The challenge of the changing health labor market

GILLES DUSSAULTEUREGIO III

3RD MASTER CLASS PROGRAMME23 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

Education pipeline

Nationals trained abroad

Immigration

Contracting

Stock/ supply of health workers

CompositionDistribution

Statutory retirement

Attrition

Emigration

Returners

A simple model of health labour market dynamics (stock and flows)

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)

16%

4% 4% 5%

34%

19%11% 12%

19%

28%

17% 14%

11%

29%

25%20%

9% 12%

26%

24%

7%6%

14%20%

4% 2% 2% 4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1987 1996 2004 2007

70+

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

GPs, Denmark

• 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)

Predicted shortages

12

Estimated shortage of HRH (DG-SANCO)

Health professionals or other health workers

Estimated shortage by 2020

Estimated percentage of care not covered

Physicians 230.000 13,5% Dentists, pharmacists and physiotherapists 150.000 13,5%

Nurse 590.000 14,0%

Total 970.000 13,8%

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)

05

101520253035404550

Austria Finland Ireland NewZealand

Norway Portugal UK USA

%

Doctors Nurses

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 ?