Doctors working in Spain’s private sector gave their work a positive recommendation score in a survey cited by Fundación IDIS: +5, against an average of -23 across Spanish businesses. The result came as participants at the IX Convención de la Profesión Médica described persistent problems with fees and contract terms.
Alfonso Carmona Martínez, president of the Colegio Oficial de Médicos de Sevilla and moderator of the panel, said private healthcare contributes to patient care while supporting medical research and training. But its growth should not come at the expense of doctors’ working conditions, he warned. Many, he said, receive fees similar to those paid 20 or 30 years ago, even as the cost of running their practices has risen considerably. He also raised concerns about missing contracts and what he described as unjustified removals from medical networks. Insurers, he said, impose terms unilaterally.
The survey offers one measure of how doctors view the sector. Fundación IDIS director general Marta Villanueva Fernández said respondents rated professional autonomy and involvement in centre management among the strongest aspects. They also valued work-life balance and training, along with opportunities for research and innovation.
José Luis Alcíbar Gallego, representing the Organización Médica Colegial (OMC)’s private practice section, said an OMC study carried out with trade union CESM had involved more than 1,400 doctors. It found problems including absent contracts and difficulty negotiating with insurers. The study also identified administrative barriers. Alcíbar argued that the OMC should help build structures that let doctors work in better conditions and called for a framework to protect professional autonomy.
That dispute over private practice is separate from public-sector recruitment, including Andalusia's 2026 health jobs plan. Alcíbar also called for renewed cooperation between doctors, hospital groups and insurers. Clinicians will need training and resources to supervise artificial intelligence tools, he said, while healthcare organisations must provide them.
For ATA secretary general José Luis Perea Blanquer, the terms under which doctors work for private centres and insurers are central to the problem. He said some doctors cannot organise their own activity or negotiate their pay, and raised concerns about the use of false self-employment. ATA, the OMC and the Consejo Andaluz de Colegios de Médicos have taken the issue to the Comisión Nacional de los Mercados y la Competencia (CNMC), citing differences in payment scales and the influence of large insurers on prices. ATA is also working on a proposed Estatuto del Profesional Sanitario to set out workers’ rights and obligations, while strengthening the requirement for written contracts.
Perea pointed to the Ley de Ordenación de las Profesiones Sanitarias, which recognises professionals’ scientific freedom and independence in choosing treatments, without decisions being shaped by external economic interests. Villanueva said around 26% of the population has private health insurance, while IDIS’s latest report counted about 75,000 doctors working in the sector. She clarified that an IDIS efficiency project with insurers and hospital groups aims to harmonise administrative processes and reduce billing problems. It does not address doctors’ fees or the economic terms of medical acts.
Patients’ expectations also came up in the discussion. Andoni Lorenzo Garmendia, president of the Foro Español de Pacientes, said more than 54% of the population has a chronic condition, increasing demand for continued care beyond individual consultations. Patients expect a close, trusting relationship with their doctor, he said. Clinicians’ working conditions, he argued, affect the quality of care they can provide.
