We need more medical specialists if we wish to develop the Danish healthcare system
The debate about how many medical specialists we need to train in Denmark is not just a question of waiting lists and day-to-day running. The number of medical specialists is crucial for the clinical research which must develop new forms of treatment and create a better basis for diagnosis, care, healing and prevention.
By Lars Bo Nielsen, Dean, Aarhus University; Ole Skøtt, Dean, University of Southern Denmark; Lars Hvilsted Rasmussen, Dean, Aalborg University; and Ulla Wewer, Dean, University of Copenhagen.
At the end of the February, the Danish Health Authority presented a new degree programme resizing plan for the number of students allowed to train as a medical specialist in the period 2022-2025.
The plan proposed that 1,040 courses of study should be offered per year. The plan ran into protests, in particular from the medical organisations, because a large group of graduates from medicine would in this case be unable to attain the specialist training that is a prerequisite for both the individual medical doctor's continued education and competency development, and for the Danish health system's development and future.
On 24 March the Danish Health Authority withdrew the draft and is currently working on a new one.
At the universities, we are pleased to see that the parties behind the resizing plan have taken the criticism seriously. In connection with this, we would like to draw attention to an important point that has not yet enjoyed much focus in the discussion: That medical specialists are absolutely essential to the clinical research.
Clinical research is e.g. testing of new diagnostic methods or treatments – such as testing drugs or medical devices on patients, gene therapy trials or register-based research. Regardless of the medical specialty, the research is a prerequisite for the Danish healthcare system’s ability to develop new forms of treatment and create a better foundation for diagnosis, care, healing and prevention.
It is absolutely crucial that we have sufficient medical specialists if we are to have the resources for research – not just on paper, but in reality. Many medical doctors are so pressured that they really do not have time to plan and carry out clinical research, even though this is part of the job description. Shared positions that combine the medical specialist's professional knowledge from their daily work with time to develop solutions, provide patients with top-self-treatment.
The clinical research is important for both society and the individual patient, because it raises the general quality of the healthcare system. Now with a reduction in the number of medical specialists being proposed, this will obviously mean even less clinical research than today.
Clinic and research go hand in hand
The operational aspect is in focus in the new degree programme resizing plan, but research needs to be too.
The Danish Health Act operates with the three elements of patient treatment, research and development, and education and training of healthcare professionals. This means that the universities and the regions have three core tasks in the field of health, which need to be equally prioritised if the healthcare system is to function. But in the plan presented in February, only one of the core tasks – patient treatment – has been taken into consideration. Although the Danish Health Act stresses the importance of ensuring development and research work for the benefit of both patients and the healthcare degree programmes, it is the operational aspect and waiting lists which steals the agenda.
In this context, we need to take a broader view and remember that it is not just a question of having enough medical doctors to take care of the patients. Medical specialists are not only indispensable in the hospitals and in general practice. They are just as much the core of the clinical research, as it is here they develop safe new point-of-care results which benefit both the individual and society.
Research and continued education are vital to ensuring that the Danish healthcare system is able to offer up-to-date treatment that meets international standards. At the same time, it ensures that the medical doctors who see patients every day also have the latest knowledge and up-to-date competences.
In recent years, clinical research in Denmark has made a decisive contribution to the new methods for e.g. better treatment of cancer, dissolution of blood clots in the brain and treatment of blood clots in the heart with acute balloon angioplasty, which has significantly reduced the mortality rate of the diseases.
Fewer medical specialists will mean less clinical research. Put starkly, this will mean that we will be unable to deliver the best to Danish patients when it comes to prevention, diagnosis and treatment. This also means that the government's future Life Science strategy will find it more difficult to achieve its ambition of strengthening the collaboration between health research and business and industry. An ambitious Life Science strategy requires highly qualified staff – including medical specialists for the innovation that develops and tests improvements in the healthcare system with better treatments, more jobs and increased exports as a result.
Optimally, research is an equally natural part of many medical specialists' work as the treatment of patients. We are far from this. However, the Danish Health Authority will have to integrate capacity for research and development in the next proposal for a degree resizing plan.
Anything less is short-sighted and unambitious.