Changes in dentist and dental hygienist numbers in the European Union and economic area.

AIM: To investigate the extent to which changes in the numbers of dental hygienists and dentists have occurred in the Member States of the European Union and Economic Area (EU/EEA) during the last ten years and discuss the changes in relation to the possibilities of sharing tasks between the two groups. METHODS: Numbers for active dentists, registered hygienists and EU/EEA member state populations in 2007 were taken from the website of the Council of European Chief Dental Officers (CECDO) (www.cecdo.org) and from CECDO records for the EU/EEA member states in 1998 and for the new EU member states (who joined in 2004 and 2007) in 2000. From these data, population: active dentists, population: registered dental hygienist and active dentists: registered dental hygienist ratios were calculated together with percentage changes in the number of dentists and dental hygienists by member state, between 1998 and 2007 for the old and between 2000 and 2007 for the new EU member states. RESULTS: In 2007, there were a total of 343,922 active dentists and 30,963 registered dental hygienists in the 30 EU/EEA member states plus Switzerland. The mean population to dentist ratio was about 1500:1 and the mean population to dental hygienist ratio (in the 25 states where dental hygienists were registered) was 13,454:1. During the study period, the population of the EU/EEA plus Switzerland increased by less that 3%, the number of dentists increased by 13% and the number dental hygienists by 42%. The overall ratio of active dentists: dental hygienists changed from 18:1 to 11:1. In six of the 30 member states plus Switzerland the population to dental hygienist ratio was between 2000:1 and 6000:1 and the dentist: dental hygienist ratio less than 1:3. CONCLUSIONS: Although, most member states educate dental hygienists and their numbers in the EU/EEA during the last 10 years have risen more than the dentist numbers, there are still only a handful countries where the hygienist numbers are great enough to make a significant difference to the delivery of oral health care.

Mobile medics? The mobility of doctors in the European Economic Area.

The Treaty of Rome seeks to generate a common European market whereby all barriers to the free movement of produce, capital, services and labour are removed. Current EU policy on the free movement of labour requires that healthcare workers, who are EU citizens and meet certain training criteria, have the right to register to practice in member states other than the one in which they trained. This policy is underpinned by the EEC Directives. For example, the Medical Directive 93/16/EEC describes the framework for the mutual recognition of medical diplomas, certificates and other evidence of qualifications through out the European Economic Area (EEA). The potential impact of this for health policy is clear-workforce planning and the demand for doctors, (and also nurses and other health care professionals), could be particularly affected by new forces impacting on their supply. This paper reports on the reality of labour mobility today, and on the factors upon which mobility depends, by the means of a case study which, investigated the movement into UK of doctors from the EEA. At a formal level there is mutual recognition of diplomas, certificates and other evidence of qualifications. However, formal and 'real life' recognition could be in tension equating in policy terms to an implementation deficit. As a result, there is a 'mixed picture' which makes predicting the future (both for individual countries and for the European Union) even more difficult. Furthermore, different policy objectives have to be reconciled. Do we want high mobility; or do we want to preserve national manpower planning?

A survey of dental hygienist numbers in Canada, the European Economic area, Japan and the United States of America in 1998.

OBJECTIVE: The aims of this study were to establish how many dental hygienists were licensed to practice in Canada, Japan, USA and the 18 member states of the European Economic Area (EEA) and to compare these with the populations and numbers of dentists practising in the countries concerned. METHOD: Data for the overall populations, numbers of 'active' dentists, of dental hygienists and of employed dental hygienists in the member states of the EEA in 1998 were taken from the responses to a Council of European Chief Dental Officers survey carried out in 2000/2001. Data for these variables for Canada, Japan and the USA in 1998 were accessed from published reports. The ratios of population: active dentist; population: dental hygienist; and active dentist: dental hygienist were calculated and compared. RESULTS: The overall populations and total number of active dentists in the 18 EEA member states and Canada plus Japan plus the USA were broadly similar in 1998 (EEA overall population 381 million with 245169 active dentists: Canada/Japan/USA overall population 421 million with 253825 active dentists). However, there were only 13295 dental hygienists in the EEA as opposed to a total of 215435 in Canada, Japan and the USA. In terms of population:dental hygienist and active dentist: dental hygienist ratios the UK was found to have proportionally far fewer dental hygienists than Canada, Japan, USA or the four Nordic members of the EEA. CONCLUSION: The survey revealed that relative to overall populations and numbers of dentists, there are far fewer dental hygienists in the EEA than in Canada, Japan and the USA and that scope for the UK to import dental hygienists from other EEA member states is probably very limited.

