Mexico’s physician shortage: struggling to bridge the gap

The low availability of physicians in underserved regions hinders access to healthcare, disproportionately impacting vulnerable populations. This challenge is not exclusive to Mexico, as many countries face similar limitations in healthcare delivery. However, a robust supply of physicians is not an indispensable condition for effective healthcare.

Every year, about 17,500 new physicians graduate from medical school in Mexico and 12,500 new specialists are licensed.¹ By 2023, the combined physician workforce was nearly 666,000 people.² There are approximately 2.5 physicians per 1000 inhabitants in the country, landing in the bottom quartile among OECD (Organisation for Economic Co-operation and Development) countries.³ An estimated one third of licensed physicians do not provide direct healthcare services,⁴ suggesting that the actual ratio of practicing physicians per capita may be lower than anticipated. The concentration of providers in urban areas, where compensation and quality of life are better, worsens the physician shortage in rural regions where healthcare needs are greatest. This imbalance presents a significant challenge for policymakers in designing and implementing cost-effective interventions aimed at improving healthcare access in deprived areas.

A solution to this issue in Mexico would be to offer increased financial incentives to encourage physicians to work in underserved rural areas, a common practice that has improved the distribution of human resources for health.⁵ In fact, there was an initiative to offer modest salary increases to physicians willing to practice in rural areas, but the overall working conditions and compensation proposed by IMSS-Bienestar (Mexican Institute of Social Security-Welfare)—the public health program that provides medical services to citizens without social security—were regarded as insufficient by Mexican physicians, resulting in an unheeded response to the program. In response to this failed attempt, to address the unmet healthcare needs, the Mexican government recruited 610 Cuban physicians,⁶ spending nearly $24 million between 2022 and 2023, a sum that could cover the salaries of around 3500 specialists or 4500 general physicians. In September 2024, former President López Obrador announced the hiring of 3100 additional physicians from Cuba to work in 23 states, making Mexico one of the main employers of Cuban health workers in the world.⁷

This decision may imply that the demand for physicians in Mexico surpasses the domestic supply. However, around 30% of licensed physicians in Mexico are unable to find employment in healthcare.⁴ The foreign recruitment policy has sparked indignation among unemployed physicians and raised concerns about the recruitment process and caveats of the initiative. The influx of foreign medical professionals may exacerbate employment prospects for local unemployed physicians, prompting them towards alternative careers. The long-term impact of such a policy warrants careful consideration and further investigation.

The recruitment of Cuban physicians is not exclusive to Mexico. With over 8 physicians per 1000 inhabitants,⁸ Cuba has the world’s highest physician-to-population ratio, providing ample opportunity to export doctors to countries in need. Ten years before Mexico’s initiative, Brazil launched the program “Mais Médicos” to address physician shortages in underserved areas, allowing 15 thousand foreign doctors practice medicine without local licensure for a limited period.⁹ However, it was dismantled by president Bolsonaro.

Cuban physician exportation has faced increasing international criticism, with significant human rights concerns labeling the practice as modern slavery.¹⁰ Most of the revenue is retained by the Cuban government, an illegal practice across the world considered as salary retention. As a result, the Cuban government collects close to 11 billion dollars annually, through the work of over 40,000 doctors in 67 countries.¹¹

Efforts to increase the internal supply of physicians in Mexico face significant challenges. Only 15 of over 165 medical schools in Mexico are accredited by the COMAEM (Mexican Council for the Accreditation of Medical Education), leading to significant variability in the quality of medical education, thereby complicating efforts to develop a qualified domestic workforce to address the country’s healthcare needs.

Merely increasing the number of physicians may not be the best approach to streamline access to healthcare. While Mexico’s ratio of 2.5 physicians per 1000 inhabitants falls below the OECD average of 3.5 physicians per 1000 inhabitants, nations with more functional healthcare systems and superior access, such as Japan, Canada, and South Korea, exhibit similar ratios.³ Instead, the focus should shift towards a more efficient allocation of physicians, nurses and other health workers; building the capacity for telehealth; the design of better compensation schemes and general labor and security conditions of health workforce in rural areas; the refinement of medical education; and the development of adequate infrastructure and resources to support effective healthcare delivery.

Contributors

DR: Idea conceptualization and design of the manuscript, realized extensive literature review, and co-wrote and edited the manuscript.

OGD: Realized extensive literature review, drafted the manuscript, and provided scientific quality to the manuscript.

Declaration of interests

The authors declare no competing interests.