M2 Isabel Alonso Magdaleno
UNIVERSITY OF OVIEDO
Evolution and Trends About
Number of Physicians
In Spain: Dynamic Analysis
Departamento de Administracion de Empresas y C ontabilidad
Facultad de Ciencias Economicas y Empresariales
Campus del Cristo
Avda. del Cristo, s/n - 33071
Phone: +34 985 10 36 99
E-mail address: ialonso@ econo.uniovi.es
OVIEDO - SPAIN
EVOLUTION AND TRENDS ABOUT NUMBER OF PHYSICIANS IN SPAIN:
DYNAMIC ANALYSIS
Nowadays, Spain has one of the biggest amount of physicians per capita.
This situation is worrying in comparison with other countries in our
environment (for example U.K, Italy, France or Germany).
That is due to the inappropriate planning policies carried for a long time,
which basically are typified by the lack of anticipation and by the prevalence
of short-term. As a result of that, in our country there is an unbalance
between demand and supply of physicians (a fact which is bringing the
system up to an untenable situation that risk the future of physicians
profession and increases the sanitary costs).
However, past and present governmental politic trends use adjustment
policies instead of preventive policies, which become the problem in a latent
and permanent (in the long-term) one.
This work argues about the rationality of present planning policies and
simulates the evolution of number of physicians for the next twenty years,
based on the formation process carried for a long time and on the politic trends.
\ CONTENTS 4
[] PROBLEM IDENTIFICATION
> Origins of the problem
[] FUTURE CONSEQUENCES
> Model elaboration
> Results of simulation
> Conclusions
a PROBLEM IDENTIFICATION
Core causes
——eeSSS Ss
Deficient planning of human resources in the sector
>>
UNBALANCE BETWEEN EMPLOYMENT AND FORMATION
Irrationality of the politics about positions summons in the
specialized medical formation (MIR)
Lack of anticipation No-delay controls
L] PROBLEM IDENTIFICATION
Important unbalance between supply and demand of specialized physicians
SPECIFIC SEQUENCE OF POSITIONS SUPPLY IN THE SPECIALIZED MEDICAL FORMATION
IN THE 80'S AND 90'S
Need of ialized
Specialized oe kak .
physicians Need of specialized Specialized
physicians physicians
Eighties Nineties
> ORIGINS OF THE PROBLEM
Seventies and early eighties
ml _—_[ Universities ...
0 High demand of undergraduate positions in the medical field
g Lack of de incentive to reduce them
L] Positions summon of Internal Resident Physician (MIR) ...
oO Reduced amount of positions in the specialized medical formation -
MIR formation (limitations)
LI Social needs ...
o Less Generalist Physicians=Primary Care Medicine (Surplus of graduates)
0 More Specialist Physicians (shortage of specialized physicians)
“Historic Bag” of graduates without specialization
Specialized Physicians without official diploma (MESTOS)
> ORIGINS OF THE PROBLEM
Late eighties and nineties
mu || Universities ...
0 Diminution of undergraduate positions (insufficient)
L] Positions summon of Internal Resident Physician (MIR) ...
0 Progressive increment in the amount of positions summoned until 1995
oO Harmonization norms from the European Union
O Since 1995, positions summoned excel in number to the graduates
LI Social needs ...
