Medical Specialists Analysis (EU5)

Part
01
of nine
Part
01

Pharmacist Challenges- EU5

The pharmaceutical market is a strongly regulated market with many restrictions. Challenges include price cuts by the government, the inability to expand services, medication non-adherence, and medication shortages.


A Strongly Regulated Market

  • The European Commission challenged ownership rules in the European Court a few years ago. They wanted to expand the market, but the courts stated that the restrictions placed on the number of pharmacies allowed and what they are able to exclusively sell are justified based on public health grounds. Pharmacists in Germany, Italy, and France celebrated this victory. With more and more countries favoring on lifting the restricting bans, no one knows how much longer the monopolies will remain in place. In France, pharmacists are engaged in a fierce battle with their own competition authorities to preserve the OTC monopoly. Even German pharmacists are pessimistic about the chances of excluding chains in the future.
  • Critics of the market state that tradition limits customer choice and inflates prices. The EU has pushed to deregulate services for years, which account for 70% of the bloc’s gross domestic product and 90% of its jobs, arguing that doing so could expand the bloc’s economy by almost 2%. The EU in 2010 fined France’s order of pharmacists $5.7 million for cartel activities in the clinical laboratory market.

Price Cuts

  • With the economic issues facing the EU, many governments have slashed pharmacy budgets. They are not directly cutting payments to pharmacists, but they are driving down the prices of medicines, especially generics. Price cuts are a big problem if the pharmacy relies partly on discounts.

Inability to Expand Services

  • The UK is very similar to the US market, with pharmacists providing community services like blood pressure checks, but in the rest of the EU that is not the case. There are legal restrictions that prevent them from doing anything other than dispensing medication. As curious as that sounds, it comes from a strong opposition of physicians. They are paid on a per visit basis usually and do not want pharmacies cutting into any of their billings.
  • The Pharmaceutical Group of the European Union (PGEU) is the association representing Europe’s community pharmacists. With the aging population and increased need for medical services, coupled with a physician shortage, they are advocating for a change in the pharmacist's role. This role would be more patient centered and place the pharmacist on the care team fort he patient.
  • Community pharmacy could provide the entry-point into the health service, with the community pharmacists acting as a preventive care provider (e.g. screening for chronic diseases) and reliable, rapid diagnostic testing (e.g. for the presence or otherwise of bacterial infections). There are also opportunities; community pharmacists could increase their support for managing minor and self limiting ailments, act as health educators, collaborate more closely with care and / or nursing homes and managing the medication of polypharmacy patients.

Medication Non-Adherence

  • According to the PGEU, medication non-adherence costs the EU $1.35 billion per year in direct and indirect costs. There are 194,500 deaths yearly from not taking medication correctly.
  • 69% of medication-related hospital admissions are due to poor adherence.
  • 50% of new statin patients will stop taking their medication after 6 months.

Medication Shortages

  • A continuing challenge is meeting patient needs for medication when there are shortages. The European Association of Hospital Pharmacists (EAHP) has called for action on medication shortages since 2012 and it published the first Europe-wide survey on the topic in 2014. Many of the actions called for at that time are currently underway, with increased research on the topic in an EU-funded initiative, the COST Action on medication shortages1 and actions at national level supported by the European Medicines Agency (EMA) and the Heads of Medicines Agencies.
  • "EAHP believes that there is an increased risk of medication shortages in 2019 and 2020 because of the manufacturing changes required by the Falsified Medicines Directive and because of Brexit. Many marketing authorizations need amendments because of medications authorized for use in Europe through the UK medicines agency (MHRA). As it is believed that this agency will not be part of the European network post-Brexit, pharmaceutical companies need to examine their marketing authorizations to ensure these are valid for Europe post-Brexit."

