In the last decade, the OECD estimate that more than 4000 doctors have left Spain to work abroad, and this is causing a massive strain on the health system. "The outflow of health professionals is contributing to aggravating staff shortages that we also see in many countries,” says APH vice-director Dionne Kringos, associate professor of health systems at Amsterdam UMC and one of the authors of this report.  

However, improving working conditions, among other factors, would be enough to entice half of these doctors back to Spain. This research, the result of a collaboration between Amsterdam UMC and the Spanish Royal College of Physicians, is based on surveys, qualitative interviews and focus groups with 158 GPs trained in Spain who are currently working overseas. 

It is predicted that in Spain there will be GP deficit of 10% in the next 5 years, with a shortfall of up to 10,000 GPs by 2028. Although this is partly caused by the increase in demand and an aging workforce, currently 60% of GPS are older than 50, there are also fundamental issues regarding staff retention. 

Priorities for GPs 

It is believed that these retention issues often come due to a lack of job satisfaction and, in order to analyse this, the study looked at what was important for the GPs themselves:  

"We saw that GPs valued being able to “choose” their working conditions, including where, when, and how often they were meant to practice. They also want sufficient time to listen to and deal with patients’ concerns as they believe this will contribute to doing their jobs better,” says Sara Calderón-Larrañaga, GP and PhD researcher at Wolfson Institute of Population Health, Queen Mary University of London and lead author of the report.  

Improving Retention 

Across the various interviews and surveys used in this study, there were a multitude of factors that contributed to a participant's decision to leave Spain. Insecurity of employment was a large concern, as well as excessive workloads, lack of professional development opportunities, inflexibility in the workplace and the promise of a better salary abroad. The average salary of a Spanish doctor currently ranks 19th out of the 27 EU members with limited margins for growth through additional professional responsibilities, financial incentives or seniority. 

Importantly, almost half of the respondents would consider returning to Spanish general practice if their professional demands were satisfied. International migration of primary care workers has effects on the performance of health systems and, as the population ages, is a major threat to future national health planning. 

This research, performed between May and September 2022, also sought to provide insights for the development of effective retention policies in Spanish general practice, offering 10 policy recommendations: "These recommendations centre around improving the quality of employment contracts and working conditions but they look as well at offering more opportunities for professional development. We really hope they can have a quick effect on policy as this is urgently needed,” says Calderón-Larrañaga.  

Download the full report below, the study is awaiting peer-reviewed publication and will shortly be made it available.

Full Report (in Spanish)PDF 3.088 kb