Medical specialist manpower planning in The Netherlands.
The subject of this chapter is manpower planning of medical specialists in The Netherlands. The concept of manpower planning refers both to a policy plan and to the process of its development. The goal of such a policy plan is to reach and maintain a dynamic equilibrium on the national level between the number of available specialists and the number of jobs in their specialty. Policy development has an analytical component. Policy analysis can generate operational goals for a labour market equilibrium, using highquality statistical information about historical and current numbers of specialists and jobs, as well as high-quality information about the future development of the demand for specialist health services. Policy analysis can also generate a set of instruments, appropriate to control (directly or indirectly) factors that cause variations in the number of specialist positions and in the number of specialists. For such analytical purposes knowledge has to be generated about: (a) the factors that actually cause the variations; (b) the way these factors can be influenced; and (c) the boundary conditions that limit the range of influence. Policy analysis also has a sociopolitical component. Decisions on goals and instruments are seldom determined by the results of policy analysis alone. The results are used as inputs in complex decision-making processes where strong sociopolitical variables influence the choice of goals and instruments. These variables constitute many of the boundary conditions that limit the possibilities for rational control of demand and supply variations in the medical specialist labour market. The primary goal of this paper is to contribute to the empirical development of the knowledge needed to understand the dynamics of the sociopolitical component of manpower planning. To that end, it describes and analyses how the interacting policies of several governmental and non-governmental agencies determined the development of the number of jobs and specialists in The Netherlands, especially