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.

Romper el ciclo de la invisibilidad. El empleo como vía para favorecer la inclusión

"[ES] En España las posibilidades de empleo de las personas en riesgo de exclusión social no son satisfactorias. Se trata de un problema que centramos en las concepciones educativas de la enseñanza-aprendizaje inicial, que orientan minoritariamente a la formación para el empleo como a la oferta y demanda de trabajo de esos colectivos. En nuestro sistema educativo de la desatención y marginación del alumnado en riesgo de exclusión social se pasó a la educación especial; luego, a la normalización e integración, lo que condujo a la inclusión educativa. En ese momento final que nos encontramos aparecen visiones innovadoras como la escuela para todos, empleo con apoyo, y vida con apoyo que desarrollan el paradigma de la autonomía y vida independiente. [EN] Employment chances for people in risk of social exclusion are not satisfactory in Spain. This has been a problem at the core of educational conceptions concerning primary education, scarcely orientated towards the employment of such groups. In our system, from margination and neglect of our pupils in risk of social exclusion, we sent them to special education first, then to normalization and integration and finally to inclusive education. Nowadays, innovative visions such as school for all, employment and life with support are developing the model of autonomy and independent life. "