As Few Pediatricians as Possible and as Many Pediatricians as Necessary?

This article discusses the very important issue of the shortage of pediatricains during the next years. A common mantra is “as little as possible and as much as necessary.” This perception can be applied to all kinds of different projects in everyday life in order to help achieve a good outcome. It also applies to medicine, for example, “as little antibiotics as possible and as much/many antibiotics as necessary.” However, does this “rule” also apply to the pediatric workforce, that is, “as few pediatricians as possible and as many pediatricians as necessary”? How can we develop a sustainable pediatric workforce to meet the healthcare needs of children? We previously offered different equations for calculating the needed numbers of annually trained pediatricians to keep the actual number of pediatricians in a country stable in view of variable working conditions such as full-time or part-time working equivalents1,2 and weekly working hours and night shifts.3 We now describe pediatric workforces in 2013-2018 in 16 European countries, 11 European Union and 5 nonEuropean Union countries. National child healthcare systems are embedded in the underlying political and economic systems such as capitalistic, liberal, monarchic, socialistic, or social market system. National pediatric workforces can be analyzed according to the triangle of need–supply–demand. Our analysis neither intended to compare national pediatric workforces with the underlying political systems nor did it investigate the role of different types of health insurance systems, for example, financed by levies to insurance funds (Bismarck system) or by taxes (Beveridge system). We also tried to avoid a singlesided view of pediatricians whose understandable aim is to defend their own needs and to improve working conditions. Instead, we wanted to look at the child healthcare services through the eyes of families and their children. The priority of families is to have an available, adequate/appropriate, affordable, and easily accessible healthcare service provided by highly qualified personnel on all levels ranging from generalists to specialists. Families wish to have a wellfunctioning and competent child healthcare system that—if fragmented—should be well-coordinated. Different bodies and institutions involved in the care of children should communicate and cooperate well, reaching a consensus wherever and whenever possible.