Study on medical demography 2018 Cuadernos CGCOM Study on medical demography- 2018.

253.796 221.470 MEDICAL DEMOGRAPHY 2018 1. Registered doctors 2017: Notes for the efficiency of the health system 1. Registered doctors 2017: 253.796 ACTIVE DOCTORS 221.470 MEDICAL DEMOGRAPHY 2018 Notes for the efficiency of the health system. 1. Registered doctors 2017: 253.796 Active doctors: 221.470

Fuentes: Datos publicados por el INE. Médicos colegiados REGISTERED DOCTORS. Año 2017. The number of registered doctors has increased by 2,3% in 2017, according to the Spanish Statistics National Institute (INE) and the data provided by the Medical Colleges. To calculate the interanual variation of the previous years, the data used were published by the Spanish Statistics National Institute (INE) in "The Statistics of Registered Health Professionals" that investigates the number and characteristics of the health professionals registered in their respective professional associations or professional councils/chambers. This research provides information to various international organizations such as the OECD and the Statistical Office of the European Union (Eurostat ). Registered Doctors Absolute numbers The number of registered doctors has increased by 2,3% in 2017, according to the Spanish Statistics National Institute (INE) and the data provided by the Medical Colleges. To calculate the interannual variation of the previous years, the data used were published by the Spanish Statistics National Institute (INE) in "The Statistics of Registered Health Professionals" that investigates the number and characteristics of the health professionals registered in their respective professional associations or professional councils/chambers. This research provides information to various international organizations such as the OECD and the Statistical Office of the European Union (Eurostat ). - Registered doctors in absolute numbers - Interanual variation Interanual Variation Fuentes: Datos publicados por el INE. Médicos colegiados

MÉDICOS COLEGIADOS POR 100.000 HABITANTES Médicos colegiados. Año 2017. The number of doctors registered in Spain per 100,000 inhabitants in 2017 is 545, which represents an increase of 2.1% over the previous year. Medical registration (membership to the professional Associations) is mandatory and is a constitutional guarantee for patient, as it serves to certify that doctors with exercise comply with the necessary requirements to practice the profession of doctor. The Public Administrations must request this certificate when they hire doctors to avoid specialists who practice without the approved title. In this matter, the CGCOM (General Council of the Official Associations of Physicians) is the main driver of the VPC (Periodic Validation of the Registration to the professional college of physicians ). The CGCOM defines the VPC as "a type of certification in which a certifying body, the Medical Associations, evaluate and recognize good professional practice, the appropriate psychophysical state and the Continuing Professional Development of doctors for the practice of their profession. Therefore the VPC testifies that the doctor who obtains it meets and maintains the defined standards to practice medicine” (http://www.cgcom.es) The goal to be achieved by the CGCOM is that the VPC should be universal and enforceable INC. (%) 2005 0,4% 2006 0,7% 2007 1,5% 2008 1,9% 2009 1,7% 2010 0,2% 2011 0,8% 2012 2013 2,8% 2014 2,1% 2015 2016 2017 MÉDICOS COLEGIADOS POR 100.000 HABITANTES The number of doctors registered in Spain per 100,000 inhabitants in 2017 is 545, which represents an increase of 2.1% over the previous year. Medical registration (membership to the professional Associations) is mandatory and is a constitutional guarantee for patient, as it serves to certify that doctors with exercise comply with the necessary requirements to practice the profession of doctor. The Public Administrations must request this certificate when they hire doctors to avoid specialists who practice without the approved title. In this matter, the CGCOM (General Council of the Official Associations of Physicians) is the main driver of the VPC (Periodic Validation of the Registration to the professional college of physicians ). The CGCOM defines the VPC as "a type of certification in which a certifying body, the Medical Associations, evaluate and recognize good professional practice, the appropriate psychophysical state and the Continuing Professional Development of doctors for the practice of their profession. Therefore the VPC testifies that the doctor who obtains it meets and maintains the defined standards to practice medicine” (http://www.cgcom.es) The goal to be achieved by the CGCOM is that the VPC should be universal and enforceable. Fuentes: Datos publicados por el INE. Médicos colegiados por 100.000 habitantes

SPECIALIZED MEDICAL STAFF PER 1.000 HAB. MÉDICOS ESPECIALISTAS SPECIALIZED MEDICAL STAFF PER 1.000 HAB. The Spanish Ministry of Health, Social Services and Equality offers in its portal "Key Indicators of the Spanish Health System (SNS)” the following data on the specialized Medical Staff (AE) that provides services both in hospital and in the specialty centers (public and private centers). The most recent data offered by the Ministry of Health is from 2015. Internal resident doctors, volunteers, collaborators or medical students with scholarships are not counted. Once again we appreciate a North-South gap related to the number of specialists. As we can see in the graph. Above the national average (1.86) we can see Spanish region of Navarra (2.33), followed by Asturias (2.25) and Aragón (2.21). In the last positions are Andalusia (1.54) and Melilla (1.25). The Spanish Ministry of Health, Social Services and Equality offers in its portal "Key Indicators of the Spanish Health System (SNS)” the following data on the specialized Medical Staff (AE) that provides services both in hospital and in the specialty centers (public and private centers). The most recent data offered by the Ministry of Health is from 2015. Internal resident doctors, volunteers, collaborators or medical students with scholarships are not counted. Once again we appreciate a North-South gap related to the number of specialists. As we can see in the graph. Above the national average (1.86) we can see Spanish region of Navarra (2.33), followed by Asturias (2.25) and Aragón (2.21). In the last positions are Andalusia (1.54) and Melilla (1.25). Fuente: Ministerio de Sanidad, Servicios Sociales e Igualdad

