Medical Manpower in Belgium

Numerus clausus

Alain De Wever

Medicine

A. Medical planning agents in Belgium

Belgium

Federal State

Regions Communities

Flemish French Dutch speaking

1° Federal level

Establish the number of doctors who have access to the practice in the health insurance system

1996 : Creation of the « Commission de planification » (Planning Commission)

2° Communities’ level

Flemish Community

Entrance exam

(Decree of July 24, 1996)

2° Communities’ level

French community

End Bachelor examination – Third year(Decree of July 17, 1997)

End Master examination for the specialization – seventh year (Decree of July 27, 2003)

Examination at the end of the first year and at the entrance in the specialization training(Decree of July 1st, 2005)

3° Difference between communities

Flemish Community French Community

Entrance exam Examination

Number of students < quotas Number of students = quotas

At the end of the first year, classification of the best students per university

At the end of the seventh year, inter-universities commission

GP (43 %) Specialists (57 %) Quotas per specialization

The examinations in the French Community

The exam consists of 2 parts :

Exam assessing the scientific knowledge (physics, chemistry, biology, mathematics)

Comprehension tests (assessment of the ability to acquire & assimilate information through comprehension & restitution tests)

Entrance exam in the Flemish Community

B. Too much doctors in Belgium ?

Medical density

Medical acts / inhabitant

Time

Number

Plethora

1° Past trend

Fig.1

Sources : D. Deliège (SESA – UCL)

2° Current trend

Ageing medical population and increase of the retirement

Increase of the feminization of the medical population

Increase of the healthcare consumption Diversification of the medical profession

(pharma industry, civil agent, professor, etc.)

2.1. a Ageing medical population

-

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

0,90

1,00

1,10

2004 2009 2014 2019 2024 2029 2034 2039 2044 2049 2054

Flemish Com. Total < 75 surviving (incl. Overquota)

Flemish Com. Remaining practising care

French Com. Total < 75 surviving (incl. Overquota)

French Com. Remaining practising care

Ageing medical population : 55-74 / 20-54

Source : UCL – Sesa – Deliège D.

2.1. b Retirements’ boom

French and Dutch speaking communities

Source : UCL – Sesa – Deliège D.

0

500

1.000

1.500

2.000

2.500

<30 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74

Dutch speaking men

Dutch speaking w omen

French speaking men

French speaking w omen

2.2. Feminization of the profession

Women doctors’ rate

Source : UCL – Sesa – Deliège D.

0%

10%

20%

30%

40%

50%

60%

70%

2004 2009 2014 2019 2024 2029 2034 2039 2044 2049 2054

Flemish Com. Remaining practising care

French Com. Remaining practising care

2.3. Consumption increase

Due to the ageing (22 %) Due to others agents including the wealth (66 %)

Source : UCL – Sesa – Deliège D.

05000

1000015000

2000025000

3000035000

4000045000

50000

2030 2050 2030 2050

% Croissance totale % Croissance totale % Croissance horsPIB

% Croissance horsPIB

Vieillissement

Démo

Surplus>PIB

PIB

Time

Medical acts / inhabitant

Medical density

Number

Plethora

Shortage

3° Coming trend

Sources : D. Deliège (SESA – UCL)

Demographic bump Feminization Working hours’ decrease (48 hours/

week – European Directive – Colla law)

Possible shortage

Physiotherapists

Restriction by the federal level of the number of physiotherapists who can work in the health insurance reimbursement system

No restriction at communities’ level (training)

However, the French Community limits the

access for the students who do not live in

Belgium (30 %) economical reasons (by

lottery)

Examination organized by the Federal State : Attitude test for the self-employed practice Ability test for the self-employed practice Knowledge test :

Laws about physiotherapists’ rights and duties About the health insurance