Healthcare professionals are a crucial element of a performant health system. Hence, the availability of a sufficient number of doctors, nurses and other healthcare workers and the ability to maintain an adequate workforce for the future is an important factor for a sustainable health system.
In this section, this aspect of sustainability will be assessed through indicators relating to :
- The inflow of new healthcare professionals – the number of new medical graduates (S-4), of new medical graduates who become GPs (S-5), of new nursing graduates (S-8) and of new nursing graduates with a bachelor’s degree (S-9), but also the proportion of physicians (S-14) and nurses (S-16) who are licensed to practise in Belgium but were trained abroad.
- The expected outflow, through the proportion of physicians over 55 (S-7) and nurses over 50 (S-10).
- Potential (future) shortages, through projections on the evolution of demand (expected needs for GPs (S-18) and supply (expected number of active GPs (S-19) and nurses (S-22).
Additional information about the current workforce and (potential) shortages can be found in the sections on accessibility (A-10 to A-16), resilience (R-1 to R-3, R-12) and mental health care (MH-2, MH-12).
Inflow of new healthcare professionals – nurses (S-8, S-9, S-16)
To maintain or increase the workforce in healthcare, it is crucial to invest in training but also to make sure working conditions are attractive enough to keep professionals in the field.
Nursing, in particular, is currently an area of concern for many industrialized countries, triggering various measures to increase the number of students in nursing education programmes to remedy or prevent shortages. In Belgium, one example of this trend is Project 600, which offers employees in the healthcare sector the opportunity to pursue a nursing education while keeping their current salary. Recently, the government also decided to increase salaries within the official IFIC system, to improve working conditions and to reflect on the tasks that can be entrusted to nursing professionals based on their specific degrees and education.
The education level of nurses is a distinct but related issue. While a bachelor’s degree is already the normal standard in many parts of the world, some countries including Belgium still offer lower-level degrees as well, in spite of solid evidence that a higher degree of education in nurses results in better patient outcomes and lower mortality. It is therefore important to encourage the training and employment of nurses with a bachelor’s degree, but also to know what kind of degree currently active nurses have.
Finally, as nurses are not only essential workers in many settings but make up one of the largest groups of healthcare professionals, the share of the nursing workforce that was trained abroad is an important indicator of the sustainability of the system (or lack thereof). Aside from the ethical issues raised by mass recruitment of skilled foreign professionals, there is no guarantee that foreign nurses will remain readily available in future and training a sufficient number of them locally is the best way to ensure future supply.
Results
New nursing graduates with a Belgian diploma per 100 000 population (S-8)
- In 2021, 5304 students graduated from nursing schools in Belgium. Approximately 85% of them were female, and this proportion has remained stable over time.
- In 2020, the number of new nursing graduates per 100 000 population in Belgium (45.0) was well above the EU-14 (36.7) and EU-27 averages (29.7). However, this comparison is biased by the substantial proportion of foreign students who usually leave Belgium after they graduate (see next bullet).
- The proportion of foreign students in Belgian nursing schools is increasing, particularly in the French Community, where it reached 35.4% of new graduates in 2021 (+19.2 percentage points compared to 2010); over 80% of them were French nationals. In Flanders, this proportion remains small (7.3%, +5.6 percentage points compared to 2010).
- A recent increase in the length of nursing studies caused a dip in the number of new graduates in 2019, and current levels remain below those of 2014-2018 (6446 nursing graduates in 2018). This could be due to a higher number of drop-outs during the COVID-19 pandemic or to a negative impact of the longer study course.
Link to the technical sheet and detailed results
Data source: OECD health data 2023
Nursing graduates with a bachelor’s degree (% of nursing graduates) (S-9)
- The percentage of new nursing graduates with a bachelor’s degree in Belgium remained stable at around 56% between 2010 and 2018.
- In 2019, the extension of the length of nursing studies caused this percentage to drop to 45.1%; in 2021, it was still only 48.8%.
- The share of new nursing graduates with a bachelor’s degree remains consistently higher in the French community (58.7% in 2021) than in the Flemish community (42.0% in 2021).
- The proportion of foreign students graduating from Belgian nursing schools is higher for lower-level degrees (A2) than for bachelor’s degrees (A1).
Link to the technical sheet and detailed results
Data source: FPS Public Health, Cadastre, KCE calculation
Foreign-trained nurses (% of nurses licensed to practice) (S-16)
- In 2021, 4.2% of all nurses licensed to practice in Belgium had been trained in another country (n = 9488). They were predominantly female (80.2%) and aged under 55 (87.1%, compared to only 60.5% of Belgian-trained nurses).
- The share of foreign-trained nurses in Belgium has increased over time (from 1.5% in 2010 to 4.2% in 2021), but remains much lower than the share of foreign-trained physicians (13.1% in 2021, see below).
- Belgian figures remain slightly below EU-14 and EU-27 averages, but with a sharper increase between 2010 and 2021.
