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Last Updated: 14 October 2022

It is important to note that the supervision of healthcare professionals begins even before their training.

This supervision includes the monitoring and planning of the health care. The general idea is to ensure that the health needs of the population are met by avoiding both excesses and shortages of professionals in any given field.

What is planning ?

Planning the health care professional workforce is critical to ensuring the health of the population, in order to:

• guarantee that the supply and demand for care match
• avoid shortages
• anticipate abundance

All of these are essential to ensure quality of care, the well-being of our professionals, budgetary sustainability and the efficiency of social security. The Medical Offer Planning Commission was established in 1996 for this purpose. It is composed of representatives from universities, mutual health funds (Collège Intermutualiste), healthcare professions (professional organisations), the relevant ministries, the Communities, NIHDI and the FPS HFCSE.

Today, the information available to the planning commission is complex. The data is extracted from different databases, anonymised and analysed to provide the most detailed and realistic picture of the activity of health professionals in Belgium.

Planning was initially limited to doctors and dentists. Now, it extends to an ever-growing number of professionals. Like the needs of the population, planning is a dynamic and constantly improving process.

Medical Offer Planning Commission: consultativebodies.health.belgium.be

The planning stages

The figure below summarises the different steps taken by the Planning Commission for each profession, from the completion of the PlanCad to the writing of the recommendations.

THE PLANNING STAGES

DESCRIPTION OF THE ACTIVITY OF A PROFESSION IN THE BELGIAN EMPLOYMENT MARKET

While the register is very useful for the Planning Commission, providing a summary of everyone who has applied to a licensed professional activity, it is not sufficient for it to carry out its tasks.

This database does not show us the proportion of certified persons who are actually working, the extent to which this activity is carried out, in which sectors and in which geographical area.

However, the Planning Commission needs information on the activity of health professionals and on the level of this activity, so it can accurately monitor this workforce, prepare forecasts of its evolution and plan the supply of professionals, in particular by determining the quota of physicians and dentists. This is why Art. 99 of the law of 10 May 2015 provides for the possibility of linking register data with a series of other databases.

The "PlanCad" project, on this basis, links data from various sources to supplement e-CAD. These sources include:

the National Institute for Health and Disability Insurance (NIHDI),

the National Social Security Office (NSSO) for employee data,

the National Institute of Social Insurance for the Self-Employed (NISISE) for data on the self-employed.

The identification of individuals is made impossible by anonymisation. This linking allows relevant answers to be provided to questions related to the workforce of the professions.

The data used covers several years. This makes it possible to identify developments and estimate trends in future workforce development projections.

BASIC SCENARIO

The health professions planning work involves reviewing available data to develop a numerical "forecast". Several workforce evolution scenarios are developed for each profession.

The workforce projection model is the working tool on which the forecast is based. It is of the "stock and flow" type. It starts with the premise that for each healthcare profession, there is demand and supply.

The demand comes from the population that requires healthcare. The supply is determined by the people in the healthcare sector who practise the profession in question.

The projection model has a number of parameters and takes account of international mobility, both at the beginning of studies and at the start of specialisations and professional practice. The scenarios anticipate the active professional population in Belgium, placed in a European and international context.

Several scenarios for the evolution of the workforce are developed, based on the current situation of a specific group of professionals and various assumptions about future developments.

In the baseline scenario, observed historical trends are used as a starting point and projections for the evolution of the number of active professionals are made "under unchanged conditions and policies". In these predictions, the number of active professionals is taken into account, minus exits (deaths, retirements), plus new graduates in Belgium, plus the flow of practitioners who have graduated abroad.

The evolution of the demand for care is estimated on the basis of the number of individuals, the structure of the population, according to age and sex, as well as the consumption of care.

ALTERNATIVE SCENARIOS

Alternative scenarios are then developed. The parameters of the baseline model are adapted according to a series of hypotheses relating to the future evolution of the workforce, the context, the activity, the demand for care, etc. These hypotheses are developed by the various Planning Commission working groups.

NOTICE TO THE FEDERAL MINISTER OF PUBLIC HEALTH

Once the future scenarios have been completed, the Planning Commission prepares a recommendation. This recommendation reflects the evolution of the profession, the relationship between supply and demand, and any related issues and concerns. For professions subject to a quota, the Commission also drafts a notice setting the federal quota. This quota will be used to determine the number of physicians and dentists with a Belgian diploma who qualify to apply for an internship to obtain a professional title in a specialty in Belgium. To date, only physicians and dentists are subject to such a quota.

ACTIVE PROFESSIONALS IN RELATION TO ALL REGISTERED HEALTH CARE PROFESSIONALS

Firstly, we have the number of professionals entitled to provide services. This is the number registered as of 31 December 2021 in the annual statistics of professionals entitled to provide services. It includes all professionals domiciled in and outside Belgium.

Secondly, we have the number of professionals actually working in healthcare. The rate used to estimate active practitioners is that observed in the latest available publication on the activity of the profession (published or in progress).

ESTIMATED NUMBER OF ACTIVE WORKERS AS A PERCENTAGE OF ALL
HEALTHCARE PROFESSIONALS LICENSED TO PRACTISE

The difference in rates observed between the two communities for the health care workforce is mainly explained by the significant presence of foreign students in French Community education. Many foreign students come to train in French-speaking education and then return to practise in their country of origin without strengthening the workforce in Belgium. The French Community has issued a decree to limit this number.

