It’s not just Hungary that doesn’t have enough GPs, other European countries are struggling with the problem too

Europe is facing a shortage of doctors in all specialties. The shortage of general practitioners is a particular problem. GPs are ageing, they are unevenly distributed between different regions and the profession is not attracting the young people who could be its supply.

In Hungary, the ageing of general practitioners and the high number of vacant practices are a serious problem. Although the situation in Hungary is clearly acute, many other countries in Europe face similar problems. General practitioners are traditionally the “first line of defence” in European healthcare, examining patients and referring them to specialists when necessary. But in many European countries, the profession is under double pressure: while the population is growing and ageing, GPs themselves are ageing and their numbers cannot keep pace with the growing demand.

A general shortage of GPs

The problem has multiple and complex causes and is becoming increasingly widespread. “There is a shortage of GPs all over the world,” explains Tiago Villanueva, a Portuguese GP and President of the European Union of General Practitioners (UEMO) 2023-2026. He sees this as a problem that affects the whole of Europe.

It is not just about pay […] and working conditions,” he argues, citing Norway and Denmark as examples. Despite high living standards and good wages, these countries are struggling with a shortage of GPs.

Tiago Villanueva cites other factors that may play a role. These include the lower prestige of general practice compared to specialist training (especially in higher education), the difficulty of the work, long travel times and the fact that the shortage mainly affects poorer and less attractive regions. The World Health Organisation (WHO) report 2023 summarizes the situation in this way:

A shortage of general practitioners is already and is expected to continue in many countries, which may be exacerbated by the ageing of primary care doctors and the increasing number of women, who are more likely to work part-time.

The report also highlights “the inequalities in the geographical distribution of primary care health professionals, particularly between rural and urban areas”.

Data collected for this article is fragmented. Each country has a different way of recording the GP workforce, making it difficult to produce a comparable set of data. In this study, we focused on GPs who had a verified practice in the reference year (unless otherwise indicated).

In some countries, GPs are not the only primary care providers. This is the case in Germany (where internists may also provide such work) and Greece (where pathologists are also involved in primary care). For this reason, our graph does not show all primary care providers in these countries. Unless otherwise indicated, the data also do not take into account additional health workers who are entitled to provide the same type of care, such as medical assistants or doctors in training as specialists.

In Hungary, the number of general practitioners is recorded by the KSH, 4427 in 2022 and 4305 in 2023. So, according to the KSH, there are about 0.46 general practitioners per 1000 Hungarian inhabitants in 2022 and 0.45 in 2023. The OECD also compiles statistics on the number of GPs per 1000 population, and according to these figures the situation is slightly better, and the ratio was 0.69 in 2022, the last year available. The differences may be due to the fact that, as with European sources, each statistic uses slightly different criteria for who counts as a (practising) GP.

Double ageing

One problem is the ageing of the population. While Europe’s population is growing – estimated at 449.2 million in 2024 – the rate of renewal is much slower. The OECD annual report mentioned above describes the situation in this way:

In the EU, the proportion of people aged 65 and over was 16% in 2000, but rose to 21% in 2023 and is expected to reach almost 30% by 2050 due to longer life expectancy and lower fertility rates. This demographic change is expected to lead to a significant increase in demand for health and long-term care.

According to the OECD, in 2023 the proportion of people aged 65 and over was particularly high in Italy and Portugal. These two countries, together with Greece, Spain and Lithuania, are expected to experience a significant acceleration in population ageing up to 2050.

Ageing of doctors is also a problem everywhere

The ageing of the population is also affecting doctors in all specialties. According to the report Health Snapshot: Europe 2024: “The ageing of the medical workforce is a growing concern in many EU countries, with a significant proportion of doctors close to retirement age and a significant number already beyond. In 2022, more than a third (35%) of doctors working in EU countries were over 55, and in nearly half of EU countries this proportion reached or exceeded 40%. The biggest problem is faced by Italy and Bulgaria, where more than half of doctors are over 55 and more than a fifth are over 65.”

We will have serious problems in the next ten years – worries Tiago Villanueva. “What happens when the experienced generation retires? Will the number of young doctors entering the health system be enough to compensate for the significant loss of the profession?” he adds.

In Belgium in 2021, 2 545 general practitioners were over 65, according to data from the Federal Public Health Service, accounting for almost 20% of the total workforce. In the same year, there were 2 737 GPs aged between 25 and 34 – just over 21%. Retirements are particularly worrying as the new generation – which is placing greater emphasis on a balanced lifestyle – may not be able to fully make up for this decline.

Today we estimate that it takes two young doctors to replace one retiree – says Elodie Brunel, Vice-President of the Société Scientifique de Médecine Générale (SSMG). One new doctor may not be enough to replace a retiring specialist. Determining the optimal patient-doctor ratio is not easy. It can vary from country to country and from situation to situation. We estimate that 800-900 patients per doctor per year is the threshold above which it is difficult to provide adequate care – says Elodie Brunel. But this does not take into account the uneven regional distribution of GPs – a problem that is widespread across Europe.

Regional distribution

It is not only in Hungary that GPs are not attracted to rural practices. In France, the term déserts médicaux (medical deserts) is widely used to refer to areas (often rural regions) where access to healthcare is limited. The Medical Demographic Atlas 2022, compiled by the French Medical Association, summarizes the situation in this way:

In terms of numbers, general practitioners in regular practice are more numerous in the most densely populated departments. At the same time, there is a kind of empty belt from the north-east to the south-west of France, where the number of GPs in regular practice is low. These departments are often sparsely populated.

The central departments of France are steadily losing GPs, while the Atlantic coast and the overseas territories are seeing an increase. Since 2010, the number of GPs has fallen in 84 of the 101 departments in France, according to the French Medical Association.

Where does Hungary stand?

In Hungary (depending on the source and the year) there are between 0.45 and 0.69 general practitioners per 1000 inhabitants. This puts us in the middle to back half of the European field, although as mentioned above, exact comparisons are very difficult because of the different registers.

No panacea

The WHO 2023 report mentioned above proposes a number of solutions to address the shortage of doctors. These include: prioritising general medicine in higher education through internships or training; improving wages and working conditions; and better understanding of health care so that crises can be anticipated and managed.

There is no single ‘magic bullet’ to make primary care more attractive, but rather a continuous evolution of different models is needed – says the report.

“Based on an analysis of the local context, elements of primary care models need to be developed and/or adapted to local needs – taking into account the expectations of medical students, primary care workers, patients and society as a whole.”

The President of the European Union of General Practitioners (UEMO), Tiago Villanueva, is cautious about promoting training for GPs. “Governments often opt for ‘negative policies’,” he says with concern. They prefer to resort to measures such as increasing the number of students in medical schools or expanding training in general practice. They simply try to increase supply. […] Because if you increase supply, you offset demand, right?”

According to Villanueva, this should be accompanied by “positive policies” – measures to make the profession more attractive to young GP candidates and to ensure the long-term retention of the workforce. If you don’t make the profession more attractive, you might let more doctors into the system, but they won’t be GPs. They will choose another specialty or leave the country.

Original source: https://hvg.hu/eurologus/20250301_haziorvos-orvoshiany_adatujsagiras.