1. Manpower – who is doing the work?
Why?
How?
Problems?

2. Manpower – why? €€€€ - staff biggest cost of health care
Service planning/budgets
desired service output & standards of care?
Staff salaries make up the biggest proportion of health care budgets. The number needed is affected by the type of service planned. In our speciality that relates to numbers of procedures predicted and future trends in demographics, in disease burdens and in technological advances in therapy which can both increase and decrease the need for surgical skills.

3. Manpower – why? €€€€ - staff biggest cost of health care
Service planning/budgets
desired service output & standards of care?
Training – numbers in/out
service expansion/retirement
+ new social trends
Staff salaries make up the biggest proportion of health care budgets. The number needed is affected by the type of service planned. In our speciality that relates to numbers of procedures predicted and future trends in demographics, in disease burdens and in technological advances in therapy which can both increase and decrease the need for surgical skills.

4. Specialists Trainees Other professions
Who is doing the work?
Specialists
Trainees
Other professions

5. Who is doing the work?
Specialists:

6. Who is doing the work? Specialists: public/private CCT/nonCCT
full/part-time
EWTR?
trained & available locally

7. Who is doing the work? Specialists Trainees: full/part-time
local/foreign
EWTR
+ private/public?
Trainees may have different reasons for wanting to know about manpower. From the undergraduate stage they will want to know the competition ratios for entry into different specialities to enable career choices. Career choice will also be influenced by conditions of service and length of training.

8. Who is doing the work? Specialists Trainees Other professions:
physiotherapists
podiatrists
specialist nurses
The influence of the Allied Health Professionals varies from country to country due to legislation regarding what it is permitted for them to do. There is however a political perception that musculo-skeletal services can be provided more economically by non-doctors

9. Who is doing the work? External influences: EWTR Part time employment
Retirement
Migration
New technology
The recession!!!!!!!!!!

10. Who is doing the work? External influences:
EWTR applied variably – under review?
Part time employment - gender issues
Retirement – early/ill health/late – recession?
Migration – in & out
economic/academic/other
New technology = time + € £ $,000,000

11. What do we know? Workload 2020 – over 65s will double in number
arthroplasty – younger?
obesity?
increasing revisions?
trauma
Dunbar et al JBJS (A) 2009

12. What do we know? Femininisation: % female specialists
60% medical students
7% T & O trainees (Spain 50%)

13. What do we know?
Retirement:
60 – 70 years

14. What do we know?
Migration:
Economic
Academic
Lifestyle

15. What do we know?
New technology:
navigation
cell therapy
endoscopy

16. Manpower – who is doing the work?
Why?
How?
Problems?
YES!!!
Lag time = 6 years minimum
cannot fine tune
external graduates