Medical staffing sustainability in Romania and in the UK : the impact of the European Working Time D

1
Medical staffing sustainability in Romania and
in the UK - the impact of the European Working
Time Directive -

• Victor Turcanu MD, PhD
• Lecturer in Paediatric Allergy
• Division of Asthma, Allergy and Lung Biology
• Kings College London, UK

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European Working Time Directive
Directive 93/104/EC of the EU Council ?
August 2009 maximum 48h / week
Average hours / week over 26 weeks
? Minimum 11 ore break for each 24 h work time
M. Bannon, Arch Dis Child 2006 9168-70
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Challenges imposed by the EWTD

• ? EWTD imposes an increase in the numbers of
  doctors available to cover health services
• ? shift work (especially night time on-call) had
  to be reformed in order to accommodate the 11h
  break / 24h limit it will be illegal to work a
  normal 8-5 shift then do an on-call until the
  following morning and then continue with another
  8-5 work day
• ? solutions - increase medical student intake
• - streamline medical speciality training
• - recruit foreign doctors.

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Public Health Services staffing in the UK and
Romania
UK 2.3 doctors / 1000

• ? 1.3 million NHS employees - March 2005
• ? UK 122.345 doctors (82.568 full time post
  equivalents)
• 29.000 GP, 18.000 dentists
• ? NHS budget (2008/9) 94 bn GBP (UK
  population60m)
• ? Romania 59.850 doctors (48.199 doctors 11.651
  dentists)
• (135.353 nurses, 11.108 pharmacists, 62.292 aux.
  staff etc.)
• ? Romania (2007) 17 bn RON (RO population22m)

Romania 1.9 doctors /1000
Sources Breviar MSP, Romania 2007 UK DoH
report WHO 2008 Yearbook
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Increase of UK medical students numbers
8000
70
53.4
6794
7000
6133
5620
6000
100
5164
4734
5000
4456
4398
4333
4278
4251
4155
3997
3715
3803
3635
3718
3644
3885
3573
4000
3000
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2012
J. Parkhouse, Med Educ. 2001, 35137 A. Cole, BMJ
Careers, 02/02/2008
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1st year student intake (6794 places in total)
and applicant ratios for 29 UK medical schools
(2008)
App / place
1st year Intake
University
9
175
Aberdeen
9
305
Cardiff
9
130
Keele
9
327
Newcastle
10
336
KCL
10
184
Leicester
10
200
Peninsula
11
268
Liverpool
11
206
Southampton
12
218
Edinburgh
12
241
Sheffield
13
238
Leeds
16
138
BSMS
17
216
Bristol
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Romanian medical schools expanded significantly
after 1989
Old Medical Schools (existing before 1989)
Bucharest
Iasi
Cluj
Timisoara
Craiova
Tg. Mures
New Medical Schools
Brasov
Sibiu
Constanta
Galati
Oradea
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Streamlining medical training in the UK MMC
RO
Speciality training (3-7yrs)
Postgr. (0-3 yrs)
Undergraduate (6yrs)
1
2
3
1
2
3
4
6
5
7
UK (2005 / MMC)
Speciality training (3-7 yrs) Specialist
Registrar
House officer (1yr) FY (2yrs)
Undergraduate (5 yrs 1)
C
1
1
2
3
4
6
5
7
1
2
3
4
6
5
n
FY2
Senior House Officer (2-? yrs)
Optional intercalated year)
9
Recruitment of foreign-trained doctors in the UK
countries of origin for doctors who register for
the first time with the General Medical Council
A Cole, BMJ Careers, 02/02/2008
10
New registrations of doctors who moved to the UK
A Cole, BMJ Careers, 02/02/2008
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Challenges and opportunities brought about by the
EWTD

• ? EWTD imposes an increase in the numbers of
  doctors available to cover health services /
  shift work
• ? both Romania and the UK undertook significant
  steps towards sustainability by increasing the
  numbers of medical students and (in the case of
  the UK) by further streamlining medical
  speciality training
• ? increase in students numbers poses major
  challenges with respect to the increased costs
  and maintaining the quality of the medical
  education
• ? furthermore, the UK still employs significant
  numbers of doctors who trained abroad (6571 /
  11027 total) in 2000 and (5055 / 11188 total) in
  2007.
• ? medical universities in Romania have
  significant opportunities derived from their
  sustained expansion that took place over the last
  decade they can the provide English-language
  courses for medical students from other EU
  countries, including the UK and the Romanian
  diplomas are recognised throughout the UK.

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How many doctors are necessary ?(per 1.000
people)

• 500 ?
• 50 ? (San Marino 41.7)
• 4-6 ? (Russia 4.3 Belarus 4.6 Cuba 5.9)
• 3-4 ? (Spain 3.3 France 3.4, Germany
  3.4 Italy 3.7 Switzerland 4)
• 1-3 ? (Romania 1.9 UK 2.3 Canada
  1.9 Poland 2 Australia 2.5 USA 2.6)
• 1 ? Countries from Latin America, Asia,
  Africa etc.

Source WHO Yearbook 2008