Academia.edu no longer supports Internet Explorer.
To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser.
The Geographical Journal
https://doi.org/10.1111/geoj.12564…
8 pages
1 file
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. The information, practices and views in this article are those of the author(s) and do not necessarily reflect the opinion of the Royal Geographical Society (with IBG).
Health and Place , 2023
The recent, but overdue, publication of the NHS Long Term Workforce Plan marks a welcome investment in the future sustainability of the service. The Plan includes a near doubling of medical and nursing school places, a proposed shortening of medical degrees, growth in 'new roles' including associates and apprentices, reduced overseas recruitment of staff and efforts to boost productivity and retention. While the plan was greeted with enthusiasm by many, criticisms were also numerous. This short opinion piece does not aim to add to the critique, but instead presents an argument for why, in trying to understand the persistence of the 'health workforce crisis' across the world, we might usefully think back seven decades to international efforts to address the 'medical manpower problem'. Here, the manpower concept offers a hugely useful heuristic to think through the contours of time, space and resources that characterise(d) efforts to forecast and anticipate future health needs and, therefore, staff and resourcing. Geographers, I argue, should have far more to say about these conceptual continuities in modes and means of problematisation, as well as their consequences.
Social Science and Medicine , 2025
Health systems across the world are currently facing profound workforce shortages. This is, however, not a new phenomenon. Drawing on the case study of the British National Health Service (NHS), we explore how it has struggled to answer the fundamental question of how many doctors it needs with any accuracy or certainty. While the NHS is organisationally complex, it remains one of the world's most monopolistic health care systems. Despite this, the task of workforce planning has always been beset with basic problems of data accuracy and availability, and a lack of integration with resourcing. Given this, we first explore how fears over doctor 'shortages' have, historically, been intimately linked to concerns about the possible oversupply of doctors. We then examine the mechanistic ways in which current and future doctor numbers have been calculated before setting these efforts in political and policy context. These efforts have consistently revealed that there are numerous "imponderables" that, while crucial to answering the question of how many doctors the NHS needs, remain largely unknowable: how to achieve a 'balanced' system; understanding the work done by doctors and their productivity; and the impact of technology. Drawing on the work of British health economists writing in the 1970s, we examine how the expanded capacity to address medical need has only reinforced the need (and case) for ever more doctors. In conclusion, we argue that the insatiable need of the NHS for more doctors shows no sign of abating. Responding to this will inevitably require politically unpalatable resourcing trade-offs of the kind that have been largely absent from public debate.
Antipode, 2025
The history of Britain's National Health Service is a history of crises: staffing shortages; insufficient capital investment; and a lack of infrastructure rendered worse by the absence of the long-term funding settlements needed to ensure the service's future. The "critical condition" (Darzi 2024:131; https://www.gov.uk/government/publications/ independent-investigation-of-the-nhs-in-england) of the NHS in the present makes reflection on the future of the health service essential and unavoidable. However, the NHS is characterised by "forms of inertia" (Powell 1966:73; A New Look at Politics and Medicine) that, even as public dissatisfaction hits record levels, consistently undermines arguments for necessary change. Drawing on the example of workforce planning, I examine how efforts to imagine the future of and a future for the NHS have taken three forms: planned; tethered (to the past); and resisted. In this, I draw out why the NHS as an institution needs to be more central to radical geographical agendas and why geographers should be engaged in its future.
1998
The third report of the Medical Workforcc Standing Advisory Committee, entitled: "The Planning of the Medical Workforce" was published in December of 1997. It addresses a current imbalance between demand for doctors and the domestic supply. The purpose of this article is to present the report to a Portuguese medical audience drawing attention to the methodology used and to thedimension of the problem. Ata time when Portugal and the United Kingdom seem to have a similar problem with a shortage of doctors, but without unemployment, a rare situation in Europe, it is very important to learn the lessons from well conducted studies, despite the level of uncertainty always related with these projections. The report is divided into seven chapters with the foIlowing titles: introduction; summary of evidence; factors influencing demand; supply; balancing supply and demand: resources and risks; increasing students numbers-options, costs and benefits; recommendations.
sv.ntnu.no
Statistics show that there is a constant scarcity of medical practitioners in Norway. This excessive demand seems to be impossible to solve by an increase of medical students. A qualitative study was performed to develop an understanding of how mechanisms in the health services create the ever-larger demand for doctors. By using interviews of doctors and medical administrators an analytical model of the extensive need for medical doctors was developed. In this paper this qualitative empirical work is presented and the results discussed.
Cahiers de sociologie et de démographie …, 2008
Depuis un certain temps, le système de santé subit des pressions pour suivre le rythme de ses besoins en ressources humaines en santé (RHS). Qui plus est, les tendances démographiques futures accentuent ces pressions. Il faudra du temps pour combler les lacunes entre l'offre ...
