I had to do a lot of research this article because most of the information shared on other forums was inaccurate. The rest of the articles written online are by recruitment agencies which intentionally make the process seem complicated. So here it is, the guide for US doctors practicing medicine in Spain.
I am not sure how many US doctors practice abroad, but I suspect we never hear from these individuals. They take a trip to Europe, and they decide to stay. Somehow they figure out how to become a doctor there, and that’s that.
Another excellent resource for such information is the Hippocratic Adventure website which talks about Spain in detail.
A lot of the information I have obtained comes from my own medical colleagues in Spain who, overall, enjoy being doctors in that system. I’ve also had a chance to be a patient there in the private and cash-only system and am pretty pleased.
Becoming a Doctor in Spain
Now, you’re not trying to become a doctor, you already are one. But it was interesting to read what it takes to become a doctor in Spain.
You go straight from high school and take a placement exam where you have to earn quite a high score to get into medical school. It’s considered to be the most challenging profession to get into and the most sought-after.
Med school is a 6-year process, with the first 3 years being basic sciences, along with the didactic portion of pathophysiology, microbiology, and my favorite, pharmamotherfuckingcology – which I failed in medical school.
The following 3 years are rotations, and that’s when you try to figure out what kind of specialist you want to be. And just like in the US, you can start claiming you’re a doctor right after med school in hopes of getting laid.
Next, you must take the MIR (Medico Interno Residente) exam to enter a particular specialty. In Spain, as of this writing in 2018, geriatrics and EM, and anesthesiology are the fields that have the most significant physician shortages.
Practicing Medicine in Spain
The Spanish healthcare system is pretty strong, with most patients quite happy. That has been my impression so far when talking to people.
Spanish physicians are referred to as médicos, recognize that other countries don’t necessarily have a better healthcare system, but that doesn’t stop them from leaving for other countries.
The nice thing about the EU is that once you have done your medical school and residency in one country, you can take those credentials to another country in the EU, and it will be recognized. I’ll get into the income side of things a little later.
These doctors get their medical licenses and can practice for the public or private system. I don’t have a medical license in Spain yet. But this article is to help me figure out how to go about it – that’s how I learn most things, researching it and writing about it.
Spanish Doctors Practicing Abroad
A recent newspaper headline referred to the 3,500 Spanish physicians who have applied for work in other countries.
- 830 left to practice in the UK.
- 540 to France.
- 215 to Ireland.
- 200 to Germany.
- 125 to Portugal.
- 90 to the USA.
- 75 to the Emirates.
- 60 to Canada.
These numbers have increased over the past few years, mainly because the income for Spanish doctors is relatively low. But some have also expressed frustration with how slow-moving the medical system is.
This is referred to as the mañana phenomenon.
Public and Private Healthcare
The majority of healthcare is public in Spain. The rest is made up of large private medical groups. Practicing medicine in Spain as a US doctor means we’ll compete in the private space, not the public though both are valid options.
You don’t have to pay for public healthcare in Spain. But you have to pay a little every month to get access to private clinics and hospitals. This can range anywhere from 20-50 euros.
I have a Cadillac plan for 55 € a month to give you an idea. For this price, I have a zero copay, a zero deductible, access to public hospitals, and access to private clinics. I also have optical care but would pay 10 € extra monthly for dental coverage.
Geriatric care has become a big burden on the Spanish doctors. Elderly care, whether in the ER or in psychiatry, is becoming more and more time-consuming and requiring more specialized care.
I couldn’t confirm this but apparently, the prescription rate in Spain is high. As in, many of the elderly Spanish citizens are on multiple medications.
There is also the sentiment among physicians that these elderly individuals end up coming to the public clinics for mundane matters out of boredom.
Practicing medicine in Spain means you have to learn the culture there. And there will always be some negative sentiment towards some group. But there are also amazing healthcare being delivered in Spain.
Physician Income in Spain
As a public doctor in Spain, you can earn a gross income of 60,000 € a year. This number will vary up and down, depending on the specialty. And remember that unlike the US, taxes are sky-high here.
My primary care doctor friends take home around 2,200 per month, and my ophthalmology, psychiatry, and hematology friends around 2,500 € a month. They tell me that they enjoy quite a lavish lifestyle with this kind of income.
I’ve read reports of public jobs not being reliable. You might be employed some months and be furloughed the next. That’s why many work in the private sector on the side.
One orthopedic trauma surgeon I spoke to at a bar said that he made 90,000 € a year as the head of the department, and his hours were long but nothing as bad as what his US colleagues endured.
