PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

86 Acting early on NCDs The Partnership for Health System Sustainability and Resiliencegain admission without meeting the usual highly competitive entry thresholds. This approach seeks to create a targeted pipeline to address rural workforce shortages. Some federal states also provide scholarships and stipends to medical students who specialise in general medicine or complete rural internships (KBV, 2025). Poland’s dramatic 92.3% increase in medical school admissions represents the most aggressive expansion documented, accompanied by introduction of new professional categories to extend workforce capacity (Kupis et al., 2024). However, rapid expansion strains educational infrastructure, with concerns about maintaining quality. Clinical training sites struggle to accommodate increased student numbers, potentially compromising practical experience essential for competent practice. Spain has invested in developing projections of need for NCD-related professionals through its Report on Supply and Demand of Medical Specialists 2021–2035 (Barber Pérez & González López- Valcárcel, 2022). This systematic assessment provides vital data for workforce planning, projecting shortages of 4,000 family physicians by 2035 unless current trends reverse. The report influences medical school admissions and residency positions, though implementation faces regional variations and professional resistance. Since 2008, Japan implemented regional quotas on medical school admissions which have generated approximately 3,500-4,000 new physicians annually nationwide (MHLW, 2022c). Financial incentives and support systems Financial incentives aimed at retention and redistribution show mixed results across countries. A notable example is the autonomous community of Catalonia in Spain, which offers substantial annual salary increases for family medicine residents aim to improve the specialty’s attractiveness. Early evidence suggests modest increases in applicants, though whether these translate into sustained primary care careers remains uncertain. Income guarantees for rural practice provide security but may not overcome lifestyle concerns. France has created medical assistant positions prioritised for deployment in underserved areas to maximise physician productivity. These assistants handle administrative tasks, basic clinical procedures, and care coordination, potentially increasing physician capacity . Italy’s Ministerial Decree 77 establishes new territorial care models with infrastructure and support to make primary care practice more sustainable. Under DM77 multidisciplinary community health centres will be established, acting as a single point of access for citizens, strengthening the role of primary care physicians and facilitating integrated care. Canada offers financial incentives for rural practice, including signing bonuses, income guarantees, and loan forgiveness programmes (Health Canada, 2025b). These measures are designed to attract physicians to underserved communities and help address persistent gaps in access to care. While such incentives contribute to recruitment, questions remain about their effectiveness in ensuring longer-term retention, raising concerns about the sustainability and overall value of these investments. POLICY LEVERS: WORKFORCE CAPACITY AND DEVELOPMENT The evidence from all studied countries points to a fundamental sustainability crisis that current supply-side approaches cannot resolve. Despite varied interventions, from Germany’s rural quotas to Poland’s dramatic admission increases to Canada’s financial incentives, no country demonstrates a pathway to meeting projected NCD care demands through workforce expansion alone. Whilst task- shifting initiatives like Germany’s MFAs and Japan’s specified acts training show promise for increasing effective workforce capacity, they remain limited in scope and face implementation barriers.