The evolution of human resource needs in Europe.

The distribution of anaesthesia-related staff in Europe is characterized by a wide disparity between countries--and also within countries, between the rural regions and between large and small cities. The density of anaesthesiologists varies in different European areas--for example, 4.4 per 100,000 inhabitants in Ireland compared to 15.6 in Italy; conversely, trainee anaesthesiologists are more numerous in those countries in which the number of qualified specialists is low. These large differences may be explained by factors such as the management of training and assessment, the existence (or otherwise) of nurses, and the workload; mainly in Eastern European countries, the factors include economic conditions and health care policies. Most important are (i) the regulation of entrants into the specialty, and (ii) the range of the anaesthesiologist's duties--including (as well as anaesthesia) intensive care, emergency medicine and pain management. Important modifications could come from an increase in the workload, a decrease in the working time, and perhaps from the development of migratory flows when Eastern European countries join the European Union. The evolution of anaesthesiology in the future will depend on many unknown events: progress in pharmacology and techniques, the development of day-case anaesthesia, the behaviour of new consumers and, above all, future health policies.