Link to the technical sheet and detailed results
Data source: OECD health data 2023
Inflow of new healthcare professionals – physicians (S-4, S-5, S-14)
To make sure physicians will still be able to fulfil their crucial role in health care in the future, it is important to make sure an adequate number of new recruits are trained each year, taking into account that this takes a lot of time – at least 9 years for general practitioners (GPs) and 10-13 years for other medical specialists.
In Belgium, future doctors start with 6 years of basic medical education (a 3-year bachelor’s degree followed by a 3-year master’s degree). Those new “medical graduates” then follow 3 to 7 years of additional post-graduate training which will allow them to be recognised as medical specialists (in general practice or one of many specialist disciplines). This post-graduate training is subject to global quotas, which specify the maximum number of medical graduates having access to specialisation (see the technical sheet S-4 for more details).
Ensuring there are enough new recruits seems to be particularly challenging in general practice, while GPs are one of the cornerstones of the Belgian healthcare system. This is why we chose to examine not just the overall number of new medical graduates (-4) trained each year in Belgium, but also the percentage of them who then go on to become GPs (S-5). This is a valuable indicator of the attractiveness of GP practice, and therefore of the sustainability of this essential part of the healthcare system.
Finally, some European countries also choose to rely strongly on recruitment abroad, but this is not necessarily an ideal strategy for a number of reasons. Like for nurses, mass recruitment of foreign doctors raises ethical questions. This is also a source of workforce over which we have no control, which means we can never be certain of its future availability. This makes the percentage of foreign-trained doctors (S-14) an important indicator of the (lack of) sustainability of the system: training enough doctors locally remains the best way to ensure future supply.
Results
Medical graduates (/100 000 population) (S-4)
- In 2021, the number of new medical graduates in Belgium was almost twice as high as in 2010 and exceeded the overall quota by 674 students (1904 medical graduates, while the quota allows 1230). In order to avoid further surpluses, additional measures were taken to limit the number of students starting medical studies. Quota have also been increased (from 1230 in 2019 to 2073 in 2029) based on an analysis of future needs.
- The excess was more pronounced in the French Community than in the Flemish Community. However, the French Community also has a much higher percentage of non-Belgian medical graduates (19% vs 4% for the Flemish Community in 2021). Over half of them are French nationals who choose to complete their studies in Belgium before returning to their country to practice, as a way around the much stricter rules for access to medical education in France.
- The density of medical graduates in Belgium follows a similar pattern to the EU-14 and EU-27 averages, though it tended to be slightly lower until 2015 and slightly higher since.
Link to the technical sheet and detailed results
Data source: OECD health data 2023
Note: The sharp increase in 2018 was due to a double cohort graduating that year following a shortening of medical studies.
Medical graduates becoming GPs (% of graduates with a medical specialisation) (S-5)
- Since 2021, the federated entities are responsible for setting sub-quotas by medical specialty based on their estimated needs. In 2023, the aim is to have more than 40% of physicians who opt to specialise as GP (e.g. 43% in the French community).
- The percentage of medical graduates becoming GPs increased from 26.3% in 2011 to 38.3% in 2021, reflecting recent efforts to increase the number of GPs.
- The percentage of medical graduates becoming GPs is now higher in the French Community than in the Dutch Community (40.7% vs 35.9% in 2021); until 2018, it was the other way around.
Link to the technical sheet and detailed results
Foreign-trained physicians (% of physicians licensed to practice) (S-14)
- In 2021, about 13% of all physicians licensed to practice in Belgium (9526 out of 72 660) held a foreign degree; half of them came from France, The Netherlands and Romania.
- Among practising physicians, however, only 6.4% had a foreign degree in 2021.
- The percentage of physicians licensed to practise that were trained abroad is on the rise in Belgium (+5.3 percentage points between 2010 and 2021).
- Between 2011 and 2020, the percentage of foreign-trained physicians licensed to practice in Belgium remained slightly below the EU-14 average (12.7 in Belgium vs 14.9 for the EU-14 in 2020), but above the EU-27 average (11.4).
Link to the technical sheet and detailed results
Expected outflow of healthcare professionals (S-7, S-10)
Beyond the overall number of healthcare professionals, the age distribution of the workforce also has major implications for the future supply of healthcare services. In industrialized countries, the increasing age of people working in the healthcare sector has long been a cause for concern, as there might not be enough new recruits to replace them once they retire. An additional issue is that not all of those professionals are willing or able to stay in those psychologically and sometimes physically demanding jobs until their legal retirement age.
The indicators examined in this section give a rough estimate of the percentage of nurses and physicians who are likely to retire within 10 years.
Results
Nurses aged 50 years or more (% of practising nurses) (S-10)
- In 2018, 32.1% of practising nurses in Belgium were aged 50 years or more and 18.8% were aged 55 years or more, with roughly similar figures in all regions.
- For nurses aged 50 years or more, this share has increased by 18.1 percentage points between 2004 and 2018, which can reflect a need to obtain more new recruits but also a tendency to stay on the labour market longer/retire later. However, older nurses that remain active in the health sector usually rather perform administrative tasks.
