Government report reveals critical healthcare staffing gaps in Andorra, with zero replacement index for

Andorra's healthcare system faces a critical doctor shortage risk as ageing physicians retire without adequate replacements, according to a government report prompted by opposition party Concòrdia. Opposition leaders have urged the government to outline a comprehensive plan beyond tariff reviews to ensure generational renewal and sustain quality care.

The Health Ministry's demographic analysis reveals 392 active doctors—excluding those limited to on-call duties—for a ratio of 373.4 per 100,000 inhabitants. This includes 331 in the public sector and 61 in private practice. The average age is 49.8 years, with over 10% above 65, one in five aged 55-64, and nearly 30% between 45 and 54. Currently, 22 doctors of retirement age remain active, including 14 in family and community medicine, four psychiatrists, three urologists (out of four total), and three paediatricians. Six more could retire by 2026-2027.

The five-year replacement index—comparing doctors under 30 to those over 60—stands at zero, well below the one required for renewal. Family and community medicine leads with 56 doctors, followed by emergency medicine (26), paediatrics (20), and orthopaedic and trauma surgery (20). Several specialties have just one practitioner each: angiology, cardiovascular surgery, microbiology, legal and forensic medicine, rheumatology, and aesthetic medicine.

Primary care full-time doctors (at least 40 hours weekly) number 29 but could drop to 21 by 2035 due to retirements and low inflows, per a World Health Organization tool. Similar low replacement rates affect pharmacists (0.1, average age 52), opticians-optometrists (0.2, 51.5 years), and orthopaedic technicians (0.1). Stronger indices exist for physiotherapists (9.7), nurses (4.3), midwives (3), speech therapists (5.5), and dentists (3.2).

Doctors show 53.5% men and 46.5% women, yielding a feminisation index of 0.9 female doctors per male doctor.

Since the Health Professions Act began in December 2022, the ministry has issued 112 special authorisations to professionals lacking B2-level Catalan proficiency. These accounted for 11.16% of new hires in 2023, 14.9% in 2024, and 18.4% in 2025.

Concòrdia vice-president Núria Segués welcomed the report's snapshot of the crisis but criticised the lack of a detailed response. She highlighted failures to attract and retain talent, growing reliance on foreign hires via special authorisations, and staff ageing, especially among doctors. Segués noted high turnover among nurses and auxiliary care technicians due to stressful conditions and modest pay, warning that tariff revisions alone fall short. "We have identified the problem, but we need to see the political response," she said, calling for a clear roadmap to maintain efficient services.

Separately, the ministry is collaborating with the College of Physiotherapists and College of Physicians to curb surging physiotherapy demand, which has overwhelmed some providers. Carme Pallarès, head of health resources, stressed sufficient overall staffing, with seven new registrations this year and stable ratios of 100 patients per physiotherapist—better than international benchmarks of 1,200 inhabitants per provider (Andorra at 600 per conventional one). CASS-conventioned physiotherapists fell from 164 in 2020 to 137 in January 2026 after purging inactives, with some delisting for specialisation or higher private fees.

Pallarès prioritised "ordering" demand by setting pathology-specific session limits for better controls, alongside patient responsibility like home exercises and follow-up reviews. Only after streamlining would the ministry consider more staff, tariff changes, or process-based payments, without altering rules requiring seven years' residency for foreign conventions—special authorisations suffice as an alternative.