No Doctor, No Care: The Push to Protect Primary and Emergency Medical Services
In both primary care and hospital settings, including emergency departments, the phrase no doctor is now heard far too often. Delays, long waiting lists, and repeated absences of physicians at SAMU and other services point to a growing bottleneck that many fear will worsen in the years ahead.
A 2028 projection from the Confederation of State Medical Associations estimates that thousands of specialists will be needed to meet demand. Retirements among family physicians who trained in Spain in the early 1980s are increasingly evident, and the Granada Medical Association Study Center confirms there will not be enough family physicians to replace them. Between 2021 and 2026, about 2,650 family physicians are expected to retire each year, totaling roughly 16,000 retirements, with about 12,000 of those professionals working primarily in primary care.
This structural gap is compounded by a longstanding lack of foresight within paramedical planning. The population bears the brunt of this shortage, a point repeatedly warned by the Alicante College of Physicians. Simply replacing doctors with other staff without proper training and qualifications is not a viable solution, and the matter remains unresolved by such substitutions.
Opening the door to substitute staffing for doctors assumes those substitutes possess the appropriate qualifications. This is a legal and ethical stance supported by the Alicante College of Physicians and the General Council of the Spanish Medical Associations, a stance upheld by the justice system. Relying on substitutes would devalue the demanding training that doctors undergo, including a minimum decade of higher education, six years of medical studies, extensive clinical practice in public health, specialization after long shifts, and ongoing research. These are the pillars of safe citizen care that the profession upholds. The MIR program remains a strong path, though its limits must be recognized as part of a broader reform strategy. Professionals emphasize that finding a job should not overshadow the quality of medical training and service [COMA].
Ten Years to Specialize
Physicians play an essential role in any health system, and their preparation deserves recognition. The Alicante College of Physicians notes that doctors carry responsibility for patient outcomes and build trust-based relationships with patients. The medical profession is both demanding and rewarding, acting as a driving force for the health system. Many experts from other countries have welcomed doctors with high-quality training over the past decade, underscoring the MIR program’s success. Yet the health system must forecast needs, allocate resources, and coordinate with all medical organizations to plan for the future rather than merely increasing graduate numbers. The College emphasizes: we train doctors, we do not simply produce graduates. COMA advocates for a coordinated, strategic approach to workforce planning.
In the short term, there is a call to reduce precarity, extend contracts, fill hard-to-cover vacancies, and prevent overload in busy clinics. A reexamination of how doctors are supported and valued is urged, ensuring sustainable working conditions and fair patient access.
Medium- to long-term thinking must be global in scope. Solutions are not limited to expanding residency slots. A comprehensive demographic study is needed to map specialty needs, account for population aging, and assess available teaching units. Only with such data can training align with actual demand. The message remains clear: we train doctors; we must not flood the system with unneeded numbers without strategic planning. COMA insists that workforce planning should be a collaborative effort across the medical profession and its institutions.
Medical Leadership
Several challenges confront the profession, and urgent reform is required as part of a continuous cycle—from admissions to faculties and residency programs, through to professional practice and retirement. Resolving competency conflicts with other health professions is important, but it should never diminish medical leadership or exclude clinicians from decision-making that affects clinical practice. Physicians must lead, especially after ongoing public health pressures, including waves of COVID-19. The College has offered its expertise to governments, aiming to support a high-quality health system that remains independent of partisan interests.
The Alicante College of Physicians maintains a prudent, independent, and transparent stance, dedicated to members and society. It defends the profession, upholds ethical codes, emphasizes patient service, and calls for professional authority to lead in scientific knowledge while resisting political interference that can compromise care and patient outcomes.
It’s Not SAMU Without a Doctor
A SAMU unit should always include a physician. The campaign launched by COMA and the Valencian Community Medical Association highlights scenarios where patients face risk during emergencies when a doctor is absent. The video dramatizes a life-threatening situation and asks viewers to imagine SAMU without a physician, underscoring the safety implications for patients in urgent need of care.
The campaign also notes that, despite regulatory frameworks, high precarity in emergency medical services can leave SAMU teams under-staffed—often comprising a physician, a nurse, and a driver or stretcher bearer. The physician’s role covers on-site decision-making, initial care, and coordination of the team to ensure safe transport and life support. The objective is to safeguard patient safety and care quality, with concerns about irregularities being directed to legal services for review.
Ultimately, the core duties of SAMU physicians center on delivering urgent care at the scene, following directives from intensive care units, and ensuring continuity of care from the point of demand through transport. The aim is to maintain high standards of safety and clinical performance, even as systems face pressures and resource constraints. The medical associations continue to advocate for improvements that support doctors in delivering timely, effective care to every citizen, everywhere. [COMA, Community Medical Associations]