The Flemish government has agreed to implement a system from next academic year to limit the number of specialisations available to new graduates from medical school, in an attempt to steer more young doctors towards general practice.
The system is known as ‘subquota’, and was first created last year, under the previous government. It sets upper and lower quotas for each field of medical specialisation, to meet the needs of the medical sector.
From 2021, the government intends to cut the number of specialisations for last-year students in popular fields like surgery and gynaecology, and open up the numbers in fields where there are shortages either locally or regionally. These include general practice, psychiatry and geriatrics.
The decision to deploy subquota comes after Ben Weyts (N-VA), the minister for education, decided unilaterally to increase the quota for the number of new undergraduates allowed to begin studying medicine.
The governance of education is a responsibility for the language communities, which in Flanders means the same as the regional government (the French community has two education ministers, neither of whom sits in the Walloon regional government).
However despite that, the rules state that the communities should tailor their entrance quotas in cooperation with the federal health ministry. For years, the French community failed to do so, preferring to allow all comers to enter the first year of medical studies, relying on the pressure of work to weed out those who would never make it.
The Flemish, on the other hand, held an entrance exam for medicine and dentistry, reasoning that students with no chance of long-term success would not lose out on one or even two years of studies by starting what they could never finish.
Now, the streaming of students is to be introduced at the level of specialisation, when students have made it through general training and have to decide which specific path they wish to follow.
It is the consensus in the profession that Belgium is in dire need of more general practitioners (GPs). In a report published last year by the Federal Expertise Centre for Health care, the issue was at the forefront.
Concretely: In Flanders the number of practising GPs per 10,000 residents is 7.4; in Wallonia 6,81, and in Brussels only 4.95. In addition, the average age for a French-speaking GP is 54 years; for a Dutch-speaking GP 52 years. 59% of French-speaking GPs at aged 55 or over; for their Dutch-speaking colleagues, the figure is 51%
“The indicators for general practice and nursing raise questions about whether Belgium is capable of coping with the ageing of the population and the increase in chronic diseases,” the Centre said.
“The insufficient number of practising GPs and their rising average age pose problems. The Planning Committee has already pointed to the need for additional GPs, yet too many recent graduates still prefer careers in specialist medicine.”