Oxford Community Pharmacist Study- France

  • Oxford University carried out a community study of challenges that pharmacists faced when dispensing drugs. Out of 165 difficulties in 145 total prescriptions, the most common difficulties encountered were:
  • Quality of prescribing form- 60.6%
  • Name of physician unspecified- 62%
  • Failure in supply chain/logistics- 32.7%
  • Drug or medical device out of stock at the community pharmacy- 77.8%
  • Date of the prescription missing- 10%
  • Drug or medical device out of stock at the manufacturer- 5.6%
  • Drug or medical device not reimbursed under French public plans- 3.7%
  • Drug or medical device ceased to be marketed- 3.7%
  • Insufficient quantity prescribed- 3.7%
  • Drug prescribed twice- 1.9%
  • Drug marketed in a foreign country, but not France- 1.9%
Part
02
of nine
Part
02

Pulmonologist Challenges- EU5

Pulmonologists in the EU deal with EHR challenges, too many rules and regulations, long hours, unfair reimbursement. Their biggest concern is getting more of their patients to not smoke. Throughout all the research this was the one specialty that did not mention burnout as a challenge.

Facts

  • Mortality from respiratory related diseases is the third leading cause of death in the EU. The main causes of death from respiratory diseases are chronic obstructive pulmonary disease, pneumonia, asthma and influenza.

EHR Challenges

  • 34% of pulmonologists state that working with electronic health records is the most challenging aspect of their job. Further research on these challenges directed back to physicians, and not just pulmonologists.

Rules & Regulations

  • 19% of pulmonologists say that the number of rules and regulations is a challenging aspect of their job. Further research on these challenges directed back to physicians, and not just pulmonologists.

Long Hours

  • 14% say the long hours are challenging. Further research on these challenges directed back to physicians, and not just pulmonologists.

Unfair Reimbursement

  • 13% say that getting fair reimbursement is a challenge. Further research on these challenges directed back to physicians as a whole, and not just pulmonologists.

Patients That Smoke

  • A recurring theme is the frustrations with patients that smoke and refuse to quit. Tobacco consumption is the largest avoidable health risk in the EU.
  • Almost 20% of adults in the EU smoke daily, despite public education.
  • Death rates from respiratory diseases are on average 85% higher among men than among women in all EU countries. This is partly due to higher smoking rates among men. Smoking is an important risk factor for chronic obstructive pulmonary disease and other respiratory diseases.
  • In May 2016, the new Tobacco Products Directive became effective in all EU Member States. This directive particularly targets adolescents and young adults, as 25% of 15-24 year olds in the European Union are smokers (Pötschke-Langer, 2016). It bans flavored cigarettes, makes larger health warnings (image and text) on packages mandatory, and introduces safety, quality and packaging regulations pertaining to e-cigarettes.

Research Strategy

Pulmonology had the least amount of research out of all the disciplines. Focusing just on the EU, we were able to locate the information on smoking patients. After expanding to a global focus we discovered a survey of pulmonologists where they shared their biggest challenges. Using these statistics, we researched each individual challenge that the pulmonologists shared in the hopes of discovering more information. Each time we were led back to challenges of general practitioners or other specialties. We did not include this information as it would be a duplicate of the other projects.

Part
03
of nine
Part
03

Oncologists Challenges EU5

Oncologists face issues of burnout, intense emotional challenges, treatment issues, increased patient flow, and a drive for distinction. It has been suggested that more support in the workplace, especially emotionally, would help to alleviate some of the issues they face on a daily basis.

Burnout

  • In a study of young oncologists in Europe, 71% showed evidence of burnout. 40% of current oncologists are 40 years old or younger.
  • There were signs of depersonalization (50%), emotional exhaustion (45%), and low accomplishment (35%). Men had higher depersonalization scores than women.
  • 22% reported they requested support for burnout during training and 74% reported no access to hospital support services.
  • Factors that attributed to burnout were work/life balance, access to support services, living alone, and inadequate vacation time.
  • The study concluded that raising awareness, support, and interventional research are needed. Another study indicated there should be peer networks for support and workplace debriefing to ensure longevity in the specialty.
  • Some consequences of burnout include substance abuse, depression, suicide, medical errors, professional misconduct, leaving the specialty, and a significant impact on the quality of patient care.

