Why Spain is running out of doctors

With almost 20,000 doctors leaving Spain to work abroad and a generation readying for retirement, there are fears of a serious shortage of medical specialists in the coming years. Crucially, foreign doctors eager to help are being held back by bureaucracy.

spain lack of doctors
Many Spanish doctors, particularly those practicing in regions in the north of Spain like Catalonia, have gone to France for better pay and conditions. (Photo by JAVIER SORIANO / AFP)

The Spanish healthcare service is internationally renowned and regularly ranks in the top 10 in the world. But it’s not without its problems, and these are particularly concentrated in its workforce.

With ongoing doctors strikes in Madrid, new stoppages beginning in Cantabria this week, and reported walkouts planned in Navarre in the New Year, doctors in Spain have for years now complained that they are overworked, and their health centres understaffed.

These latest strikes are in protest about working conditions, including long hours, pay and, fundamentally, a lack of doctors in the system putting huge pressure on their workloads.

This combination of factors has in recent years led many Spanish doctors to leave the country.

In fact, in the last decade alone, almost Spanish 20,000 doctors have emigrated abroad.

Tens of thousands of doctors are also set to retire in the next decade in Spain meaning that there will be a shortfall of 9,000 médicos in the next five years, double that figure by 2035.

According to a number of medical publications, there isn’t a lack of medical graduates per se, but rather a scarcity of medical specialists and medics who have passed their MIR, the exam they need to pass to work for Spain’s public health system.

Around 600,000 children in Spain only have access to a GP rather than a paediatrician, as the country is lacking at least 1,300 specialists in child medicine. 

Some regions don’t have enough oncologists, there are half the number of radiologists needed across the country, there aren’t enough pulmonologists, nephrologists, endocrinologists, ENTs, practically all the different types of medical specialists are in short supply. 

The same applies with other health professions. The Spanish health system reportedly needs 120,000 nurses as well as thousands more public sector psychologists and psychiatrists to help solve the country’s mental health crisis (there are only 11 psychiatrists per 100,000 inhabitants).

READ MORE: Why Spain has become a nation of self-medicators

For the general public, this generally results in longer waiting times to see a medical specialist, sometimes several months. 

READ ALSO: What is the average waiting time across Spain to see a doctor?

Poor pay

Salaries in other European countries can be significantly higher than in Spain, and it is often the case that when a doctor finishes their training and qualifies, it can take a long time to find a permanent or stable position in a hospital.

In Spain, a newly qualified doctor’s basic salary is around €1,600 gross per month. As is the case in most professions, the salary rises with experience, but trade unions are warning that a significant proportion of Spain’s doctors are due to retire in the coming years.

The evidence points to Spain facing a severe shortage as many of this younger generation of doctors could continue the emigration trend and go abroad.

Many Spanish doctors, particularly those practicing in regions in the north of Spain like Catalonia, have gone to France for better pay and conditions, but swathes have also left for the United Kingdom. The International Medical Compensation Report 2021 found that American doctors are the best paid in the world, with an average annual salary of €273,000. As for European countries, the report found that the best paid doctors in Europe are German doctors, who make €158,000 a year on average.

The UK came in third with an annual salary of €119,000, France fourth with an average income of €85,000 a year, and then Italian doctors, who made an €60,000 euros a year. Where did Spain come in the findings? Down in the sixth place, with an average annual salary of €49,000 – almost a third of what German doctors make.

Foreign doctors prevented from working

There are many foreign trained doctors living in Spain who are not practicing even though they want to, as they are struggling to have their foreign qualifications recognised by the Spanish government through an unnecessarily laborious administrative process known as homologación.

Even though they could provide a quick solution to the lack of doctors in the country, they are forced to wait as Spain’s public administrations take two or three for their regulated qualifications to be processed, and then they have to wait for months to be able to sit the MIR public health exam.

READ MORE: ‘Homologación’: How Spain is ruining the careers of thousands of qualified foreigners

In fact, over 6,000 Venezuelan doctors living in Spain have formally offered to step in to try to ease Spain’s primary care crisis. Dr. Giovanni Provenza, President of the Association of Venezuelan Physicians in Spain (AMEVESP), told Spanish newspaper El Periódico de España that there are 1,100 Venezuelan doctors currently waiting for the recognition of their medical qualifications. In Madrid alone, there are as many as 700 Venezuelan doctors living in the city.

“They [the Spanish authorities] are not recognising the qualifications of specialist non-EU doctors,” Provenza added, suggesting that foreign-trained specialists who “cannot work as specialists in Spain or practice in general medicine, and in the best of scenarios, they are hired in private medicine…. All the authorities know it, [but] they turn a blind eye.”

