A. Medical manpower planning: Dynamics without direction

Abstract

One tempting conclusion to draw from the comparative history of medical manpower planning is that Don Quixote was a hard-headed realist in comparison to those who have undertaken this reckless enterprise. The manic-depressive cycle of shortages followed by surpluses, and so da cqo, seems to be the one common factor that emerges from the various national studies in this volume. Moreover, the concepts themselves are themselves socially and politically determined: different countries, at different times, have defined ‘shortages’ and ‘surpluses’ at different levels. So, for example, the British medical profession is currently worried about the prospect of a surplus, even though Britain’s doctor-patient ratio would suggest that the country is still desperately short of physicians when compared to, say, the F.R.G. or Sweden. Perceptions seem to be shaped both by past history and the structure of medical care, organisational and financial, within which doctors work. The notion that we can find some rational model of medical manpower planning with universal application, if only we search with enough determination, does not stand up to scrutiny. Hence, of course, the importance of looking at manpower planning as a political process: politics are not an exogenous factor, distorting rationality, but are endogenous to the process itself. Since it is likely that governments everywhere will go on attempting to plan medical manpower given the financial implications improving our understanding of the politics of planning is at least as important as developing the technologies of planning. In what follows, I therefore briefly examine three sets of issues that emerge from the various country-specific chapters in this volume, concentrating in particular on the problems and opportunities presented by comparative studies of this kind. Specifically, I will review first the methodological issues involved in such comparisons, then the explanatory issues in making sense of any patterns revealed and, finally, the substantive policy issues that emerge from or are illustrated by international comparisons.