. The classrooms are filled with very bright students – with at least a 12.4 out of 14 cut-off mark upon admission – but sometimes they enroll not because of their vocation, but because of the influence of their environment. It is an incipient problem that worries universities and administrations. In the 35 campuses that offered the degree in 2023, there were 70,000 pre-registrations in Medicine – they do not correspond to the number of applicants, many pre-register in different autonomies – for 6,653 places, compared to 43,000 applications in 2014. That is, there were 10.7 applicants per each chair. In addition, 14 private companies offered another 2,200 places.
The former vice-dean of Medicine at the Complutense University, Jesús Millán, reflects: “There are those who maintain that, before admission, it would be advisable to know what are the reasons that have brought the candidate there. And, with this, open the possibility of knowing your personal values. Medical schools should also take this into consideration.” Millán, emeritus professor of internal medicine, maintains that, beyond the “vocational impulse,” high school graduates are “influenced by external reasons,” such as family, the social vision of the profession, interest in specific areas of knowledge, visualization of attractive models or “more or less founded economic expectations” (it is the highest paid career in Spain, doctors). And he emphasizes that, to be a good doctor, the “capacity for dedication and sacrifice, generosity, altruism…” is essential.
The Ministry of Health confirms that this issue was discussed informally at an interterritorial meeting of the sector, which brings together the portfolio with representatives of the autonomous governments, in April 2023. The department considers that this is a global debate, which does not It is limited only to Spain. based on a survey in which the vocation of the new ones is not questioned, but not practicing at any price: “Resident doctors do not feel identified with the idea of a ‘vocational’ job. Despite feeling interest and passion for your profession, these feelings are not your only motivation to continue. They also expect financial remuneration for all the time worked, good working conditions and to feel valued for their effort.”
Does this lack of vocation take its toll? “There are published records that demonstrate that there is a clear correlation between motivations and the future performance of the profession,” emphasizes the dean. “Among them, the ‘desire to help others’ is usually a qualitatively and quantitatively determining motivation for success.” The State Council of Medical Students does not have a position on this matter, but its president, Markel Gamarra, expresses his own opinion. “It is undeniable that a doctor has to be supportive, empathetic, committed to his work and the health of his patients. But it is the job of the educational and healthcare system to instill these values in medical students, not to demand them a priori,” says this fifth-year student. He disagrees, therefore, with Millán on the idea of knowing the candidates’ reasons for choosing to study the degree: “It is an unfeasible judgment to implement. The student body is a heterogeneous group, and as such there is no defined profile of what a good doctor is, if anything a spectrum.”
Juan José Giner, vice dean of Chemistry and member of the admission commission for new students at the University of Córdoba, shares this reasoning. “I am concerned that the medical profession is seen more as something about economic success, recognition… than as an altruistic service to the community. That behind it there is something more instrumental than humanistic,” he emphasizes. And he adds: false expectations are generated. Before with a 9 [sobre 10] You chose the career you wanted. And then there is social, family pressure, what they see on social networks…” “In short, we have generated a single hallway in which all students aspire to study Medicine because it is the solution to everything; when it’s not real. There are many university options in which to develop yourself as a person and citizen,” he summarizes.
Giner participates in meetings with high school students. “We make a friendly announcement, but medical professors tend to be almost dissuasive. They highlight how hard the race is, because they have to deal with the patient and their environment.” Cristina Beltrán, also a professor in Córdoba, but of legal medicine, emphasizes this on the networks: “It will not be because they are not told and insists on the PACE talks [Plan Anual de Captación de Estudiantes]. To them and to the counselors. In our center presentation there are slides specific to this topic. We spend more time on that issue [la dureza de la profesión] “I have to tell them how great our facilities are.”
The psychologist Juan de Vicente Abad, counselor at the Miguel Catalán public institute in Coslada (Madrid), has former students studying Medicine, but more in Nursing ―with a job almost guaranteed after four years of studies―, Psychology or the Higher FP degree in Anatomy Pathological, which serves as a bridge to end up becoming a doctor. This is health month and students receive advice from nursing, medical, psychology or veterinary professionals. “Students have to know that studying Medicine is a 10-year priesthood.” [seis de carrera más cuatro de MIR (Médico Interno Residente)] and that is the starting point,” he explains. “In Spain there is a lot of social prestige to be a doctor, as in the Nordic countries the best records go to education.”
Vicente Abad points out how candidates can have very poor mental health due to their self-demand. “Entering medicine causes them a lot of anxiety, they are very attentive to their grades,” he worries. This feeling does not disappear afterwards: 21.5% suffer from high levels of anxiety and 45% of sixth graders, according to the data in the article (DABE), based on 5,200 interviews.
Álvaro Ruiz de la Sierra, coordinator of the Guidance department of SEK schools, has not seen interest in Medicine grow in these private centers, except for the year of the pandemic (2020/2021). 3% end up studying this degree. “Before there was perhaps a family tradition to study Medicine, but now there is an offer of more than 3,000 degrees and students are paralyzed. “Where am I going?” asks the psychologist. “And they are subject to many imputand this somewhat dilutes the deepening of his interests. They have to know what Medicine is going to entail. Every time we find fewer and fewer pure students in terms of the vocation as such, and yes in terms of interest.”
“Many students do not have plan B. They believe that because they have excellent grades they will get in and situations of brutal frustration are created,” adds Giner. “I have had very angry parents during the entrance exam reviews. “They are not able to understand that their son is not going to enter Medicine.” The dropout rate in Medicine – an eminently female career, with 69% women – is very low, when compared to the total number of degrees. 2.6% of those enrolled in the public and 6.8% of the private enroll in another degree after the first year of Medicine and 3.3% and 2.6%, respectively, leave the university system .
