The performance of health systems in terms of access and quality depends crucially on the size, composition, distribution and productivity of the health workforce. Health workers are the cornerstone of health systems, and many OECD countries are reviewing their health human resource strategies to ensure a sufficient number of health care providers, with the right skills and in the right settings, to respond to the demand for high-quality health services.

The health and social sectors employ a large and growing number of people in OECD countries. The data reported in this section include people working in the health sector along with those working in the social sector (including long-term care, child care and other types of social work). The data include professionals providing direct services to people together with administrative and other support staff.

In many OECD countries, there are concerns about current or looming shortages of doctors (OECD, 2008e). This section provides information on the number of doctors per capita in OECD countries, including a disaggregation by gender and by general practitioners and specialists.

Maintaining or increasing the number of doctors requires either investment in training new doctors or recruiting trained physicians from abroad (see Indicator 3.4 “Foreign-trained physicians”). If it takes about ten years to train a doctor, any current shortages can be met only by recruiting qualified doctors from abroad, unless there are unemployed doctors at home. Conversely, any surpluses or sudden fall in demand may mean that new graduates, in particular, struggle to find vacant posts at home.

The international migration of doctors has raised a lot of attention among policy makers during the past decade. In 2007, the percentage of foreign-trained doctors ranges from a low of 3.1% in France (although this figure is under-estimated; see “Definition and deviations” below) to a high of 33.6% in Ireland (Figure 3.4.1). High percentages are also recorded in New Zealand and the United Kingdom where almost a third of all doctors were trained abroad. In Australia and the United States, this percentage is respectively 22.8% (2006) and 25.9%.

Remuneration levels are among the factors affecting the attractiveness of different medical professions. They also affect health spending. Gathering comparable data on the remuneration of doctors is difficult, however, because countries collect data based on different sources covering different categories of physicians, and often not including all income sources (see the box on “Definition and deviations” below). Hence, the data should be interpreted with caution.

Gynaecologists are concerned with the functions and diseases specific to women, especially those affecting the reproductive system, while obstetricians specialise in pregnancy and childbirth. A doctor will often specialise in both these areas, and the data reported in this section does not allow a distinction between these two specialties. Midwives provide care and advice to women during pregnancy, labour and childbirth and the post-natal period for cases without complications. They deliver babies working independently or in collaboration with doctors and nurses.

At any point in time, about 10% of the adult population will report having some type of mental or behavioural disorder (WHO, 2001). People with mental health problems may receive help from a variety of professionals, including general practitioners, psychiatrists, psychologists, psychotherapists, social workers, specialist nurses and others. In Europe, a population-based survey carried out in 2005-06 indicated that, on average across EU countries, 13% of the population reported seeking help from a health professional for a psychological or emotional health problem over the past year (Eurobarometer, 2006). Among the people who sought help, two-thirds (67%) had consulted a general practitioner, while 15% sought help from a psychiatrist and another 15% from a psychologist (Figure 3.7.3).

Nurses are usually the most numerous health profession, greatly outnumbering physicians in most OECD countries. Nurses play a critical role in providing health care not only in traditional settings such as hospitals and long-term care institutions but increasingly in primary care (especially in offering care to the chronically ill) and in domiciliary settings. However, there are concerns in many countries about shortages of nurses, and these concerns may well intensify in the future as the demand for nurses continues to increase and the ageing of the “baby boom” generation precipitates a wave of retirements among nurses. These concerns have prompted actions in many countries to increase the training of new nurses combined with efforts to increase the retention of nurses in the profession (OECD, 2008e).

Many OECD countries have taken steps in recent years to expand the number of students in nursing education programmes in response to concerns about current or anticipated shortages of nurses. Increasing investment in nursing education is particularly important as the nursing workforce is ageing in many countries and the baby boom generation of nurses approaches retirement.

The remuneration level of nurses is one of the factors affecting job satisfaction and the attractiveness of the profession. It also has a direct impact on costs, as wages represent one of the main spending items in health systems.

Dentists are the main provider of dental care, although some services are also provided by dental hygienists, dental assistants and dental prosthetists. Most dentists in OECD countries work in their own office or in a group practice (dental clinics), although a small proportion also work in hospitals and other health care facilities.

Pharmacists assist people in obtaining medication and ensuring that these are used in a safe and proper fashion. In most countries, they have completed studies in pharmacy at university level and have completed an examination administered by the regulatory authority to obtain a license to practice.