The national and international implications of a decade of doctor migration in the Irish context.

BACKGROUND: Between 2000 and 2010, Ireland became increasingly dependent on foreign-trained doctors to staff its health system. An inability to train and retain sufficient doctors to meet demand is the primary reason for the dependence on foreign-trained doctors. By 2008 the proportion of foreign-trained doctors was the second highest in the OECD. This increased dependence on international medical migration has both national and international policy implications. METHODS: Registration data were obtained from the Medical Council of Ireland (MCI) for a 10-year period: 2000-2010. Data indicate country of qualification but not nationality. The total number of registrants and entrants (n) was determined for each year. Immigration data were also obtained on the number of work visas issued to doctors. Registration and visa data were then compared in order to estimate doctor migration to Ireland 2000-2010. RESULTS: The proportion of foreign-trained doctors rose from 13.4% of all registered doctors in 2000 to 33.4% by 2010. The largest increase was in foreign-trained doctors from outside the EU, rising from 972 (7.4%) in 2000 to 4740 (25.3%) of registered doctors in 2010. The biggest source country in 2000 was Pakistan. By 2010, South Africa had become the biggest source country. The number of foreign-trained doctors from other EU countries doubled from 780 in 2000 to 1521 in 2010. CONCLUSIONS: Registration data are likely to over-estimate and visa data under-estimate the numbers of doctors actively working in Ireland. However, they serve to illustrate Ireland's rapidly increasing and potentially unsustainable reliance on foreign-trained doctors; and to highlight the need for better data to measure migratory flows. Improved measurement of health worker migration is necessary both for national workforce planning and to fulfil the requirements of the WHO Global Code on the International Recruitment of Health Personnel.

Mobility of health professionals pre and post 2004 and 2007 EU enlargements: evidence from the EU project PROMeTHEUS.

BACKGROUND: EU enlargement has facilitated the mobility of EU citizens, including health professionals, from the 2004 and 2007 EU accession states. Fears have been raised about a mass exodus of health professionals and the consequences for the operation of health systems. However, to date a systematic analysis of the EU enlargement's effects on the mobility of health professionals has been lacking. The aim of this article is to shed light on the changes in the scale of movement, trends and directions of flows pre and post 2004 and 2007 EU enlargements. METHODS: The study follows a pan-European secondary data analysis to (i) quantitatively and (ii) qualitatively analyse mobility before and after the EU enlargement. (i) The secondary data analysis covers 34 countries (including all EU Member States). (ii) Data were triangulated with the findings of 17 country case studies to qualitatively assess the effects of enlargement on health workforce mobility. RESULTS: The stock of health professionals from the new (EU-12) into the old EU Member States (EU-15) have increased following EU accession. The stock of medical doctors from the EU-12 in the EU-15 countries has more than doubled between 2003 and 2007. The available data suggest the same trend for dentists. The extremely limited data for nurses show that the stock of nurses has, in contrast, only slightly increased. However, while no reliable data is available evidence suggests that the number of undocumented or self-employed migrant nurses in the home-care sector has significantly increased. Health professionals trained in the EU-12 are becoming increasingly important in providing sufficient health care in some destination countries and regions facing staff shortages. CONCLUSION: A mass exodus of health professionals has not taken place after the 2004 and 2007 EU enlargements. The estimated annual outflows from the EU-12 countries have rarely exceeded 3% of the domestic workforce. This is partly due to labour market restrictions in the destination countries, but also to improvements in salaries and working conditions in some source countries. The overall mobility of health professionals is hence relatively moderate and in line with the overall movement of citizens within the EU. However, for some countries even losing small numbers of health professionals can have impacts in underserved regions.

