Setting the context

The last two decades have seen significant improvements in planning methodologies, in refining definitions of medical manpower needs, and in the sophistication of manpower analyses, both national and international. It has become the conventional wisdom that manpower planning is a quasi-scientific endeavor and that continued progress in concepts, tools and methodologies will enable planners, in a rational and intelligent manner, to assure systematically that the right number of physicians will be found in the desired specialities and locations. An examination of the situation in most if not all countries, as seen later in this volume, suggests that this Brave New Medical World is more fantasy than reality. There are no nations in which problems of shortage, surpluses and maldistribution have been prevented or promptly and adequately remedied. One possible explanation is the neglect of the political context in which planning, policy determination and implementation take place in a systematic and effective manner. In an attempt to address the neglect of political, economic and socio-cultural factors, a group of interdisciplinary and international experts from industrial countries were invited to prepare individual country case studies analysing the political context and the non-health systems variables which, in the final analysis, shape and constrain physician manpower and plans. In a perfect world and in the perfect health care system, the number of physicians matches the demand or need which the society has for them. As the health system evolves from year to year, as new demands appear on the part of the population, as demographics change, as new knowledge and technologies emerge, specially trained physicians come on line, and those whose specialty has become obsolescent or redundant are recycled into new medical areas. At the same time, the number of primary care physicians or generalists is adequate to meet the needs of the public, and they are distributed geographically and socially on an equitable basis so that no one is deprived of the opportunity of seeing a physician when the need arises. Likewise, the health care system is so structured and managed that its costs are kept within reasonable limits, and other social needs are met without encroaching on those of the health care system. Physicians are assisted by an array of other health personnel and technicians who support, extend and complement the work of doctors so they can concentrate on what they are uniquely qualified to do. In such