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Europe needs physicians, and Spain is no exception. However, the way healthcare systems recruit international doctors increasingly reflects deeper structural weaknesses rather than long-term workforce solutions. According to data from the Organisation for Economic Co-operation and Development report Health at a Glance: Europe 2024, the number of physicians trained abroad and hired in Europe increased by 17% between 2019 and 2022, from 28,000 to 33,000. In 2023, the trend accelerated further, with the number of international physicians increasing by 40% compared with 2022 in 11 of the 12 European countries providing updated data.

Norway, Ireland, and Switzerland have already reported that more than 40% of physicians were trained abroad, although many were nationals who completed medical training in another country. The UK shows a different pattern, with one third of international physicians coming from India and Pakistan and another 20% from Nigeria, Egypt, and Sudan. In Switzerland, 93% of foreign-trained physicians and 98% of foreign-trained nurses came from EU countries, primarily Germany, France, and Italy.

These data reflect a broader structural problem affecting healthcare systems across Western countries: a persistent shortage of specialists in hard-to-fill positions. Spain has increasingly illustrated this reality, making foreign-trained healthcare professionals an essential part of the national healthcare workforce.

Foreign Physicians

Despite widespread concerns regarding physician shortages, Spain currently has more physicians than ever.

According to the 2025 Medical Demographics Study by the Spanish Medical Association (Organización Médica Colegial, OMC), the number of registered doctors has risen substantially over the past 10 years. In 2014, there were 512 doctors per 100,000 inhabitants, and by 2024, this figure had reached 633, an increase of about 23.6%, or roughly 24%.

Compared with neighboring countries, Spain has fewer medical graduates per capita than Portugal, Italy, and Belgium, all of which have more than 16 medical graduates per 100,000 inhabitants. Spain still ranks above France, which has 11.3 medical graduates per 100,000 inhabitants. Another factor is the 11.7% migration rate between 2017 and 2024. Together, these trends help explain why Spain has, out of necessity, become one of the European countries with the highest numbers of physicians trained abroad.

Foreign physicians in Spain also had a distinct profile. According to El Periódico, citing the Ministry of Health’s workforce needs assessment report, 15,153 foreign physicians were registered with Spain’s Social Security system, and approximately two thirds came from outside the EU, primarily from Latin America.

Manuel Martínez-Sellés, MD, president of the Ilustre Colegio Oficial de Médicos de Madrid, Madrid’s official medical association, reported in the March 2026 issue of Madrid Médico, the organization’s official publication, that nearly 8000 of Madrid’s approximately 55,000 licensed physicians come from Latin America. Although they represent approximately 15% of all registered members, the proportion exceeds 20% among actively practicing physicians after retired doctors are excluded.

“Their arrival is not a recent phenomenon, but the increase in recent years has been striking. We already have more than 1000 members from countries such as Venezuela and Cuba and between 500 and 1000 from Argentina, Colombia, Ecuador, and Peru”, he noted. “In my experience, one of the most notable characteristics of Ibero American physicians is their strong foundational training and holistic views of the patient. However, their integration into our healthcare system remains challenging.”

Difficult Path

Speaking with El Médico Interactivo, part of the Medscape Professional Network, José Jhazing Peada Clavijo, MD, president of the Federation of Ibero-American Medical Associations in Spain, described the migration process as difficult and highly uncertain and said, “The decision to emigrate is not an easy one and often depends on training opportunities in the country of origin or job prospects.” “In many cases, Spain becomes the destination of choice because of the language.”

However, practicing within Spain’s National Health System requires completing a residency training (known in Spain as the MIR or Médico Interno Residente) examination process. “It is a demanding exam that requires preparation and a significant investment,” Peada Clavijo said. “Courses can cost between €2500 and €4000 and last anywhere from 6 months to more than 1 year.”

Moving to Spain adds financial pressure. “If you decide to come 6 months before the exam to become familiar with the environment and the test, you need at least €10,000, with no guarantee of obtaining a residency position,” he said, referring particularly to Colombian physicians.

