Residents of the Abrantes neighborhood in Madrid say that they sometimes have to wait up to four weeks to see their family doctor or pediatrician. For months, some of them have gathered every Thursday at the health center to demand coverage of vacant places and to solve a problem that exemplifies a reality that, to a greater or lesser extent, affects almost all of Spain: there is a deficit of 4,502 family doctors, according to a report that the Ministry of Health presented this Thursday to the autonomous communities and to which EL PAÍS has had access.
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Residents of the Abrantes neighborhood in Madrid say that they sometimes have to wait up to four weeks to see their family doctor or pediatrician. For months, some of them have gathered every Thursday at the health center to demand coverage of vacant places and to solve a problem that exemplifies a reality that, to a greater or lesser extent, affects almost all of Spain: there is a deficit of 4,502 family doctors, according to a report that the Ministry of Health presented this Thursday to the autonomous communities and to which EL PAÍS has had access.
This means that it would be necessary to increase the number of doctors by 10% to cover all the positions. The situation will get worse in the coming years: the deficit will continue to grow until 2028, when 5,500 family doctors will be needed to meet demand. From there this imbalance will begin to be corrected, although in 2035 there will still be 2,000 fewer professionals than required, according to projections from the Report on the need for specialist doctors in Spain 2023-2035.
Family medicine (whose professionals work in both Primary Care and Hospital Emergencies) is not the only one with a lack of professionals. In total, throughout the system there is a deficit of 5,874 doctors, but it is undoubtedly the family that accounts for the bulk of the shortages. Immunology, surgery, clinical analysis, pharmacology and psychiatry, among others, are specialties that also have fewer personnel than would be necessary. Meanwhile, some such as the digestive system, endocrinology, neurology or gynecology enjoy a surplus.
The general shortcomings of the system will be reduced year by year, until reaching equilibrium in 2032 and exceeding the number of doctors needed by more than 6,000 in 2035, if the document’s forecasts are met. This hypothesis adds all the specialties and compensates the deficits with the surpluses. Or what is the same, in some (as a family) there will continue to be a lack of professionals for those dates, while in others there will be many more doctors than would be necessary.
To reach these conclusions, the researchers, from the University of Las Palmas de Gran Canaria, cross variables to calculate the demand for care – such as the evolution of the population and its age – with the supply – in which they include the number of doctors who They are expected to enter the system and those who are going to retire remain. The study, whose mission is to serve the Ministry of Health and the autonomous communities by adapting their training and employment offer to the needs of the system, updates another one they presented in 2022, which was subject to distortions as a consequence of the pandemic.
Covid was the great trigger for the Primary Care crisis in Spain. When the first waves passed – which overwhelmed hospitals – and infections became increasingly milder, demand in health centers multiplied. And this high influx to clinics has continued since then, with increasingly reduced staff. What should ideally be attention within the day, or in a maximum of 48 hours, has skyrocketed. According to the CIS health barometer, seven out of every ten patients who used their health center had to wait more than 24 hours to be treated. This group had to wait an average of 9.12 days to see their doctor.
The panorama, however, varies greatly depending on the communities. “Castilla y León, Extremadura and Aragón stand out for their good staff of family doctors compared to the Balearic Islands, Madrid and the Canary Islands. As for paediatricians per 1,000 children, Navarra, the Valencian Community and the Canary Islands are better equipped, and at the lower end the Balearic Islands and the two Castiles are better equipped,” the report states.
The study that Health is now transferring to the autonomous communities arrives at the gates of summer, a critical season in terms of the number of professionals, since the workforce is decimated by the holidays. The ministry will have a meeting with councilors next week to address this issue, which has become a political weapon.
Some autonomies governed by the PP (and the party itself) blame Health for the lack of professionals and ask it to call for more MIR positions, which are those that configure the number of personnel who will be able to work in public health once their training is completed. . The problem, however, is somewhat more complex. The deficits that primary care now supports come (beyond demand) from the retirements of doctors of the generation of the baby boomwhich has not been compensated with an incorporation of young residents, since in the years of the crisis – between 2010 and 2016 – the number of places was drastically cut.
Since 2017 it has been rising, but this does not completely solve the problem: on the one hand, the MIR positions offered today will not become professionals ready to join for another four years. On the other hand, in the last three, community and family medicine leaves vacancies. They were 91 in 2021, they rose to 131 in 2022, and there have been 246 this year.
And not only are there unfilled places, but family, the specialty that offers the most places, is also the one that has the most resignations (of those who reject the place to repeat the exam the following year, 45% are family), and that generates the most abandonments once they are filled: 241 residents left their position in 2022, according to the Study Center of the Granda Medical Union. In Spain, this lack is particularly felt in rural and remote regions.
Incentives to become a family doctor
The apparent lack of attractiveness of the specialty does not only occur in Spain. The Organization for Economic Cooperation and Development (OECD) has warned about the growing concern in many countries about the shortage of general practitioners or specialists in family and community medicine. Following the pandemic, most OECD countries reported that they were designing incentives to encourage more students to choose general practice during their internship and postgraduate residency, in order to address this shortage.
The approaches are being varied, but at the moment they cannot solve the situation. This Thursday, the Federation of Associations in Defense of Public Health (FADSP) has presented a document to “save primary care” with a dozen proposals, which include the incorporation of approximately 8,000 doctors specializing in Family and Community Medicine and 15,000 professionals nursing, in addition to other health professionals, such as physiotherapists, midwives, social workers, mental health professionals, speech therapists, opticians-optometrists, podiatrists, who are currently not available or are only accessible by external referral.
In order to fill the places and get more students interested in Primary Care, the FADSP proposes including more weight in this specialty, which today is almost not touched on, in the degree study plans. It is a long-standing demand shared by scientific societies of family medicine, which have been complaining for years about “hospitalocentric” university degrees that focus students on other branches.
They are medium and long term strategies. Meanwhile, neighbors like those in Abrantes continue to be neglected. In the last rally, this Thursday, they demanded: “That when we make an appointment we don’t have to wait months; that when we go to the health center, the doctor who treats us is not different on each visit; that there are pediatricians who care for our girls and boys; that in out-of-hospital emergencies in neighborhoods and towns there are doctors, and that the teams are complete; “That when we go to the emergency room of a hospital we don’t have to wait for hours in the hallways.”