Family Medicine: 131 unfilled MIR places and 225 abandoned

131 unfilled Family Medicine MIR places and 10% deficit by 2028

In 2023, 119 more places were offered in Family Medicine than the previous year, yet 131 remained unfilled. Such a figure had not been seen since 2014, when 108 were left vacant. The specialty with the most offers in the system is also the one with the most vacancies and the most residents who abandon it. For two consecutive years, an extraordinary period has been needed to try to fill gaps nobody wanted: in 2022, 93 places went unassigned and 29 resignations were recorded.

Why are there places nobody wants?

The report from the Medical College (OMC) points to four causes: the workload in primary care, the working conditions of residents, the system for choosing places, and resignations. On paper, there is plenty of vocation. In practice, daily life devours it.

Clara wanted Family Medicine. She asked several doctors and the answer was that she shouldn't even consider it. She was tormented by having five minutes per patient and everything ending up on paper. "Seeing 50 people a day is madness," she summarizes. She ended up in Allergology.

Vicente Baos retired after 39 years in practice and has seen generations of students pass through. His diagnosis is without anesthesia: "No vocation can withstand this; increasing Family Medicine places is an absolutely empty measure if it is not accompanied by something more." Miguel Moreno, a resident and member of the MIR Association, agrees: the problem won't be fixed just by expanding places, but by managing to hire. And someone who chose Traumatology says it bluntly: Family Medicine has poor quality of life and lots of paperwork, and half of the patients are sick leaves and electronic prescriptions.

25% of abandoned MIR places are in Family Medicine

Since the 17/18 academic year, 892 MIR places have been abandoned. Of these, 225 belong to Family and Community Medicine: one in four. The average is around 45 resignations per year. For the 23-24 call, 2,492 places were offered in Family Medicine, 37 more, and the deficit projected by the Government itself exceeds 10% by 2028. Increasing places, without touching contracts or organization, behaves like a band-aid on an uninfected wound.

How many patients does a family doctor see per day?

Those on the inside put numbers on it. One doctor estimates between 40 and 50 patients per day counting telephone care, 6 to 15 on weekday shifts and 14 to 30 on weekends. Another notes that first visits stretch to half an hour when the patient gets to the point and doesn't tell their life story. And some remember when a doctor saw 100 people in two hours, with the warning that that was also outrageous.

Not everyone accepts the picture of saturation. Another current holds that consultations get blocked, schedules are closed, and much of the time goes to paperwork and prescriptions, not patients. The 13-day wait for an ear discomfort that a patient describes feeds that suspicion. The real disagreement is how much is volume and how much is management.

The paycheck that doesn't match the hours

Money also weighs. In public healthcare, it is argued, all specialties earn the same and Family Medicine compensates with shifts and geographic dispersion. A doctor describes his last month worked in Spain: double shift due to lack of staff in primary care and emergencies, 300-something hours in the month and two paychecks, one from primary care of about 2,100 euros and another from hospital of about 3,000 after covering all weekends, holidays and Christmas. The first payment arrived incomplete: 300 euros, waiting for the accountant to return from vacation.

A proposal that appears in the debate is not to open more medical schools, but to pay more. Doubling the salary, it is argued, would make an today avoided specialty attractive. On the other side weighs the argument that there are not enough doctors and budget, and that without money there is neither one nor the other.

The pendulum: are doctors missing or will there be too many?

Some deny the shortage. The calculation: in 2033-2035, about 4,500 doctors will retire per year, while about 9,000 residents will finish MIR if the increase in places is not stopped. With those figures, in a decade there would be a surplus of physicians and many would work only in the summer months. Against that forecast plays the aging population, which skyrockets demand for consultations. And in between, an uncomfortable detail: there are destinations that offer permanent contracts from day one and still fail to fill the place because they are far from Madrid or Barcelona.

Between the two scenarios—shortage or surplus—remains the question that no report answers with numbers: whether the knot is about places, salary, or a model that has turned the consultation into a counter for prescriptions and referrals. How many places would have to be peine for someone to want to fill them?