Effective Advocacy for Health in Europe

1. Effective Advocacyfor Health in Europe Medical Education in European Integration context : new challenges for accession countries Emanuil Grigore Stoicescu College of Physicians, Bucharest Riga, Latvia 3 – 5 April, 2003

2. Medical Education • Why it is important : • free movement of health professionals • EU requirements • development of medical science and technology • rationalization of resources • social factors • quality of medical care

3. Medical Education • The purpose is: • “to train physicians that are authorized (licensed), according to their preparation, to practice the medicine without limitation” (The international Medical Association and the International Association of Medical Education)

4. Undergraduate Medical Training EU recommendations Directives 73/362, 75/363, 93/16 Standing Committee of Europeans Doctors European Union of Medical Specialists • Duration of training • 6 years (5500 hours) • any student, before getting the degree, must perform at least one year of clinical practice • teaching resources

5. Undergraduate Medical Training EU recommendations • Curricula • biological and behavioral science • socio-economic aspects of medical services • ethical principles

6. Undergraduate Medical Training • Romania • appropriate length of training • 13 medical schools • 3 private • 7 created after 1989 • Negatives • exaggerated development of theoretical component • no respond to the social needs • health promotion,recovery, responsibilities • hospital based training • no cooperation between education managers and health authorities • no “numerus clausus”

7. Postgraduate training - specialization • Directives 93/16 and 2001/19 • 14 medical specialties recognize in all member states • 36 specialties recognize in al least 2 member states • Duration of training • Excessive specialization • increase inequality in distribution of health services • Too many specialists • competition for a job • great offer of medical services • Increase the number of referrals to specialists • Increase the number of procedures

8. Postgraduate training - specialization • Too many rigidly delimited specialties • difficult to plan the number of doctors needed • inequities in distribution • Romania • 53 medical specialties (2 for dentists) • duration of training – 3 to 7 years • “common trunk” principle • Quality of training programme • Insufficient clinical problem solving capability

9. Training General Practitioners Directive 2001/19 • 3 years of training • at least 6 months in hospitals • minimum 6 months in a general medical practice • maximum 6 month in other health establishments • Romania • the specialty was introduced in 1990 • residency programme since 1993 • chairs within medical schools – 1997 • general practitioners represent 43% of the total number • Bucharest – 10%

10. Continuing Medical Education / Continuing Professional Development • “formal and informal activities undertaken by doctors in order to maintain,update and develop their competence” • importance • meet the real demands • meet the needs of patients • determined by day to day practice • recertification

11. Continuing Medical Education / Continuing Professional Development • Romania • CME organized by the College of Physicians • recertification of physicians based on CME credits – minimum 200 CME credits for 5 years • CME providers accredited by the College

12. Continuing Medical Education / Continuing Professional Development • College of Physicians • professional organization (NGO) • special law • membership mandatory • organized at the national and district level • elections each 4 years • attributions • certification/recertification • medical ethics/judicial problems • guidelines • quality of care

13. Number of Doctors • Standing Committee of European Doctors • 1982 - Concern about the uncontrolled development of the number of physicians • Negative impact • quality of training • free circulation • mutual recognition of degrees • waste of economical resources • 1986 – asked for • “numerus clausus” in member states • ratio inhabitants/doctor kept constant • number of students regarding training capacities • 1989 – 200 000 unemployed doctors in UE

14. Number of Doctors • Romania • geographic misdistribution • ¾ of the counties are below the country average • 86% of physicians practice in urban areas • 14% - provide health care for 47% of the population in rural areas • Bucharest – almost 25% of the romanian doctors • no real medical unemployment • jobs available • no significant loses during the medical school • more than 30% of graduates abandon the system

15. Romania in European Context

16. Doctors / 100000 population Romania (1999)……191.4 Europa (1996) …... 297.5 CEE (1996) ……311.1

20. Doctors’ Ratio in Romania Source: National Commission for Statistics, 2000

21. Medical Schools

24. Conclusions • Romania needs 14,000-15,000 doctors to reach the EU average • Keep a level of 2,500 entries in medical schools for the next 5 years • Cooperation - health care authorities / education institutions • Revise that number in 2008-2012 regarding the economical evolution • Merging some medical specialties and maintain the list stable minimum 5 years

25. Conclusions • Number of residents by specialty be stable at least for 5 years • Emphasize the role of general practitioners • Training programmes more practical and oriented toward • common medical problems • socio-medical aspects • public health