In the health system, not only the patients age So do doctors who cares for them And that forces us to rethink basic aspects of the system, such as access, mobility, incentives, leadership and replacement. The numbers make it clear: the system already lacks 4,000 medical specialists, According to the report on supply and demand of doctors that yesterday disseminated the Ministry of Health. And to this we must add that 20.5% of the 138,797 medical specialists who had in 2018 the public health system, about 28,500, are 60 years old or more. That means they are going to retire in five years at the most. The current gap, 2.9%, will go to 10.5% in five years, and then moderate its growth to 13.4% in 2030.
The training system of specialists, the MIR, is very regulated, and each year it is completed by an average of around 6,500 new specialists, recalls Vicente Matas, from the Primary School Urbana Vocalism of the Collegial Medical Organization. That gives about 20,000 in three years, the average time left for the most veteran specialists. The difference is going to swell the deficit that reflects the work of health economists Beatriz González and Patricia Barber. Matas says that public health also suffers the effect of baby boom, with a very large group of doctors, mostly men, between 50 and 59 years, followed by a generation – which should replace the most senior in positions of responsibility – less numerous.
A distribution problem
But the real problem, says Beatriz González, one of the authors of the work, is not only the total number, but its distribution, both between communities and between specialties. Among the most aged there is Family Medicine, that of the physicians of the health centers, which should be the key in a system increasingly focused on patients with multiple pathologies, chronic and elderly. 62.5% of its professionals are over 50 years old. And there is a great variability between the different specialties. Occupational Medicine (72% with more than 50 years); the youngest, Medical Oncology (27.5%).
In total, nine of the 44 specialties have more than half of the staff with more than 50 years. Proof of the loss of seniority that the public health system will experience with retirement is that in 2030 only three of the specialties will have that age profile. In total numbers, those under 50 will go from being 50% of the workforce to 60%.
If that is the general situation, there are communities where the problem will be greater. Castilla y León, for example, has one in four doctors over 60 years old, and almost 60% of the staff of specialists above 50. They are followed by Catalonia and Ceuta and Melilla (the two autonomous cities are managed by the Ministry of Health through Ingesa) as those who are more sexagenarian. At the opposite extreme, Cantabria has the youngest doctors, with half of Castilla y León above 60, followed by Madrid, the Balearic Islands and the Canary Islands.
The management of generational replacement will be a general challenge, but Beatriz González believes that the solution is not only to accept more students in medical schools and to expand the MIR training of specialists. "The major reference hospitals in the capitals will never lack specialists. The small county centers will have the problem. For example, in Aragon, the hospitals of the city of Zaragoza will easily cover the demand, but the same will not happen with the others, "he says.
11 years of training
In addition, the time it takes to train a specialist (at least 11 years between careers, preparation of the MIR and specialization, says Matas) means that there is no time to use this route to stop the impact of the retirements of the elderly.
Therefore, the co-author of the report, member of the Health Economics Association and professor at the University of Las Palmas, believes that other measures will be needed, such as facilitating mobility, re-specialization and incentives for less attractive positions.
The retirement in 15 years of 50% of the staff of specialists does not cause only a numerical problem. Matas and González agree that it is a loss of experience, since most of the heads of service and other management positions are occupied by the most veteran doctors. Ana Rodríguez Cala, member of the board of directors of the Spanish Society of Health Managers, points in this direction: apart from training young people, the way of directing will also have to be changed. "We have to think about the relay, and we have to reorganize the health system," he says. "The word is multidisciplinarity." "A change in the management model is already underway, more focused on the teams," he says. The idea is to take advantage of the change that is imposed in the population pyramid of the workforce to adapt their work to the change in the patients' pyramid.
Fifty-five percent of all medical specialists in the national health system are women, according to the report commissioned by the Ministry of Health to experts in health economics Beatriz González and Patricia Barber. And the rate will continue to grow, but moderately. It will reach 63.7% in 2030. The evolution is relatively easy to predict depending on those approved to do the MIR. The maximum number of women was in 2013, almost 68%. They are the ones that are ending now. Then the percentage has dropped.
Also in this aspect there is a great variety between specialties (71% of pediatricians and 21% of urologists) and communities (Madrid has 63.7% of doctors, Extremadura, less than half).
"Feminization is not a problem. Simply, you have to make some adaptations for pregnancies, "says Gonzalez. Vicente Matas, of the Collegial Medical Organization, agrees. "You just have to adapt a traditionally male system."