Some physicians will work in the public sector in the morning and finish their day by working the private clinics. It’s not hard to pull in north of 120,000 € for these workhorses.
A US physician practicing abroad likely won’t work 15-hour days. But it’s worth discussing how medicine is practiced in these European countries.
The Clinical Workload in Spain
The need for a doctor, specifically the urgent need for a doctor, is much lower in Spain. While in the US, it’s common to find primary care doctors and specialists who work on weekends, here, it would be uncommon.
Most of my physician colleagues in Spain have 8:00 am – 3:00 pm schedules, and they are pretty happy with the hours and the work.
Volumes can be high. Some doctors practicing medicine in Spain report seeing the volumes we are used to seeing in the US.
Most importantly, the paperwork, documentation, lawsuits, and investigations are minimal. The majority of the time is spent with the patient.
And – interestingly – there is minimal emphasis on customer service. This is probably aided by the fact that the Spanish culture is a very warm and friendly one, generally speaking. So I’m sure the doctors aren’t giving their patients the middle finger, but science is valued higher than bedside manners.
It’s the difference between going to a Jiffy Lube to have your oil plug stripped off with a smile or going to an excellent mechanic who may never make eye contact with you.
Lawsuits have gradually risen as Spain has increasingly tried to privatize healthcare. But it’s still infrequent to hear about a lawsuit unless a doctor intentionally tried to harm a patient.
US Doctors Practicing Medicine in Spain
US doctors who attended accredited medical schools in the US and completed a residency program can practice medicine in Spain without taking any particular exam.
I just finished retaking my family medicine board exam (as of November 2020), so I’m excited not to have to take yet another test.
The MIR Exam
Tampoco se refiere para el centro de donaciones que según el perfil de Twitter el ser médico es un “trabajo cómodo y bien remunerado. Realizas cuestionario de salud a los donantes, control de cifras de tensión y hemoglobina…” sin necesidad de un MIR. Tampoco es necesario para la investigación o realización de un doctorado; como médico aeroportuario, que “desarrollan sus funciones en los aeropuertos. Sus pacientes son las personas que transitan por el aeropuerto, con lo que su trabajo es generalista y muy variado”; Medicina Estética o médico de Sanidad Marítima.Redaccion Medica
There is a difference between the public and private sectors – this is important. If you want to work in the public sector, you have to take a placement test to determine where you’ll end up for a job in the country.
If you want to work in a private clinic or open your own, you must have your credentials accepted by Spain (homologation/convalidation), as we’ll see below.
You do not need to redo a residency; you do not have to take the MIR, or any other exam to start practicing. Some specialists can start practicing primary care in Spain while they wait for their credentials to be approved. This can take a year or even longer.
You may have to be supervised the first year you work. I haven’t been able to get enough information on this. But it’s not like you must be attached to another doctor at the hip. It’s more of a mentorship.
The authorities here make a lot of language competency, but from my understanding, it’s pretty easy to reach a competent speaking level within four months.
This level is enough to pass the language exam. Of course, I’m talking about studying 6-8 hours daily – not just doodling on Duolingo. The level needed is a C1 diploma which isn’t hard to obtain from a language school.
The diploma you receive for your language level is what you’d submit to Madrid for your medical degree to be convalidated or for homologation.
Jobs for US Physicians Practicing in Spain
Many physicians from Latin America move over to Spain for a better income. So, there are pretty apparent paths that many of these doctors have taken; most of us have to follow in their footsteps.
From what I have gathered here is that the Spanish people prefer to have Spanish doctors. Some believe that the quality of care they receive from Latin American doctors isn’t as good.
It’s becoming more usual to see older people here with obesity, diabetes, and a laundry list of medications. Beta-blockers, ACE-I’s, statins, metformin, and insulin are gaining traction.
As a US doctor practicing in Spain, you’ll compete with other doctors from other countries.
Process of Getting Licensed in Spain
The summary is below in Spanish, as I’ve found on other reliable websites. If someone could translate it for the rest of us, please do so in the comment section below.
- La Solicitud cuyo formulario debe de ir debidamente cumplimentado.
- Acreditación del pago de la tasa, Modelo 790.
- Copia compulsada del documento que acredite la identidad y nacionalidad del solicitante.
- Copia compulsada del título cuya homologación se solicita o de la certificación acreditativa de su expedición.
- Copia compulsada de la certificación académica de los estudios realizados para la obtención del título, en la que consten, entre otros extremos, la duración oficial en años académicos del plan de estudios seguido, las asignaturas cursadas y la carga horaria total de cada una de ellas expresada en horas o en créditos ECTS (europeos).
