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

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.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.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.The provision of human resources in the health field is a logistical task of great complexity. The need for long-term planning in a context of uncertainty and on a national scale, the interconnections between training, formal position and actual duties, and tensions over jurisdiction between national and regional authorities aggravate the problem. The labour market for health professionals must be extremely adaptable in order to absorb swiftly changes required by new technologies, scientific advances, societal demands, and new models of organization. The job profiles of health specialists, however, have not been adapting to this rapid and exigent pace of change.A shortage of health professionals, whether because of poor planning or corporative barrie