Spain tackles GP crisis: Doctors get double pay for not retiring

PRIMARY care doctors have been given the option to claim 75% of their State pension along with 100% of their salary to continue working beyond retirement age in a bid to address the shortage in Spain's health centres.

With more general practitioners (GPs) or family doctors at local surgeries retiring than newly-qualified medics entering the profession, Spain's government has become concerned about a growing impact on State healthcare.

Meanwhile, GPs themselves, and paediatricians, have been calling for incentives to make it worth their while prolonging their working life.

A pilot scheme launched by the ministry for inclusion, Social Security and migrations – led by José Luis Escrivá – allows GPs and paediatricians to effectively work for 175% of their wages if they continue to do so beyond age 65.

So far, seven in 10 family doctors aged 65 or over have taken up the offer, or a total of 313, reveals Escrivá's department.

Explaining how the scheme proves to be a 'win-win situation' for all concerned, Escrivá says medics who would otherwise stop work are continuing to pay their Social Security (national insurance) contributions, helping to fund State pensions, whilst also saving the State 25% of what they would be earning if they had decided not to continue – and getting nearly double their money for doing the same job as when they were 64.

'Ageing' profession

According to a recent ministry report covering supply and demand for public healthcare facilities over the period from 2021 to 2035, GPs, or primary care doctors, are one of the most 'threatened species' in the profession.

They are the second-oldest specialists in the medical industry, with a third of them aged over 60 and more than six in 10 being aged between 50 and 65.

This means that, through retirement alone, Spain could lose an average of 7,000 to 8,000 GPs every year, resulting in around 80,000 fewer GPs by the year 2032.

Escrivá reveals that the problem is likely to become most critical in the next three or four years, especially in light of the extra physical and psychological pressures and higher workload medics faced during the pandemic.

Since the difficult Covid years, fewer and fewer GPs have been opting to stay in their jobs longer than they had to.

At the time the combined pension and salary scheme was introduced – in late 2022 – a total of 12,000 family doctors were aged between 60 and 64 inclusive, and around 1,500 were aged 65 or above and still working. 

In addition to those who have applied to continue in their profession, the scheme allows GPs who have already retired to come back to work on 100% of their salary whilst claiming 75% of their pension, Escrivá says.

'Offer medicine graduates higher pay for taking GP route'

Given that the 'ageing GP' situation is not sustainable long-term – eventually, post-retirement doctors will being to find their physical and cognitive faculties are not conducive to practising such a high-pressured rôle where accuracy and attention to detail can literally mean life or death – Spain's government has increased the number of junior doctor places this year to give aspiring new medics greater opportunities to enter the profession.

For 2023, internships have been expanded by 4%, giving 8,503 places.

Spain's Family and Community Medicine Society (semFYC) does not, however, believe a 4% increase will compensate for retirements due between now and 2026 or 2027, and is calling for greater incentives and investment.

The Society says steps need to be taken to encourage more medical students to opt for GP positions after they qualify – including better salaries.

State pensions for next generation 'under threat'

Spain's public sector in general is facing a wave of retirements that could see numbers depleted and the pension pot struggling to pay them all.

In addition to those due to turn 65 in the next decade, in another generation, State pensions will reach a 'critical situation', Escrivá's department warns.

The ever-plummeting birth rate in Spain means it is one of the oldest countries in Europe in terms of average age, and between 2039 and 2043, is likely to have more pensioners than working-aged residents.

Recently, the State has been applying incentives for those who wish to carry on working beyond age 65 – ranging from lump-sum payments upon reaching retirement age to pension increases of 4% - and penalties for those who opt to retire early.

In April 2023, only 5.4% workers who had reached State pension age gave up work.