To manage migration effectively it is necessary for governments and other agencies to develop a more strategic approach towards regulating the flow of health workers between countries. Each country has to develop its own strategy for dealing with the issue of migration in its own context. It is clear that migration does not exist outside the development of health systems and that a range of policy and strategy interventions is required to address the broader health-systems issues that influence the retention, recruitment, deployment, and development of health workers. Improving data collection Having reliable data about the health-care workforce is key to good workforce planning. Establishing and maintaining appropriate information systems on human resources, including a database on migration, is a vital first step. Diallo (9) discusses the use and reliability of available data sources and acknowledges the difficulties in finding accurate data. He recommends a process of triangulation of different sources to give the most comprehensive overall picture. Data from destination countries are much more accurate than data from source countries. One easily implemented strategy would be to set up a regular exchange of data between countries; this would include information on the number of health workers entering the destination country. Financial and non-financial incentives In many developing countries health-care systems are suffering from years of underinvestment, and for health-care workers this has resulted in low wages, poor working conditions, a lack of leadership, and few incentives of any kind. Korte et al., studying the motivation of health-care workers in four developing countries in Africa a , have observed that low job satisfaction and motivation affect the performance of health workers as well as acting to push people to migrate. Their study has found that non-financial incentives are important in motivating heath care workers both to do a good job and to continue working in public health services; these incentives include training, study leave, the opportunity to work in a team, and support and feedback from supervisors. Some incentives were found to work well to retain staff in rural areas. These included providing housing and transport, agreeing the number of years that will be spent in a rural location (rather than expecting a worker to remain there indefinitely), offering further training, and offering financial incentives. These findings support previous work on motivation (18, 19), and indicate that even simple, relatively low-cost measures may have a positive effect on the motivation of health workers and on retention. Nevertheless, the prospect of making substantially more money is thought to be a pivotal factor in the decision to migrate (20, 21), and in many source countries, introducing a competitive wage will be impossible. Targeted incentives may be a more realistic
Biosecurity Interventions, 2008
Rosen, 187, citing the classic Report … on an inquiry into the Sanitary Conditions of the Labouring Population of Great Britain. Ian Hacking looks to this period to find the moment when a "laws of sickness" were discovered, in part through the use of benefit societies' actuarial tables. See The Taming of Chance.
Introduction to forthcoming section in the Journal of Social History The papers in this section address a common question: how likely were sick people in early modern Europe to seek care from a medical practitioner? The evidence they present reveals a level of engagement with commercial medical provision that varied substantially across Europe, but that for the most part shared one striking characteristic: growth. While the likelihood that someone would turn to a medical practitioner for help was markedly higher in the urban Mediterranean than in the countryside of North West Europe, in all three of the locations that these papers study we see the use of care rising over the sixteenth to nineteenth centuries. In short, people across Europe grew ever more reliant on commercial medical practitioners—individuals earning a living from their work in health care— in the early modern period. These findings substantially advance our understanding of developments in medical consumption over time. By shifting attention from goods to services, they provide a major complement to our understanding of consumption more generally. And they also present us with the challenge of explaining how these profound shifts in the medical economy connected with and contributed to wider economic, social and cultural developments. In turning to the task of identifying and measuring long run changes in the demand and supply of medical services, these papers move on from the essential work of uncovering the variety and abundance of medical care and medical practice that historians have undertaken in a series of studies over the last forty years.
Journal of Health Politics Policy and Law, 2002
A heightened awareness about medical manpower issues can be observed in countries that are in a state of political, economic, and social transition. Slovenia entered the transition process in 1989 and became an independent country in 1991. Transition and independence influenced its health care in several ways. It changed the health care system and its financing (by introducing a Bismarckian style of social insurance). It then redistributed power from the Ministry of Health to several stakeholders. A major change occurred in the labor market in health care when the flow of health professionals from the newly independent countries greatly decreased. The decrease was partly due to the consequences of the war in the Balkans and partly due to independent labor legislation in Slovenia. Transitional changes brought new stakeholders to the scene, with a resulting redistribution of responsibilities for health manpower policies and the use of various methodologies. This policy analysis offers a detailed description of the contextual framework, quantitative data on medical manpower development, and, most important, interviews with representatives of the key stakeholders and study of relevant policy documents. We conclude that all stakeholders underpin the need for a structured approach toward health manpower planning in the form of a more coherent system of planning, decision making, and control. A compromise on mutual responsibilities between the less dominant Ministry of Health and the two new powerful stakeholders, the Health Insurance Institute of Slovenia and the Medical Chamber of Slovenia, seems necessary. This article deals with medical manpower planning in Slovenia. While such planning has been a salient topic in health policy and health services research for several decades in the Western countries (and especially in
2014
Due to the necessity of guaranteeing an adequate quality of healthcare, manpower planning is considered to be a crucial topic in the 21st century. This article examines the perspectives of EU policymakers concerning manpower planning for medical specialists. The main topics to be discussed include:
ZRC SAZU, Založba ZRC eBooks, 2023
Euromediterranean Biomedical Journal, 2019
An increasing need for healthcare workers as been estimated worldwide. To provide a comprehensive framework of the medical workforce in Italy, we investigated the post-lauream medical workforce training supply and demand. Further, a comparison of the medical workforce between Italy and other European Countries with a similar epidemiological and/or demographic context was performed. The distribution of pre- and post-lauream medical educational providers and post-lauream resources in place in Italy was analyzed among Italian macro-areas in the academic years 2015-2016, 2016-2017 and 2017-2018.Italy and the European countries in study were compared in term of post-lauream funding and number of active physicians by specialization per 1,000 inhabitants. Open access data from official Italian and European institutional sources were used. The most of medical schools were distributed in the North, followed by South, islands and Central Italy, while the highest enrolment rate in the pre-laur...