- Acreditación de la competencia lingüística necesaria para el ejercicio en España de la correspondiente profesión regulada. Esta acreditación no la necesitaría tu hijo, porque el título obtenido lo ha realizado en una universidad de lengua hispana.
1. Contact the Ministry of Education
The first department you’ll have to wrestle with is the Ministry for Education, located in Madrid. The main website is at Ministerio De Educación Y Formación Profesional. The website changes a lot so search for it online.
From there, you will need to find the education section. Then navigate to the University section (Universitarios) and Foreign Titles (Títulos Extranjeros).
When I first wrote this article, everything was done over snail mail. You can submit your stuff electronically, but you may need to be present in Spain because it requires a digital certificate. You can get this from the social security office if you have an NIE number.
Next, you will need to navigate over to the homologation – homologación. If this link is broken, then search above until you find the page.
You can also submit your application to a Spanish consulate in the US. But it’s recommended that you submit it to Madrid either in person, mail it within Spain, or do it digitally.
They will need to verify all your diplomas and licenses from the USA. It can take up to 12 months for this to take place. So buckle down, and get ready.
The process is quite streamlined, but a huge backlog of physicians is waiting to get approved to work in Spain. Check out this headline below.
Ministerio de Educación de España. Centro de Información y Atención al Ciudadano. Sección de Información Educativa
Calle Alcalá, 34
T: 917 018 000 (centralita), 902 21 85 00
F: (91) 701 86 48
Subdirección General de Títulos, Convalidaciones y Homologaciones, Servicio de Homologación de Títulos Extranjeros Universitarios
Calle Paseo del Prado, 28
T: (91) 420-16-94 , (91) 420-07-67
2. Register with The OMC
Next comes the OMC, about which you can read a little wiki. It’s called the Organizacióon Médica Colegial De España. It’s the medical college, depending on which province you’re in. This is where you register for your medical license.
Each autonomous region has its own health ministry which can be accessed online.
The Spanish Medical College Organization regulates the medical profession in each particular region. I’m living in Galicia, so I’d do it there.
The entire list can be found here. There are 52 regions.
The OMC will need to permit you to work in their region. They will also need to give you a particular number to prescribe medication.
I believe they are also responsible for selling your practice insurance. I don’t think they call it malpractice insurance – interestingly enough. It was all quite cheap.
3. Work for One Year, Supervised
I referred to this above. You’ll see your own patients. You’ll be completely independent, but you’ll be working under supervision. I’ll write more on this as I get closer to it.
As of 2022, when I’m updating this post, I haven’t yet gotten my medical license in Spain. I missed a significant window during the pandemic when the Spanish government fast-tracked anyone in the pipeline.
Work Permit, Visa
Very few US physicians are trying to leave their $300k US jobs for 30k euro jobs in Spain. That’s why all this information was a pain in the ass to come by.
So, the Ministry approved your medical school and residency paperwork. Then you got the local college to approve you to work after demonstrating a language competency. Next, you need a work visa to work in Spain.
Unless your region is hurting for doctors, the private healthcare system may not extend a job to you, so you’ll have to resort to being an autónomo.
Interestingly, the private sector often has many more jobs and is much more willing to help you get the proper work permits and visas figured out.
Private Practice in Spain
If you speak English, you’ll be highly sought after in the beach cities of Spain, especially Malaga, Madrid, and Cadiz.
It’s not easy finding patients for a new private practice since the advertising rules aren’t what you are used to in the US. But if you can hold out long enough, you’ll eventually get clients as a US doctor practicing in Spain.
Word of mouth is like Yelp here. All it takes is a few bad reviews, and people will avoid you like the plague. Probably more so in smaller cities.
My Personal Strategy
I want to get my medical license convalidated in Spain, even if I may never work in Spain. It’s excellent insurance to have, especially with how wonderfully things are going for me in the US.
Most medical schools in the US are recognized as valid medical schools by Spain, and my residency is in Family Medicine, so that shouldn’t be a problem.
Fortunately, the jobs which are least desirable here are what I like the most. I can either work in the ER as an FP or ride in the back of an ambulance as an urgent care doctor.
After learning the language and homologizing my credentials, I’ll work in the public and private sectors for a year. It’s not hard finding part-time gigs in the private sector.
Practicing medicine in Spain long-term would only be attractive if I open my own small private practice from 9:00 am until noon, Monday-Thursday, somewhere in Cadiz, Spain. I would add some telemedicine, which is barely happening at the major hospitals.
Dr. Bulbena Cabre has shared their story online, applying to work in Spain as a psychiatrist.