Belgium’s shortage of General Practitioners: a slow-burning crisis

“I have a practice and it’s off to a good start – I’m happy about that. But at the same time, in two or three years’ time, I wonder what it’s going to be like.” Alice (not her real name) is a young general practitioner (GP, or family doctor). In search of open spaces and a more “old-fashioned” way of practising her profession, she chose to settle in the Ardennes region of southeastern Belgium. She fell in love with the place and its people, and decided to stay. She is aware of the difficult situation in the region, which is short of doctors. For now, Alice is trying to reconcile a balanced lifestyle with the need to welcome new patients. But she’s worried: “At some point, we’re going to have to close the floodgates and stop accepting all the patients who turn up.”

To be a GP in a region where there is a shortage of doctors is to play a rewarding role in the life of often vulnerable communities. It also means carrying out a wide variety of medical procedures. But there are drawbacks too: remoteness, difficult working hours and the need to relocate one’s life. These are all things that might put off young candidates, explains Alice. The result: doctor shortages.

Elodie Brunel is vice-president of the Société Scientifique de Médecine Générale, a professional body representing GPs. She agrees that difficult working conditions are putting pressure on GPs’ numbers. “The younger generation of doctors is demanding a better work-life balance and does not want to work the same hours as doctors of the previous generation”, she says.

Another problem, according to Brunel, is the quota of official registrations allocated to healthcare professionals on graduation (known in Belgium as INAMI numbers). These are unevenly distributed between general practitioners and specialists, to the advantage of the latter. Brunel acknowledges that there are shortages in all specialisations.

A European problem

In Belgium, the Europe-wide GP shortage is particularly acute in the majority-Francophone south of the country. In 2023, the planning commission of the federal public-health service published a study tracking the change in the number of Belgium’s doctors between 2017 and 2021. The document, based on data from several official sources, provides an exhaustive description of the situation. A similar study exists for the period 2004-2016.

In 2021, Belgium had 12,841 GPs working in healthcare: 1,325 in the Brussels-Capital Region, 7,323 in the Flemish Region and 4,157 in the Walloon Region. 36 are considered to be living abroad or have no known profile. With a population of 11,521,238 that year, Belgium is well above the average medical density for the countries studied: 1.1 GPs per 1,000 inhabitants, compared with an average of 0.75 for other EU countries, according to our partial figures.

Medical density (at national and regional level, as is the case in this article) gives an overall idea of the number of practising doctors, but it is an imperfect indicator. It does not reflect the uneven distribution of doctors across the country. This is a very real challenge in Belgium on both sides of the language border. Half of the communes in Wallonia are now considered to have a shortage of doctors. Inequality in access to primary healthcare is a widespread problem across Europe. In its report Health at a Glance: Europe 2024, the OECD (a transnational research body) notes: “In many countries, the main concern about doctor shortages has been the growing shortage of general practitioners, particularly in rural and remote areas, which limits access to primary healthcare.” The report mentions Lithuania, Latvia, Hungary, Slovakia, Slovenia and France as countries with particularly striking rural-urban disparities in medical density.

Time bomb

The shortage of doctors poses a threat to the Belgian healthcare system. In 2021, 19.81 % of practising GPs (2,545 in number) had reached or passed (in some cases well passed) the retirement age, set at 65 at the time. What will happen when all these essential doctors are no longer working? Will there be enough replacements to make up for the shortfall? “Today, it is estimated that it takes two young people to replace a doctor who retires”, points out Élodie Brunel. Given that some doctors continue to practice after reaching retirement age, and that others may take long periods of leave for other reasons, it is hard to know how many GPs will actually stop practising. For the year 2021, the federal health service estimates the number of retirements at 234, cautioning that the figure may be an overestimate.

Belgium is not the only European country facing an ageing workforce of doctors. The problem is widespread throughout Europe, but the particular situation varies from country to country. In 2022, more than a quarter of Italian doctors (all specialities combined) were aged over 65, according to partial Eurostat data. This was followed by Hungary (22.38 %), Estonia (22.29 %), Czechia (22.10 %) and Cyprus (20.69 %). In all, 12 of the 21 countries studied have more than 15 % of their doctors aged over 65. Conversely, Malta is the EU country with the highest proportion of doctors under the age of 35 (1,098 practitioners, or 46.05 % of its total workforce). It is followed by Romania (34.62 %), the Netherlands (29.65 %), Croatia (27.37 %) and Lithuania (25.73 %).

Encouraging rather than forcing

Several avenues are already being explored to combat the doctor shortage, but no miracle cure is on the horizon. Belgium has many useful initiatives: financial support, job perks, help with group practice or training of assistants who might take on some of the workload, among other things. But they do not address the root of the problem.

In 2023, the regional government of Wallonie-Bruxelles chose to replace the traditional medical entrance exam with an open competitive process. The goal was to tackle the shortage of doctors in French-speaking Belgium. That same year, 1,543 candidates were admitted to medicine, almost twice as many as the previous year, when 869 aspiring doctors passed the entrance exam.

Elodie Brunel, of the GPs’ representative body, is circumspect about “gross” increases in the number of students on higher-education courses. “Yes, we need to increase the number of students, but we must do it qualitatively”, she says. “At the moment, there are limits to what can be done in universities.” Increasing the number of students will require a capacity to provide quality teaching and decent infrastructure.

“I remain convinced that coercion will not work”, says Brunel. “You can’t force people to go and work in places with shortages.” In her view, other avenues could be explored, such as more advantageous tax arrangements, a rethink of the on-call system, or traineeships in shortage-hit areas. “We shouldn’t impose things, but rather encourage people.”

“In ten years’ time, if the situation doesn’t improve and the shortage worsens, I wonder whether I’ll have the shoulders to stand this pace of life for 40 or 50 years”, says Alice from her practice in the Ardennes. In reality, the crisis is already here. “I have colleagues […] who are 76-77 years old and still haven’t retired. I think that is partly because they don’t dare let go of their patients because they don’t know where [the patients] will go for treatment.” Ten years seems both a long time and very short.

Original source: https://voxeurop.eu/en/shortage-doctors-crisis-belgium/