Europe is short of General Practitioners

Traditionally, general practitioners (also known as primary-care doctors or family doctors) have been the “first line of defence” when it comes to health. They examine people who are unwell and refer them to a specialist if necessary. In many European countries, the profession seems to be caught in a double bind: the population is growing and ageing, while GPs themselves are ageing and their numbers are struggling to keep pace.

A blanket shortage of GPs

The causes are numerous and complex, and the situation is becoming pervasive. “There are shortages of GPs all over the world,” explains Tiago Villanueva, a GP in Portugal and president of the European Union of General Practitioners (UEMO) for the period 2023-2026. He sees this as a Europe-wide problem, both within and outside the EU. “This means that it’s not just a problem of pay […] and working conditions”, he argues, citing as examples Norway and Denmark. Despite a high quality of life and good wages, both these countries are also facing shortages.

Tiago Villanueva mentions other factors that may play a part. These include a low regard for generalist medicine compared to the specialist variety (particularly in higher education); the difficulty of the job; long travel times; and the fact that shortages are often in poorer and less desirable regions.

A report by the World Health Organisation (WHO) in 2023 summarises the situation: “Many countries are facing current and/or projected shortages of general practitioners, which may be exacerbated by the ageing and feminisation of the primary-care workforce, with female general practitioners more likely to work part-time”. The report also mentions “imbalances in the geographical distribution of primary healthcare professionals, mainly between rural and urban areas”.

Using the – very partial – data we have been able to retrieve at European level, it’s possible to sketch a picture of the situation in several countries.

Methodology

The data collected for this article is fragmentary. Each country counts its GP workforce differently, so creating a body of comparable data is complicated. For the purposes of this survey, we have chosen to focus on GPs confirmed as being in practice in the reference year (unless otherwise specified).

In some countries, GPs are not the only doctors who provide primary care. This is particularly the case in Germany (for internists) and Greece (for pathologists). As a result, our graphic does not show the full range of primary-care providers in these countries. Unless otherwise specified, the data also does not take into account other practitioners authorised to provide the same type of care, such as medical assistants or doctors undergoing specialisation.

The data analysed – and its sources – are available here: Germany (German Medical Association), Belgium (Federal Public Service Public Health), Bulgaria (National Statistical Institute), Croatia (Croatian Institute of Public Health), France (Institut National de la Statistique et Etudes Economiques), Greece (Hellenic Statistical Authority), Ireland (Medical Council), Italy (Ministry of Health), the Netherlands (Netherlands Institute for Health Services Research), Portugal (Order of Doctors), and Slovenia (National Institute of Public Health).

The lack of consistent data in this area was highlighted in the annual report Health at a Glance: Europe 2024 by the Organisation for Economic Cooperation and Development (OECD).

Double ageing

Another problem stems from the ageing of the population. While Europe’s population – estimated at 449.2 million in 2024 – is growing, it is renewing itself at a much slower rate.

This situation is described in the OECD’s annual report cited above: “The proportion of people aged 65 and over in the EU has risen from 16 % in 2000 to 21 % in 2023, and is expected to reach almost 30 % by 2050 as a result of longer life expectancy and lower fertility rates. This demographic shift is likely to lead to a sharp increase in demand for healthcare and long-term care.”

According to the OECD, the proportion of people aged over 65 in 2023 was particularly high in Italy and Portugal, two countries which, along with Greece, Spain and Lithuania, are expected to undergo a significant acceleration in the ageing of their populations between now and 2050.

The ageing of the population also holds true for doctors themselves, across all specialisations. The report Health at a Glance: Europe 2024 states: “The ageing of the physician workforce is a growing concern in many EU countries, with a substantial proportion of doctors nearing retirement age and a non-negligible number already beyond it. In 2022, over one third (35%) of doctors across EU countries were over 55 years old, with nearly half of EU countries having this proportion reach 40% or higher. Italy and Bulgaria are the two EU countries facing the most pressing concerns, with more than half of their physician populations aged over 55 and more than a fifth aged over 65.”

“We’re going to have major problems over the next ten years”, worries Villanueva. What will happen when the old guard retires? Will the influx of young doctors into healthcare systems be enough to compensate for the loss of a large chunk of the profession?”

In 2021, there were 2,545 general practitioners aged over 65 in Belgium (according to figures from the Federal Public Health Service), representing almost 20 % of the workforce. In the same year, there were 2,737 GPs aged between 25 and 34 – just over 21 % of the total. Retirements are all the more worrying given that the new generation, which is more focused on a balanced lifestyle, may not be able to compensate for this decline. “Today it is estimated that it takes two young doctors to replace one on their retirement”, says Elodie Brunel, vice-president of the Société Scientifique de Médecine Générale (SSMG). To simply replace a retiring doctor with another one may not be enough.

It is hard to say what the optimum number of patients per doctor is. The figure surely varies depending on the country and the specific situation. “We estimate that 800/900 patients [per year] per doctor is the threshold beyond which it becomes difficult to function”, says Elodie Brunel. But that’s without taking into account the uneven regional distribution of the profession, a problem that is widespread throughout Europe.

Divided countries

In the EU, inequalities in healthcare provision between rural and urban areas are well known and well documented. In France, the term “déserts médicaux” (medical deserts), although disputed, has become widely used to refer to areas (often rural) with poor access to healthcare.

An atlas of medical demography in France, drawn up by the French National Medical Council in 2022, sums up the situation: “In terms of numbers, general practitioners in regular practice are more numerous in the most densely populated départements. On the other hand, an ‘arc of emptiness’ seems to be emerging from the northeast to the southwest of mainland France, with a low number of GPs in regular practice in these départements, which are often sparsely populated.” In France, the départements in the centre of the country are losing GPs, while those on the Atlantic coast and in the overseas territories are tending to gain them. Since 2010, 84 départements (out of 101) have had a shortage of GPs, according to the French National Medical Council.

EU countries are responding to these shortages. In Romania and Belgium, subsidies exist to encourage family doctors to set up practice in areas of shortage. Greece provides financial incentives for doctors who choose to specialise in general medicine or pathology. In 2020, France replaced the “numerus clausus”, a system that limited the number of students admitted to the second year of medical school and which, for some, has contributed to the shortage of practitioners in rural and high-demand areas.

No miracle cure

In its 2023 report cited above, the WHO sets out a number of solutions for combating shortages. For example: prioritizing general medicine in higher education through internships or training sessions; improving salaries and working conditions; and gaining a better understanding of healthcare delivery so as to be able to anticipate crises more effectively.

“There is not one ‘silver bullet’ primary-care model to increase the attractiveness of primary care, but rather a continuum of primary-care models”, said the report. “Based on a contextual analysis, elements of primary-care models should be developed and/or adapted to local needs and preferences of medical students, the primary-care health workforce, patients and the general public.”

Tiago Villanueva of the European GPs’ union UEMO is guarded about encouraging the training of new doctors. “Governments often choose ‘negative policies’,” he worries. “They prefer things like increasing the number of places in medical schools or training GPs. They try to increase supply, basically. […] Because if you increase supply, you offset demand, don’t you?”

In Villanueva’s view, this approach needs to be accompanied by “positive policies” – in other words, measures that make the profession more attractive to aspiring young GPs and ensure that the workforce is retained in the long term: “If you don’t make the profession more attractive, then you may inject more doctors into the system but they won’t go into general practice. They’ll choose another speciality or they’ll leave the country.”

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