Emotional Challenges

  • On a daily basis, oncologists must interact with patients at one of the worst points in their life. They do it over and over, every day. To complicate matters, they not only get to know the patients, but their families. It is very difficult for them not to suffer when their patient does. When they lose a patient after being so invested, it is impossible for this not to have a profound effect.
  • Some have equated the effects to having untreated recurrent PTSD. Their schedule offers them very little time to process the grief and sadness since they must move onto the next patient.
  • One of the key issues these professionals face with the emotional challenges and burnout is that there are so many barriers to treatment in terms of licensing, discrimination, hospital privileges, and advancement. Due to these issues many just remain quiet.
  • In one study it was reported that out of 381,614 residents in training, 324 physicians died during their residency. Suicide was the second leading cause of these deaths overall and the top cause for men. Things as simple as distress questionnaires that the doctors fill out and then have them returned with explanations and suggestions have been found to be helpful.
  • For experienced oncologists, it is a constant struggle to not take their job home with them. After spending their days handing out bad news and complicated treatment protocols it can be frustrating, when sometimes all they want to do is comfort a patient like they would a friend. If they lose the patient after trying their very best, it is difficult. One study described the struggle as a tension between importance of intimacy versus the art of detachment.

Treatment Challenges

  • Many of the prescribed treatments cause quite a bit of suffering for the patient. Chemotherapy can cause vomiting, nausea, and large amounts discomfort. The oncologist must constantly try to pick the lesser evil.
  • The treatments are complex with constant new options being offered. Prices rise just as quickly as new options arrive. These growing prices can simply put treatment out of reach for some patient in Europe.
  • More than 27% of patients in Eastern Europe did not have access to first line treatments due to their cost, in a study performed by the European Cancer League. Only 47% of the patients had their treatment costs reimbursed. This challenge presents the oncologist with very difficult decisions as they sometimes cannot use the best treatment but must use a treatment that is affordable. Biosimilars making it to the market quicker could alleviate some of the affordability issues. To complicate these matters, sometimes these new drugs fail to produce meaningful results for the patient.

Drive for Distinction

  • A study was completed that attempted to identify emergent themes in the workforce. The job has intensified over the years creating higher benchmarks for success. There is an emphasis on attaining distinction through achievement.
  • This new trend has taken what was once considered a safe specialty and made it one without guarantees of retirement "The core dynamic within this group of participants was multifaceted and centered on: the drive to distinction, largely through gaining substantive research credentials or higher qualifications; the paucity of jobs and opportunities; and, the constant reviewing and questioning of oneself in order to “keep up”. "

Increase in Patient Flow

  • The volume of cancer patients in recent years has increased. This field is a time intensive field in regard to patient interactions. Some doctors feel they are "cutting corners" to just make it through their daily roster. Their lack of time is dictating the level of patient car they can give.
  • They feel this pace is unsustainable and will lead to other issues like reduced patient care and burnout for the oncologist.

Research Strategy

Many studies were conducted in Europe instead of one specific country. Considering it was established that the EU5 comprises the majority of the doctors in the EU, it would make sense that these studies would be reflective of the issues that an Oncologist faces in the EU5. Additionally, some global personal stories from oncologists have been shared, as their chief concerns transcend geographical borders.
Part
04
of nine
Part
04

General Practitioner Challenges- EU5

Rules, regulations, administrative tasks, electronic health records, and a changing population to care for are all challenges that GPs in Europe face daily. They are also at risk for burnout, which is a recurring theme in this research.

Rules & Regulatory Challenges

  • Doctors in Europe feel the amount of rules and regulations have become a big challenge.
  • In the UK they are already experiencing shortages of doctors. To make matters worse, hundreds of overseas doctors are considering quitting the NHS in protest at being charged thousands of pounds a year for visas and healthcare in order to work in the UK. "Dr Siti Ibrahim, a trainee GP in Yorkshire who is originally from Malaysia, will have to fork out £11,400 this August — if she decides to stay. That is made up of £4,200 for a new visa for three years and three years’ advance payment of the IHS for herself and her husband and four children. "
  • Governments in Europe have tightened policies towards reimbursement and pricing. When polling doctors, they feel that the policies are overwhelmingly unfavorable. These budgets are also impacting spending of pharma. The GDP spend on pharmaceuticals has decreased from 1.5% in 2010 to 1.36% in 2016.

