SUMMARY

In Spain, though the lack of medical practitioners remains selective, involving some specializations and geographical areas, its effects and repercussions being at first an exclusive concern of those in charge of institutions, have turned into an actual social alarm.

One can predict that the current deficit will be larger because of factors that affect both the offer and the demand of professionals. These factors strengthen the already existing imbalances within the labour market: imbalances among different types of healthcare professionals and medical specializations; geographical imbalances when it comes to resources and regional market segmentation; generation imbalances; those between public and private nets; those having place during the transition from the university to MR (Medical Residency); and those involving professionals immigration. The main bottleneck appears in the transition between the Medicine Bachelor Degree and the MR specialization.

Each year, 4,200 medical students get their bachelor’s degree in Spain, while 6,000 medical residents (MR) posts are called for physicians. MR vacancies remain uncovered, resignations spread and medical practitioners are imported.
The international mobility of physicians from and to Spain has increased and is found to be very intense. In 2006, 1,015 degrees of specialized doctors from the European Union were recognized and 3,248 degrees from extracommunitarian countries were standardized, while only 3,951 students got their Medicine Bachelor’s Degree.

The public intervention over the healthcare professionals is very intense and embraces a broad spectrum, from every step of the medical education and training to the post achievement, apart from the professional accreditation and standardization of foreign degrees. Notwithstanding, the main part of decisions are shared among the central and autonomous governements, different departments (Health and Education) and professional associations. The Health Ministry keeps competency on the accreditation and education; the autonomous communities, main solicitors of healthcare professionals, suffer the imbalances within their labour markets and put the blame on the Health Ministry for the lack of planning. Coordination is not easy, mainly due to political rivalries that aim to make some noise and an institutional design of the National Health System management that is based on governing on grounds of voluntarism.

The European Union is making efforts to standardize the education programs and university degrees to make a further step towards an effective input-output movement of the labour force within the member countries. In this context, the “license to heal” that is accorded in Spain to extracommunitarian medical practitioners is more usually taken regarding administrative criteria rather than professional ones, and is incapable of guaranteeing by itself neither the knowledge background nor the capability of carrying out a continuously dynamic profession, within a different healthcare system, counting on different epidemiological profiles, diagnostic techniques and unknown pathological processes. There is an actual risk of polarizing the profession in two extremes: the excellent and the poor ones. The periodical reaccreditation or recertification of every medical doctor is an alternative to be considered in Spain, one that other countries have already assumed.