The Venezuelan doctors, Provenza added, could even help alleviate some of the public service shortfalls in areas of the country known as ‘Empty Spain’ (España Vaciada) in rural communities in inland Spain.

“There are professionals willing to go to rural areas if they are offered decent conditions,” Provenza said.

“It is not a question of supplementing Spanish doctors here. There is no conflict of interest.”

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‘Spain must invest in Spaniards rather than turning to migrants’: EU work chief

The European Commission’s head for jobs and social rights has said Spain “must first find a solution for young people, women and the elderly” with regard to its labour market and “see later if they need immigrants”.

'Spain must invest in Spaniards rather than turning to migrants': EU work chief

The European Commissioner for Jobs and Social Rights Nicolas Schmit recently took part in a summit on job security in Bilbao, where he spoke with Spain’s Labour Minister and Second Deputy Prime Ministers Yolanda Díaz about the state of affairs for workers in the country. 

When discussing potential solutions to Spain’s high unemployment rate, Schmit explained “I would not exclude immigration, but when I analyse the data, I see youth unemployment of 30 percent, more than double the European average”.  

“The priority for Spain must be to invest in its people,” Schmit continued.

“They must first look at their labour market and find a solution for young people, women and the elderly. They will see later if they need immigrants”.

Despite high unemployment levels which currently amount to three million people, Spain has worker shortages in a wide variety of sectors. 

READ ALSO: The ‘Big Quit’ hits Spain despite high unemployment and huge job vacancies

The Spanish government recently changed its immigration laws to make it easier for employers to hire non-EU citizens for sectors with shortages, from waiters to plumbers, whereas previously recruiters were required to prove that they couldn’t find an EU candidate for the job and the skills shortage list was limited and outdated. 

READ MORE: How spain is making it easier for foreigners to work in Spain

In 2023, Spain’s Ministry of Inclusion, Social Security and Migration wants to hire 62,000 third-country workers to cover an array of construction and trades jobs, something the country’s Labour Ministry has not agreed to yet. 

READ ALSO – EXPLAINED: Spain’s plans to recruit thousands of foreigners for construction and trade jobs

The government also recently passed its new startups law to attract foreign investors, digital nomads and talent to the country.

Could Spaniards not be trained to do these jobs as Schmit alludes to? Currently, low wages and unstable working conditions are dissuading many locally trained professionals from staying.

This includes almost 20,000 doctors who have moved abroad in recent years as salaries in other European countries are significantly higher than in Spain, with a newly qualified doctor’s salary only around €1,600 gross per month.

Staff shortages in the health sector are not helped by the fact that foreigners with non-EU qualifications wait for several years for their qualifications to be recognised in Spain through an unnecessarily laborious administrative process known as homologación. This applies to a number of regulated fields, from engineering to dentistry, all of which face shortages. 

READ MORE: How Spain is ruining the careers of thousands of qualified foreigners

Spain’s Socialist-led government has partly addressed some of its labour market issues by reducing the rate of temporary contracts and increasing the minimum wage (SMI), but voices within the opposition have accused Sánchez’s administration of “dressing up” the dire reality.

When asked about the rise in minimum wage, Schmit said that he believes “it will not mean significant changes for Spain, which already has a tradition of updating the minimum wage on a regular basis… but the government must take into account factors such as the cost of living and the economic context”.

“Spain must question whether the SMI allows for a decent life or creates poor workers. Its economy cannot be supported by low wages and low productivity,” he continued.  

When asked if salaries and inflation have to go hand in hand, Schmit argued “wages must be set by collective bargaining. We are experiencing very high inflation because of the explosion in energy and food prices. If there is a large lag between wages and inflation, there will be an impact on demand and the risk of recession will increase”.

With regards to pensions, Schmit explained: “I don’t think that pensions are very high in Spain and if you leave a gap between the rise in benefits and inflation, you can create a situation of poverty among the elderly. Spain has a disadvantage in that it has one of the fastest-ageing societies… The solution is to modernise the economy to make it more productive and attract more people to the job market”.  

Despite these issues, the commissioner acknowledged that the Spanish labour market has surprised many with its resistance this year. “Employment will remain strong if there is no deep recession,” he said.  

“The national plan for access to European funds has a good combination of measures to invest in green energy, digitisation, education and public employment services… Spain experienced its economic miracle due to the real estate boom, which exploded, and now it has to transform to go in the right direction”.

According to a report carried out by human resources company Hays on work trends in Spain in 2022, 77 percent of Spaniards surveyed said they would change jobs if they could. Furthermore, 68 percent of them confessed that they are actively looking for another job and the main reason they argue is to get a better salary. 

According to Eurostat data from January 2021, 37 percent of Spain’s workforce is overqualified, 17 percent higher than the EU average.

READ ALSO: Why more people than ever in Spain are overqualified for their jobs