Programmaleider Arbeids- en Organisatievraagstukken in de Gezondheidszorg, bijzonder hoogleraar 'Arbeids- en organisatievraagstukken in de zorg', Radboud Universiteit
Publicatie
Planning the Dutch GP workforce.
Batenburg, R., Velden, L. van der, Greuningen, M. van. Planning the Dutch GP workforce.: , 2010. 77-78 p. Abstract. In: Book of Abstracts of the European Health Management Association Annual Conference 2010 'Managing Radical Change in Health. Quality, Efficiency, Equity', 30 juni- 2 juli 2010, Lahti, Finland. 10-11
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CONTEXT: For a long time, shortages of health care personnel have been a major worldwide concern of health policy makers, professional bodies and patient organisations (cf. OECD, 2008). It is commonly acknowledged that manpower planning can be an important instrument to control shortages (and oversupply) within the health care labour market, in particular by increasing or decreasing the numbers to be trained (cf. Maynard & Walker, 1997). The Netherlands is one of the countries that has a long tradition of manpower planning in health care, more specifically of general practitioners (GPs), and is therefore an interesting case to study. METHODS: For this paper, we describe and evaluate the Dutch manpower planning system with regard to the largest medical profession in the Netherlands, the GPs. Based on NIVEL registration of (nearly all) GPs in the Netherlands since 1975, data is re-analysed that has been used for the manpower planning before and after 1999. In that year, the capacity body was established to centrally plan the entrance to the medical bachelor and master (specialist) studies, including the training for GP. We perform a historical policy analysis describing the critical decisions and stakeholders between 1975 and 2008. This is combined with a statistical description of the planned and realised GP student entry numbers, as well as trends in the size and composition of the GP workforce. An interpretative and backward evaluation perspective is applied to address the question if the Netherlands was successfully in overcoming the pork cycle in GP manpower planning. RESULTS: Registry survey data shows that GPs in the Netherlands are probably the most complex and dynamic medical occupation to monitor and, hence, to plan. Over time, the popularity of becoming a GP strongly varied among medical students, and so has the entrance of graduated GPs on the labour market. During the last decade, preferences of GPs have changed with regard to the type of practice, career length and attitude towards generalisation, specialisation and multidisciplinary collaboration. Contrary to the autonomous trend towards medical specialisation, GPs are increasingly put forward by the Dutch government as the corner stone of a strong and integrated primary care. These conditions have heavily challenged the Dutch manpower planning system and the potential the pork cycle in GP manpower supply. Still, the system appears to be successful in controlling and capturing most fluctuations, although the cycle time of planning is decreasing rapidly. ANALYSIS: Although manpower models have successfully supported policy makers to steer the (numerical) entrance in the medical bachelor and GP specialist training, it can questioned if these remain feasible for the developments to come. Specifically, two trends need to be incorporated in the manpower planning for GPs that are yet underspecified. First, substitution within the primary care occupational structure will increasingly change the GP position - as tasks are re-allocated to new health occupations (such as Physician Assistants). Second, the need for local and regional health care planning will increase - in line with the policy trend to match health demand and supply as close to clients as possible. We reflect on the opportunities and barriers to extend the Dutch system of manpower system for GPs on these elements, both in terms of manpower modelling and its policy consequences for government and stakeholders. (aut. ref.)
CONTEXT: For a long time, shortages of health care personnel have been a major worldwide concern of health policy makers, professional bodies and patient organisations (cf. OECD, 2008). It is commonly acknowledged that manpower planning can be an important instrument to control shortages (and oversupply) within the health care labour market, in particular by increasing or decreasing the numbers to be trained (cf. Maynard & Walker, 1997). The Netherlands is one of the countries that has a long tradition of manpower planning in health care, more specifically of general practitioners (GPs), and is therefore an interesting case to study. METHODS: For this paper, we describe and evaluate the Dutch manpower planning system with regard to the largest medical profession in the Netherlands, the GPs. Based on NIVEL registration of (nearly all) GPs in the Netherlands since 1975, data is re-analysed that has been used for the manpower planning before and after 1999. In that year, the capacity body was established to centrally plan the entrance to the medical bachelor and master (specialist) studies, including the training for GP. We perform a historical policy analysis describing the critical decisions and stakeholders between 1975 and 2008. This is combined with a statistical description of the planned and realised GP student entry numbers, as well as trends in the size and composition of the GP workforce. An interpretative and backward evaluation perspective is applied to address the question if the Netherlands was successfully in overcoming the pork cycle in GP manpower planning. RESULTS: Registry survey data shows that GPs in the Netherlands are probably the most complex and dynamic medical occupation to monitor and, hence, to plan. Over time, the popularity of becoming a GP strongly varied among medical students, and so has the entrance of graduated GPs on the labour market. During the last decade, preferences of GPs have changed with regard to the type of practice, career length and attitude towards generalisation, specialisation and multidisciplinary collaboration. Contrary to the autonomous trend towards medical specialisation, GPs are increasingly put forward by the Dutch government as the corner stone of a strong and integrated primary care. These conditions have heavily challenged the Dutch manpower planning system and the potential the pork cycle in GP manpower supply. Still, the system appears to be successful in controlling and capturing most fluctuations, although the cycle time of planning is decreasing rapidly. ANALYSIS: Although manpower models have successfully supported policy makers to steer the (numerical) entrance in the medical bachelor and GP specialist training, it can questioned if these remain feasible for the developments to come. Specifically, two trends need to be incorporated in the manpower planning for GPs that are yet underspecified. First, substitution within the primary care occupational structure will increasingly change the GP position - as tasks are re-allocated to new health occupations (such as Physician Assistants). Second, the need for local and regional health care planning will increase - in line with the policy trend to match health demand and supply as close to clients as possible. We reflect on the opportunities and barriers to extend the Dutch system of manpower system for GPs on these elements, both in terms of manpower modelling and its policy consequences for government and stakeholders. (aut. ref.)