Link to the technical sheet and detailed results
Practising physicians aged 55 years or more (% of practising physicians) (S-7)
- In 2021, 38.6% of physicians practising in Belgium were aged 55 years or more.
- This percentage has been decreasing since 2016, but remains above 40% for rheumatologists (46.1%, increasing trend), GPs (44.6%, decreasing trend), Ear-Nose-Throat specialists (41.2%), radiologists (41%) and specialists in nuclear medicine (40.2%) (increasing trends).
- The percentage of physicians aged 55 or more remains substantially higher than EU-14 and EU-27 averages.
Note: Percentages for Belgium were calculated based on full-time equivalents (FTE) rather than headcount. The international comparison was based on headcount, as FTE data were not available.
Link to the technical sheet and detailed results
Data source: RIZIV-INAMI
Projections on the evolution of supply and demand (S-18, S-19, S-22)
Projections take into account a number of factors to predict how the need for healthcare professionals (measured here through the number of contacts patients have with them) is likely to increase or decrease and how the number of active healthcare professionals will evolve in the next few years, both in headcount and in full-time equivalents (FTE). This is a crucial exercise to assess the sustainability of the system, as it can help us anticipate imbalances between supply and demand, and take appropriate action to prevent or mitigate them.
Results
Projection of the number of contacts with GPs (demand), evolution in % (S-18)
- The number of contacts with GPs in Belgium is expected to increase from around 51.3 million in 2022 to 57.3 million in 2033 (+1% per year on average).
- Between 2022 and 2027, the number of contacts with GPs is expected to increase by a total of 3.4% in Belgium (3.2% in Brussels, 3.6% in Wallonia and 3.4% in Flanders).
Link to the technical sheet and detailed results
Data source: Federal Planning Bureau, PROMES model estimates September 2023 based on EPS 17
Note: GP = General Practitioner.
Projection of the number of practising GPs, evolution in % (S-19)
- The number of practising GPs (i.e. those who work in the healthcare sector) in Belgium is expected to increase from 12 554 in 2021 to 13 089 in 2026 (+4.3%), then to 13 606 in 2031 (+3.9%), 14 716 in 2036 (+8.2%) and 16 268 in 2041 (+10.5%).
- However, in a simulation based on a recent change in policy where an optimal (and higher) number of doctors start the practical GP training from 2029 onwards, the increase would be +13.3% between 2031 and 2036 and +14.7% between 2036 and 2041.
- In the French Community, the number of practising GPs is expected to increase by 4.3% between 2021 and 2026, while the number of FTE drops by 8.6%. Between 2021 and 2041, the headcount would increase by 18.6% (+987) and the number of FTE by 3.2% (+38.7% and +19.0% in the “alternative” simulation).
- In the Flemish Community, the number of practising GPs is expected to increase by 4.2% between 2021 and 2026, while the number of FTE drops by 7.1%. Between 2021 and 2041, the headcount would increase by 37.6% (+2727) and the number of FTEs by 22.0% (+42.5% and + 26.1% in the “alternative” simulation).
Link to the technical sheet and detailed results
Data source: Planning Unit for the Supply of the Healthcare Professions (FPS Public Health, Food Chain Safety and Environment)
Note: GP = General Practitioner.
Data source: Planning Unit for the Supply of the Healthcare Professions (FPS Public Health, Food Chain Safety and Environment)
Note: GP = General Practitioner, FTE = full-time equivalent.
Projection of the number of practising nurses, evolution in % (S-22)
According to a 2019 KCE report, 1629 more FTE nurses would have been required immediately – and 5527 within five years – to ensure durably safe patient-to-nurse ratios in hospitals. Projections of the number of (FTE) practising nurses in the hospital sector can be used to assess if such an increase is expected.
- The overall number of FTE practicing nurses is expected to increase by 5345 FTE (+5.0%) between 2018 and 2023 and by 5198 FTE (+4.6%) between 2023 and 2028.
- In hospitals, this number is expected to increase by 3201 FTE (+4.8%) between 2018 and 2023 and by 2554 FTE (+3.7%) between 2023 and 2028. This is not enough to ensure sustainably safe patient-to-nurse ratios in hospitals as defined in the 2019 KCE study.
- In nursing homes, this number is expected to increase by 1334 FTE (+7.4%) between 2018 and 2023 and by 1292 FTE (+6.7%) between 2023 and 2028.
- In the home care sector, this number is expected to increase by 587 FTE (+3.0%) between 2018 and 2023 and by 1242 FTE (+6.3%) between 2023 and 2028.
- Overall, the increase between 2018 and 2043 is expected to be similar in both linguistic communities. However, it is likely the French Community will experience a higher increase in the short run, while the biggest increase will happen later in the Flemish Community.
Link to the technical sheet and detailed results
Data source: Planning Unit for the Supply of the Healthcare Professions (FPS Public Health, Food Chain Safety and Environment)
Data source: Planning Unit for the Supply of the Healthcare Professions (FPS Public Health, Food Chain Safety and Environment)
Note: FTE = full-time equivalent.