Medical deserts: some parts of Brussels do not have enough doctors

The supply of general practitioners in Brussels is sufficient but unevenly distributed, according to the latest mapping of general medicine carried out by the Brussels Health and Social Observatory.

The map shows 1,656 general practitioners working in the capital, which is more than the federal standard of 90 doctors per 100,000 inhabitants, but a third of Brussels residents live in areas where the current supply is insufficient.

Accessibility to a GP is poorer in all of Ganshoren, several areas of Ixelles and the outlying parts of Watermael-Boitsfort, Uccle, Forest, Anderlecht, Molenbeek, Neder-over-Heembeek, Haren and Evere.

“You could say that overall there are enough GPs, but that figure says little about the local situation,” said sociologist Sarah Missine, who helped conduct the study. “In fact, the situation is not ideal, neither for GPs nor for the patients themselves.”

In the west of Molenbeek and Ganshoren, which are undergoing significant social change and an increasing rate of job insecurity, moving away from the centre of the municipality means greater difficulty in finding a GP.

The study also shows many non-Brussels residents seeking treatment there. On average, 18% of consultations are with Walloon or Flemish patients, mainly commuters, students or people living on the outskirts of Brussels.

In collaboration with the Brussels general practitioners' associations, the Observatory mapped the supply of general practitioner care on a scale even smaller than the neighbourhood level.

Using advanced geographical analyses, the number of consultations per year available to each Brussels resident within a radius of 600 metres from their place of residence was calculated.

In some outlying neighbourhoods, the Observatory found, the shortages have grown historically.

“Young doctors tend to work in the city centre and prefer to join existing group practices – these are mainly found in municipalities such as Brussels-City, Molenbeek and Anderlecht, while we see more individual practices in Uccle and Woluwe,” Missine said, noting that while the government does offer incentives to set up new group practices, the risk of doing so is high for a young doctor.

“You would effectively have to manage a business, which is a deterrent, especially since doctors mainly want to focus on their profession. Moreover, many buildings – often townhouses – in Brussels are not suitable for conversion into a group practice.”

Not helping the matter is the rising price of real estate in Brussels.

“That plays a major role – if you want to open a practice in Uccle or Watermael-Boitsfort, or really anywhere in Brussels, everything is very expensive and that’s a major barrier,” said Els Van Hooste, chair of the Observatory.

“Many young GPs would love to work in Brussels, but when it comes down to it and you want to start your own practice, you are suddenly faced with a whole host of practical problems.

"As doctors, we spend a lot of time dealing with administrative matters, such as certificates and other documents. If we could receive sufficient support to lighten that workload, we would be able to help many more people."

The Observatory calculated that Brussels GPs work an average of 44.8 hours per week, of which they spend 70% to 78% in direct interaction with the patient.

However, 57% of the GPs indicate that they would like to work less and 17% of Brussels GPs are older than 65, putting them close to retirement.

Given that, the Observatory predicts that the number of available GP contacts could soon drop by 35% compared to the current situation.

The shortage zones will then no longer be limited to outlying areas and even become critical in a number of places already deemed a medical desert, namely in almost all of Ixelles, the lower part of Saint-Gilles, part of eastern Molenbeek and, among others, the zones in the north-east of Saint-Josse-ten-Noode.

“We expect many young doctors to graduate within the next eight to 10 years, but the shortages will only increase before then,” said the Observatory’s Hicham Vanborm.