Análisis de la movilidad de los fisioterapeutas españoles en el contexto de la Unión Europea / Analysis of the mobility of Spanish physiotherapists in the context of the European Union

Objetivo: Analizar la movilidad de los fisioterapeutas españoles en el contexto de la UE entre los años 1997-2012 al amparo de la Directiva 2005/36/EC. Material y métodos: Búsqueda de información en la base de datos de la Comisión Europea (CE) en el mes de enero de 2014. Se han incluido en el análisis los países pertenecientes a la UE, centrándonos en el reconocimiento profesional, excluyendo los datos relativos a la movilidad temporal. Resultados: La fisioterapia en España es la cuarta profesión más móvil a países europeos entre el año 1997 y el 2012. Los países que más solicitudes de reconocimiento profesional acumulan por parte de nuestros profesionales son Francia, Italia, Reino Unido, Portugal e Irlanda, seguidos de Bélgica y Alemania. Las solicitudes realizadas por años muestran un pico máximo de solicitudes de reconocimiento profesional en el año 2011. Los países que emiten un mayor número de reconocimientos positivos son Portugal, Italia y Bélgica y los que menos Irlanda, Francia y Alemania. Irlanda concentra también el mayor porcentaje de situaciones neutrales de reconocimiento, seguida de Francia. Conclusiones: La fisioterapia española presenta una alta movilidad hacia Europa. Los 7 países de mayor demanda son Francia, Italia, Reino Unido, Portugal, Irlanda, Bélgica y Alemania. Los países que más fácilmente reconocen las cualificaciones profesionales de los fisioterapeutas españoles son Portugal, Italia y Bélgica. Los países que más dificultan esta movilidad son Irlanda y Alemania. La medida complementaria más adoptada para otorgar un reconocimiento positivo es la realización de un periodo de adaptación

Objective: To analyze the mobility applications of Spanish physiotherapists in the context of the European Union between 1997 and 2011, according to Directive 2005/36/EC. Material and methods: The research has been carried out with the database of the European Commission (EC) in January of 2014. All countries belonging to the EU have been included, focusing on professional recognition and excluding data concerning temporary mobility. Results: Physiotherapy is the fourth most mobile profession in Spain between 1997 and 2012. The most demanding host countries for professional recognition were France, Italy, United Kingdom, Portugal and Ireland, followed by Belgium and Germany. The peak of maximal applications for professional recognition occurs in 2011. Hosted countries with a greater number of positive recognitions were Portugal, Italy and Belgium. On the other hand, Ireland and Germany have the highest rate of negative recognitions. Ireland also has the largest number of neutral recognition situations. Conclusions: Spanish Physiotherapy demonstrates a high mobility through Europe. The seven most demanded host countries were France, Italy, United Kingdom, Portugal, Ireland, Belgium and Germany. Countries where the professional qualifications recognition is easiest to achieve are Portugal, Italy and Belgium. Countries where it is more difficult are Ireland and Germany. The complementary requirement more frequently adopted to give the positive recognition is the development of an adaptation period in the host country

Anaesthesiological manpower in Europe.

Information about physician anaesthesiologist manpower in the countries of the European Union was collected from questionnaires sent to the delegates representing their respective countries on the European Board of Anaesthesiology. In the countries of the European Union and Switzerland and Norway 40,259 specialist anaesthesiologists are recorded. The number of anaesthesiologists in relation to population varies between as little as 4.4 and 4.6 (Ireland and UK) and as many as 15.6 (Italy), with a mean of 10.8/100,000 inhabitants. There are 11,610 physicians recorded in training in anaesthesiology. The ratio of trainees to specialists in the European Union countries was 28.8/100, varying from as low as 6.5 in France, to as high as 96.7 and 98/100 in Ireland and the UK respectively. These figures indicate a wide difference in the numbers of specialists and trainees between the European countries studied. However, the overall mean figure is close to that reported in the USA (9.2/100,000).