Andorra Faces Doctor Shortage Crisis as Specialists Retire

Albert Dorca, president of the Andorran College of Physicians, warns that all medical specialities face a generational replacement crisis in the next 5-10 years, as a large share of doctors nears retirement age past 60. He stresses the growing impact on patients, with rising referrals abroad due to long waiting lists in multiple specialities.

In recent comments, Dorca noted that Andorra's "preferred pathway" covers consultations with foreign specialists when local appointments cannot be scheduled within a month—a threshold many specialities now exceed for non-urgent cases. Referrals for lack of local availability have surged over the past year, he said, reflecting broader challenges in attracting talent. "What we don't have here won't stop people from seeking care; it just means they'll go to neighbouring countries, with the disruption that entails," Dorca explained, citing added work absences and costs for brief visits.

The College is refining data through a joint commission with the CASS health service, preparing a framework document to map current capacities across specialities and sub-specialities, such as traumatology. Doctors can now specify referral reasons—whether for a second opinion or timely unavailability—providing clearer insights into demand pressures. Personal networks among Andorran physicians also help expedite urgent foreign consultations, a benefit of the system's small scale.

Dorca linked these strains to uncompetitive pay, drawing from feedback by about 18 Andorran doctors abroad. Spanish public salaries have adjusted over 15 years, while Andorran fees were updated only three times and lack inflation indexing. Earlier this year, the College urged the Health Ministry to adopt a three-pillar plan: ministry-coordinated training for efficiency; performance incentives like rewards for managing diabetes or screenings, inspired by France; and tariff hikes to regain edge over southern neighbours.

The ministry is revising fees for shortages in diagnostic (K-letter) and surgical (Q-letter) areas, but Dorca called the broader proposal more ambitious and overdue. "Even if approved tomorrow, we doubt it would suffice given current tightness," he said.

Primary care ratios lag the European average, though system flexibility—such as extended hours during flu peaks—keeps waits shorter than in Catalonia. Not all practices are equally loaded; some handle higher quotas or loyal patients, hindering redistribution. The medical on-call service at Meritxell Clinic, now in its second year of full Christmas coverage, draws 90% direct visits, up from mostly emergency referrals when based in Plaça Coprínceps. Reverse referrals from A&E to primary care remain rare, as patients prefer to wait on-site.

Quantifying needs is complex in Andorra's small population, with overlapping roles—endocrinologists, internists, and primary care sharing diabetes cases; rheumatologists and internal medicine handling autoimmune conditions. Family medicine, with about 40 doctors, absorbs fluctuations better than specialities.

Health Minister Helena Mas recently told parliament that CASS's Cosvai commission is analysing foreign referrals amid rising costs, which she attributes to an ageing population, chronic diseases, expanded services, and fee increases—not overuse.