Causes and Consequences of Doctor Shortages

While healthcare systems vary in their structure and available resources, doctors play a key role in their adaptation and performance. Their fundamental place in the system is an indicator of quality care provision. Still, doctors in Mexico struggle to have their contributions recognized.

According to OECD standards, effective health systems have a rate of 3.2 doctors per 1,000 inhabitants. By 2019, Mexico only had 1.95 professionals in this area per 1,000 inhabitants. As a result, before the COVID-19 pandemic, the country was estimated to have a deficit of more than 73,000 doctors. This has been the cause of concern for policymakers and authorities, especially after the COVID-19 pandemic evidenced the weakness of Mexico’s health system.

In Mexico, 18,000 doctors graduate per year. Almost all of them look forward to entering a specialty by completing the National Exam of Candidates to Medical Residences (ENARM). Passing the ENARM test and then finding a job is the challenge, explained German Fajardo, Director, UNAM School of Health Sciences. Many of these doctors end up working at one of the 20,000 pharmacy-adjacent offices in Mexico, as there is a lack of opportunities for general doctors to specialize or to enter the field they desire, which frequently leads candidates to start working in another area, according to Fajardo. As a result, many states have almost no specialists, which is a historical problem in Mexico and deprives people of proper access to healthcare. This, in broad terms, is part of what fuels the deficit of medical doctors. However, the problem goes as far as educational training.

To obtain a medical or nursing degree, students must contribute to the country's health institutions as part of their social service or their specialization. These medical and nursing students are given responsibilities and obligations similar to those of an average employee. However, ONG Nosotrxs found that while serving as interns, most students face precarious conditions and abuse from authorities, including shifts longer than 8 hours with low and delayed pay, sexual abuse and harassment from authorities.

“This happens partly because universities are responsible de jure for students, but medical care units are the ones in charge de facto. This leaves students in a vacuum facing possible violations to their rights,” said a report by Nosotrxs, which highlights that these situations affect employee personal and professional development as they face abuse and uncertainty from this very early stage.

There is a mismatch between education and employment opportunities, coupled with a lack of investment in education and training, which eventually leads to brain drain in the field, says an analysis by UANL scholars. Still, a recent study by IMCO found that medicine is the best paid professional career in Mexico, with an average monthly salary of MX$17,846 (US$886). While at the top of the list, Mexican medical professionals face low wages when compared to other countries. “This profession is totally vocational, doctors in Mexico are not highly paid, at least not compared to other countries and to the cost of the career itself,” according to Misael Uribe, President, Médica Sur.

A doctor with a postgraduate education earns about MX$25,000 (US$1,241.16) per month or MX$132 (US$6.55) per hour. A general nurse in the public sector earns around MX$10,000 (US$496.46) and a nursing specialist earns around MX$15,000 (US$744). However, in rural or remote areas of the country, medical professionals are paid between MX$300 (US$15.10) and MX$1,000 (US$50.32) less than in urban areas. Meanwhile, according to Medscape, in the US, primary care doctors earn US$20,250 per month, while specialists earn around US$28,833 per month. Nurses earn approximately US$6,108 per month and nursing specialists an average of US$8,853 per month.

Around 72 percent of all doctors in Mexico work in the public sector. Meanwhile, specialists work largely in the private sector. Approximately 55 percent of these specialists are concentrated in Mexico City, State of Mexico, Jalisco, Nuevo Leon, Guanajuato and Puebla. In 2018, according to the National Institute for Public Health, Mexico had 1.1 medical specialist for every 1,000 people and most of them focused on seven areas: family medicine, anesthesiology, pediatrics, gynecology, surgery and emergency medicine.

The COVID-19 pandemic exacerbated the precarious conditions of health workers in Mexico, who have suffered public harassment, discrimination and even violence from society. They have also faced a lack of medical supplies to face the pandemic safely. In 2020, Mexico had the highest number of healthcare worker deaths from COVID-19. Amnesty International found that globally, more than 3,000 healthcare workers had died after contracting COVID-19. The countries with the highest mortality rates were Mexico (1,320), USA (1,077) and the UK (649). The Lancet launched a special study on the subject and reported that less than three weeks after Mexico recorded its first COVID-19 case, around 70 protests had taken place, with medical staff evidencing shortages of supplies and tests, along with a lack of hospital infrastructure and even proper training.

Reverting the current scenario for doctors would improve their professional and personal development, while creating a positive impact on care provision and patient attention in the country. Solutions for some of these problems began to see the light in early 2019 when the government proposed salary raises for doctors in rural areas with the purpose of attracting doctors to areas in need. Nonetheless, later proposals have shifted their focus from improving conditions for Mexican doctors and medical students to instead hiring foreign doctors and specialist to come work in Mexico’s rural areas. During one of President Andrés Manuel López Obrador morning press conferences, he announced that his administration will employ 500 doctors from Cuba “to guarantee health in Mexico” said López Obrador. The agreement also offers to train general practitioners as specialists in Cuba.

Mexico’s federations and medical associations have stated that López Obrador's initiative discriminates Mexican doctors as they already compete in an oversaturated labor market. In addition, they highlighted that Cuban doctors do not meet the legal requirements to work in the country. Therefore, the government is giving them preferential treatment by employing them, reported MBN.

Parallel to this situation, general doctors that were hired by public heath institutions such as IMSS to assist during the COVID-19 pandemic are being let go after they were promised a long-term position. The government opened a recruitment process where vacancies for these general doctors were expected but the positions required specialists only.

Limited budgets at public institutions are part of the problem regarding the lack of general doctor vacancies, as well as the general dynamic of care provision at these facilities, according to Andrés Castañeda, Health and Wellness Coordinator, Nosotrxs. He explains that limited hiring by cash-strapped public health institutions leads to medical students filling in for general doctors. “This becomes a ‘cheap labor’ dynamic that affects both medical residents, who are not being paid for the job they are doing, and patients, who end up receiving care from a student and not a qualified doctor,” said Castañeda.

Doctors’ associations are actively seeking for better working conditions and training experiences for their members through initiatives like Médicos en Formación (Doctors in Training), which focuses on gathering complaints from medical doctors under trying circumstances to build a unified voice. “We have allied with doctors’ associations to enhance the impact of this project. Also, with the support of legal experts, we are creating a proposal to reform the norms and regulations on the subject,” explained Castañeda, a leader of this collective.