More than 300 general practitioners are due to retire in Malaga province by 2030, without enough professionals to replace them

Andalusian healthcare is facing a serious challenge - the shortage of professionals, especially general practitioners. Just over 300 GPs (18%) out of a workforce of between 1,700 and 1,800 in Malaga province will retire by 2030 and there are not enough doctors to make up for the loss, which will affect the base of the system's pyramid - prevention.

The Simeg Vicente Matas study centre foundation of the Andalusian medical union (SMA) has drawn attention to the workforce shortage in the healthcare field. The number of new specialists who have completed their training in recent years is lower than that of doctors around the age of 60, who are soon to retire. In addition, the union adds, "many of those who finish their training prefer to work in hospitals, private healthcare or abroad, where the working, professional and remuneration conditions are much better".

On 28 December 2022, the Ministry of Inclusion, Social Security and Migration published an amendment to the general social security law allowing for enhanced active retirement so that 75% of the retirement pension could be combined with work in primary care for GPs and paediatricians.

This pilot plan ends on 28 December. In order for those doctors to take advantage of it, they had to have reached the ordinary legal retirement age, which depends on the number of years they have contributed and ranges from 65 to 66 and eight months, depending on the case. Some of those who have taken advantage of it have been able to continue working until the age of 70 on an exceptional and voluntary basis, as explained by the SMA in the report drawn up by Dr Vicente Matas.

Last week, minister of health Mónica García said that she had already set in motion the protocol that will lead to the extension of early active retirement for doctors. She stated that both her ministry and that of Inclusion, Social Security and Migration are committed to the measure, but she did not give any details about a decision that must be taken before 28 December, which continues to worry doctors, as SUR has learned.

More than 1,100 doctors across the country are covered by this measure, but there are health centres that will no longer be able to see patients from 28 December, which is far from what the minister announced.

The SMA report said that "it is necessary and very urgent to extend [active retirement] for a few more years, as the problem in primary care will persist past 2025 and there are some specialties that may need this aid".

It is worth noting that, within the public healthcare system (and the civil service as a whole), there has long been a mechanism allowing staff to remain in active service until the age of 70. This is voluntary, must be applied for by the doctor and authorised by the administration, but it is entirely separate from the enhanced active retirement scheme.

The health commission of the lower house has proposed extending this type of retirement to 72 years of age and "not the current 70". The SMA has submitted a letter to the ministry of Elma Saiz in which it says that, at present, "public health suffers a serious lack of specialist doctors caused by the increase in retirements due to the population pyramid and the deficit of specialists that has been dragging since 2008, which is not compensated by the rate of new doctors".

The SMA demands the extension of active retirement to all specialties in the national health system where there is a lack of professionals. There are 1,100 doctors affected throughout Spain by the elimination of enhanced active retirement.

Regional minister of health, presidency and emergencies Antonio Sanz has also called for the extension of the measure until the age of 72, "given the structural deficit of professionals in the country" and in order to avoid "the loss of thousands of medical appointments in Andalucía, guaranteeing continuity of care in health centres".

Royal decree-law 20/2022 is due to expire, in response to which Sanz said: "Not acting and not extending it will mean the loss of hundreds of qualified professionals and general practitioners, who provide services in public health centres." He urged the minister of health to extend the royal decree-law until 31 December 2028 and to consider extending it to other specialties, not just GPs.

President of the Malaga medical union (SMM) Antonio Martín Noblejas believes that "there are people who voluntarily want to prolong their career and the measure should be extended". "It should be extended not only for GPs, but also for hospital specialities where there are shortages," he said.

According to Noblejas, the extension should encompass internal medicine, digestive medicine, neurology and anaesthesiology.

The official college of doctors of Malaga believes that "this measure must be exceptional, voluntary and it must allow compatibility with private healthcare practice". It also believes that GPs must be retained "with an attractive environment, with salaries in line with the rest of Spain, with time for training and research and, most importantly, with stable, long-term contracts". "These are the key points. There is an urgent need for a profound reform in primary care," it said, adding that inaction would lead to "a deep structural problem".

According to data from the college of Malaga, around 369 doctors specialising in primary care could retire by 2032, i.e. in seven years' time. The retirement age is 65, but this may vary because there are others who retire at 70. The total number of specialist doctors currently working in Malaga province and registered in the college's database is 1,554 (different from the Andalusian helthcare service's data), although this does not include general practitioners (those who did not obtain the MIR speciality and work in primary care) or foreigners who do not have an approved speciality but nevertheless practice in health centres.

The regional government of Andalucía has taken further steps in this direction: on Tuesday, it approved the exemption of the nationality requirement (being Spanish or born in an EU country) for non-EU foreign specialist doctors and nurses to be recruited by the healthcare service (SAS).

It has also approved a decree regulating the specific competitive selection procedure for posts that are difficult to fill.