Document Type : Original Article


1 Department of Management, School of Management, Sharif University of Technology, Tehran, Iran

2 Department of Surgery, School of Medicine, Qazvin University of Medical Sciences, Qazvin,


CONTEXT: Shortage of physicians particularly in specialty levels is considered as an important issue
in Iran health system. Thus, in an uncertain environment, long‑term planning is required for health
professionals as a basic priority on a national scale.
AIMS: This study aimed to estimate the number of required neurosurgeons using system dynamic
SETTING AND DESIGN: System dynamic modeling was applied to predict the gap between stock
and number of required neurosurgeons in Iran up to 2020.
SUBJECTS AND METHODS: A supply and demand simulation model was constructed for
neurosurgeons using system dynamic approach. The demand model included epidemiological,
demographic, and utilization variables along with supply model‑incorporated current stock of
neurosurgeons and flow variables such as attrition, migration, and retirement rate.
STATISTICAL ANALYSIS USED: Data were obtained from various governmental databases and
were analyzed by Vensim PLE Version 3.0 to address the flow of health professionals, clinical
infrastructure, population demographics, and disease prevalence during the time.
RESULTS: It was forecasted that shortage in number of neurosurgeons would disappear at 2020.
The most dominant determinants on predicted number of neurosurgeons were the prevalence of
neurosurgical diseases, the rate for service utilization, and medical capacity of the region.
CONCLUSIONS: Shortage of neurosurgeons in some areas of the country relates to maldistribution of
the specialists. Accordingly, there is a need to reconsider the allocation system for health professionals
within the country instead of increasing the overall number of acceptance quota in training positions.


1. Roberfroid D, Stordeur S, Camberlin C, Van de Voorde C,
Vrijens F, Léonard C. Physician workforce supply in Belgium: Current situation and challenges. Health Services Research (HSR).
KCE Reports C. Brussels: Belgian Health Care Knowledge
Centre (KCE); 2008.
2. Simoens S, Hurst J. The supply of physician services in OECD
countries. OCDE Work Pap 2006;21:62.
3. World Health Organization. Working together for health. In:
World Health Report. Geneva: World Health Organization; 2006.
4. Buchan J, Wismar M, Glinos IA, Bremner J. Health Professional
Mobility in a Changing Europe. World Health Organization: The
European Observatory on Health Systems and Policies; 2014.
5. Birch S. Health human resource planning for the new millennium:
Inputs in the production of health, illness, and recovery in
populations. Can J Nurs Res 2002;33:109‑14.
6. Stokker JH, Gillian H. The right person, in the right job, with the
right skills, at the right time. A workforce planning model that
goes beyond metrics. Libr Manag 2009;30:561‑71.
7. Roberfroid D, Leonard C, Stordeur S. Physician supply forecast:
Better than peering in a crystal ball? Hum Resour Health 2009;7:10.
8. Busato A, Künzi B. Primary care physician supply and other key
determinants of health care utilisation: The case of Switzerland.
BMC Health Serv Res 2008;8:8.
9. Retail Online Integration. Contact Centers: How to Calculate Staff
Levels and Scheduling Requirements. Available from: http://‑centers‑how
‑calculate‑staff‑levels‑scheduling-requirements‑27109/1. [Last
retrieved on 2011 Jul 13].
10. Murphy TG, Birch S, MacKenzie A. Needs‑based Health Human
Resources Planning: the Challenge of Linking Needs to Provider
Requirements. Ottawa: Canadian Nurses Association and
Canadian Medical Association; 2007.
11. Araseki M, Yokooka Y, Ishikawa T, Ogasawara K. The number
of Japanese radiologic technologists will be increased in 40 years.
Radiol Phys Technol 2013;6:467‑73.
12. Homer JB, Hirsch GB. System dynamics modeling for public
health: Background and opportunities. Am J Public Health
13. Joyce C, McNeil J, Stoelwinder J. More doctors, but not enough:
Australian medical workforce supply 2001‑2012. Med J Aust
14. Mills MD, Thornewill J, Esterhay RJ. Future trends in the supply
and demand for radiation oncology physicists. J Appl Clin Med
Phys 2010;11:3005.
15. Chung SH, Jung Chae D, Yoon S, Lee D. A dynamic forecasting
model for nursing manpower requirements in the medical service
industry. Serv Bus 2010;4:225‑36.
16. Barber P, López‑Valcárcel BG. Forecasting the need for medical
specialists in spain: Application of a system dynamics model.
Hum Resour Health 2010;8:24.
17. Taati E, Meshkini A, Khorasani Zavareh D. Distribution
of specialists in public hospitals of Iran. Health Inf Manag
18. Taghavi M. Need Assesment and Policy Manking to Develop
Specialized Human Resources. Research and Planning Center of
Higher Education. Iran, Tehran; 2001.
19. Simforoosh N, Ziaee SA, Tabatabai SH. Growth trends in
medical specialists education in Iran; 1979 – 2013. Arch Iran Med
20. Nikpajouh A. Projecting the demand for cardiologists in Iran:
Benchmarking. Payesh 2012;11:589‑4.
21. Joyce CM, McNeil JJ, Stoelwinder JU. Time for a new approach
to medical workforce planning. Med J Aust 2004;180:343‑6.
22. Deloitte Center for Health Solutions. Better Health Care Worker
Demand Projections: A Twenty First Century Approach. United
States: Bipartisan Policy Center; 2013.
23. Forrester JW. Industrial Dynamics. Cambridge MA: MIT Press;
24. Chopra M, Munro S, Lavis JN, Vist G, Bennett S. Effects of policy
options for human resources for health: An analysis of systematic
reviews. Lancet 2008;371:668‑74.
25. Senese F, Tubertini P, Mazzocchetti A, Lodi A, Ruozi C, Grilli R,
et al. Forecasting future needs and optimal allocation of medical
residency positions: The Emilia‑Romagna region case study. Hum
Resour Health 2015;13:7.
26. Rafiei S, ArabM, RashidianA, MahmoudiM, Rahimi‑MovagharV.
Factors influencing neurosurgeons’ decision to retain in a work
location: A Qualitative study. Glob J Health Sci 2015;7:333‑51.