Favorite destinations MEDICAL DEMOGRAPHY 2018 Notes for the efficiency of the health system 9. “Suitability” certificates: Favorite destinations United Kingdom France Ireland Germany “Suitability” certificates: Favorite destinations: United Kingdom, France, Ireland and Germany In 2017, Catalonia was the leading community in issued “suitability” certificates with 471, ahead of the Community of Madrid which remains in 2nd position with 451. Third and fourth position are Andalusia with 219 certificates and the Autonomous Community of Valencia with 174 certificates. In 2017, Catalonia was the leading community in issued “suitability” certificates with 471, ahead of the Community of Madrid which remains in 2nd position with 451. Third and fourth position are Andalusia with 219 certificates and the Autonomous Community of Valencia with 174 certificates

CERTIFICATES OF SUITABILITY The certificates of suitability are issued by the CGCOM to doctors who want to practice abroad. In the last seven years almost 20.000 certificates have been requested by Spanish physicians. In 2012 and 2013 there was the largest increase in these applications. 49,7 50,3 SOLICITUD POR EDAD y SEXO (13%) (11%) (9%) 20.000 CERTIFICATES OF SUITABILITY (2011-2017) (7%) (3%) (2%) *If each Certificate of Suitability requested coincides with the number of doctor moving abroad, we would be talking about a very serious problem. Our NHS would be investing huge sums of money in training Resident Doctors that would benefit other countries, especially France and the United Kingdom. ESPECIALIDAD (+36,3%) (+0,6%) (+16,8%) (-3,7%) (-11,6%) (20%) (18%) (6%) (5%) The certificates of suitability are issued by the CGCOM to doctors who want to practice abroad. In the last seven years almost 20.000 certificates have been requested by Spanish physicians. In 2012 and 2013 there was the largest increase in these applications. *If each Certificate of Suitability requested coincides with the number of doctor moving abroad, we would be talking about a very serious problem. Our NHS would be investing huge sums of money in training Resident Doctors that would benefit other countries, especially France and the United Kingdom. (+74,3%) DESTINO PREFERIDO Gráfico: Evolución Certificados de Idoneidad Fuente: CGCOM. Datos 2017 (no definitivos)

MAIN CONCLUSIONS The request for certificates of suitability does not involve moving to another country. The number of this kind of certificates is greater than the number of doctors who applies fort it and this is due to the fact that some doctors send job applications to several countries. The reasons to request a certificate of suitability: 70% work reasons, 8% for cooperation and another 8% due to bureaucratic procedures. From 3.282 certificates requested in 2017, 2.919 were made by doctors with Spanish nationality and 363 certificates were requested by non-Spanish doctors. This is important because there is a number of foreign doctors who take the Spanish examination to become a doctor (MIR) with the obligation to return to their countries. Since 2016, the date on which the professional suitability certificates was provided online, it has been possible to verify how many doctors, of those who requested their professional suitability certificate in 2016 and 2017, are still registered in Spain. We deduce that doctors who remain collegiate in Spanish Medical Associations is because they have not left, because they have returned or because they think that their stay abroad will be very short. From the 2.073 doctors who applied for suitability certificates in 2017, only 390 are not registered and with a fairly reliable approximation, approximately 90 were foreign doctors who were committed to return to their country. Therefore we can affirm that doctors who have left Spain definitively in 2017 are 300. In the statistics collected in 2016 there were 560, so we observed a tendency to remain in our country despite the request of these certificates or maybe because their stay abroad is temporary. Main conclusions: The request for certificates of suitability does not involve moving to another country. The number of this kind of certificates is greater than the number of doctors who applies fort it and this is due to the fact that some doctors send job applications to several countries. The reasons to request a certificate of suitability: 70% work reasons, 8% for cooperation and another 8% due to bureaucratic procedures. From 3.282 certificates requested in 2017, 2.919 were made by doctors with Spanish nationality and 363 certificates were requested by non-Spanish doctors. This is important because there is a number of foreign doctors who take the Spanish examination to become a doctor (MIR) with the obligation to return to their countries. Since 2016, the date on which the professional suitability certificates was provided online, it has been possible to verify how many doctors, of those who requested their professional suitability certificate in 2016 and 2017, are still registered in Spain. We deduce that doctors who remain collegiate in Spanish Medical Associations is because they have not left, because they have returned or because they think that their stay abroad will be very short. From the 2.073 doctors who applied for suitability certificates in 2017, only 390 are not registered and with a fairly reliable approximation, approximately 90 were foreign doctors who were committed to return to their country. Therefore we can affirm that doctors who have left Spain definitively in 2017 are 300. In the statistics collected in 2016 there were 560, so we observed a tendency to remain in our country despite the request of these certificates or maybe because their stay abroad is temporary.