o Less Generalist Physicians =Primary Care Medicine (Surplus of graduates)
o Less Specialist Physicians (surplus of specialized graduates)
“Historic Bag” of graduates without specialization
“Bag” of Specialized Physicians with official diploma
> ORIGINS OF THE PROBLEM
SS
——
- - - -Graduates
Positions in specialized
medical formation
> ORIGINS OF THE PROBLEM
Physician groups created by the different summon politics
“ HISTORIC BAG” OF
GRADUATES
Unemployed graduates before
1995
GROUPS CAUSED
BY THE POLITICS OF
MIR POSITIONS SUMMON
USED ALONG LAST
TWO DECADES
“BAG” OF GRADUATES
POST-95
Unemployed graduates after
1995
“BAG” OF SPECIALIZED
PHYSICIANS
SPECIALIZED
PHYSICIANS WITHOUT
OFFICIAL DIPLOMA
(MESTOS)
|] FUTURE CONSEQUENCES
Specialized positions
Symptomatic
solution
+
Number of
graduates re Number of
specialized positio specialized
physicians
Fundamental
solution
Undergraduate
positions
|] FUTURE CONSEQUENCES
PRESENT SITUATION —————"tENAnIO FUTURE SITUATION
* Selective entry to medicine faculty is kept on actual levels
* Supply of MIR positions is around the value of last five year’s mean
* Obligatory retirement at the age of seventy
1, The system is inclined to saturate
2. Exclusion of non-specific specialties
3. Incorporation of specialties with different length of time (five, four, three and two years);
MIR positions summons in 1995, 1996, 1997 and 1998
4, The distribution of positions in each specialty is equal to the value of last five year’s mean}
and is kept along the simulation
5. Simulation period: 2000-2020
> MODEL ELABORATION
|
& yy
Desertion
Selective entry to medicine faculty
v3 B| Medicine students \Yv :
Graduates
Undergraduate positions
D
> MODEL ELABORATION
Total number of
specialized
physicians on
primary care
medicine
3
‘Access to specialized A
formation MIR positions
(global estimation) ~* summoned
MIR positions of primary care medicine «Primary care medicine rate
Death rate | > Deaths on the primary care system II
Physicians
MIR of primary care
medicine | physicians on P.C.M available
Specialized
. Specialized physicians on
Access to MIR of primary primary care medicine
care medicine
Nt
Needs of specialized
physicians on primary
care medicine
Recruitment of specialized
physicians on primary care
On; Specialized physicians on
Deaths on the primary ae
care system |
Retirement rate |
Jm#70 | J mf6o
medicine
P.C.M on active service
Retirement of
specialized
physicians on primary care
medicine
Jmf65_ swretirement x
> MODEL ELABORATION
Other specialized
Swretirement II physicians in active | <<.
service
Physicians
MIR positions for —___| SW” | Access to specialized formation
other specialties for other specialties
Specialties rates Mir
other specialties
<Access to specialize
formation (global estimation)>
D
Deaths for other ‘
‘ Specialized
specialties | 2
physicians
Total number of other Death rate II
specialized physicians
Th y
Other specialized XY
physicians available
Retirement
rate II
Recruitment for — “Deaths for other
other specialties specialties II
Retirement for other
specialties
Needs of
other specialties
!
> MODEL ELABORATION
Number of specialized
physicians(global
estimations) a)
Retirements A Deaths <Deaths on the primary
care system | >
Specialized physicians
(global estimation) <=
Global retirements Global deaths j
ts pecialized physicians A
on primary
ae care medicine >
Total eureents for otHER MIR (global estimation) Total other <Deaths on the primary care
a specialized system Il >
specialties A physicians
Reet oF Total deaths for other
physicians on . Access to MIR specialties
primary care Retirements for other (global estimation) A
medicine:ss specialties>
A Speciale <Deaths for other specialties | >
Physicians (global physicians>
estimation) <Deaths for other
specialties Il >
MIR positions
summoned
> RESULTS OF SIMULATION
ALLERGOLOGY MORBID ANATOMY AND HISTOPATHOLOGY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 469 : : 2000 886 : .
