Governing a Health Professional Work Force in Flux: Policy Dynamics and Employment patterns in Medicine and Nursing
Social and Policy Sciences University of Bath Bath, United Kingdom
Institute for Economics, Labour and Culture Goethe University Frankfurt/Main Frankfurt, Germany
Workforce governance is increasingly recognised as a key issue of health policy and a source for innovating healthcare systems. New health policies attempt on changing the skill-mix of the workforce and improving the management of professional performance. Dynamics also arise from bottom-up changes in the health professional workforce, such as professionalisation and new emerging professional groups, increasing labour market participation of women, migration and mobility. This paper sets focus on the professions as backbone of the healthcare systems and key of workforce governance. Analysis of employment patterns and workforce trends in medicine and nursing in Germany in the last decade serve as case studies to explore how policy matters. In terms of methodology we use document analysis and public data files. We will highlight two conclusions drawn from the analysis: first, our data reveal new inequalities in the German health workforce between medicine and nursing and private and public provider organisations and their gendered effects; second, the findings highlight that blockades towards more effective workforce governance are not only an outcome of "boundary work" and "tribalism" of professions but embedded in the regulatory structure of healthcare systems. Finally, we will place our results in the context of an emerging European health workforce and discuss some suggestions for future research into comparative health workforce governance.