Physician workforce planning and the transition to primary health care in former socialist countries

Abstract

With the collapse of the Soviet Union, countries in Eastern Europe and the Newly Independent States inherited a physician workforce that was often too large, dominated by specialists, and poorly prepared for the transition to primary health care and the addition of the family/general practice specialty. We examine attempts in selected countries to plan the future physician workforce, while attempting to reduce the size of the workforce and train physicians to lead the transition to primary health care (PHC). We look the impact these efforts have had on the current workforce and will have on the future physician workforce. With few exceptions, the first move after independence was to reduce the inputs into the physician workforce in an attempt to reduce the size of the workforce, considered large by western standards, in 1990 between 350 and 400 per 100, 000 population compared to the EU average of 299. These reductions often did not result from planning and ignored the lengthy physician training process, leading to concerns for the future supply of physicians and the conclusion that many other factors were influencing the number of physicians. At the same time, two methods were being employed to rapidly prepare physicians for PHC, retraining of existing physicians for the short-term and the establishment of training programs in the faculties of medicine to train family/general practitioners (GPs) for the long-term. GPs per 100,000 population remained at about 102 throughout the period in the original EU countries, but in the new EU countries went from 51 in 1991 to 63 in 2002. The success of the programs was varied and often depended on the overall organization of the physician workforce, the status of the new family physician within the workforce and the commitment at the national level to the transition to PHC. After over a decade of independence, there is still a struggle to have a physician workforce with the right numbers, the right specialty mix, and practicing in the right locations.