Spanish Health System Overview
Health System Rankings
Health System Outcomes
Coverage and Access
Costs for Consumers
Health System Expenditures
Health System Financing
Preventive Healthcare
Medical graduates per 100,000 population
– 2023: 13.6
– 2013: 10.2
Nursing graduates per 100,000 population
– 2023: 24.0
– 2013: 18.8
Source: OECD (2025), Health at a Glance 2025: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/8f9e3f98-en.
“Spain is working to improve quality and access to primary care, but regional shortages of health professionals remain a significant challenge. While the overall number of doctors per 1,000 population is slightly above the EU average, there are persistent disparities across autonomous communities. In 2022, the number of primary care physicians ranged from 0.6 to 1.1 per 1,000 population, and primary care nurses from 0.5 to 0.9 per 1 000. For specialists, the figures ranged from 1.6 to 2.7 per 1,000 for doctors and 3.3 to 6.9 per 1,000 for nurses. These variations often reflect the more dispersed populations in rural areas.
“To address these imbalances, national and regional authorities have introduced targeted strategies. A 2023 technical document defined 13 criteria for identifying hard-to-fill positions. If a primary care post meets at least five of these criteria, it qualifies for incentives such as financial bonuses, housing support, career development opportunities and better work–life balance measures.”
Source: OECD/European Observatory on Health Systems and Policies (2025), Country Health Profile 2025: Spain. State of Health in the EU, OECD Publishing, Paris/ European Observatory on Health Systems and Policies, Brussels.
“The number of physicians in Spain exceeds the EU average (see Section 4), but there are worrying trends in the health workforce. Both the rate of medical graduates (14.2 per 100,000 population) and the rate of nursing graduates (23 per 100,000) in Spain were below EU averages in 2021 (17.5 per 100,000 medical graduates and 44.3 per 100,000 nursing graduates) (Figure 19). However, nursing assistants are not included in these figures, so this under-estimates the number of new graduates from nursing-related programmes. Following a continuous decline between 2014 and 2018, the rate of nursing graduates in Spain has slightly risen from 2019 onwards. As the population ages and the burden of chronic conditions continues to grow (see Section 2), there are threats of shortages, particularly of nurses and specialist practitioners nationwide, and of GPs and paediatricians in remote areas of the country.
“The share of temporary employment contracts has contributed to healthcare staffing challenges.
“In the SNS, the issuing of temporary contracts increased from 28.5 % in 2012 to 41.9 % in 2020. In efforts to reverse this trend, in July 2022, the government took measures to reduce temporary employment in the SNS through a process – the largest in the history of the system – leading to the employment of 80,000 health professionals. This process also provides a new legal framework that places limits on temporary work through modification of the Framework Statute for Health Personnel.Specific measures to address shortages in certain medical specialities include increased vacancies in the MIR specialisation programme and in nurse training places (see Section 5.2).”
Source: OECD/European Observatory on Health Systems and Policies (2023), Spain: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
“Since 2010, a significant change of health personnel training was debated and has materialized in the RD 639/2014, affecting postgraduate medical internship programmes and regulating nurses’ specialization. Unlike the current system, with 46 medical specialties having separate medical internship programmes, the reform sought to establish a common 2-year training programme for postgraduate trainees before splitting into subspecialties for most of the medical specialties. This reform aimed to provide a common holistic base of knowledge for all health professionals in a way that improves their response to their patients’ complexity, mitigating care fragmentation and overcoming the current silo mentality that impedes flexibility in human resources management. The reform raised much controversy as some medical specialties were strongly opposed to entering the core modules of the medical or surgical specialties. The reform process has ended up in the courts of justice with a Supreme Court ruling declaring the RD 639/2014 void, leaving the current previous legislation in place (see section 5.2 in GarcíaArmesto et al., 2010).”
Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.
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Page last updated September 25, 2026 by Doug McVay, Editor.