*Wojciech S. Zgliczyński1, Dorota Cianciara2, Daniel Śliż1, 3, Olga Rostkowska, Jarosław Pinkas1
Physicians and dentists – staffing and training system in Poland
Lekarze i lekarze dentyści w Polsce – stan kadrowy i system kształcenia
1Department of Healthcare Organizations and the Medical Jurisprudence, School of Public Health, Centre of Postgraduate Medical Education, Warsaw
Head of Department: Jarosław Pinkas, MD, PhD
2Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, Warsaw
Head of Department: Dorota Cianciara, PhD, Associate Professor
3Third Department of Internal Medicine and Cardiology, Medical University of Warsaw
Head of Department: prof. Artur Mamcarz, MD, PhD
Wstęp. Lekarze i lekarze dentyści to jeden z podstawowych elementów systemu zdrowia. Od m.in. ich liczby, rozmieszczenia i kwalifikacji w istotnym stopniu zależy efektywność i skuteczność tego systemu.
Cel pracy. Celem pracy było przedstawienie obecnego stanu kadrowego lekarzy i lekarzy dentystów oraz systemu ich kształcenia w Polsce.
Materiał i metody. Badanie miało charakter opisowy i zostało przeprowadzone w oparciu o ogólnie dostępne dane i opracowania GUS, NIK, OECD, UE, NIL oraz MZ.
Wyniki. W Polsce liczba lekarzy jest niewystarczająca w stosunku do potrzeb zdrowotnych populacji. Liczba lekarzy w kolejnych latach będzie maleć w związku z brakiem zastępowalności pokoleniowej w tym zawodzie i emigracją. Możliwości dydaktyczne systemu kształcenia przeddyplomowego nie są w pełni wykorzystywane do zaspokojenia zapotrzebowania krajowego systemu zdrowotnego na lekarzy. System kształcenia podyplomowego, mimo zmian organizacyjnych i zwiększenia liczby przyznawanych miejsc rezydenckich, również nie spełnia pokładanych w nim oczekiwań.
Wnioski. Stan kadr lekarskich w Polsce jest alarmujący. W dalszym ciągu brakuje systematycznych analiz dotyczących zapotrzebowania na lekarzy ogólnie oraz lekarzy poszczególnych specjalności. Niezbędne jest opracowanie całościowej polityki rozwoju zasobów ludzkich w ochronie zdrowia obejmującej lekarzy, pielęgniarki, pracowników zdrowia publicznego oraz inne zawody i specjalności.
Introduction. Doctors and dentists are one of the key elements of a healthcare system. The efficiency and effectiveness of the system heavily depends, among others, on the number, distribution and qualifications of these healthcare professionals.
Aim. The aim of this research was to demonstrate the current situation in the staffing of doctors and dentists as well as medical education system in Poland.
Material and methods. The research has a descriptive character and is based on publicly available data and publications prepared by the Central Statistical Office of Poland, Supreme Chamber of Control of Poland, Polish Chamber of Physicians and Dentists, Polish Ministry of Health, OECD and EU.
Results. The quota of doctors in Poland is insufficient when confronted with the health needs of the population. In the years to come, this number will be gradually decreasing due to inadequate generation replacement and migration. Educational potential of the institutions offering undergraduate medical education is not fully used to face the future demand for doctors in the national healthcare system. Despite organizational changes and increased number of residencies, postgraduate training system of today does not meet all the expectations yet.
Conclusions. The situation in Poland concerning insufficiency of doctors and dentists is alarming. There is a continuous lack of systematic analyses of how many doctors are needed and of which specialties. It is essential to create a comprehensive policy for human resources development in the Polish healthcare system, concerning doctors, nurses, public health workers and other healthcare professionals.
In accordance with the provisions of the Medical Profession Act (Journal of Laws of 2015 item 464), medical practice consists in providing health benefits, in particular: examinations of health, diagnosing diseases and their prevention, treatment and rehabilitation of patients, providing medical advice, as well as issuing opinions and medical certificates by a person qualified, confirmed by relevant documents. In turn, the profession of dentistry involves providing the above-mentioned services by a person with the required qualifications, confirmed by the relevant documents, with reference to diseases of the teeth, mouth, facial skull and tissues.