2005 680 44,98 44,98 2005 1086 22,57 22,57
2010 863 57,94 84 2010 1279 36,18 44,35
2015 1022 64,07. 117,91 2015 1372 37,99 54,85
2020 1169 68,49 = 149,25 2020 1377 35,78 55,41
ANGIOLOGY AND VASCULAR SURGERY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 = 2810 : : 2000 208 : :
2005 = 3617 28,71 28,71 2005 321 54,32 54,32
20104237 39,45 50,78 2010 420 66,04 101,92
2015 4566 41,44 62,49 2015 517 73,57 148,55
2020 4607 39,35 63,95 2020 564 6885 = 171,15
CARDIO-VASCULAR DISEASES
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAJE
2000 = 1028 0 : : 2000 1085 : :
2005 1321 293 285 28,5 2005 1463 3483 34,83
1576 548 41,48 53,3 2010 1756 45,86 61,84
1732 704 44,67 68,48 2015 1945 48,97 72,96
1780 752 43,41 73,15 2020 1990 46,52 83,41
> RESULTS OF SIMULATION
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 136 : . 2000 2066 0 . :
2005 166 22,05 = 22,05 2005 2367 301 14,56 14,56
2010 185 29,51 36,02 2010 2652 586 24,75 28,36
2015 192 30,27. 41,17 2015 2760 694 26,16 33,59
2020 181 23,43 33,08 2020 2534 468 16,95 22,65
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 202 0 : . 2000 172 :
2005 325 60,89 60,89 2005 197 14,53 14,53
2010 425 68,61 110,39 2010 211 19,79 22,67
2015 512 72,94 = 153,46 2015 210 18 22,09
2020 588 75,39 191,08 2020 169 7 1,42 1,74
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 76 0 : . 2000 360 . :
2005 106 39,47 39,47 2005 501 39,16 39,16
2010 131 51,88 72,36 2010 607 49,3 68,61
2015 147 54,19 93,42 2015 682 53,04 89,44
2020 153 52,38 101,31 2020 714 51,9 98,33
> RESULTS OF SIMULATION
DERMATOLOGY AND VENEREOLOGY ENDOCRINOLOGY AND DIABETES MELLITUS
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 655 0 : : 2000 513 0 : .
2005 869 214 32,67 32,67 2005 618 105 20,46 20,46
2010 1045 390 44,87 59,54 a) 706 193 31,22 37,62
2015 1171 516 49,37 78,77 2015 762 249 35,26 48,53
2020 1223 568 48,5 86,71 2020 790 277 36,35 53,99
CLINICAL PHARMACOLOGY AND THERAPEUTICS GERIATRICS
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 192 . : 2000 265 : .
2005 280 45,83 45,83 2005 434 63,77 63,77
2010 355 58,21 84,89 en) 584 73,5 120,37
2015 427 66,19 122,39 2015 718 77,56 170,94
2020 469 64,87 144,27 2020 825 77,99 211,32
HAEMATOLOGY AND HAEMOTHERAPY INTENSIVE CARE MEDICINE
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 957 0 : . 2000 955 0
2005 1157 200 20,89 20,89 2005 1423 468
2010 1319 362 31,28 37,82 a) 1850 895
2015 1378 421 31,91 43,99 2015 2164 1209
2020 1291 334 24,23 34,9 2020 2227
> RESULTS OF SIMULATION
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 3174 0 . . 2000 290 . :
2005 4511 1337 42,12 42,12 2005 400 37,93 37,93
2010 5103 1929 42,76 60,77 2010 509 54,75 75,51
2015 5403 2229 43,68 70,22 2015 599 60,7 106,55
2020 5109 1935 35,81 60,96 2020 654 60,76 125,51
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 483 . . 2000 528 . .
2005 695 43,89 43,89 2005 671 27,08 27,08
2010 876 56,54 81,36 2010 800 40,53 51,51
2015 1040 63,58 115,32 2015 866 42,25 64,01
2020 1150 64,13 138,09 2020 829 34,75 57
NEUROLOGICAL SURGERY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 891 : : 2000 179 : :
2005 = 1083 21,54 21,54 2005 243 35,75 35,75
20101275 35,45 43,09 2010 292 46,5 63,12
2015 =—1410 40,7 58,24 2015 313 45,89 74,86
20201446 39,36 62,28 2020 298 38,01 66,48
> RESULTS OF SIMULATION
a INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 316 0 : . 2000 769 0 : .
