CEOM Plenary Meeting Medical Demography – Presentation of the SNAPS Working Group Luxembourg Hannu Halila Deputy CEO, Finnish Medical Association MD PhD, Specialist in Obstetrics and Gynaecology, Adjunct Professor in Health Care Administration, eMBA

Hannu Halila Disclosure Employed by the Finnish Medical Association Adjunct professor of health care administration, University of Helsinki Practicing part time gynaecologist Past-President, UEMS, European Union of Medical Specialists Member of the Rome CME/CPD Group sponsored by the Society for Worldwide Medical Exchange

Nordic Countries Already from 1954 a joint Nordic labour market for health care personnel This has been continued even after Denmark, Sweden and Finland are members of the EU This agreement allows free movement of doctors more widely than the European Union Directive on professional recognition

Nordic Medical Associations A lot of collaboration in various fields Similar cultural background Homogeneous population Swedish, Danish and Norwegian languages close to each other Health care systems quite similar

SNAPS A working group of the Nordic medical associations dealing with workforce prognosis and specialist training issues Founded in 1976, first report in 1978 Reports in Swedish language, a small leaflet, Physicians in the Nordic countries, in English also

SAM N ORDISK ARBETSGRUPP FÖR PROGNOS- OCH SPECIALISTUTBILDNINGSFRÅGOR

SNAPS

Meetings yearly, reports every two years Meeting place rotates between the five countries as well as leadership of the group The group discussed the future the prognoses work in its meeting in May 2015, full extensive printed reports perhaps not possible to publish anymore in the future, ather collection of the national prognosis reports in English in Internet

SNAPS Prognosis for Medical Manpower Various different factors used in the prognosis of workforce supply: Current workforce Average age in the beginning of medical studies Medical education Dropout rate during studies Retirement Mortality during working life Part-time work Yearly working time Proportion of doctors outside the workforce or in other sectors Migration of doctors (immigration and emigration)

Demand of Doctors Traditionally the five countries have used different scenarios for doctors’ demand One model is based on constant physicians/population-ratio The other model is based on estimation of economic growth and the growing need of doctors

Example :SNAPS 2008 Prognosis Demand of Doctors FinlandIcelandNorwa y Sweden Alternative A (economic growth) 0.5 %0 %2.7 %1.6 % Alternative B (increase of population) 0.3 %1.06 %2.1 %*0.4 %

Example :SNAPS 2008 Prognosis Supply and demand (surplus + shortage –) FinlandIcelandNorwaySweden ABABABAB 2007–900 00–400 – –500– –2350– – –4400– – – – –2000–200 Alternative Aeconomic growth Alternative Bpopulation growth

Finland - The assumptions of the model The length of basic medical training is 6 years, drop-out rate is 5%. Proportion of female students is expected to stay at 60%. The percentage of physicians working in their profession is 93% for male physicians and 87% for female physicians. About 14% of men and 23% of women are working part-time, 60% of full-time work. An average physician is expected to have a working life of 38 years. The retirement age is 65 years. About 50% of physicians continues working after reaching age of 65. Net migration of physicians is + 60 per year.

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Tilastotietoja lääkäreistä ja terveydenhuollosta 2014 | Statistics on physicians and the health care system

The demand of doctors is much more difficult to estimate than the supply Historically the supply of doctors has been quite accurately predicted but the demand has changed very much even at short intervals The most difficult factor to predict is the economic growth and the possibilities of national governments to invest in health care

Migration of Doctors Within the Nordic Countries Traditionally this has been quite active because of similar languages and health care systems SNAPS prognosis has helped in predictions: one country may predict shortage of doctors and another surplus of doctors which is balanced by migration

SNAPS prognosis work has also been as a model for national predictions of the Nordic countries and has helped in the discussion about the future need of doctors and the number of new medical students SNAPS model is quite well-known even among national governments in the Nordic countries SNAPS working group is a useful network for exchange of information of the developments in the different Nordic countries

Kiitos! Tack!Thanks ! Merci! 34