining physicians. Increased enrolment to physician training programmes since 2002 as well as change in the legal status of medical residents contributed to ensuring at least partial substitution for the number of those physicians who leave the profession annually. Establishment of re-entry programme into profession in 2009 was a positive development, especially with coverage of 90% of traineeship costs. Unfavourable retirement conditions, while not a specific physicians’ retention policy, contributed to retaining practicing physicians after their retirement age.
Immediate challenges that need to be addressed by policy makers are rapid physician ageing (especially in some specialties), which will inevitably cause shortages of physicians in the next decade, and numerous student drop out from studies. Increasing training enrolments is relevant only as part of a broader policy portfolio for medium- or long-term solutions. The effect of reducing drop out occurs immediately and also avoids the substantial costs of extra capacity in study programs as well, representing a more efficient use of resources. Therefore author recommends modifying the selection procedure for medical students, including assessment of applicants’ noncognitive and cognitive abilities. As in other countries, establishment of comprehensive monitoring system and harmonization of physician human resources planning with ongoing health care reform objectives remains one of the biggest future challenges for Lithuania.
Lithuania has retained stable physician per population ratio between 1994 and 2011. This was influenced by a combination of various factors as well as health policy decisions. First of all, the influence of declining overall population number should be noted; the number of population decreased by almost half a million (427 thousand) in 1994-2011. Because of that, while the overall number of physicians decreased by 12.3%, the physician to population ratio remained stable (41.7 per 10,000 population).
None of the planning projections proved to be very accurate; however they served as an important tool for policy makers in taking decisions regarding physician human resources.
Financial support of the EU Structural funds, which enabled renovation of most hospitals and supply of new medical equipment, contributed to significant changes in working conditions of physicians. The support was also given to physicians’ continuous professional development. Health policy decision to increase the salaries (they increased by 2.5 times between 2005 and 2011) also played an important role in retaining physicians. Increased enrolment to physician training programmes since 2002 as well as change in the legal status of medical residents contributed to ensuring at least partial substitution for the number of those physicians who leave the profession annually. Establishment of re-entry programme into profession in 2009 was a positive development, especially with coverage of 90% of traineeship costs. Unfavourable retirement conditions, while not a specific physicians’ retention policy, contributed to retaining practicing physicians after their retirement age.
Immediate challenges that need to be addressed by policy makers are rapid physician ageing (especially in some specialties), which will inevitably cause shortages of physicians in the next decade, and numerous student drop out from studies. Increasing training enrolments is relevant only as part of a broader policy portfolio for medium- or long-term solutions. The effect of reducing drop out occurs immediately and also avoids the substantial costs of extra capacity in study programs as well, representing a more efficient use of resources. Therefore author recommends modifying the selection procedure for medical students, including assessment of applicants’ noncognitive and cognitive abilities. As in other countries, establishment of comprehensive monitoring system and harmonization of physician human resources planning with ongoing health care reform objectives remains one of the biggest future challenges for Lithuania.
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