BMC Health Services Research, 2018
Background: The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, particularly for low-income, source countries. In the past decade, Ireland has doubled the number of doctors it trains annually, but because of its failure to retain doctors, it remains heavily reliant on internationally trained doctors to staff its health system. To halve its dependence on internationally trained doctors by 2030, in line with World Health Organisation (WHO) recommendations, Ireland must become more adept at retaining doctors. Method: This paper presents findings from in-depth interviews conducted with 50 early career doctors between May and July 2015. The paper explores the generational component of Ireland's failure to retain doctors and makes recommendations for retention policy and practice. Results: Interviews revealed that a new generation of doctors differ from previous generations in several distinct ways. Their early experiences of training and practice have been in an overstretched , under-staffed health system and this shapes their decision to remain in Ireland, or to leave. Perhaps as a result of the distinct challenges they have faced in an austerity-constrained health system and their awareness of the working conditions available globally, they challenge the traditional view of medicine as a vocation that should be prioritised before family and other commitments. A new generation of doctors have career options that are also strongly shaped by globalisation and by the opportunities presented by emigration. Discussion: Understanding the medical workforce from a generational perspective requires that the health system address the issues of concern to a new generation of doctors, in terms of working conditions and training structures and also in terms of their desire for a more acceptable balance between work and life. This will be an important step towards futureproofing the medical workforce and is essential to achieving medical workforce self-sufficiency.
World health and population, 2015
With the United Nations Development Programme (UNDP) Post-2015 Development Agenda upon us, it is increasingly important to address the worldwide deficit of human resources for health. Ironically, there is a unique subset of regionally trained healthcare providers that has existed for centuries, functioning often as an “invisible” workforce. These practitioners have been trained in an accelerated medical model and serve their communities in over 46 countries worldwide. For the purpose of this paper, “medical model” is defined as the evidence-based and scientific manner of training and practice that defines physicians globally. Inconsistent nomenclature, however, has resulted in these workers practicing as a virtually unidentified and disjointed cadre on the margins of health policy planning. We use the term Accelerated Medically Trained Clinician (AMTC) here as a categorical designation to encompass these professionals who have been referred to by various titles. We conducted an expl...
Background: Manpower planning is a crucial topic in the 21st century in order to guarantee an adequate quality of healthcare. We examined the perspectives of EUpolicymakers concerning manpower planning of medical specialists. Summary of work: The so-called “CIA-project”, was conducted with the use of a semi-structured questionnaire and stakeholder interviews in order to analyze three main aspects at the macro-system level: 1. Current situation and trends; 2. Importance of developments and desired innovations; 3. Attainability of desired innovations. The interviews were held among policymakers in eight selected EU-countries. Summary of results: The results include a summary of the policies in terms of manpower planning in the field of PGME. Five of the eight countries indicate the need for more „generalists‟ in medical care. None of the eight countries agree that EU-policy assists in developing sufficient local training capacity. Capacity planning and employability appears to be of m...
Health Policy, 1990
Human resource is one of the most important components of health systems. Support for human resources planning for health ranks low on the health policy agenda of many national governments and international agencies. The aim of this study is to present various existing methodologies for estimating the health manpower requirement and forecasting approaches and to discuss some of the methodological challenges, their potential advantages, limitations and indications for their use. The most common approaches which were used for estimating man power requirement are health needs based, demand based, service targets based and health manpower to population ratio. These approaches use different assumptions and require distinct data sets for estimating requirement of human resource for health. Depending on need, health planners have modified four basic methods described above, and developed an alternative approaches for estimating as well as forecasting health manpower requirement and some of them have been discussed in details. Estimating the requirement and forecasting the health manpower is the most difficult but essential task for planners. Any assessment of the optimal number of health manpower, regardless of the specific method used, is bound to have a large range of uncertainty. Hence, any country considering requirement and forecasting of health manpower can deviate from intentions in either direction. The main concern must be to have the right number and appropriate mix and distribution of health manpower to provide quality health care service to achieve positive health outcomes. Key words: Methods, estimating health manpower requirement, forecasting health manpower requirement, human resources for health, health work-force
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.