2005 487 71 54,11 54,11 2005 1071 302 39,27 39,27
2010 643 327 67,14 103,48 2010 1350 581 54,24 75,55
2015 757 441 68,58 139,55 2015 1562 793 58,74 103,12
2020 811 495 65,38 156,64 2020 1692 923 59,09 120,02
OBSTETRICS AND GYNAECOLOGY OPHTHALMOLOGY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 2350 0 : : 2000 1375 . :
2005 3044 694 29,53 29,53 2005 1667 21,23 21,23
2010 3595 1245 40,9 52,97 2010 1951 34,55 41,89
2015 3949 1599 44,47 68,04 2015 2146 39,51 56,07
2020 4063 1713 43,37 72,89 2020 2143 35,78 55,85
a INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 406 0 : : 2000 328 . :
2005 653 247 60,83 60,83 2005 437 33,23 33,23
2010 888 482 73,81 118,71 2010 557 52,4 69,81
2015 687 77,36 169,21 2015 651 57,98 98,47
2020 854 78,13 210,34 2020 731 61,9 122,86
> RESULTS OF SIMULATION
OTOLARYNGOLOGY PAEDIATRICS
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 1035 0 - : 2000 4214 0 - :
2005 1241 19,90 19,90 2005 4879 665 15,78 15,78
2010 1437 32,39 38,84 2010 5464 1250 25,62 29,66
2015 1561 36,60 50,82 2015 5817 1603 29,33 38,03
2020 1542 32,47 48,98 2020 5796 1582 27,19 37,54
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 1707 0 : : 2000 1618 0 : :
2005 2285 33,86 33,86 2005 2024 25,09 25,09
2010 2760 46,08 61,68 2010 2399 38,58 48,26
2015 3062 49,09 79,37 2015 2639 42,55 63,10
2020 3228 49,67 89,10 2020 2682 40,31 65,76
REHABILITATION RHEUMATOLOGY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 840 0 - - 2000 585 0 - :
2005 1135 35,11 35,11 2005 749 164 28,03 28,03
2010 1378 47,40 64,04 2010 889 304 40,58 51,96
2015 1554 51,81 85,00 2015 988 403 45,33 68,88
2020 1611 49,61 91,78 2020 1019 43,92 74,18
> RESULTS OF SIMULATION
ORTHOPAEDIC SURGERY UROLOGY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 1854 0 . : 2000 71 0 : :
2005 2472 618 33,33 33,33 2005 869 22,22 22,22
2010 2976 1122 45,38 60,51 2010 1027 36,36 44,44
2015 3289 1435 48,21 77,40 2015 1128 40,60 58,64
2020 3322 1468 44,63 79,18 2020 1105 34,92 55,41
PRIMARY CARE MEDICINE ESTOMATOLOGY
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 67006 0 . : 2000 2938 ) : :
2005 72149 5143 7,67 7,67 2005 2786 -152 517 5,17
2010 77060 10054 13,93 15,00 2010 2659 -279 -10,01 -9,49
2015 80698 13692 17,76 = 20,43 2015 2492 446 -16,77 -15,18
2020 78671 11665 1445 17,40 2020 2172 -766 -30,73 -26,07
HYDROLOGY PHYSICAL EDUCATION MEDICINE
NUMBER INCREASE PERCENTAGE NUMBER INCREASE PERCENTAGE
2000 222 0 . : 2000 731 0 : :
2005 308 86 38,73 38,73 2005 950 29,95 29,95
2010 383 161 52,27 72,52 2010 1141 43,15 56,08
2015 455 233 60,83 104,95 2015 1330 52,49 81,94
2020 509 287 63,07 = 129,27 2020 1497 57,59 104,78
NUMBER
260
343
411
471
513
> RESULTS OF SIMULATION
INCREASE
0
83
1
217
253
PERCENTAGE
31,92 31,92
44,02 58,07
52,79 83,46
53,03 97,3
Total number Increase Perc
108604
111864
115096
118297
221510
124563
127565
130540
133488
136121
138725
141304
143864
145402
146923
148428
149922
149278
148644
148016
147398
> CONCLUSIONS
|
e The amount of physicians in Spain will continue growing up next two decades
e Important unbalance between system-in (joining) and system-out (retirement).
People between 36-50 age, will limit future distribution by obstructing the access of
new professionals to labor markets during the next years
e Specialties with younger physicians have less capacity of absorption new
professionals
e Some specialties are considerably increased, for example Oral and Maxillo-Facial
Surgery, Geriatrics and Medical Oncology, which will cause important unemployment
e Other specialties will be deficit ones, for example Pediatrics Surgery and
Estomatology
