Doctors play a central role in health systems, and
there are concerns in many OECD countries about current or future shortages of
doctors, and the problem this might create for access to care.
Practising physicians are defined as the
number of doctors providing care to patients. Generalists include doctors assuming
responsibility for the provision of continuing care to individuals and families, as
well as other generalist/non-specialist practitioners. Specialists include
paediatricians, obstetricians/gynaecologists, psychiatrists, medical specialists and
surgical specialists. Medical doctors not further defined include interns/residents if
they are 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, Finland, France,
Greece, Iceland, Ireland, the Netherlands, the Slovak Republic 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 licensed to practice
(resulting in a large overestimation). Data for Spain include dentists and
stomatologists, while data for Belgium include stomatologists. Data for Chile are an
under-estimation as they do not cover all practising doctors.
Not all countries are able to
report all their practising physicians in the two broad categories of specialists and
generalists because of missing information.
From 2000 to 2010, the number of doctors
per 1 000 population has grown in all OECD countries, except in Estonia and Poland
where it decreased slightly. On average across OECD countries, it increased from
2.7 doctors per 1 000 population in 2000 to 3.1 in 2010. The number increased
particularly rapidly in countries which started with lower levels in 2000, such as
Turkey, Korea and Mexico. But it also increased rapidly in Greece, although all of
the growth took place between 2000 and 2008 and the number has stabilised since
In nearly all countries, the
balance between generalist and specialist doctors has changed over the past few
decades, with the number of specialists increasing much more rapidly. As a result,
there are more specialists than generalists in most countries, except in Ireland,
Norway and Portugal. This may be explained by reduced interest in the traditional
mode of practice of “family medicine”, given the workload and constraints attached
to it. In addition, in many countries, there is a growing remuneration gap between
generalists and specialists.
Virtually all OECD countries
exercise some form of control over medical school intakes, often by limiting the
number of available training places, for example in the form of a numerus clausus. In 2010, Austria, Ireland, Denmark,
Greece and the Czech Republic had the highest number of medical graduates per 100
000 population. However, in countries such as Ireland and the Czech Republic, a
large share of graduates is made up of foreign students who may return home upon
graduation. Graduation rates were the lowest in Israel, Chile, Japan and France.
The average across OECD countries was slightly over ten new medical graduates per
100 000 population in 2010, up from nine in 2000.
WHO-Europe for Russian
Federation, and national sources for other non-OECD countries.
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.