A Changing Population To Treat

  • By 2030, 25% of the EUs population will be aged 65 and over, up from 19% in 2015. This aging of the population equates to more healthcare needed to deal with more chronic diseases that are more prevalent.
  • Chronic diseases are on the rise, also requiring more treatment from their healthcare professionals. From 2018 to 2040, cancer is predicted to increase by 23%. By 2045 the number of people in Europe with diabetes is predicted to increase by 16%, yet Europe is facing a shortage of doctors.

Electronic Health Records & Administrative Tasks

  • Those in independent practices feel that administrative tasks take away from their patients. Increasing demands on provider time, and electronic health records are a pain point with GPs. They feel it is impacting their quality of care.
  • According to a study in the Annals of Internal Medicine, physicians spent just 27% of an average day or shift with patients, while nearly 50% of their day was spent on electronic health records and other “desk work”.
  • Health information technology tools such as electronic health records (EHRs) have the potential to significantly improve care delivery and patient outcomes. However, physicians who have adopted EHRs continue to struggle to effectively use these systems because of the difficulty of dividing their time between the patient and the computer. The average GP can spend 30-50% of a patient encounter looking directly at the EHR. Finding a balance between effective care and effective use of EHRs would greatly help this challenge.
  • To deal with the time that EHRs take, it is recommended to hire a scribe and to take any training offered that will help make the process easier.

Burnout

  • Job burnout could be one of the biggest challenges that GPs face, and a theme seen across all medical specialties.
  • According the NEJM Catalyst survey, 83% of clinicians and healthcare leaders believe that burnout is a serious or moderate problem in their organization.

Research Strategy

Many studies were conducted in Europe instead of one specific country. Considering it was established that the EU5 comprises the majority of the doctors in the EU, it would make sense that these studies would be reflective of the issues that an GP faces in the EU5. Additionally, some global stories have been shared, as their chief concerns transcend geographical borders.
Part
05
of nine
Part
05

Medical Professional Psychographics- EU5

A psychographic profile for medical professionals (doctors and pharmacists) has been compiled. This psychographic has focused more on professional traits, values, and interests, than personal traits.

Personality Traits

  • The physician feels there is a distinctive trade off when dealing with pharmaceutical companies coming into the office. On one hand, they can learn about new products, but on the other hand, they lose valuable time with patients. Furthermore, they are likely to be loyal to a company and prescribe more prescriptions from that pharmaceutical company.
  • The physician, when searching for pharmaceuticals feels that their colleagues, conventions, meetings, and conferences are the best way to obtain information, in that order. Information they find on the internet is viewed as complimentary.
  • If the physician has a specialty, he or she strongly identifies by that title.
  • Being a physician is the core of their identity. Some put off retirement because they fear a loss of purpose.
  • More than half of this group lives with stress, and 10% have had to take time off in last year to combat the stress.
  • In a US survey it was found that 40% of doctors marry other doctors.
  • Overall, doctors would gladly choose their profession again if they had the chance.

Values

  • The doctor knows that he or she must do what is best for the patient, but sometimes this comes into direct conflict with personal values. Therefore, they must learn to accept that even though a task might go against their values, for instance abortion, they are still acting in the best interest of the patient.
  • GPs in the UK tend to be the most satisfied with their work-life balance.
  • In France, frustration over the public hospital funding and staffing levels, have left doctors quite frustrated. They are very concerned about the quality of care and the safety of their patients. 1,200 doctors recently resigned from supervisory roles over these issues.
  • Overall, they feel they are performing their job well. French doctors report a very high level of feeling they are very good at what they do and find it rewarding (62%).

Hobbies/Interests

  • Medical professionals tend to work 40-60 hours per week, leaving little time for hobbies or outside interests, even though they are widely recommended for preventing burnout. Consequently, there were no profiles that shared personal hobbies.
  • An American survey from the American Medical Association took a survey on the most popular activities. 58% enjoyed book reading, 46% gourmet cooking, 43% walking for health, 39% attending cultural or art events, 36% running or jogging, and 31% enjoyed bicycling. These statistics are very likely to apply to medical professionals in larger European countries like those in the EU5 also, considering that similar personality types choose to be doctors regardless of geographical boundaries.