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Last Updated: 13 October 2022

The advisory bodies

There are different advisory bodies for the healthcare professions, each with advisory powers. Their mission is to give the Minister of Public Health, at the Minister's request or on its own initiative, advice on the practice of the profession(s) they represent and, if necessary, advice on the accreditation criteria for these practitioners and the internship supervisors and internship centres for the disciplines concerned.

There are currently eight advisory boards and two technical commissions:

Generally speaking, these advisory bodies are mainly composed of representatives of the profession from professional associations or the academic world. Physicians sit on most of them. The exact composition of these advisory bodies differs, however, depending on the profession represented.

To prepare these recommendations, each advisory body can create working groups with a specific mission. These working groups are composed of members of the board or commission concerned and possibly external experts. Fixed working groups may also be established, depending on the specific competencies assigned to the advisory body.

When the profession requires an internship, these working groups are responsible for analysing individual cases and preparing recommendations within the framework of legal procedures (granting or renewal of approval as an internship supervisor, etc.). This is the case for physicians, dentists, hospital pharmacists and the mental health professions.

RECOMMENDATIONS

The recommendations may concern a series of measures affecting the training that students in the various medical professions will undergo.

The following is a non-exhaustive list of the topics that may be the subject of a recommendation:

• the opportunity to create regulated titles or professions
• the revision of existing criteria
• the duration and level of training
• the final skills to be acquired
• the reserved acts, which can be exercised independently, which can be delegated, etc.
• the topics presenting new challenges, such as artificial intelligence, telemedicine, etc.
• if applicable, the number of training hours to be completed
• etc.

Consult the recommendations issued by the Minister's advisory bodies: consultativebodies.health.belgium.be

In 2021, a total of 32 recommendations were issued.

NUMBER OF RECOMMENDATIONS ISSUED

The health crisis has heavily impacted the work of the advisory bodies since March 2020. They have been asked to provide emergency recommendations on matters specific to this pandemic. In addition, the professionals who sit on these boards and commissions have been heavily involved in the field. For these reasons, non-pandemic work slowed down during the first part of the crisis, although the impact was felt differently by each Council.

The advisory bodies have since resumed their activities at a more usual pace. However, some Councils are in the process of changing or have been very recently changed. This also plays a role in their activities.

PROPORTIONALITY

The Legislation on proportionality has impacted the work of advisory bodies since 2021. In accordance with the 2018 European Directive, the legislator must justify the proportionality of measures when they have a restrictive impact on access to or the exercise of any profession.

Many recommendations from the Councils and other bodies fall into one or both of these categories. Where this is the case, the body now has to demonstrate that they have an objective of general interest and are well justified.

A proportionality test must therefore be carried out when the measure adds restrictive measures to the access to or practice of a profession. This can be, for example:

• extending the number of years of study
• adding or extending the number of training hours
• introducing continuing education to practise a profession
• making the practice of a profession conditional on membership in a professional body
• etc.

In addition, the directive also includes a disclosure requirement. The regulations allow any person to be informed of the envisaged measures before they are established. Stakeholders can then react to them if they wish. This right of reaction is granted to practitioners themselves, as well as to students, patients, associations, etc.

For more information on proportionality: www.health.belgium.be

INTERNSHIP SUPERVISOR AND CONTINUING EDUCATION

As mentioned above, for certain professions a decision may be made that training must be organised for interns. This is the case for physicians, dentists, hospital pharmacists, clinical psychologists and clinical orthopedagogues[2], who are referred to as "interns" for the duration of their internship. These interns are trained by a practising practitioner, called a "internship supervisor". There is an approval process for these supervisors and internship centres. The Minister of Public Health is competent to issue these approvals. According to the legislation, the Minister bases the decision on the recommendations given by the relevant advisory bodies, in particular the Higher Council of Specialist Physicians and General Practitioners, the Dental Council, the Federal Council of Mental Health Professions and the Commission for the Accreditation of Hospital Pharmacists.

To ensure the quality of training, criteria for the approval of supervisors and internship centres have been established for each profession and speciality. These concern both the future supervisor and the activity and supervision that the internship centres can offer.

Criteria adapted to each type of practice guarantee the quality of the training for both a future general physician who trains in general practice and a clinical psychologist who trains in a hospital institution.

These internship supervisor approvals represent a fairly large annual volume of applications. The dossiers are analysed by the administration, then presented to working groups, and the recommendations are confirmed by the competent board before being sent to the Minister, who makes the final decision.

Here are some figures[3] to illustrate the volume of applications and recommendations issued concerning the approval of internship supervisors and continuing education according to the different professions.

^{[1] The Federal Council of Pharmacists is currently being instaured.}

^{[2]Internship is in place for the last two professions but it has not yet been made mandatory.}

^{[3] These are the numbers of dossiers finalised during year X, i.e. that received a recommendation from the board and a ministerial decision. This is not a volume of activity, since each dossier is counted only once, regardless of the number of intermediate recommendations that the council has issued.}

^{[4] 2020 and 2021 were impacted by the health crisis. The organisation of continuing education was particularly disrupted.}