Medical Manpower in Belgium Numerus clausus Alain De

Medical Manpower in Belgium Numerus clausus Alain De Wever

Medicine

A. Medical planning agents in Belgium

Belgium Federal State Regions Flemish Communities French Dutch speaking

1° Federal level n Establish the number of doctors who have access to the practice in the health insurance system n 1996 : Creation of the « Commission de planification » (Planning Commission)

2° Communities’ level n Flemish Community ¨ Entrance exam (Decree of July 24, 1996)

2° Communities’ level n French community ¨ End Bachelor examination – Third year (Decree of July 17, 1997) ¨ End Master examination for the specialization – seventh year (Decree of July 27, 2003) ¨ Examination at the end of the first year and at the entrance in the specialization training (Decree of July 1 st, 2005)

3° Difference between communities Flemish Community French Community Entrance exam Examination Number of students < quotas Number of students = quotas

The examinations in the French Community n At the end of the first year, classification of the best students per university n At the end of the seventh year, inter-universities commission ¨ GP (43 %) ¨ Specialists (57 %) Quotas per specialization

Entrance exam in the Flemish Community The exam consists of 2 parts : Exam assessing the scientific knowledge (physics, chemistry, biology, mathematics) n Comprehension tests (assessment of the ability to acquire & assimilate information through comprehension & restitution tests) n

B. Too much doctors in Belgium ?

1° Past trend Fig. 1 Number Medical acts / inhabitant Plethora Medical density Time Sources : D. Deliège (SESA – UCL)

2° Current trend Ageing medical population and increase of the retirement n Increase of the feminization of the medical population n Increase of the healthcare consumption n Diversification of the medical profession (pharma industry, civil agent, professor, etc. ) n

2. 1. a Ageing medical population : 55 -74 / 20 -54 Source : UCL – Sesa – Deliège D.

2. 1. b Retirements’ boom French and Dutch speaking communities Source : UCL – Sesa – Deliège D.

2. 2. Feminization of the profession Women doctors’ rate Source : UCL – Sesa – Deliège D.

2. 3. Consumption increase Due to the ageing (22 %) Due to others agents including the wealth (66 %) Source : UCL – Sesa – Deliège D.

3° Coming trend Number Medical acts / inhabitant Shortage Plethora Medical density Time Sources : D. Deliège (SESA – UCL)

Demographic bump n Feminization n Working hours’ decrease (48 hours/ week – European Directive – Colla law) n Possible shortage

Physiotherapists

n Restriction by the federal level of the number of physiotherapists who can work in the health insurance reimbursement system n No restriction at communities’ level (training)

n However, the French Community limits the access for the students who do not live in Belgium (30 %) economical reasons (by lottery)

n Examination organized by the Federal State : Attitude test for the self-employed practice ¨ Ability test for the self-employed practice ¨ Knowledge test : ¨ Laws about physiotherapists’ rights and duties n About the health insurance n