[Training Present and Future Doctors for Chile: How Many and For What? The Urgent Need to Review the Physician Quota Generation Model].

Abstract

Before 1990, Chile showed fewer medical schools, six in total, increasing to 13 by 2000. From then on, there was an explosive increase, reaching 29 faculties or schools by 2024. Medical students increased from 1,816 in 2010 to 3,000 by 2024. The number of doctors in the country in 2010 was 24,455, rising to 65,737 by 2023, of which 25% are foreign professionals. In 2010, there was a ratio of 1.43 doctors per 1000 inhabitants, increasing to 3.13 by 2024, with a reasonable projection for 2034 close to 6, in other words, one doctor for every 170 inhabitants, reaching the OECD curve, surpassing WHO recommendations, and continuing to rise non-linearly. By 2024, one in two doctors practicing in Chile has one or more medical specialties. The Public Health System reported that in 2023, approximately one-third of the total available registered professionals working hours hired represented medical specialists (61%). Specialist doctor rates by region, as of September 2023, are relatively homogeneous, with higher rates tending to be in the southern part of the country. There is underrepresentation in non-metropolitan regions of specialties such as infectious diseases, emergency medicine, adult intensive care, neonatology, hematology, and pediatric neurology. However, for most specialties, this asymmetry is not observed. Compared to other countries, Chile, with a rate of 28.4 between 2012-2020, ranks 57 out of 200 countries with available data, presenting a rate of 1.64 specialist doctors per 1000 inhabitants, while the OECD average was 2.35. This strongly suggests that Chile will likely end up with an excessive number of doctors overall but with room to grow in specialist doctors. It is possible to envision interactions and coordination that could benefit the country without exceeding a regulated system; however, professional training should be avoided to continue unregulated and subject only to free will based on marketing strategies and demand rules. National and international studies assessing healthcare challenges for the coming decades and the professional capacities required to address them at the level of general medicine, primary specialties, and derived specialties are urgently needed. Regarding clinical fields, conducting a relevant study to determine the total public and private sector training capacity that may be part of the training system for the necessary clinical competencies is essential. Forming a working group with relevant stakeholders with knowledge, concern, and involvement would be significant, e.g., the Academy of Medicine, ASOFAMECH, medical schools, Ministry of Health, Ministry of Education, and community representatives. From our higher education perspective, with a nationwide vision, universities should start a joint reflection on our role in this critical topic with a future-oriented view.