Forecasting the need for medical specialists in Spain: application of a system dynamics model

[EN] Background: Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods: We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results: In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions: The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.

Reconstruction of the aquifer history of Gran Canaria

[EN]A study on the recent history and current state of the aquifer in the Island of Gran Canaria (Canary Is., 28oN, 15oW) is performed. Though rainfall is scarce on the island, traditional agricultural practices and small population were able to keep the aquifer in a constant state for centuries. Nevertheless, at the beginning of the 20th Century, culture of several water-consuming species was introduced on a commercial basis due to the relative proximity of the Canaries to continental Europe and to the possibility of more than one yearly harvest. This led to generalised well digging (more than 300m deep in many cases) and to the appearance of a chronic hydraulic deficit, as well as to spoiling vastcoastal areas of the aquifer through intrusion of brackish water. In the mid 1960’s, coincident with the apex of agricultural exploitation, massive tourism appeared in the scene. This new activity soon became a susbstitute for Agriculture, but it attracted more new labour force to the island, and a fast growth of population was the main result. Moreover, new water use practices entered the scene. As a consequence, the main causes for the aquifer decline are population growth and extensive Agriculture practices in use during the last half of the 20th Century. Some remarks on sustainability issues in order to cope with Climate Change are also offered.