Due to the tasks performed, doctors and dentists are the exposed and vital group of professionals in the health system. Their number, their skills and qualifications, as well as territorial distribution, significantly influence the effectiveness and efficiency of the health system, which is essential for the implementation of public tasks in ensuring the health and safety of the population. In recent decades, due to, among others, demographic changes and migrations, medical personnel deficit has been global (1). At the same time the deficit increases within the most qualified and thus the most difficult to be educated profession in the health system, which doctors. In order to improve the situation it is necessary to conduct systematic analyses of the current state of human resources and analyses of the system of undergraduate and postgraduate education, and design remedial actions based on the results of the analyses.
The aim of the study was to analyze the personnel status of doctors and dentists in Poland in the given period, due to, among others, their number, age and specialty and to compare the situation in Poland with the situation in other countries as well as to analyse the education system undergraduate and postgraduate of the professional groups in the years 2006-2015, including the evaluation of the actions undertaken by public authorities in the organization of the system.
MATERIAL AND METHODS
The material analyzed included documents and data of the Supreme Medical Chamber, the Ministry of Health (including the report on state budget execution in the field of health care and the Ordinance of the Ministry of Health), the Central Statistical Office, and the European Union and OECD (Organization for Economic Co-operation and Development). A comprehensive analysis of the existing, public sources was conducted in the following areas: number, age and sex of doctors; the number of doctors in relation to the population; migration of doctors; undergraduate and postgraduate education in the framework of specialties.
Number, age and sex of doctors
According to the data of the Supreme Medical Chamber (NIL) as of 31.10.2015 the total number of the members of the Chamber was 184 074 persons, including 143 226 doctors and 40 243 dentists. However, the number of doctors and dentists practitioners amounted to 167 116 people, including 131 157 doctors and 35 511 dentists (2).
The group pf doctors and dentists was dominated by women. They accounted for 57.4 and 75.7% of these professions (2). According to OECD statistics (Organization for Economic Co-operation and Development) the Share of women among doctors in Poland (56.5%) in 2013 was significantly higher than the average for OECD countries, which amounted to 44.5%. Participation of women has increased in comparison to 2000 when it amounted to 54.2% in Poland and the average in OECD countries, 37.5% (3).
Analysis of the age structure of physicians and dentists in Poland shows that half of the practicing physicians have already exceeded 45 years of age. In turn, the group of physicians at the age of 65 accounted for 13.7% (tab. 1). Moreover, as shown by the analysis of the Central Statistical Office, the share of this group is steadily growing. At the same time, the number of doctors in the group of 35-44 is decreasing (4).
Tab. 1. Age structure of doctors and dentists practitioners registered in the Supreme Medical Chamber by gender in October 2015
|Age in years||Number of men doctors||%||Number of women doctors||%||Total number of doctors||%|
|26-30||6343||9.8||11 902||11.6||18 245||10.9|
|31-35||5263||8.1||10 322||10.1||15 585||9.3|
|41-45||7082||10.9||10 419||10.2||17 501||10.5|
|46-50||8752||13.5||12 362||12.1||21 114||12.6|
|51-55||7871||12.1||11 205||11.0||19 076||11.4|
|56-60||7730||11.9||11 471||11.2||19 201||11.5|
|Above 70||5709||8.8||7692||7.5||13 401||8.0|
|Total||64 797||100.0||102 317||100.0||167 114||100.0|
Source: Based on the statistical information of the Supreme Medical Chamber
Physicians by specialty
According to the Supreme Medical Chamber’s data as at 31.10.2015, the number of physicians and dentists with specialty (including those with both the I and II degree of specialty) and practitioners was 114 189, which accounted for 68.3% of these professionals in Poland. In addition, 46 022 people obtained the I degree of specialty in the old system. Both groups consisted of a total of 160 211 people, which accounted for 95.8% of all these professionals in Poland (2). The largest group of specialists practitioners are specialists of the following areas: internal medicine (18 057 people), family medicine (10 510), paediatrics (7009), obstetrics and gynecology (6178), general surgery (6079), anesthesiology and intensive care (5183). The group of dentists included the largest group of specialists in conservative dentistry with endodontics (11 945). Small numbers of geriatricians (335) and public health professionals (1354) draw attention.
According to the OECD data for 2013 in Poland there were relatively few primary care physicians (15%), with a large share of medical specialists (85%). It clearly differs from the OECD average of 62 and 29%, as well as from the situation in individual member countries, such as Germany (58 and 42%), the Netherlands (54 and 44%), France (53 and 47%) and Ireland (40 and 60%) (3).
