Doctors will be key to raising productivity levels to plug shortages in workforce

BMJ 2012; 345 doi: (Published 09 November 2012) Cite this as: BMJ 2012;345:e7635
  1. Charlotte Santry
  1. 1Toronto

Demand for healthcare workers in many of the world’s major economies, including the United Kingdom, will outstrip supply by up to 29% in the next decade, analysts have predicted.

A discussion paper by the consultancy firm KPMG warns of a “widening chasm” between the growing demand for health services and declining availability of staff in the countries of the Organisation for Economic Co-operation and Development.1

The report forecasts a 22% to 29% gap between demand for and supply of health workers in the OECD by 2022. It puts this down to ageing workforces, more part time employment, and medical technologies requiring people with additional skills.

The analysts argue that because recruiting more workers to plug the shortage is “not feasible,” because of spending constraints, staff will need to work more efficiently.

Discussing the findings at the Health Achieve conference in Toronto on 5 to 7 November, KPMG’s global health practice chairman, Mark Britnell, said that clearer outcome measures for doctors would help to raise productivity.

He said that among “lawyers, doctors, accountants, [management] consultants—that professional services strata—if you think about what’s happened over the 20th century, the only great last tribe that hasn’t been held to account properly for the performance of its organisations is doctors.”

The report highlights the way that the independent healthcare provider Circle awarded performance based pay to staff, largely on the basis of feedback from between five and 10 colleagues.

It also includes examples of productivity drives around the world. In Mozambique, for example, non-medical workers called “technicos” have been trained to undertake some obstetric surgical procedures at a quarter of the cost of training doctors in those procedures.

A coauthor of the report, Marc Berg, who trained as a medical doctor, said that this was not a model that could necessarily be imported to the UK, but it showed the value of non-traditional roles.

He said, “There’s so much productivity and work satisfaction to be gained. If you’re a doctor and can stop doing things at the bottom of your skill set it improves your professional life.

“For everyone it can be a gain, but we’re often afraid to breach professional domains.”

Although the biggest shortfall in staffing was in nursing, he added, doctors would be the “most central players” in raising productivity levels because of their influence and leadership.

The report describes how the Aravind Eye Care System in India had adopted an “assembly line approach” to surgery and also published the complication rates of individual surgeons each month.

But in many places, the report says, doctors have not been sufficiently consulted about efficiency drives. It states, “The old deal has been replaced without any explicit conversation and across the world this has been manifesting itself in discontent amongst many doctors.”

In the United States, Virginia Mason Medical Center tried to avoid this by interviewing medical leaders to understand their frustrations. Managers then spent six months with the doctors to devise a set of clear expectations, including “provide and accept feedback” and “embracing innovation and continuous improvement.”

Berg said that the need for greater productivity was particularly important in the UK, which “more than anywhere else is slamming the breaks on its spending.”


Cite this as: BMJ 2012;345:e7635