Managing medical workforces: from relative stability to disequilibrium in the UK NHS.

The management of the medical workforce, in particular the market for physicians, is costly and complex. For decades this process has been dominated by largely mechanistic forecasting (e.g., fixed doctor-population ratios), which ignored economic determinants. Internationally, and specifically in the UK, such practices achieved some success in producing modest cyclical shortages and surpluses in the past. However with large increases in UK health care funding, together with the international recognition of significant practice, activity and outcome variations in health care, this approach is now inadequate. With physician shortages emerging internationally, the impact of incentives (both financial and non-financial) on skill-mix (are nurses cost effective substitutes or complements for physicians?), activity (can distribution means be shifted and variation reduced?) and outcomes (can survival duration and quality of life of survival be improved?) is now central to policy development. Such issues create nice challenges for researchers and policy makers.