Eskilstuna is an attractive town around 120 kilometers west of the Swedish capital of Stockholm, the headquarters of car maker Volvo, and the home of Abba singer Frida Lyngstad, the brunette. Soon it will be the home of pediatrician Jorge Sotoca and opthalmologist Mercedes López, a Spanish couple both aged 32. Next February they will begin working at Eskilstuna's hospital, which has a catchment area of 400,000 people. They have already arranged nursery care for their one-year-old baby.
Their reasons for leaving Spain are simple: "Job insecurity, uncertainty and fear about where Spain is heading, few opportunities for career growth, and the chance to give our daughter a good start in life," explains Sotoca.
Spain's worsening economic crisis -- coupled with deep spending cuts in health that mean working under temporary contracts with little hope of a permanent position in a hospital -- is prompting growing numbers of young medics whose training has cost the country millions of euros to leave to work abroad.
Médica Colegial, the body that represents Spain's medical associations, says that in the first six months of this year it issued around 1,350 copies of medical licenses required under European Union law for doctors and nurses who want to work outside their own country. Last year it issued 2,349 such copies, and 1,835 the previous year. These are just some of those leaving to work abroad; non-EU states do not require the certificate.
At the same time, doctors and nurses are joining the ranks of the unemployed, with a sharp increase in joblessness among medics in the first half of this year, taking the number to 13,400, up from 6,400 in late 2010. Sotoca and López, currently enjoying a brief holiday before beginning a full-time, three month course in Swedish paid for by the hospital, along with a 700-euro monthly grant, were not unemployed when they found work in Sweden. Sotoca has spent the last three years working in provincial hospitals on renewable short-term contracts; his wife was standing in for medics on sick or maternity leave.
Many younger medics just finishing their in-hospital training face an even bleaker future, and more and more will likely follow in Sotoca and López's footsteps. "Residents who finished in May are now finding that the only opportunities for them are working night shifts and weekends, or joining the ranks of the unemployed," says Tomás Toranzo of CESM, the national confederation of medical unions.
It's tragic we are losing people when staffing levels in Spain are minimal"
"We are very worried, because this is just the beginning. Apart from anything else, we have to bear in mind that the state has invested huge amounts of money in these people's training, so when they leave to work abroad, we are simply wasting money: we are failing to capitalize on highly qualified professionals," he says, estimating the cost of training a doctor at around 200,000 euros.
It isn't that there are too many medics in Spain, either. In 2009, the Health Ministry warned that there was a shortage, and that the country needed around 3,200 more doctors. By 2025, the shortfall will be around 25,000 at the present rate. The government has talked of increasing the number of university and medical school places, as well as making it easier for overseas personnel to work here. The country's medical associations disagree, saying that the problem is not so much a lack of trained medics, but rather the poor distribution of specialists.
Either way, the current crisis has hit the sector hard, and the experts say that the brain drain has only just begun. Juan José Rodríguez Sendín, president of Médica Colegial, says that within two years there will be more than 10,000 unemployed medics. "There has been no reduction in the number of places to study medicine; around 7,000 doctors qualify each year, and more and more of them will join the unemployed. Their only hope of finding work is to go abroad. Some are happy to seek a new life and career opportunities abroad, but the majority feel that they have no choice," he says.
María Martina, aged 30, is among those with no choice but to leave Spain. Born in Argentina to Spanish parents, she left the South American country to train as a kidney specialist in Barcelona. She finished her training last year, since when she has been working in private clinics, running dialysis machines. Last week she left Barcelona for Baltimore.
"It's a great hospital I'm going to, with the possibility of research into immunology, and the job is well paid," she says. "There are no permanent positions for specialists in Barcelona. If they had offered me something, I would have stayed. It isn't good for Spain that all these qualified people are leaving. It's a waste of money and time training people."
Máximo González Jurado, president of the General Council of Nursing Colleges, is worried about the long-term implications of the medical brain drain. "Spain continues to train magnificent professionals, and it is a tragedy that they are being snapped up by other countries when there is a shortage of nurses, and many hospitals are having to cope with minimum staffing levels," he says. Spain has some 541 nurses for every 100,000 inhabitants, compared to 797 in the rest of the European Union. "The cuts mean that contracts are not being renewed, and people leaving are not being replaced, among other measures, and this means that things will get a lot worse," Jurado adds.
They had better know where to find us because Spain is going to need medics"
Spain's medical associations, aware of the growing number of health professionals leaving the country, are now looking at ways to encourage them to stay. "We need to see how we can give them some guarantees," says Sendín. In the meantime, medics looking to work abroad can either make their own arrangements, or pay an agency to find them work.
