Debate: Do we have enough doctors for both our citizens and the market?

By Allan Flyvbjerg, Dean of the Faculty of Health, Aarhus University, Camilla Rathcke, Chair of The Danish Association of Junior Doctors and Ida Sofie Jensen, Director General of the Danish Association of the Pharmaceutical Industry

When we talk about a shortage of medical doctors in Denmark, the discussion quickly comes to revolve around abandoned doctor’s practices in Western Jutland or hospitals being forced to close down specialist departments because they do not have medical specialists. This is a major challenge – and one that the Danish Health and Medicines Authority must take into account when it extrapolates the requirements for study places. The most recent prognosis from March 2016 also showed an increase in the number of places on the medical degree programme, so that from 2025 approximately 1,250 medical doctors will be trained annually. We are relatively well covered with medical doctors for treatment and prevention compared to the countries we typically compare ourselves with.

In addition to finding solutions that also ensure that people living in remote and regional areas can enjoy full value for their health insurance, and that all hospital departments are fully operational, the Danish Health and Medicines Authority ought to bear in mind that one of the country’s largest export sectors, the pharmaceutical industry, also makes use of employees with a medical education.

The pharmaceutical industry has enjoyed a steadily increasing export curve over a number of years, and in 2015, total annual exports exceeded DKK 85 billion. Pharmaceutical companies make use of academics in development and manufacture, and an analysis carried out by the Danish Association of the Pharmaceutical Industry shows a need for up to 3,000 employees with a long-cycle post-secondary degree, including a not insignificant part of these comprising health science graduates, including medical doctors. During their degree programme, medicine students have switched between theoretical lectures and clinical training, while also becoming acquainted with research. It is this mix of medical knowledge and experience which is particularly attractive for pharmaceutical companies.

However, the requirements of the pharmaceutical industry are overlooked when calculating the number of medical doctors that need to be trained in Denmark. Primarily because no real prognosis for the level of demand is actually produced, so that there is no clear picture of the number of doctors needed for patient treatment, but also because the needs of the industry are not taken into consideration.

The pharmaceutical industry has grown rapid over the last decade, but the reason for the industry’s needs being overlooked can perhaps be found in the composition of the committee that undertakes the work of prognosis, forecasting and degree resizing and calculates the required number. Nevertheless, the committee is remarkably exempt for participants from the universities and the pharmaceutical industry. which plays a significant role in this context. Both as an educational institution and major employer.

We have no reason to doubt the competency of the committee in balancing the number of qualified medical doctors for patient treatment, but in general there is a need to investigate the demand for medical doctors in the workforce in a more in-depth and real manner. Why not invite the people who train the graduates, together with such an important employer as the pharmaceutical industry, into the discussions to get a balanced and holistic picture of the demand for medical doctors in Denmark?

Alternatively, we run the risk of seeing the pharmaceutical industry challenging the public healthcare system by courting the modest pool of graduates and enticing them with interesting career paths as well as jobs that surpass the paychecks and working conditions offered by a public-sector lab coat. That is neither fair nor smart. Because ensuring that there are well-trained doctors for all employers is a shared task.

The task of the universities is simple, but very essential. The universities must ensure that the students have the best educational opportunities in order to train talented doctors and create the foundation for skilled clinicians.

This will also put an end to the junior doctors' worries about being locked into a particular path. Today, it is difficult for junior doctors to try working in the industrial sector, because they risk exceeding the five-year deadline within which they must complete their specialist training. As such, the five-year deadline is a factor which deters doctors from entering the pharmaceutical industry.

It is, of course, relevant to ask the more general question: do we risk training too many doctors, so that they end in unemployment? The pharmaceutical industry's success and requirement for manpower from among health science graduates is naturally dependent on how the markets develop. However, in the light of the considerable uncertainty in the latest prognosis, together with the more general call for increased medical services, imaging a situation where we end with excess capacity when it comes to medical doctors is a very difficult proposition. The population is ageing, we are able to treat more disorders, and we are still increasing the number of treatment options. All of which is good news for patients. And good for the pharmaceutical industry. But it is nonetheless always relevant to consider whether we can afford to train even more doctors from a social perspective. Medicine is one of the most expensive degree programmes at the university. On the other hand, there is the question of whether we can afford not to?

Looking at the bottom line, it is inexpedient for the Danish Health and Medicines Authority to focus narrowly on the interests of the healthcare system when it comes to the degree programme resizing of the degree programme. The labour market for medical doctors is larger than this area alone, and doctors are being imported from other places. In light of this, it makes sense to ensure greater diversity in the composition of the prognosis committee and to keep in mind what its purpose it. And that is to ensure that Denmark has enough doctors for the benefit of its citizens' health, but also to contribute to the national economy via work in the pharmaceutical industry.

This article was published in Danish the Danish daily newspaper Politiken on 16 June 2016