A perfect storm is forming over the Spanish health system. The demand for care continues to grow year after year due to the aging of the population while the health workforce shrinks due to structural factors that are difficult to reverse. Particularly devastating is the growing flight of doctors and nurses to other European countries where they find better working conditions. In the last 10 years, at least 18,000 doctors have emigrated to practice in other countries. To this must be added the growing deficit of doctors due to the massive retirement of professionals planned for the coming years.
The Primary Care Forum estimates that there are currently 4,700 family doctors and 1,300 paediatricians missing, in addition to other specialists. Unfilled positions result in greater stress and overload on the rest of the workforce. The situation is increasingly serious and it will be difficult to find a way out of the crisis without addressing the underlying structural problems, as indicated by the limited impact of the measures that have been taken so far. In the last 15 years, the places to study Medicine have increased by 75%, mainly thanks to the creation of new faculties, which have gone from 28 to 46, and next year it is expected that 1,000 more undergraduate places will be created . And the offer of MIR places for the training of specialists has increased by 38% since 2018. But this strategy collides with another obstacle: to the shortage of doctors, we must add the lack of teachers in the faculties of Medicine, which the conference of deans estimates already now in about 3,800 teachers.
Taking into account that the training of a doctor, whether in Family and Community Medicine or in any other specialty, requires 12 years of study, increasing the offer does not offer short-term results and is not enough to stop the background current that bleeds to the health system. It is of little use to increase the places if, when they finish their degree, more and more doctors emigrate to other countries fleeing job insecurity – a third of doctors have temporary contracts – and increasingly stressful working conditions. According to the Survey on the Situation of the Medical Profession in Spain carried out on 20,000 professionals, one in three doctors is dissatisfied and the main reasons for dissatisfaction are the care load (65.2%), the level of demand (32.9% ) and emotional exhaustion (55.7%). In other countries they not only find better professional conditions, but a salary that in the United Kingdom or Germany more than doubles, and in some Nordic countries even triples, what they can get in Spain.
From all these data it can be inferred that if there is no intervention on the salary and working conditions of the doctors, it will be difficult to stop the bleeding. Countries such as the United Kingdom, Germany or France, which also have a shortage of physicians and will suffer the massive retirement of their professionals in the coming years, will absorb a significant part of those who are trained in Spanish faculties and hospitals. And Spain will have to import, as is happening now, foreign doctors who in many cases will have received a more precarious training and who are also needed in their countries. The public health system is one of the great pillars of the welfare state in Spain. Allowing its main asset, which is to have a sufficient contingent of well-trained professionals, to be decapitalized, is something that no government, national or regional, should allow.