Competing for doctors with the public sector in Europe
Whichever way you want to dress it up, it is undoubtedly true that private operators are in direct competition with the public sector across Europe for clinicians and nurses.
And this power struggle to a very great extent is what determines whether the private sector grows, or shrinks.
In essence the private sector can offer clinicians three things – more money, more autonomy and a better place to work. In some countries, notably all of Eastern Europe, it is a lopsided battle which private providers have no trouble winning. And that is why the private sector is growing so fast in countries like Romania and Bulgaria (and in almost all emerging markets beyond Europe).
In Western Europe it is a far harder battle to win. Ideologically many doctors refuse to work for the private sector. It would be interesting to know the percentage by country.
In the UK beyond London and the M25 ring road around it, and in southern Europe, clinicians often earn more in the public sector. Professional indemnity costs render a small private practice uneconomic in the UK. In Spain, a private lab group told us that it is losing lab doctors to a public sector which is prepared to pay twice as much to people who will work fewer hours.
The feminisation of the profession as well as a new, less-driven generation across Western Europe means that the newly minted clinicians are often less entrepreneurial and want to work fewer hours. That can cut both ways. In France it makes public hospitals preferable to the onerous life as a freelancer building a practice in the private sector. In Finland private operators tempt doctors with more flexible packages than the public sector.
Occasionally the private sector can win over an entire team. Bergman Clinics managed this feat in the Netherlands where half a dozen orthopaedic surgeons have moved to a new private clinic. They get paid the same rate as in the public sector but can be much more productive in a purpose-built centre where they are freed from administrative burdens. Eventually the centre should generate revenue of €20-25m a year. Insurers should like the standards and the low prices. Bergman has turned to this route after (so far) failing to persuade public hospitals to outsource specialities.
Long-term, given the shortages, the private sector needs to train its own supply of doctors and nurses. This is starting to happen, albeit mainly outside Europe. We are told that a single Indian group Dr Agarwal Eye Hospitals trains more ophthalmologists than the English NHS. Laureate, a US-listed international tertiary education supplier is training nurses on several continents. But that is a subject for another time.
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