The number of doctors in relation to population
According to data from the European Commission, in 2012, the number of physicians per 1000 inhabitants was 2.2 in Poland with the average for the 28 EU countries of 3.4 (5) (note: the average for EU countries is calculated on the basis of data provided by individual Member States, therefore it is not always 28 countries) (fig. 1).
Fig. 1. Number of doctors per 1000 inhabitants in 2012
Source: Health at a Glance: Europe 2014, OECD 2014
The number of physicians in Poland per 100,000 inhabitants was growing steadily since 1960 to 1997, from 96.9 to 235.8. In later years, the number of physicians decreased, except for 2003, when it reached 243.4 per 100,000 inhabitants (6). According to the CSO data from 2013, the number of doctors per 10 thousand inhabitants in 2013 was the smallest in the Wielkopolska Region, where it reached 15, while it was the highest in the Mazowieckie Region, where it reached 26 (7).
According to data from the European Commission, in 2012 the number of dentists per 100,000 inhabitants in Poland amounted to 32.4 while the average for the 19 countries of the EU was 72.0. For comparison, the figures were: Bulgaria – 92.4, Sweden – 80.9, Germany – 80.7, France – 63.8, Hungary – 56.5, United Kingdom – 52.8 (6). The number of dentists in Poland in the period from 1980 to 1990 maintained at 47 per 100,000 inhabitants. In subsequent years, there was a decrease in the number of dentists, until 2001, when this indicator reached 26.5. From that moment, the situation had improved and since 2004, the number of dentists has been maintained at over 30 per 100,000 inhabitants (6).
Migrations of physicians
There is no data on the exact number of Polish physicians who went abroad. However, there are estimates based on Supreme Medical Chamber’s data. According to the Supreme Medical Chamber’s data as at 10.11.2015, certificates confirming formal qualifications were issued to 9320 doctors applying for their recognition of qualifications in other EU countries. This represented a 7.08% of practitioners (2). Due to the obligation to register, accurate data is known for foreigner physicians in Poland. According to the Supreme Medical Chamber’s data as at 31.11.2015, the number of foreigner doctors and dentists who obtained a license to practice in Poland amounted to 554 persons (2).
Education in the professions of doctors and dentists takes place under the provisions of the Act on higher education (8) and the Medical Profession Act (1).
The professions of a physician and a dentist are subject to the EU rules, and training in these professions must comply with the requirements of the Professional Qualifications Directive (9). According to them, the training of doctors takes at for least 6 years or 5500 hours of theoretical and practical training at a university or under supervision. In the case of dentists, education includes at least 5 years of theoretical and practical full-time studies at the university level, in line with the program specified in the directive mentioned above.
Detailed educational standards in the medical and medical-dental fields are defined in the Regulation of the Minister of Science and Higher Education on education standards for the fields of study: medical, dental, pharmacy, nursing and midwifery (10). According to these standards, uniform Master’s degree in medicine last no less than 12 semesters, and the number of hours of instruction and practice cannot be less than 5700 (the number of ECTS credits is at least 360). In turn, uniform master’s degree at the Faculty of Medicine and Dentistry last at least 10 semesters, and the number of hours of instruction and practice cannot be less than 5000 (the number of ECTS credits is at least 300). In Poland, studying medical and dental faculties can be taken up in a stationary mode (studies are free of charge) or non-stationary mode (additional charge for the studies – e.g. at the Medical University of Warsaw, the fee for a year of extramural studies conducted in Polish at the Faculty of Medicine was PLN 35 400 and at the Faculty of Medicine and Dentistry – PLN 37 500) and in a language other than Polish (in practice, these studies are conducted in English), which are paid studies (e.g. at the Medical University of Warsaw in the academic year 2014/2015 one-time fee for the entire course of studies in English at the Faculty of Medicine was EUR 66 600 for the six-year program and EUR 57 600 for the four-year program. On the other hand, in the case of the dental faculty, the fee for the studies was EUR 82 900).
In 2015, 15 institutions had the authorization for a higher education institution in medicine and 10 had the authorization for a higher education institution in the Faculty of Medicine and Dentistry. Since the academic year 2015/2016, three new facilities have obtained the authorization for a higher education institution in the Faculty of Medicine, i.e. the Faculty of Health Sciences at the Jan Kochanowski University in Kielce, the Faculty of Medicine at the University of Rzeszow and the Faculty of Education, Sociology and Health Sciences at the University of Zielona Góra (11). What is more, in the academic year 2016/2017, i.e. the first non-public university, the Department of Health and Medical Sciences at the Jan Modrzewski Krakow Academy will start recruitment for medical studies (12).
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