Access to high-quality health services depends
crucially on the size, skill mix, geographic distribution and productivity of the
health workforce. Health workers, and in particular doctors and nurses, are the
cornerstone of health systems.
Many OECD countries are concerned about
current or looming doctor shortages. Forecasting the future supply and demand of
doctors is difficult, because of uncertainties concerning overall economic growth,
changes in physician productivity, advances in medical technologies, changing roles of
physicians versus other care providers, as well as changes in the health needs of the
Practising physicians are defined as the
number of doctors providing care to patients. General practitioners include doctors
assuming responsibility for the provision of continuing care to individuals and
families, as well as other generalist/non-specialist medical practitioners.
Specialists include paediatricians, obstetricians/gynaecologists, psychiatrists,
medical specialists and surgical specialists. Other physicians include
interns/residents if not reported in the field in which they are training, and doctors
not elsewhere classified. The numbers are based on head counts.
In several countries (Canada, France, Greece,
Iceland, Ireland, the Netherlands, and Turkey), the data include not only physicians
providing direct care to patients, but also those working in the health sector as
managers, educators, researchers, etc. This can add another 5-10% of doctors. Data for
Portugal refer to all physicians who are licensed to practice (resulting in a large
overestimation). Data for Spain include dentists and stomatologists, while data for
Belgium include stomatologists. Data for Chile include only doctors working in the
Not all countries are able to report all their
practising physicians in the two broad categories of specialists and generalists. For
example, specialty-specific data may not be available for doctors in training or for
those working in private practice.
In 2009, there were just over three
doctors per 1 000 population across OECD countries. Greece had by far the highest
number of doctors per capita, followed by Austria, Chile, Turkey, Korea and Mexico
had the lowest number, with between one and two doctors per 1 000 population. The
number of doctors per capita is lower in some of the major emerging economies,
with less than one doctor per 1 000 population in Indonesia, India and South
From 2000 to 2009, the ratio of practising
physicians per 1 000 population has grown in most OECD countries. On average
across OECD countries, physician density grew at a rate of 1.7% per year. The
growth rate was particularly rapid in countries which started with lower levels in
2000 (Turkey, Chile, Korea and Mexico) as well as in the United Kingdom and
Greece. There was no growth in the number of physicians per capita in Estonia,
France, Israel and Poland, and there was a marked decline in the Slovak Republic.
The decline in the Slovak Republic can be explained at least partly by a reduction
in the number of medical graduates since the late 1990s. In France, following the
reduction in the number of new entrants into medical schools during the 1980s and
1990s, the number of doctors per capita began to decline since 2006. This downward
trend is expected to continue.
In 2009, 43% of doctors on average across OECD
countries were women, up from 29% in 1990. This ranged from highs of more than
half in central and eastern European countries (Estonia, Slovenia, Poland, the
Slovak Republic, the Czech Republic and Hungary) and Finland to lows of less than
20% in Korea. The share of women physicians increased in all OECD countries over
this time period with particularly high increases in the United States, Spain and
The balance in the physician workforce between
general practitioners and specialists has changed over the past few decades, with
the number of specialists increasing much more rapidly. Although health policy and
research emphasises the importance and cost-effectiveness of generalist primary
care, on average across OECD countries, general practitioners made up only a
quarter of all physicians in 2009. There were more than two specialists for every
general practitioner in 2009, while this ratio was one-and-a-half in 1990.
Specialists greatly out-number generalists in central and eastern European
countries and in Greece. However, some countries have maintained a more equal
balance between specialists and generalists, such as Australia, Canada, France,
and Portugal, where generalists made up nearly half of all doctors. In some
countries, for example in the United States, general internal medicine doctors are
categorised as specialists although their practice can be very similar to that of
general practitioners, resulting in some underestimation of the capacity of these
countries to provide generalist care.
Fujisawa, R. and G. Lafortune (2008), “The
Remuneration of General Practitioners and Specialists in 14 OECD Countries:
What are the Factors Influencing Variations across Countries?”, OECD Health Working Papers, No. 41.