Spending/Money

  • This group most likely has disposable income.
  • Retirement saving are a top concern. They have racked up debt obtaining their education and surprisingly can be behind in their retirement goals.
  • The majority of doctors feel they are not fairy compensated. German doctors have the most satisfaction with their salaries (44.5%), while doctors in Spain are very unhappy with salaries (14.5% feel they are fairly compensated).
  • Europeans are much more likely to have a savings account and save 10.5% of their disposable income compared to the US (0.8%).
  • They are also less likely to buy on credit, when compared to Americans. In Germany and France the average credit card usage is a year is $64 and $30 respectively. Whereas in the US, that number skyrockets to $5,500.
Part
06
of nine
Part
06

Social Media on Online Habits of Medical Professionals (EU5)

Medical professionals are leery about interacting with patients on social media due to regulations and the increased risk of malpractice. They do enjoy using social media for their personal life.

Personal Use

  • In a survey conducted amongst European doctors, most use social media privately. 95.4% report checking them once a day. The median time spent on social media sites during a typical working day was 120 minutes.
  • 20% have received a friend request from a patient.
  • The typical age group that was identified in the demographics prefer Facebook (86%), Instagram (45.9%), and Twitter (24.5%).
  • 56% believe there is too much advertising on social media.

Professional Use

  • Females and physicians used social media more for professional purposes than did residents. Male physicians used social media less for educational and learning purposes, and instead used it for personal reasons and leisure.
  • 30.5% have communicated with patients through email.
  • 60.8% are comfortable with their patients using online forums to access information about them before a visit.
  • 65.8% are hesitant to immerse themselves more fully on social media and online communications due to worries about public access and legal concerns.
  • 47% of physicians state they have posted, followed, or communicated with colleagues on professional social networks.
  • 18% of all doctors say they value professional Social Communities/Networks as a source of information. The majority of these doctors are female and under the age of 45.
  • 65% believe that social media increased their job performance and increased the quality of patient care.
  • On Twitter, the most posts come from Anesthesiologists and Emergency Medicine doctors. On SERMO, endocrinologists and doctors of internal medicine make the most posts.
  • SERMO is the most popular site to get second opinions and have social conversations. SERMO, a doctor-only site, gives the doctors a sense of safety since they can post anonymously if they choose, plus they are not visible to the public on this site.
  • 88% of physicians will use the internet to research into pharmaceutical, biotech, and medical devices.
  • 76% utilize mobile devices in their place of practice.
  • Pharmacists, in particular, are using social media and seeing a positive effect on their business (68%) Facebook is a popular choice to keep in touch with patients and post content that keeps them engaged.

Other Popular Social Media Websites For Medical Professionals

  • DailyRounds- This is a community of international phsycians with 30,000 members. They can chat, compare notes, share expertise, and access a drug database.
  • Figure1- This resource lets providers from around the world share images and compare them to other images and diagnoses on the website. They also have a place for professionals to discuss issues and ask for advice.
  • AmongDoctors- this networking website is similar to SERMO, but it is doctors only and they must be verified. Pharmaceutical reps are forbidden from joining.
  • IncisionAcademy- This platform is specifically for surgeons. The learning site allows surgeons to share techniques and gain new insights from other surgeons.
Part
07
of nine
Part
07

Pharmacist Demographics

The EU5 consists of Spain, Germany, Italy, France, and the UK. Individual statistics for Pharmacists have been provided for these countries. Overall, women dominate this profession and the majority work in community pharmacies.

Overview

  • There were over 450,000 pharmacists in the EU in 2017.
  • In France and Spain pharmacies must be owned by a pharmacist. Chains are banned. New pharmacies may not be established unless certain distance and population criteria are met. They also have the exclusive rights to sell over-the-counter medication.
  • Germany does not permit chain pharmacies either.
  • The UK, with fewer restrictions, offers a broader range of services to the consumer.

