WMA Resolution on Medical Workforce

Adopted by the 50^th World Medical Assembly, Ottawa, Canada, October 1998
revised by the 60^th WMA General Assembly, New Delhi, India, October 2009 and
the 74^th WMA General Assembly, Kigali, Rwanda, October 2023

PREAMBLE 

The medical workforce is essential to healthcare systems. To meet the present and future health needs of the global populations, adequate healthcare services in all fields of medicine should be provided. This requires ensuring sufficient numbers of trained physicians in all countries taking into consideration evolving populational healthcare needs as well as physicians’ right to international mobility, while preserving the well-being and safety of both patients and physicians.

Population growth in many parts of the world, combined with ageing populations in other regions point toward an increasing shortage of physicians. Comprehensive and extensive medical workforce planning on both the national level and the international levels is therefore essential, within an ethical coordinated global framework, as recommended in WHO Global Code of Practice on the international Recruitment of Health Personnel. In this regard, the WMA reaffirms its Statement on Ethical Guidelines for the International Migration of Health Workers, and its Resolution on Task shifting in dealing with the significant global shortages of medical workforce [1].

Inadequate working conditions and the lack of support to the medical workforce has exacerbated the workforce shortage situation causing physicians to leave their home countries. This phenomenon occurred especially during the COVID-19 pandemic, which has renewed focus on physicians’ well-being and safety.

In this regard the WMA reaffirms its policies on Bullying and Harassment within the Profession, Physician well-being, Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence, Workplace Violence in the Health Sector, Epidemics and Pandemics, the Medical Profession and COVID-19, Digital Health, as well as Augmented Intelligence in Healthcare, Gender Equality in Medicine and Medical Education.

Thriving both professionally and personally is critical for the medical workforce to carry out their vital responsibilities, and to ensure quality healthcare services.

The World Health Organization (WHO) has developed several instruments that support the medical workforce, and acknowledge the global urgency to support and protect health personnel, in particular:

• the Global health and care worker compact, a technical tool provided to prevent harm, provide support, safeguard rights, and ensure inclusivity of the health workforce across the world;
• the Global Strategy on Human Resources for Health: Workforce 2030, to identify and implement solutions to the healthcare workforce problems.

RECOMMENDATIONS

The WMA stresses the need for comprehensive and gender equal measures to guarantee physicians’ well-being and safety via an adequate working environment, including in emergency contexts, and emphasizes on the employer’s responsibility to ensure it.

The WMA calls on the following stakeholders to:

WHO and other relevant international entities

1. strengthen the management of the medical workforce through international cooperation and consensus;
2. provide timely data and information to guide the international and national efforts on medical workforce recruitment and retention;
3. identify the skills, knowledge and ways of working that the evolving workforce will require in the future.

Academic institutions

4. ensure that the education, training and development of the medical workforce meets the highest possible standards, including student support, and that they are carried out with solidarity, consideration and mutual respect;
5. conduct and publish research on the impact of working conditions of physicians on the quality of healthcare services provided, and on the effectiveness of interventions aimed at ensuring workplace safety;
6. include clinical informatics and digital health literacy in medical training and education to ensure the workforce is equipped with the skills and knowledge to harness existing and emerging technologies, in accordance with the principle of confidentiality, to improve health outcomes.

Governments / Health authorities

7. guarantee the ethical international recruitment of health personnel, considering the rights, obligations and expectations of source countries, destination countries and migrant health personnel, in reference to WHO Global Code of Practice on the International Recruitment of Health Personnel;
8. develop and implement Positive Practice Environments in health care settings in line with the World Health Professions Alliance (WHPA) campaign in order to increase physician retention;
9. establish an appropriate monitoring and reporting mechanisms at institutional and system level, to document deviations from best practices for healthcare workplaces, e.g. unacceptable working conditions, shortage of staff and equipment. Such a database should be made available to professional organizations and other relevant stakeholders;
10. ensure that appropriate and safe patient to physicians’ ratios are maintained between the populations and the medical workforce at all levels, including mechanisms to align supply with population healthcare need, and address access to care in rural and remote areas, based on evidence-based workforce planning, accepted international norms and standards where these are available, and in accordance with the WMA Statement on Access to Healthcare;
11. directly address the obligations of hospitals’ commercial management and/or representative organizations to ensure safe and healthy working conditions;
12. allocate sufficient financial resources for the education, training and development of the medical workforce to meet the health needs of the entire population in the country in reference to the WMA Statement on Medical Education;
13. combat discrimination and foster inclusive policies for physicians and personnel from foreign countries;
14. adequately engage and collaborate with medical professional bodies on the development and implementation of policies impacting on medical practice, such as policies around Universal Health Coverage, reimbursement, and allocation/distribution of medical personnel, in accordance with the WMA Declaration of Seoul on Professional Autonomy and Clinical Independence;
15. adequately invest in the recruitment and retention of the needed medical workforce via the improvement of working conditions, including:

• • provision of fatigue management and safe rostering practices, including consideration of a maximum of weekly working hours for physicians in all health care establishments to prevent burnout and sustain motivation,
  • access to appropriate facilities, equipment, treatment modalities, etc.
  • adequate support from other trained healthcare professionals,
  • protection from harassment, violence, workplace stress, stigma and forced labour,
  • access to career development opportunities at all professional levels, including promotion of equity, inclusion and diversity,
  • adequate professional support and fair remuneration.

16. in partnership with health professions’ organisations, timely anticipate potential imbalances between the supply and demand of medical workforce in order to assess future needs in human resources and design plans to meet those needs;
17. address telemedicine in the contractual responsibilities of recruited physicians while recognizing the diverse needs of the medical workforce by enabling greater work-life balance, through flexible and remote working where clinically appropriate;
18. develop transparent memoranda of understanding between countries where migration of physicians is an issue of concern.

WMA constituent members

19. promote WHPA Positive Practice Environments campaign to create health care settings that are high quality and supportive workplaces;
20. advocate for governments to develop policies to support the recruitment of physician candidates from within their own countries;
21. actively advocate for the protection of physicians from harm, while promoting adequate working and living conditions;
22. work with the government to devise appropriate policies addressing multidisciplinary practice;
23. promote regular evaluation and improvement of the workforce planning solutions’ impact and effectiveness.

[1]Terminology:
– The term “medical workforce” in the text refers to physicians.
– According to WHO Health Workforce-related terminology:
“Health workforce” refers to health workers considered collectively.
“Health workers” are all people primarily engaged in actions with the primary intent of enhancing health.