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Spain must tackle uneven distribution of its doctors, report says

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39471.584618.DB (Published 31 January 2008) Cite this as: BMJ 2008;336:241
  1. Tiago Villanueva
  1. 1Lisbon

    Although Spain has a higher proportion of doctors per head of population than most other European countries, the distribution is uneven, and some specialties have shortages, a report from the Organización Médica Colegial says.

    Juan José Rodríguez Sendín, secretary general of the college, which represents all Spain’s registered doctors, said, “The problem is not one of supply, but of unregulated, unforeseen, or unplanned demand influenced by the intervention of many factors of variable importance, such as population, human resource policies of the Spanish Ministry of Health, and planning.

    “There is only an occasional lack of doctors in Spain in certain specialties, provinces, and departments. It is more correct to talk about maldistribution rather than a real lack of doctors. The professionals we have in Spain are not well distributed according to the needs of each community.”

    According to the report, which compared data throughout member countries of the Organisation for Economic Cooperation and Development (OECD), in 2005 Spain had an average of 380 practising doctors per 100 000 inhabitants, and the OECD average was 300. The number of practising doctors per 100 000 inhabitants was higher in only Greece, Belgium, and Italy.

    Figures from the Organización Médica Colegial show that the number of registered doctors under 65 per 100 000 inhabitants for 2007 was 415, higher than the OECD figure for 2005 (possibly because not all registered doctors are practising medicine). The distribution varied from areas with many doctors, such as Aragon, in northeast Spain (534 per 100 000), and Madrid (499 per 100 000), to areas unpopular with doctors, such as the autonomous community of Melilla, a Spanish city on the Mediterranean coast of Africa, with only 284 doctors per 100 000.

    A report released in March 2007 by the Spanish Ministry of Health pointed out a lack of GPs, anaesthetists, radiologists, general surgeons, and paediatricians.

    The new report outlines some measures to tackle the problem. One entails the creation of a register of the number and distribution of specialist doctors in the country to improve staff planning.

    The report also says that the government must try to increase the number of younger doctors in Spain because about half the Spanish medical workforce is older than 45, and about 59 000 doctors, out of a total medical workforce of 203 000, are expected to retire between 2016 and 2026.

    Also, the number of undergraduate admissions to medical schools and postgraduate training posts needs to be regulated according to the type of doctors that are needed, which is not happening at present.

    The college says that an indiscriminate increase in the number of undergraduate and postgraduate specialty training placements could worsen the situation.

    The report calls for measures to discourage the migration of Spanish doctors through the creation of incentives for doctors willing to practice in rural and less appealing areas. About a quarter of qualified Spanish doctors work abroad, with Portugal and the United Kingdom the most preferred locations.

    Because of the rigidity of the internal labour market of each of Spain’s 17 autonomous communities (each with its own health authority) and of the Spanish national health service, internal mobility is limited, and so many doctors are lured by the prospects of the accessibility of the external labour market because medical degrees from member countries of the European Union are automatically recognised.

    Enrique Gávilan, a Spanish academic GP and head of the young GPs’ section of the Spanish Society of Family and Community Medicine (Sociedad de Medicina Familiar y Comunitária), told the BMJ: “If you ask Spanish doctors who have gone abroad, the most usual feeling is the working conditions are not very attractive in Spain. There should be incentives to work not only in rural areas but also in the country in general. Incentives mean stable contracts, worthy working conditions, and respect for the training period of junior doctors undergoing specialist training.”

    Footnotes