Number Of Pharmacists

  • France has 69,346 pharmacists with 103.7 pharmacists per 100,000 inhabitants.
  • Germany has 53,480 pharmacists with 64.7 pharmacists per 100,000 inhabitants.
  • Italy has 70,934 pharmacists with 117.2 pharmacists per 100,000 inhabitants.
  • Spain has 53,867 pharmacists with 115.6 pharmacists per 100,000 inhabitants. Over 48,000 of these pharmacists work in dispensing pharmacies.
  • The UK has 58,329 pharmacists with 88.3 pharmacists per 100,000 inhabitants. 64% work in a community pharmacy, and 22% work in a hospital setting. 13% work in settings like primary care, other or multiple settings.

Age

  • In The UK, according to a pharmacy workforce study in 2013, 21.6% were under the age of 30, 31.9% were 30-39, 22.4% were 40-49, 17.4% were 50-59, and 6.8% were over 60. This would mean that the majority (31.9%) of pharmacists today are 37-46 years old.
  • The average age in France is 50.3.
  • The average age for a pharmacist in Italy, is 25-34 years (29%) followed closely by 35-44 years old (28%). Therefore, 57% of pharmacists are between the ages of 25-44.
  • Spain did not publish the average age in any of their data that was located. A study on continuing education for pharmacists reported that the average age was 38.8 years old. This is not representative of all pharmacists, but is a good proxy.
  • In Germany, the average age is 46.2.

Gender

  • In Europe women comprise 63% of all pharmacists, men comprise 37%.
  • In the UK, 39.6% of the pharmacists are male, and 63.3% are women.
  • In France 54.7% of licensed pharmacists are women.
  • In Italy, there is an even distribution of male and female pharmacists in the community pharmacy and in healthcare facilities.
  • In Germany, women make up 70.9% of the pharmacist workforce.
  • The study of continuing education for pharmacists in Spain reported that 81% of their participants were female. This number probably is not as high for the total population, but it does fall in line with the trend of females dominating the profession.

Ethnicity

  • In the UK, 59% of the pharmacists are white, 29% are Asian, 6% black, 3% Chinese, 2% mixed, and 1% are other. Locating information pertaining to ethnicity was not reported in pharmaceutical studies by the other countries.

Income

  • In the UK, pharmacists have an average salary of $53,300-$57,000.
  • In Germany, the average pharmacist salary was $44,800
  • In Spain, the average pharmacist makes $77,510.
  • Italy, the average pharmacist makes $56,341.
  • In France, the average pharmacist salary is $73,710.

Education

  • To become a pharmacist in the UK, one must have a Master’s degree in Pharmacy and work for one year under supervision, along with passing an exam.
  • In France, one must become a “diplome d'état de Docteur en Pharmacie”. This is obtained after 6 or 9 years of study, depending on the path chosen.
  • In Italy a degree must be obtained in Chemistry and Pharmaceutical studies. This takes 5 years.
  • In Spain an advanced degree in Pharmacy must be obtained. This takes 5 years.
  • In Germany, they mention that one must obtain a degree, but the amount of time is not stated.

Average Day

  • In the UK, men work 38.6 hours per week and women work 31.9. Pharmacists under the age of 30 work the most hours (38.1). Community pharmacists spend their day (by percentage that report doing the task) providing advice to patients (84%), supplying medicines and medical devices (84%), providing advice to health care professionals (17%), clinical work (10%), managing staff (35%), and routine tasks to manage the pharmacy environment (29%). In the hospital setting responses were quite similar, but they provided more advice to health professionals (77%), less advice to patients (57%), and more time on governance and paperwork (20%).
  • While at work, the average UK pharmacist prescribes more antibiotics (39%), anticoagulants (29%), cardiovascular medications (37%), hypertension medication (36%), respiratory medications (31%), and medications for minor ailments (27%) than anything else.
  • In France, the majority of pharmacists work at local pharmacies. Their day is spent connecting with patients and working with a small team. Their success is highly dependent upon filling prescriptions, as it is 80% of their day. They see from 90-200 patients per day. They begin their day by reviewing the previous day's information. They spend 30% of their day in the back office, and 70% of their day in the front. Pharmacists in larger chain pharmacies spend a much larger portion of their day in the back office dealing with administrative duties.