HCL Nursing is one such agency, specializing in recruiting European nurses to work in Britain's National Health Service hospitals. "We help professionals to find somewhere to live, we pay the first month's rent, and we guarantee them a minimum of 300 pounds a week, along with flexible hours, uniforms, and training," says María Pineros, who works in HCL's human resource department.
Pablo Rubio used HCL's services once the 24-year-old nurse was already in London. He's been there for nine months, and is happy with his new life. He explains that the only members of the team that graduated last year from his university in Castellón to find work went abroad. Those that stayed in Spain are jobless: "Not one. Only those of us who went abroad are now working." He works in several hospitals in east London, and does home visits in the west of the city. He works a 12-hour shift three days a week, and has the rest of the time to himself. "Working arrangements are much more flexible in Britain than in Spain. Employees are looked after, and with what I am paid I am able to live well, pay my rent, food, transport and still have something left to save," he says. "I don't know when I'll be going back to Spain. I will stay here for at least a couple of years more, and hope that things sort themselves out in Spain. I have made friends here, and it's like having a small family. And I make new friends all the time," he adds.
Along with France and Portugal, the United Kingdom is one of the most popular destinations for Spanish healthcare professionals. There is work, and Spanish medics are well regarded. Andrea Martín decided to go to Germany, where there are also excellent opportunities. The 23-year-old says that she always wanted to study abroad, but unable to find work in Spain, decided to look for a job overseas.
"Due to the cuts, I had no choice but to seek work abroad. There is no work in Spain, and the little there is is badly paid," she says. She eventually found a job advertised by a company that provides nurses for in-home intensive care. The company was looking for Spanish nurses and came to Madrid to arrange a round of interviews. Martín is about to finish her training course, paid for by the company, which is also paying her 700 euros a month while she does so. She has one month to go. She will begin on a starting salary of 1,800 euros a month.
"It's not a fantastically high salary, and is lower than most Germans, but they are paying for the training and we have a Spanish-speaking tutor. It's not a bad starting point," she says.
Mats Ignell, the head of selection at Medicarrera, the agency that found Sotoca and López work in Sweden, says that more and more Spaniards are showing an interest in working abroad. He adds that they have a good reputation. He says demand is particularly high in Scandinavia, with opportunities in a range of specialities. Using Medicarrera, Swedish hospitals select candidates, and once a job offer has been made, the hospitals take care of finding somewhere to live, a school for children, and the language.
"The hospitals pay for the language courses. They have to. We're not talking about English or German, but a language that nobody else speaks," says Ignell.
Swedish may not be the easiest language to learn, but working in Sweden provides valuable experience for young medics unable to find work in Spain, says Francesc Duch, the secretary general of Catalan labor union Metges de Catalunya. "Things are going to get much worse in Spain: there will be a lot of sackings this autumn," he says. Catalonia began cutting back on health spending last year, prompting an exodus of medical staff, who first looked for work in other parts of Spain. "But it is the same everywhere in Spain, so people soon began looking for work abroad."
Sergi Ortiz-Alinque is a 32-year-old GP who has moved from a comfortable three-story house in Barcelona to a 30-meter apartment in the center of London; the only aspect of his move that he says he lost out on. He has been working for seven months in a health center in the center of London, where he says he feels valued and appreciated. Ortiz-Alinque says that worsening labor conditions and a widespread inability to improve things on the part of the local government led him to pack his bags and head abroad. Since he left he has been offered a full-time position in Catalonia, but says that he has no intentions of returning, at least for the time being. "Things are getting worse and worse in Spain. The hours are longer and longer, doctors have to see more and more patients in less and less time, and for salaries that are getting lower and lower. And what's more, there is no sign from the government that it wants or is able to improve things," he says.
Ortiz-Alinque says that in contrast, in London he works a four-hour shift during which he sees a maximum of 20 patients. "In Spain, you see 40 people in a row. The salary is quite good as well. It is basically double that of Spain for fewer hours and under better conditions. And there are continual training courses to acquire new skills," he adds. Nevertheless, he is unhappy that so many professionals are obliged to leave Spain to find work. "The people we are losing are vital to the future of Spain: young professionals, with new ideas and a will to change things. But this is not the moment to be in Spain. Perhaps in three or four years we will be needed. They better know where to find us, because the country is going to need medics, and those of us that have worked abroad have much to offer."
And that may well prove a problem several years down the line, when couples with children have put down roots in their adopted country: talented professionals whose training cost Spain millions of euros who are offering the best years of their lives to other countries.