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.

Role of slowly settling particles in the ocean carbon cycle

[EN] Here we present results from sediment traps that separate particles as a function of their settling velocity, which were moored in the Canary Current region over a 1.5-year period. This study represents the longest time series using “in situ” particle settling velocity traps to date and are unique in providing year-round estimates. We find that, at least during half of the year in subtropical waters (the largest ocean domain), more than 60% of total particulate organic carbon is contained in slowly settling particles (0.7–11 m d−1). Analyses of organic biomarkers reveal that these particles have the same degradation state, or are even fresher than rapidly sinking particles. Thus, if slowly settling particles dominate the exportable carbon pool, most organic matter would be respired in surface waters, acting as a biological source of CO2 susceptible to exchange with the atmosphere. In the context of climate change, if the predicted changes in phytoplankton community structure occur, slowly settling particles would be favored, affecting the strength of the biological pump in the ocean.