Religion

  • 48% of pharmacists in the UK are Christian, 20% have no religion, 12% are Hindu, and 13% are Muslim.

Research Strategy

Every attempt was made to use the most current data available. Reporting time frames were quite different for each country, with some reporting yearly and others every five years or more. Countries also had different ways of reporting. With each country, every effort was made to locate similar information.
Part
08
of nine
Part
08

Specialist Physicians Demographics

The EU5 consists of Spain, Germany, Italy, France, and the UK. Individual statistics for Medical and Surgical Specialists have been provided for these countries.

Overview

  • These are general statistics that will apply across all medical professions.
  • Germany has 351,000 physicians, Italy has 242,000, France has 211,000, Spain has 181,000, and the UK has 186,000.
  • These five EU states account for 63.3% of the total numbers of practicing physicians in the EU-28.
  • In Germany, there are 424.9 physicians per 100,000 inhabitants, France has 305.8, Italy has 399, Spain has 387.7, and the UK has 281.1.
  • The number of specialists is growing much faster than that of GPs.

Number Of Medical & Surgical Specialists

  • France has 50,915 medical specialists and 31,756 surgical specialists.
  • Germany has 11,411 medical specialists and 97,707 surgical specialists.
  • Italy has 87,157 medical specialists and 60,467 surgical specialists.
  • Spain has 49,630 medical specialists and 44,728 surgical specialists. 635 specialists are categorized as other.
  • The UK has 46,845 medical specialists and 55,837 surgical specialists.

Age

  • Age demographics were reported for all doctors and not broken down by specialty or GPs. These figures apply to all doctors within the countries specified.
  • The rapid aging of the workforce is a concern for all countries in the EU.
  • Italy has the highest share of physicians that are over the age of 55 (55%).
  • Germany, Spain, and France also have 43-48% of their physicians in this age bracket.
  • In Italy, they are pushing to move the retirement age to 70 to combat the loss of doctors.

Gender

  • Gender demographics were reported for all doctors and not broken down by specialty or GPs. These figures apply to all doctors within the country.
  • Between 2007 and 2017, the number of female physicians generally rose.
  • 54-59% of the physicians in Italy, France, and Germany are male.
  • 51% of the physicians in the UK are male.
  • Spain is the only country of the five researched that has more female physicians than male (55% female).

Ethnicity

  • In the UK, ethnic diversity is increasing. From 2011-2015, there was a 22% increase in the number of specialists that described themselves as black and minority ethnic (BME), and an 18% increase in GPs identifying is BME.

Income

  • Specialists in France have an average income of $160,795 yearly. Specialists charge higher fees than GPs, but these rates are agreed upon with the national health service. Many specialists charge higher than the agreed upon fees. These costs are absorbed by the patient.
  • Specialists in Italy have an average annual income of $74,500. Italy does not readily provide these numbers. The annual salary for surgeons was located and used as a proxy.
  • In the UK, the average income is $108,000 for women, and $149,000 for men. Nearly all specialists in the UK are employed by a NHS hospital. They can engage in private practice in addition to being employed by the hospital. This could possibly inflate these numbers.
  • In Germany, the average income is $117,000 for women, and $172,000 for men.
  • In Spain, the average annual salary is $57,000 for women, and $68,000 for men.

Education

  • In the UK, to become a doctor one must spend 5-6 years in school. A specialty can take up to 12 additional years.
  • In Germany, it takes 6 years to become a doctor. A specialty can take up to 13 additional years.
  • In France, it takes 8 years to become a doctor and 11 additional years for a specialty.
  • In Spain, it takes 6 years to become a doctor and 2-5 additional years for a specialty

Research Strategy

Every attempt was made to use the most current data available. Reporting time frames were quite different for each country, with some reporting yearly and others every five years or more.
Part
09
of nine
Part
09

General Practitioner Demographics

The EU5 consists of Spain, Germany, Italy, France, and the UK. Individual statistics for General Practitioners have been provided for these countries, as there were some stark differences that would make an average demographic misleading. Overall, the group is aging. There are more male than female doctors and they make more money. Their days are split between seeing patients and the bureaucracy of paperwork.

