Access to medical care requires a sufficient number and proper distribution of doctors in all parts of the country. A shortage of doctors – either widespread or in specific regions – can lead to inequalities in access to care and unmet needs. In all OECD countries, the number of doctors has increased more rapidly than population size over the past decade, so that on average the number of doctors per 1 000 population rose from 3.3 in 2013 to 3.9 in 2023 (Figure 8.4). However, this does not mean that the shortage of doctors has decreased, given rising demand for healthcare, driven in part by population ageing.
In 2023, Greece, Portugal, Austria, Italy and Norway had the highest number of doctors among OECD countries, with 5.0 or more doctors per 1 000 population, although the numbers in Greece and Portugal are overestimated as they include all doctors licensed to practise (not just those actively practising). By contrast, the number of doctors was the lowest in Türkiye and Colombia, with 2.5 or fewer doctors per 1 000 population. Many non-European countries, notably Japan and Korea in Asia and Canada, Mexico and the United States in North America, also had relatively few doctors compared to the OECD average. Among OECD accession countries, Brazil and Peru had fewer doctors per population than any OECD country in 2023. While Argentina appears to have more doctors than the OECD average, the number is overestimated as it includes all doctors licensed to practise.
The growing number of doctors in OECD countries has been driven mainly by an increase in the number of students graduating from domestic medical schools (see section on “Medical graduates”). Long-held concerns about doctor shortages and the ageing of the medical workforce prompted many OECD countries to increase the number of students in medical schools several years ago (OECD, 2023[1]). In some countries, the immigration of foreign-trained doctors also contributed to the growth of available doctors (see section on “International migration of doctors”). A third factor is that in several countries more doctors are extending their careers beyond the previous standard retirement age (see section on “Doctors (by age, gender and category)”).
While the number of doctors per population has increased over the past decade in all countries, the average working hours of doctors has decreased in most countries, so the increase in the number of full-time equivalents (FTEs) has been more modest. Data from the European Union (EU) Labour Force Survey show that on average across EU countries, the working hours of male doctors fell from 44.3 hours per week in 2012 to 43.2 hours in 2022 (a reduction of 2.5%), while the working hours of female doctors fell slightly from 40.0 hours per week to 39.5 hours (a reduction of 1.2%) (OECD/European Commission, 2024[2]).
The density of doctors varies not only across but also within countries, and is generally greater in metropolitan regions, reflecting the concentration of specialised services and physicians’ preferences to practise in densely populated areas. In many countries, there is a particularly high concentration of doctors in national capital regions (Figure 8.5) (see also the section on “Physical access to services” in Chapter 5 on variations in doctor density between metropolitan and rural/remote areas).
Doctors may be reluctant to practise outside urban regions due to concerns about their professional life and social amenities. A range of policy levers can be used to influence the choice of practice location of physicians, including: 1) providing financial incentives for doctors to work in underserved areas; 2) increasing enrolment in medical education programmes of students from rural backgrounds or decentralising the location of medical schools; 3) regulating the choice of practice location of new doctors; and 4) reorganising service delivery to improve the working conditions of doctors in rural and other underserved areas (OECD, 2016[3]).
