Beyond the bottleneck: Addressing Spain’s medical specialist shortage through strategic MIR* expansion and quality training

The government or Ministry of Health must play a leading role in addressing the bottleneck in the Medical Intern Resident (MIR) system through several key actions. Here few proposals for policy review:

Increasing MIR Positions: By annually expanding the number of MIR positions targeting specific specialities, the government can directly address the bottleneck. However, it’s important to note that the effects of such measures are not immediate due to the duration of medical specialty training. Any increase in MIR positions today will only start to alleviate the bottleneck after several years, highlighting the need for long-term planning.

Quality Assurance in Training: While increasing the number of training positions, the government must ensure that the expansion does not compromise the quality of training. High-quality specialist training is crucial for maintaining the standard of healthcare services. The Ministry of Health should implement and enforce strict quality control measures for training programs to ensure that the increase in quantity does not lead to a decrease in the quality of medical specialists.

Incentive Plans for Understaffed Specialties: To address the uneven distribution of medical specialists and the lack of interest in certain specialties, the government can develop incentive plans. These plans could include financial incentives, career development opportunities, and improved working conditions, particularly for primary care and specialties that are less popular among MIR candidates but are critical for the healthcare system.

Facilitating the Integration of Foreign-Trained Doctors: The situation of foreign students, particularly those coming to Spain to pursue medical careers, is influenced by the country’s economic cycles and the public healthcare spending trends. During the early 2000s up to 2008, there was an increase in the number of foreign doctors coming to Spain, many of whom were aiming to join the Medical Intern Resident (MIR) program. The peak year was 2008, with 7,709 foreign-trained doctors arriving in Spain. However, the economic crisis led to a significant reduction in these numbers, dropping to only 1,383 foreign medical professionals immigrating to Spain by 2015. This decline in immigration, especially from Latin American countries, reflects more on a decrease in demand (pull factors) rather than a push from their home countries. The Spanish healthcare system’s capacity to attract foreign medical professionals is closely tied to its economic health and the availability of positions within the MIR system.

By streamlining the recognition and integration process for foreign-trained doctors, the government can mitigate the shortage of medical professionals in certain areas and specialties. This could involve simplifying the homologation of foreign medical degrees and offering language and integration courses to ease their transition into the Spanish healthcare system.

Long-Term Workforce Planning: The government should engage in long-term healthcare workforce planning, taking into account demographic changes, disease prevalence, and healthcare delivery models. This involves not only adjusting the number of MIR positions but also forecasting the specialties that will be in high demand in the future and planning accordingly.

Expanding MIR positions annually has been proposed as a solution to this bottleneck. However, this approach does not offer an immediate resolution due to the inherent time required for specialist training, which spans several years. Therefore, any increase in MIR positions today would only start to alleviate the specialist shortage several years down the line. This delay in the effects of policy changes underscores the complexity of planning for healthcare workforce needs and the importance of long-term strategic planning.

Moreover, there is a valid concern that merely increasing the number of training positions (+2.5% from 2022 to 2023) without parallel efforts to ensure the quality of training could lead to a dilution of healthcare quality. High-quality training is essential for producing specialists capable of delivering excellent patient care. Expanding training capacity without adequate resources, faculty, and infrastructure could compromise the training quality. This could, in turn, affect the overall quality of healthcare services, as the effectiveness of healthcare delivery heavily relies on the competence and expertise of its practitioners.

We can say while increasing MIR positions is a necessary step towards addressing the shortage of medical specialists in Spain, it is not a panacea. It must be accompanied by measures to ensure the quality of specialist training and a strategic approach to healthcare workforce planning that considers the time-lagged nature of training and its impact on healthcare delivery.