Availability of doctors
Proper access to medical care requires having a sufficient number of doctors, with a proper mix of generalists and specialists, and a proper geographic distribution to serve the population in the whole country.
The number of doctors in EU countries increased from about 1.5 million in 2010 to 1.8 million in 2020. In all EU countries, the number of doctors increased more rapidly than population size over the past decade, so that, on average, the number of doctors rose from 3.4 per 1 000 population in 2010 to 4.0 in 2020.
In 2020, Greece had the highest number of doctors (6.2 per 1 000 population), followed by Portugal (4.5 per 1 000 population), but the number in these two countries is an over-estimation as it includes all doctors licensed to practice (including retired physicians and those who might have emigrated to other countries but have kept their licence in the country). The number of doctors per capita was lowest in Luxembourg, Hungary, France and Belgium (3 or slightly more than 3 per 1 000 population), although the number in France and Belgium is an under-estimation as it does not include physicians-in-training. While the number of doctors per population has increased in all EU countries, the rise in Luxembourg, Hungary, France, Belgium, Italy, Estonia and Latvia has been very marginal (Figure 7.10).
In many countries, the main concern has been about growing shortages of general practitioners (GPs), particularly in rural and other under-served areas. Whereas the overall number of doctors per capita has increased in all countries, the share of GPs has come down in most countries. On average across EU countries, only one in five doctors were GPs in 2020 (Figure 7.11). A few countries, such as Portugal, Belgium, Luxembourg and France, have been able to maintain a better balance between GPs and specialists. Several countries have increased the number of postgraduate training places in general medicine to address GP shortages. For example, in France, at least 40% of all new postgraduate training places have been allocated to general medicine since 2017, a greater proportion than in most other EU countries. However, in France as in other countries, attracting a sufficient number of medical students to fill the available places in general medicine remains a challenge because of the lower remuneration and prestige of general practice.
In all countries, the density of physicians is generally greater in urban areas than in rural areas, reflecting the concentration of specialised services such as surgery in urban centres and physicians’ preferences to live and practice in cities. Differences in the density of doctors between urban and rural areas are particularly large in Hungary, the Slovak Republic, Lithuania and Latvia (OECD, 2021[1]).
Following the pandemic, many countries have increased the number of medical students to address current or expected future shortages of doctors, although the effect of these decisions will only be felt in a few years’ time as it takes 8-12 years to train new doctors. Some countries have also increased the recruitment of doctors from other countries as a quicker way to address current shortages, but this can raise issues about “brain drain” when the recruitment is from lower-income countries that are confronted with even greater shortages of doctors.
Practising physicians are defined as doctors who are providing care for patients. In some countries, the numbers also include doctors working in administration, management, academic and research positions (“professionally active” physicians), adding another 5-10% of doctors. Greece and Portugal report all physicians entitled to practice, resulting in an even greater overestimation. Interns and resident physicians who provide services under the supervision of other doctors are included in most countries, but not in Belgium and France.
References
[1] OECD (2021), Health at a Glance: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/19991312.
Note: The EU average is unweighted. 1. Data refer to all doctors licensed to practice, resulting in a large over-estimation of the number of practising doctors (e.g. of around 30% in Portugal). 2. Data include not only doctors providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. (adding another 5-10% of doctors). 3. Medical interns and residents are not included. 4. The latest data refer to 2017 only. 5. The latest data refer to 2014 only.
Source: OECD Health Statistics 2022; Eurostat Database; WHO National Health Workforce Accounts for Moldova and Ukraine.
Note: The EU average is unweighted. 1. The category “Other doctors” includes non-specialist doctors working in hospital, recent medical graduates who have not yet started post-graduate specialty training, as well as any other doctors not further defined. 2. In Portugal, only about 30% of doctors employed by the public sector work as GPs in primary care – the other 70% work in hospitals.
Source: OECD Health Statistics 2022; Eurostat Database.