Global supply of health professionals.

Copyright © 2014 Massachusetts Medical Society. There is a global crisis of severe shortages and marked maldistribution of health professionals that is exacerbated by three great global transitions — demographic changes, epidemiologic shifts, and redistribution of the disability burden. Each of these transitions exerts a powerful force for change in health care systems, the roles of health professionals, and the design of health professional education.1-5 Every country will have to respond to these global pressures for change. There are many other reasons that it is important to think globally about the education and role of health professionals.6 The knowledge base of the profession is global in scope, and there is increasing cross-national transfer of technology, expertise, and services. Health professionals are migrating in what is now effectively a global market for their talent, while patients are also traveling for treatment. One quarter of the doctors in the United States come from abroad, and the “medical tourism” market for travel to such countries as Thailand and Singapore is growing at a rate of 20% annually.7,8 All people worldwide are threatened by risks such as global infectious epidemics and climate change. Health professionals globally are interlinked and interdependent, facing shared challenges. Global diversity characterizes the way health professionals are defined, educated, and deployed.5 The U.S. pattern of 4 years of college followed by 4 years of medical school is unusual. The United Kingdom requires 5 or 6 years of post–highschool education, and China is moving to consolidate its education of doctors to two levels of 5 or 8 years after high school. Nursing education is more varied, ranging from vocational high-school training to doctoral programs. There are also large differences among countries and regions in numbers of health workers and their skill mix. Table 1 shows that there are 9.2 million doctors and 18.1 million nurses worldwide.9 The United States, with 4% of the world’s population, has 8% of the doctors and 17% of the nurses. Among world regions, the density of health workers can vary by a factor of 10, and there is great variability in the skill mix. The United States has a nurse-to-doctor ratio of 4, whereas the ratios in China and India are close to 1. The World Health Organization has underscored the alarming global shortage of approximately 4.3 million doctors and nurses, which constitutes a shortfall of 15% of the total number of doctors and nurses worldwide. It is estimated that 57 poor countries are facing a severe crisis in that they have insufficient human resources to meet minimum needs.3 Indeed, some countries — for example, Maldives, Bhutan, Botswana, and Namibia — do not have any medical schools at all, funded by either the state or private sources. The shortage is worsened by a global imbalance between the availability of health workers and the burden of disease. Figure 1 shows countries according to the density of doctors, nurses, and midwives. Figure 2 shows that sub-Saharan Africa, with the lowest density of doctors and nurses, has the highest disease burden. These problems are made worse by migration. The 2010 WHO Global Code of