Housing is another major challenge. “Access to housing during the first few months is very difficult, especially without financial stability or a support network,” he said. Unlike many Spanish physicians, international physicians frequently arrive without family support systems or clear information regarding accreditation procedures. “Many arrive without a clear understanding of the process and without accreditation, which is like playing Russian roulette.”

Employment opportunities have also remained limited. “Primary care physicians have few options and often are forced into the private healthcare sector, particularly emergency departments, insurance-related care, or medical examinations,” Peada Clavijo explained. However, he emphasized that many Latin American physicians enter practice with substantial clinical experience because they often begin independently managing complex clinical cases during the second year of training.

Peada Clavijo acknowledged that some foreign-trained primary care physicians without residency certification are hired in primary care settings because of staffing shortages, particularly in rural regions. This practice remains controversial within the healthcare system. “If you enter through the MIR program, you are treated similarly to any other Spanish doctor,” he said. “However, if you have not gone through that process, there can be pressure or suspicion because you have not followed the same training pathway.”

Recognition Debate

One of the most contentious issues is recognition of medical credentials. Reports indicated that more than 85,000 credential applications were processed in 2025, 79% involving medical degrees, with 30,303 credentials recognized in a single year.

This increase has reignited the debate regarding Spain’s current accreditation system. During a forum organized by the OMC, participants discussed whether competency-based examinations similar to the Objective Structured Clinical Examination should supplement administrative recognition processes to ensure the quality of care and place internationally trained physicians on equal footing with Spanish-trained graduates.

According to data released by the OMC, annual approvals ranged from approximately 1500 to 1800 between 2015 and 2020 before increasing to approximately 7000 annually in 2021. In 2025, approvals increased sharply because of efforts to reduce administrative backlogs, comply with European directives, and digitize the process. Most applications came from Colombia, Venezuela, Cuba, Argentina, Ecuador, and Peru, although applications from Eastern European countries also increased substantially. Approximately 14% of the applications came from Spanish nationals trained abroad.

Tomás Cobo Castro, MD, president of the OMC, Madrid, Spain, described the increase as a major imbalance that has not been matched by adjustments within Spain’s training system. However, several experts noted that recognized credentials do not necessarily translate into 30,000 additional MIR applications because many physicians submitting applications do not ultimately move to Spain.

José Antonio Trujillo Ruíz, MD, PhD, MPH, vice president of the Medical Association of Málaga, Málaga, Spain, argued that Spain should adopt stricter European-style certification standards. “The procedures there are not based solely on direct administrative certification but rather on enhanced clinical certification, which provides an additional safeguard for both professionals and patients,” he said.

Beyond administrative recognition and language testing, which require a B2 level of Spanish proficiency, many European countries also mandate supervised clinical training and compulsory professional registration before physicians can practice independently.

System Impact

Speaking with El Médico Interactivo, Víctor Pedrera Carbonell, MD, secretary general of the Confederación Española de Sindicatos Médicos — the National or State Confederation of Medical Unions of Spain — noted that the Spanish healthcare system increasingly depends on foreign-trained physicians to fill positions that otherwise remain vacant. “There is a structural reliance on these professionals, especially in hard-to-fill positions where it is not possible to hire doctors with officially recognized credentials under normal circumstances,” he said.

Pedrera Carbonell also warned that the current model creates risks for both foreign physicians and the broader healthcare workforce. “We cannot rely on doctors without proper accreditation to fill positions with poor working conditions,” he said. According to Pedrera Carbonell, the system risks placing foreign physicians in precarious professional situations while simultaneously allowing poor working conditions within the domestic healthcare system to persist.

“Foreign doctors without accredited credentials are being used as unregulated labor to fill positions that should be improved in terms of working conditions,” he concluded.

Under current circumstances, recruiting foreign physicians has become a necessary response, although not without challenges. The key issue is not simply the number of doctors arriving, but also the conditions under which they are integrated into the Spanish healthcare system and the roles they are expected to play.

This article was translated from El Médico Interactivo on Univadis.