Overview

  • Germany has 351,000 physicians, Italy has 242,000, France has 211,000, Spain has 181,000, and the UK has 186,000.
  • These five EU states account for 63.3% of the total numbers of practicing physicians in the EU-28.
  • In Germany, there are 424.9 physicians per 100,000 inhabitants, France has 305.8, Italy has 399, Spain has 387.7, and the UK has 281.1.
  • The number of specialists is growing much faster than that of GPs.

Number Of General Practitioners (GPs)

  • France has 60,214 GPs.
  • Germany has 58,171 GPs.
  • Italy has 43,731 GPs.
  • Spain has 35,378 GPs.
  • The UK has 49,824 GPs.
  • In France, there are 9.1% fewer GPs than there were ten years ago.
  • Italy could lose 34,000 doctors by 2028.
  • Europe could be short 230,000 doctors by 2020, meaning that 13.5% of Europe's health needs will not be taken care of. The lack of candidates with the proper qualifications is the cause of over half of the current vacant positions.
  • The UK could need 190,000 additional new doctors by 2027.

Age

  • The rapid aging of the workforce is a concern for all countries in the EU.
  • Italy has the highest share of physicians that are over the age of 55 (55%).
  • Germany, Spain, and France also have 43-48% of their physicians in this age bracket.
  • In Italy, they are pushing to move the retirement age to 70 to combat the loss of doctors.

Gender

  • Between 2007 and 2017, the number of female physicians generally rose.
  • 54-59% of the physicians in Italy, France, and Germany are male.
  • 51% of the physicians in the UK are male.
  • Spain is the only country of the five researched that has more female physicians than male (55% female).

Ethnicity

  • In the UK, ethnic diversity is increasing. From 2011-2015, there was a 22% increase in the number of specialists that described themselves as black and minority ethnic (BME), and an 18% increase in GPs identifying is BME.

Workload

  • A study was completed on GPs in the UK in regard to their workload. During the seven years the study ran (2007-2014), phone consultations doubled. Standard consultations increased on average of 12-36%. Consultation rates were highest in infants (age 0–4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. Overall, number of consultations, consultation duration, and total patient facing workload increased.
  • In the UK, GPs spend an average of 30-33 hours per week seeing patient. 57% spend between 10-24 hours per week on paperwork, while 26% spend between 1-9 hours.
  • Germany has similar numbers (32-35 hours) for seeing patients. 59% spend between 10-24 hours per week on paperwork, while 18% spend between 1-9 hours.
  • In France, the average GP spends 43-45 hours per week seeing patients. 52% spend between 10-24 hours per week on paperwork, while 37% spend between 1-9 hours.
  • In Spain, 50% of GPs spend 10-24 hours on paperwork, while 36% spend between 1-9 hours. They did not report on the hours spent seeing patients.

Income

  • GPs in France can contract with the government for a guaranteed monthly income of $8,313 if they set up their practices in a region that has a need for physicians. The average income for primary doctors in France was $108,000 in 2019.
  • GPs in Italy have an average annual income of $160,000.
  • In the UK, the average income if $131,503.
  • In Germany, the average income was $163,000 in 2019. Physicians receive an average of $254,452 annually in reimbursement from the government for patient care provided through the government health care program. This must cover costs for personnel, office space, and other costs, but does not include income from private patients.
  • In Spain, the average annual salary is $63,000.
  • In the three reported areas (UK, Germany, France, and Italy), men made consistently more money than women. In the UK men averaged an additional $28,000 per year, in Germany it was $32,000, and in France they made an additional $12,000.

Education

  • In the UK, to become a doctor one must spend 5-6 years in school. A specialty can take up to 12 additional years.
  • In Germany, it takes 6 years to become a doctor. A specialty can take up to 13 additional years.
  • In France, it takes 8 years to become a doctor and 11 additional years for a specialty.
  • In Spain, it takes 6 years to become a doctor and 2-5 additional years for a specialty.
Sources
Sources

From Part 05