ABSTRACT

Staffing structure planning in medicine has an appeal which was obvious in the UK since the beginning of the National Health Service (NHS) (Parkhouse 1978) and has become an attractive idea to other countries more recently. In theory, one can train the right number of doctors, distribute them appropriately and thus provide a good standard of medical care without unemployment or waste of money. In practice, this works only up to a point, that point depending on the way the planning is done and the degree to which it can be implemented, which has a lot to do with the way doctors earn their living. Forecasting of supply and demand is one thing; bringing about change is another. With increasing medical specialization-itself a matter of serious interest in many countries (World Health Organization 1985; Parkhouse 1989b)—planning involves not only regulating the total number of medical school places, with or without immigration controls, but also sorting out the kinds of work different numbers of doctors do: by chance, choice, direction of labour or a mixture of all three.